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15 Cards in this Set
- Front
- Back
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Reproduction System- Endometriosis and Fibroids by Aliff
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Reproduction System- Endometriosis and Fibroids by Aliff
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What, so what is endometriosis? what is it called if it's just glands? where can it happen?
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Misplaced endometrial tissue: Glands and stroma
Endosalpingiosis – glands only Uterosacral ligaments Posterior cul de sac Bladder serosa Fallopian tubes Ovaries – endometrioma (chocolate cyst) Myometrium – adenomyosis Appendix Lung – pneumothorax Bowel C – section scar |
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Presentation
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Dysmenorrhea
Menorrhagia Dyspareunia Chronic Pelvic Pain Infertility Incidental finding on laparoscopy Amount of disease does not necessarily correlate with symptoms Endometriosis does not necessarily mean infertility 10% overall occurrence 25-35% of infertility patients have endometriosis |
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Path theories, clinical findings, dx criteria
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Path theories:
Lymphatic or hematogenous Retrograde flow Hereditary / embryologic Clinical Findings: Uterosacral nodularity Cervical motion tenderness Boggy uterus Diagnostic Criteria: Laparoscopic proven with or without biopsies Response to Depo lupron |
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Depo lupron.. what the heck.
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GnRH antagonist
Puts you into Pseudomenopause; Medical hysterectomy 6 months limit – osteoporosis Consider add back estrogen – birth control Can help quiet the inflammation as an adjunct in infertility cases Expensive |
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Laparoscopic Findings
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Adhesions
Chocolate cysts Peritoneal windows in cul de sac Implants – clear, brown, black (powder burn appearance) Hyperemic tissues Normal pelvis can make their own blood supply |
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Treatment
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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 |
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What is the most common female tumor? always a problem?
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Fibroids:
Leiomyomata – smooth muscle tumors Most common female tumor Benign – leiomyosarcoma rare Bleeding, pain May cause no problems at all Very common in black women Can occur anywhere in the pelvis |
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Presentation and diagnosis and effects of pregnancy
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Pain – usually dysmenorrhea
Back pain Pelvic fullness Urinary frequency Heavy menses Sometimes intermenstrual bleeding Pelvic mass on bimanual exam Pelvic ultrasound Incidental finding at laparoscopy or c – section Effects of pregnancy: high estrogen causes growth; shrink spontaneously |
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How do you treat these things?
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If it ain’t broke, don’t fix it
Myomectomy Uterine artery embolization Hysterectomy Depo lupron |
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Myomectomy (excise fibroid from the uterus)
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Used as an adjunct to infertility or recurrent miscarriages
Hysteroscopic resection – submucosal Laparoscopic Laparotomy If transmural – treat like a classical c-section…15% uterine rupture if labored…**labor is contraindicated (you do NOT want women who have had a myomectomy to go into labor!!!!!!!) they are a bloody mess. the only reason to do these is if you think the fibroid is messing with the woman's fertility. |
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How do you name a fibroid?
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Name it where you find it, yo.
Sessile – flat Pedunculated – mushroom like Subserosal Intramural Submucosal |
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Uterine Artery Embolization causes what?
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Plugs
Causes infarction of the uterus Collateral blood flow unclear long term results-depends on size and location |
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What is the most common treatment for fibroids? How are the done most often?
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Hysterectomy:
Most common treatment for fibroids Most often abdominally Vaginally – coring, morcellation, bivalving Size does matter |
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Depo Lupron and fibroids.
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Estrogen feeds fibroids, causes growth
Shrinks fibroids Optimal shrinkage occurs after 3 months of treatment *May help change the route of hysterectomy from abdominal to vaginal Not a long term treatment option – rapid regrowth after stopping |
