Urogyn; Endometrium And Myometrium

Front 1

Acute endometritis: what's the cause?

Back 1

retained products of contraception, usually

Front 2

Chronic endometritis: what cell is it characterized by?

Back 2

plasma cells

Front 3

What is an endometrial polyp?

Back 3

hyperplastic protrusion of endometrium that causes bleeding

Front 4

endometrial polyp can be a side effect of what drug and why?

Back 4

tamoxifen.

Tamoxifen is anti- estrogen in breast but weakly pro-estrogen in endometrium.

Front 5

sx of endometrial polyp

Back 5

bleeding

Front 6

endometrial hyperplasia: defn

Back 6

Hyperplasia of glands relative to stroma.

Front 7

endometrial hyperplasia: cause

Back 7

caused by unopposed estrogen (no or not enough progesterone).

Can happen in obese person as fat converts androgens to estrone.

Front 8

Most important predictor for cancer progression

Back 8

cell atypia

Front 9

When there is postmenopausal bleeding, think _________

Back 9

endometrial carcinoma

Front 10

How is endometrial hyperplasia classified?

Back 10

Based on architecture and whether there is cell atypia

Front 11

two main categories of endometrial carcinoma

Back 11

1) Estrogen dependent: Hyperplastic
2) Estrogen independent: Sporadic

Front 12

Atrophic Endometrium: what age groups?

Back 12

This means it's not under the influence of estrogen or progesterone.

pre-menarche
post-menopause

Front 13

Hypersecretory glands and
decidualized stroma
is characteristic of what type of endometrium?

Back 13

Gestational endometrium

Front 14

Arias-Stella reaction: defn

Back 14

benign change in the endometrium associated with the presence of chorionic tissue.

Can be misdiagnosed as cancer when it's normal during pregnancy.

It is characterized by nuclear enlargement and may also have any of the following: an irregular nuclear membrane, granular chromatin, centronuclear vacuolization, and pseudonuclear inclusions.

Front 15

Dysfunctional Uterine Bleeding (DUB): defn

Back 15

bleeding >5 days of unknown cause in women of childbearing age

Front 16

Most common causes of Dysfunctional Uterine Bleeding (DUB):

Back 16

<b>Anovulatory cycles</b>
Chronic endometritis
Coagulation disorder (coumadin etc.)
Organic lesions: endometrial carcinoma (5-15% of postmenopausal bleeding)
endometrial polyp (5-15%), adenomyosis, leiomyoma
pregnancy complications
endocrine disorder
degenerative changes in uterine blood vessels associated with atrophy

Front 17

Anovulatory cycles: What happens?

Back 17

In childbearing age women, if there is no ovulation ---> continuous estrogen with no opposition by progesterone --> endometrial lining thickens until it outgrows blood supply --> endometrial lining breaks down and sheds out of phase

Front 18

Clinical Features of acute endometritis

Back 18

Fever, chills, pelvic tenderness, leukorrhea

Front 19

Plasma cells are more associated with (acute, chronic) endometritis

Back 19

chronic

Front 20

Infertility
Dysmenorrhea
Dyspareunia
Pelvic pain
Rectal bleeding

All signs of what?

Back 20

Endometriosis

Front 21

prolonged estrogen stimulation can cause what endometrial problem?

Back 21

endometrial hyperplasia

Front 22

What is PTEN?

Back 22

tumor suppressor gene that acts to prevent cells from dividing too rapidly. Mutated in a large number of cancers at high frequency.

Front 23

What is simple vs complex hyperplasia?

Back 23

Simple: stroma is 1/3 of volume or less
Complex: there is inactivation of PTEN with crowding and budding stroma between glands

Front 24

Wht are endometrial changes with progestin tx?

Back 24

Endometrial glandular arrest

Small inactive glands

No mitotic figures

Stromal decidual reaction

Front 25

Malignant Tumors of theEndometrium: most common

Back 25

Endometrioid: estrogen dependent

Front 26

Which endometrial cancer is associated with endometrial hyperplasia?

Back 26

Endometrioid: estrogen dependent

Front 27

What type of endometrial cancer(s) occur in older patients (>70)?

Back 27

Estrogen independent

Front 28

Estrogen independent: what are the endometrial cancer(s)?

