Repro Exam 2: Aliff: Endometriosis And Fibroids

Front 1

Objectives for endometriosis:

- define endometriosis
- common differentials
- diagnostic modalities
- hormonal v surgery tx

Back 1

Objectives Fibroid:
- define leiomyomata
- common differentiral dx
- diagnostic modalities
- hormonal v surgery tx

Front 2

What is Endometriosis?****

Back 2

Misplaced uterine tissue

- glands and stroma

Front 3

What is endosalpingiosis?****

Back 3

Misplacement of endometrial tissue

glands only!

Front 4

If we have endometriosis what do we call it?

Back 4

Ovaries – endometrioma (chocolate cyst)

***Chocolate syrup

Front 5

What do we call endometriosis in the the myometrium?

Back 5

Myometrium – adenomyosis*****

glands grow into the wall of the uterus

big
swollen
tender

Front 6

Where is a place in the thorax where endometriosis may appear but in real life never seen

Back 6

Lung – pneumothorax Bowel

Front 7

What is common symptoms of endometriosis?

Back 7

pain with sex

Front 8

On physical exam what is the BUZZWORD***EXAM

for endometriosis?

Back 8

Powderburn lesions

Front 9

What are symptoms on presentation for endometriosis?

Back 9

Dysmenorrhea
Menorrhagia
Dyspareunia
Chronic Pelvic Pain
Infertility
Incidental finding on laparoscopy

Front 10

What is dysmenorrhea?

Back 10

pain w/ periods

Front 11

What is menorrhagia?

Back 11

excess amount of bleeding

Front 12

What is Dyspareunia?

Back 12

pain with sex

Front 13

Does the # of symptoms tell you the amount of disease for endometriosis

Back 13

Amount of disease does not necessarily correlate with symptoms

Front 14

Will a women be infertile if she has endometriosis?

Back 14

Endometriosis does not necessarily mean infertility

Front 15

What are the 3 pathogenesis theories for endometriosis?

Back 15

Lymphatic or hematogenous
Retrograde flow
Hereditary / embryologic

Front 16

What are 3 clinical findings for endometriosis?

Back 16

Uterosacral nodularity
Cervical motion tenderness
Boggy uterus

Front 17

What are the 2 ways to diagnose endometriosis?

Back 17

Laparoscopic proven with or without biopsies

Response to Depo lupron

Front 18

What is Depo lupron?

Back 18

GnRH agonist!
down regulates GnRH receptor
decreases estrogen levels

aka Medical hysterectomy

Front 19

How long do you use depo lupron and what side effect do you look for?

Back 19

6 months limit – osteoporosis

Front 20

How can depo lupron be used as an adjunct in infertility cases?

Back 20

Can help quiet the inflammation as an adjunct in infertility cases

Front 21

What are treatment options for endometriosis?

Back 21

- Laser ablation of visible disease

- LUNA – laparoscopic uterosacral nerve ablation

-Appendectomy if needed

-Follow with Depo lupron, Depo
- Provera or oral contraceptives; NSAID’s

-Goal of medical management – anovulation

Laparoscopy – 2 year improvement with slow return

Presacral neurectomy

Total hysterectomy with bilateral salpingoophorectomy – cures

Front 22

What is goal of medical management for treatement of endometriosis?

Back 22

anovulation

anovulatory cycle is a menstrual cycle during which the ovaries do not release an oocyte. Therefore, ovulation does not take place.

Front 23

What is the only CURE for endometriosis?

Back 23

Total hysterectomy with bilateral salpingoophorectomy – cures*****EXAM


just a hysterectomy is NOT enough

Front 24

After you remove the endometriosis tissue what can you give the women?

Back 24

*******Consider estrogen – will not stimulate regrowth

Front 25

You have a women with HEAVY PERIODS
CRAMPS
DYSPAREUNIA (refuses sex......say what)
+ uterosacral tenderness with nodularity
boggy retroverted uterus
+CMT reproducing pain
left adnexal 4 cm tender mass
US- left ovarian cyst
What is the assessment?

