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26 Cards in this Set
- Front
- Back
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Uterine myomas, prolapse, and endometriosis are all possible indications for what surgical tx?
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hysterectomy
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Dysfunctional uterine bleeding is a dx of ______.
Define Dysfunctional uterine bleeding. |
exclusion; have to exclude all the other potential causes of menstrual dz.
Abnormal uterine bleeding not related to pregnancy, pelvic pathology, or systemic disease |
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What causes the breakdown of the endometrium if pregnancy does not occur?
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drop in E2 and P --> waves of vasoconstriction --> ischemia --> tissue breakdown --> coagulation --> hemostasis
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The Anovulatory woman is always in which stage?
What can happen to the endometrium of such a woman? Consequently, bleeding in these women is ____ and often quite ____. |
follicular stage b/c she's exposed only to E2 all the time.
Grow to an abnormal height Become vascular and fragile, lacking stromal support Endometrial shedding is focal, asynchronous, variable - no organized vasconstriction as in the normal cycle Irregular, often quite severe/heavy. |
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What is the most important tool for dx'ing menstrual dz?
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good menstrual hx.
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Pt presents, having always had 4 menstrual periods per year. They're variable in timing and often quite heavy. Can you make a dx w/o objective assessment?
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yes, this is extremely characteristic of anovulation.
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correctly timed serum progesterone >3ng/mL is dx of what?
Is serial transvaginal US needed? In this context, what is endometrial biopsy used for? |
confirms ovulation.
not really. Can help rule out hypertrophy, etc... can also confirm anovulation/ovulation. |
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Should empirical hormonal tx be used to tx suspected anovulation?
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only if you can confirm anovulation!
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What is more important re: risk of endometrial carcinoma - duration of unopposed E tx, or age?
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duration of unopposed E2 tx.
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On endometrial biopsy, if you see a plasma cell infiltrate in the endometrial stroma, what should you think?
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chronic endometritis
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What are the primary indications (2) for imaging use in dx of menstrual dz?
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(1) suspected anatomic cause
(2) failed medical management |
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What menstrual hx in the pt (3) might suggest an anatomic cause that would make imaging a good idea?
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1) Regular monthly cycles complicated by inter-menstrual bleeding
2) Regular monthly cycles that have become heavy or prolonged 3) Abnormal bleeding despite evidence of ovulation |
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what is the normal thickness of the endometrium on US?
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5-12mm = normal.
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What is sonohysterography? Advantages?
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inject normal saline into uterus cavity --> US.
Greater sensitivity. |
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What is the definitive method of intrauterine cavitary dx?
- this is generally reserved for what these days? |
hysteroscopy.
- reserved for the tx of lesions w/i the cavity. |
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How do you tx anovulatory bleeding when there is NO suspicion of anatomical abnormality?
- is contraception required? |
cyclic progestin.
- no, so long as you're SURE that they're anovulatory, not oligoovulatory |
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If you tx oligoovulatory bleeding with progestin along with some estrogen, do you need concurrent contraception?
- should this be used with a suspicion of anatomical abnormality? |
yes.
- no. |
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Anovulatory states are associated with acute, heavy bleeding. How do we tx that?
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attain hemodynamic stability (IV fluids, Transfusion, curettage).
consider biopsy US Medical tx --> high dose progestin --> taper down into maintenance |
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How do we tx the endometrial attenuation/denudation sometimes seen w/ anovulatory bleeding?
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Estrogen and Progestin on a cycle.
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How can you tx "breakthrough" bleeding?
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w/ hormonal contraception
a progestin only "minipill" or depot medroxyprogesterone acetate |
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Why are we so concerned w/ tx'ing anovulatory bleeding - what can it turn into?
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endometrial hyperplasia/neoplasia.
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How do we tx endometrial hyperplasia WITHOUT cytologic atypia?
WITH? - refractory? |
cyclic progestin or OCP; repeat biopsy if abnormal bleeding occurs
megestrol acetate repeat biopsy to confirm resolution --> hysterectomy for refractory dz |
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How do we tx ectopic preg?
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salpinostomy (opening a fallopian tube)
salpingectomy (removal of a fallopian tube) methotrexate |
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How do we tx an incomplete/inevitable abortion?
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curettage
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How do we tx myomas medically?
Surgx? |
OCP or NSAID; both of which decrease menses severity.
Myomectomy, Hysterectomy. |
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What is the best tx of unexplained menorrhagia (heavy menses) in a woman w/ a chronic illness?
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IUD.
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