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48 Cards in this Set
- Front
- Back
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uterine leiomyomata is AKA?
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fibroid
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__ 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
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is a fibroid malignant, premalignant, or benign?
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benign
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is a fibroid estrogen dependent or independent?
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estrogen dependent
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t/f
0.1% start out as malignancy, fibroids do not "become" cancer |
true
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a localized proliferation of smooth __ cells in a swirly pattern surrounded by a pseudocapsule of compressed muscle fibers.
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smooth muscle cells
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what are the 3 locations for fibroids?
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-submucosal-just under endometium
-subserosal-under submucosa can be pedunculated -intramural-in the myometrium |
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name the 3 rare variants to fibroids....
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-intravenous leiomyomatosis
-benign metastasizing leiomyoma -leiomyomatosis peritonealis dissemination |
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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
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which is described as "implants on peritoneal surface"
-intravenous leiomyomatosis -benign metastasizing leiomyoma -leiomyomatosis peritonealis dissmeniation |
leiomyomatosis peritonealis dissemination
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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
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what gross and histologic changes occur within a benign fibroid...it is know as?
-generation -degeneration |
degeneration
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what are the 3 types of fibroid degeneration?
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red-hemorrhagic changes d/t rapid growth, outgrows vasculature
-hyaline-occurs after menopause -calcification-after menopause |
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what is the most common type of degeneration?
-red -hyaline -calcification |
red
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what are the symptoms that pt's c/o when they have fibroids?
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pain
pressure bleeding |
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is the bleeding r/t fibroids cyclic?
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no
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with fibroids there will be abnormal uterine bleeding....
-premenopausal -perimenopausal -postmenopausal |
premenopausal
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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
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-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
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bleeding with fibroids commonly causes?
-iron deficiency anemia -syncope -profound acute blood loss -all of the above -a & c |
a & c
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what is the most common type of fibroid r/t bleeding?
-submucosal -subserosal -intramural |
submucous fibroids and intramural cause bleeding
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what type of degeneration causes pain?
-red -hyaline -calcification |
red d/t ischemia of tissue
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what other conditions cause pain with fibroids?
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-progressive increase in dysmenorrhea
torsion of pedunculated fibroid -dyspareunia -prolapse of pedunculated fibroid thru cervical os |
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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
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how do you diagnose fibroids on clinical exam, what are you looking for?
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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 |
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what is the best imaging of uterine fibroids?
-u/s -ct -mri |
u/s
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in what method can you see all the 3 types of fibroids?
-u/s -hysteroscopically -laparoscopically |
laparoscopically
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__ large intramural and submucosal fibroids can be seen.
-hysteroscopically -laparoscopically -u/s |
hysteroscopically
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why aren't ct or mri used to visualize fibroids?
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not cost effective tools for diagnosis
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what is the treatment of fibroids if the pt is asymptomatic?
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none, reassureance and observation
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if a woman over the age of 35 has fibroids and AUB what should you ?
-watch -laparoscope -EB |
EB
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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
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if a fibroid uterus is very large, what other test should you order and why?
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ct with dye to ensure ureters are not blocked
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what are the non-surgical options for tx of uterine fibroids?
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-progesterone meds
-bcp -nsaid's -GnRh agonist (Lupron) |
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what does Lupron injuections do?
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temporarily shrinks fibroids
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what is the purpose of progesterone meds in the tx of fibroids?
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to stop or lighten menses
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what are "conservative" methods of txing fibroids?
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uterine artery embolization
myomectomy destruction of fibroids (cryo) |
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what is a myomectomy?
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removal of the fibroid only, can affect future pregnancy
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you cannot do uterine artery embolization in what pt population?
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women who want kids
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what is the definitive procedure in the tx of fibroids?
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hysterectomy
must meet criteria finished with child bearing |
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what is the purpose of GnRh agonists, what does it do?
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puts the woman into menopause
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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)
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what is uterine sarcoma?
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ca in the uterine wall
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t/f
uterine sarcoma causes pelvic pain |
false;rarely presents as pelvic pain
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t/f
there is an increased incidence of uterine sarcoma with tamoxifene |
true
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what are the 3 types of uterine sarcoma?
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carcinosarcoma-arises from endometruim
leiomyosarcoma-from myometruim -endometrial stroma |
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what is the most common type of uterine sarcoma?
-carcinosarcoma-endometrium -leiomyosarcoma-myometrium -endometrial stoma |
carcinosarcoma 40-50%
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what type of uterine sarcoma appears in infants?
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rhabdomyosarcoma-looks like grapes coming out of the vagina
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