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48 Cards in this Set

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  • Back
uterine leiomyomata is AKA?
fibroid
__ is the most common cause of uterine enlargement.
-occur in 30% of american women
-more common in african american women
-most women have no symptoms
-are seen as the reason for 30% of all hysterectomies
fibroids
is a fibroid malignant, premalignant, or benign?
benign
is a fibroid estrogen dependent or independent?
estrogen dependent
t/f

0.1% start out as malignancy, fibroids do not "become" cancer
true
a localized proliferation of smooth __ cells in a swirly pattern surrounded by a pseudocapsule of compressed muscle fibers.
smooth muscle cells
what are the 3 locations for fibroids?
-submucosal-just under endometium
-subserosal-under submucosa can be pedunculated
-intramural-in the myometrium
name the 3 rare variants to fibroids....
-intravenous leiomyomatosis
-benign metastasizing leiomyoma
-leiomyomatosis peritonealis dissemination
of the 3 fibroid variants which one is describes as "invades pelvic veins and vena cava with mature benign smooth muscle tumor"

-intravenous leiomyomatosis
-benign metastasizing leiomyoma
-leiomyomatosis peritonealis dissemination
intravenous leiomyomatosis
which is described as "implants on peritoneal surface"

-intravenous leiomyomatosis
-benign metastasizing leiomyoma
-leiomyomatosis peritonealis dissmeniation
leiomyomatosis peritonealis dissemination
which of the 3 fibroid variants is described as "cardiac, lymphatics, pulmonary nodules, with possible lymphatic or venous emobolization"

-intravenous leiomyomatosis
-benign metastasizing leiomymomata
-leiomyomatosisi peritonealis dissemination
benign metastasizing leiomymomata
what gross and histologic changes occur within a benign fibroid...it is know as?

-generation
-degeneration
degeneration
what are the 3 types of fibroid degeneration?
red-hemorrhagic changes d/t rapid growth, outgrows vasculature
-hyaline-occurs after menopause
-calcification-after menopause
what is the most common type of degeneration?

-red
-hyaline
-calcification
red
what are the symptoms that pt's c/o when they have fibroids?
pain
pressure
bleeding
is the bleeding r/t fibroids cyclic?
no
with fibroids there will be abnormal uterine bleeding....

-premenopausal
-perimenopausal
-postmenopausal
premenopausal
what happens to flow over time?

-progressively heavier with longer duration
-progressively longer with longer duration
-progressively lighter with longer duration
progressively heavier with longer duration
-change in normal contractile fcn in small arteriorlar bld supply under endometrium
-inability of overlying endometrium to respond to normal estrogen and progesterone phases in cycle
-pressure necrosis if overlying endometrial bed exposing vascular surfaces

are all possibilities d/t __ of the uterine cavity
distortion
bleeding with fibroids commonly causes?

-iron deficiency anemia
-syncope
-profound acute blood loss
-all of the above
-a & c
a & c
what is the most common type of fibroid r/t bleeding?

-submucosal
-subserosal
-intramural
submucous fibroids and intramural cause bleeding
what type of degeneration causes pain?

-red
-hyaline
-calcification
red d/t ischemia of tissue
what other conditions cause pain with fibroids?
-progressive increase in dysmenorrhea
torsion of pedunculated fibroid
-dyspareunia
-prolapse of pedunculated fibroid thru cervical os
is a pt with fibroids is c/o...
fullness feeling
bladder pressure
rectal pressure
pressure on sacrum/back pain
pressure on pelvic floor
palpably enlarged uterus w/ irregual contour
can cause ureteral obstruction causing hydroureter/hydronephrosis if they get big enough is...

pain
pressure
bleeding
pressure dummy
how do you diagnose fibroids on clinical exam, what are you looking for?
midline pelvic mass, usually mobile, irregular contour, solid feeling

size the uterus by weeks

if on lateral edge of uterus or pedunculated, if can feel like an adenexal mass

some are so large that they displace the uterus laterally
what is the best imaging of uterine fibroids?

-u/s
-ct
-mri
u/s
in what method can you see all the 3 types of fibroids?

-u/s
-hysteroscopically
-laparoscopically
laparoscopically
__ large intramural and submucosal fibroids can be seen.

-hysteroscopically
-laparoscopically
-u/s
hysteroscopically
why aren't ct or mri used to visualize fibroids?
not cost effective tools for diagnosis
what is the treatment of fibroids if the pt is asymptomatic?
none, reassureance and observation
if a woman over the age of 35 has fibroids and AUB what should you ?

-watch
-laparoscope
-EB
EB
in a woman in which you are not ready to do surgery on yet, what do you do to watch her fibroid progress?

-serial EB
-serial u/s
serial u/s
if a fibroid uterus is very large, what other test should you order and why?
ct with dye to ensure ureters are not blocked
what are the non-surgical options for tx of uterine fibroids?
-progesterone meds
-bcp
-nsaid's
-GnRh agonist (Lupron)
what does Lupron injuections do?
temporarily shrinks fibroids
what is the purpose of progesterone meds in the tx of fibroids?
to stop or lighten menses
what are "conservative" methods of txing fibroids?
uterine artery embolization
myomectomy
destruction of fibroids (cryo)
what is a myomectomy?
removal of the fibroid only, can affect future pregnancy
you cannot do uterine artery embolization in what pt population?
women who want kids
what is the definitive procedure in the tx of fibroids?
hysterectomy

must meet criteria
finished with child bearing
what is the purpose of GnRh agonists, what does it do?
puts the woman into menopause
what agent is...

temporizing
useful in perimenopause
suppresses hypothalamic-pituitary-ovarian axis (medical menopause)
can be used for 3 mths before surger to shrink the fibroids and dec. blood loss at surgery
GnRH agonist (lupron)
what is uterine sarcoma?
ca in the uterine wall
t/f

uterine sarcoma causes pelvic pain
false;rarely presents as pelvic pain
t/f

there is an increased incidence of uterine sarcoma with tamoxifene
true
what are the 3 types of uterine sarcoma?
carcinosarcoma-arises from endometruim
leiomyosarcoma-from myometruim
-endometrial stroma
what is the most common type of uterine sarcoma?

-carcinosarcoma-endometrium
-leiomyosarcoma-myometrium
-endometrial stoma
carcinosarcoma 40-50%
what type of uterine sarcoma appears in infants?
rhabdomyosarcoma-looks like grapes coming out of the vagina