Obgyn Uterine Leiomyoma And Neoplasia

Front 1

uterine leiomyomata/fibroids/myomas

Back 1

localized proliferation of smooth muscle cells surrounded by a pseudocapsule of compressed muscle fibers
-estrogen responsive benign tumors (may grow during pregnancy, shrink in menopause)

Front 2

What is the most common indication for hysterectomy?

Back 2

uterine fibroids

Front 3

Three main types of leiomyomata

Back 3

1. intramural- centered in the muscular wall of the uterus
2. subserosal - just beneath uterine serosa (subcategory- pedunculated leiomyoma-- stump-like)
3. submucosal- just beneath the endometrium

Front 4

classic presentation of uterine malignancy?

Back 4

postmenopausal women with rapidly enlarging uterine mass, postmenopausal bleeding, unusual vaginal discharge and pelvic pain

Front 5

most common presenting symptom of uterine fibroids?

Back 5

bleeding-- development of menorrhagia-- heavier periods that last longer-- may cause IDA

Front 6

diagnosis of uterine leiomyomas

Back 6

clinical diagnosis, although US, CT and MRI may help
- endometrial bx should not be done unless there is suspicion of cancer

Front 7

treatment of uterine leimyomas

Back 7

most patients do not require either surgical or medical tx. initial tx should be directed at symptoms
- surgical: myomyectomy. hysterectomy
- medical: progestin supplement to minimze uterine bleeding, prostaglandin synthase inhibitors to decrease amount of secondary dysmenorrhea or amount of menstrual flow

Front 8

indications for myomyectomy

Back 8

rapidly enlarging pelvic mass, persistent bleeding, pain or pressure, enlargement of an asx to myoma to more than 8cm in a woman who has not completed childbearing
- hysterectomy should not be considered definitive treatment for a women who has not completed childbearing

Front 9

contraindications of myomyectomy

Back 9

pregnancy, advanced adnexal disease, malignancy, enucleation of myoma could compromise uterine function

Front 10

within 20 years of myomyectomy what proportion of women require hysterectomy?

Back 10

1 in 4-- usually because of recurrence

Front 11

indication for hysterectomy in leiomyomata

Back 11

1, 2, or 3
1. asx myoma of such size that they are palpable abdominally and are of concern to the patient
2. excessive uterine bleeding evidenced by: a) profuse bleeding with flooding or clots or repetitive periods lasting > 8 days, b) anemia caused by acute or chronic blood loss
3. pelvic discomfort caused by myomas that is a) acute and severe, b) chronic lower abdominal pain or low back pressure, c) bladder pressure with urinary frequency not caused by UTI

Front 12

actions that must be taken prior to hysterectomy for uterine fibroids

Back 12

- confirm no cervical malignancy
- eliminate anovulation and other causes of abnormal bleeding
- when abnormal bleeding is present, confirm no endometrial malignancy
- assess surgical risk
- consider medical and psychological risks to patient from surgery

Front 13

contraindications to hysterectomy for uterine fibroids

Back 13

1. desire to maintain fertility-- should try to myomyectomy
2. asx myoma of 12 weeks' gestation determined by physical exam or US