Back 25

Assessment:

Dysparenia
Dysmenorrhea
Menorrhagia
Complex ovarian cyst
Likely endometriosis*****

Front 26

EXAM****

WHAT IS THE MOST COMMON FEMALE TUMOR?

Back 26

fibroids

Front 27

This is a smooth muscle tumors of fibroids?

Back 27

Leiomyomata

Front 28

Are most leiomyomata's benign or malignant?

Back 28

benign

Front 29

How do Fibroid leiomyomata's present?

Back 29

Bleeding
and
pain

Front 30

What race are leiomyomata common in?

Back 30

black women

Front 31

Where do leiomyomata occur?

Back 31

can occur anywhere in the pelvis

Front 32

Where do uterine fibroid occur:
intraligamentary

Back 32

outside the uterus near ligaments

Front 33

Where do uterine fibroid occur:
Protruding submucosal

Back 33

In the submucosal of the uterus

Front 34

Where do uterine fibroid occur:
submucosal

Back 34

In the submucosa of the uterus

Front 35

Where do uterine fibroid occur:
subserosal

Back 35

Front 36

How do MOST fibroids present?

Back 36

Pain – usually dysmenorrhea

Front 37

What are other symptoms of fibroids?

Back 37

Back pain
Pelvic fullness
Urinary frequency
Heavy menses
Sometimes intermenstrual bleeding

Front 38

How do we diagnose fibroids?

Back 38

Pelvic mass on bimanual exam

Pelvic ultrasound

Incidental finding at laparoscopy or c – section

Front 39

What is a sessile fibroid?

Back 39

Flat

Front 40

What is pedunclulated fibroid?

Back 40

Mushroom like

Front 41

how can pregnancy affect fibroids?

Back 41

High estrogen causes growth

Shrink spontaneously

Front 42

What are treatment options for fibroids?

Back 42

Myomectomy

Uterine artery embolization

Hysterectomy

Depo lupron - decrease estrogen which causes firboid to grow

Front 43

What is a myomectomy?

Back 43

Used as an adjunct to infertility or recurrent miscarriages

Front 44

If you have a fibroid in the myometrium of the uterus how can you remove this?

Back 44

Myomectomy

Hysteroscopic resection – submucosal

Front 45

What if you have a transmural fibroid, how would you treat this?

Back 45

Myomectomy

treat like a classical c-section…15% uterine rupture if labored…labor is contraindicated

Front 46

What is another way to decrease growth of a fibroid?

Back 46

Uterine artery embolization

minimally-invasive procedure performed by an interventional radiologist and interventional neuroradiologists. It involves the selective occlusion of blood vessels by purposely introducing emboli.

Front 47

What is uterine artery embolization?

Back 47

Plugs

Causes infarction of the uterus

Collateral blood flow

unclear long term results-depends on size and location

Front 48

What women would you NEVER do uterine artery embolization

Back 48

In a women who wants to become pregnant

Front 49

ON EXAM******

What is the most common cause of Hysterectomy?

Back 49

F*&king
FIBROID

Front 50

How are hysterectomys most commonly done?

Back 50

abdominally

Front 51

What is a great drug for fibroids?

Back 51

Depo Lupron

Estrogen feeds fibroids, causes growth
Shrinks fibroids

Front 52

How long does it take for optimal shrinkage of a fibroid with depo lupron?

Back 52

Optimal shrinkage occurs after 3 months of treatment

Front 53

What happens after you stop depo lupron for fibroid treatment?

Back 53

Not a long term treatment option – rapid regrowth after stopping

Front 54

ON EXAM*****

How long do you treat endometriosis with depo lupron?

Back 54

6 months

Front 55

ON EXAM*****

How long do you treat fibroids with depo lupron?

Back 55

3 months

Front 56

What is the tx for fibroids?
*****EXAM

Back 56

Hysterectomy - uterus only

Front 57

What is the tx for Endometriosis?
*****EXAM

Back 57

Hysterectomy + Ovaries

Uterus + Ovaries must go!