Back 28

Serous
Clear Cell
MMMT: mucinosarcoma (malignant mixed mullerian tumor: 1% of endometrial cancers)

Front 29

Molecular alterations associated with Estrogen independent endometrial cancer

Back 29

p53

Front 30

Molecular alterations associated with Estrogen dependent endometrial cancer

Back 30

PTEN, MSI,
β-catenin

Front 31

T/F Estrogen independent endometrial cancer are most common.

Back 31

F. Estrogen DEPENDENT are ~80%

Front 32

psammoma bodies : defn

Back 32

round collection of calcium, seen microscopically.

Commonly seen in Endometrial adenocarcinomas (Papillary serous carcinoma ~3%-4%)

Front 33

What is this?

Back 33

psammoma body.

Front 34

psammoma bodies are associated with what gyn cancer?

Back 34

serous carcinoma of endometrium (estrogen independent)

Front 35

Carcinosarcoma (Malignant Mixed Mullerian Tumor) MMMT : What is this?

Back 35

Biphasic tumor: Carcinoma and Sarcoma

Occurs in Postmenopausal women (PM bleeding)

It's a Polypoid mass (extends through cervical OS)

Front 36

Adenosarcoma has a (MALIGNANT,BENIGN) glandular epithelium- (MALIGNANT, BENIGN) STROMA

Back 36

benign; malignant

Front 37

Leiomyoma is aka

Back 37

uterine fibroid

Front 38

benign proliferation of smooth muscle (myometrium in uterus)

Back 38

leiomyoma

Front 39

How to differentiate a leiomyoma from leiomyosarcoma?

Back 39

Leiomyoma: multiple masses, well-defined and circumscribed, white and whorly

Leiomyosarcoma: Usually just one mass, there is necrosis, hemorrhage on gross exam, invasion into surrounding tissue; occur post-menopausal.

Front 40

Major Risk Factor for Urinary Incontinence

Back 40

Childbearing

Front 41

Kegel exercises involve contraction of the _______ muscles

Back 41

levator ani

Front 42

measurement of pressure/volume relationship of the bladder during the filling and storage phases

Back 42

cystometry

Front 43

What is the difference between STRESS vs URGE incontinence?

Back 43

Stress: urine loss synchronously with physical exertion

Urge: spontaneous/unprovoked contraction of detrusor muscle during the filling/storage phase

Front 44

spontaneous/unprovoked contraction of detrusor muscle during the filling/storage phase

Back 44

urge incontinence

Front 45

urine loss synchronously with physical exertion

Back 45

stress incontinence

Front 46

What is the detrusor muscle?

Back 46

Muscle that contracts when urinating to squeeze out urine.Otherwise, it remains relaxed to allow the bladder to fill

Front 47

main support for pelvic floor

Back 47

uterosacral ligaments

Front 48

What is the culprit in a cystocele?

Back 48

weak anterior vaginal wall

Front 49

medical condition that occurs when the tough fibrous wall between a woman's bladder and her vagina (the pubocervical fascia) is torn by childbirth, allowing the bladder to herniate into the vagina.

Back 49

cystocele

Front 50

To urinate, the detrusor muscle (relaxes, contracts)

Back 50

contracts

Front 51

(Alpha, beta) sympathetic fibers predominate in bladder and promote detrusor relaxation and therefore filling/storage

Back 51

beta

Front 52

What type of fibers cause detrusor contractions and relaxation of urethral smooth muscle therefore promoting emptying?

Back 52

parasympathetic - cholinergic fibers

Front 53

What is the incidence of urinary incontinence in community dwelling, elderly adults?

Back 53

15-36%

Front 54

Most common type of incontinence

Back 54

stress

Front 55

What are the 2 etiologies of stress incontinence?

Back 55

1) Hypermobility of urethra/bladder due to lack of anatomic support (sphincter is fine) : 90%

2) Intrinsic sphincter deficiency : 10%

Front 56

detrusor instability is aka

Back 56

overactive bladder

Front 57

What test is used to assess detrusor instability?

Back 57

cystometrogram

Front 58

What is the Q-tip test?

Back 58

Q-tip inserted into urethra and patient is asked to cough/strain.

The mobility of the Q-tip is assessed to assess mobility of urethra/bladder. A more mobile urethra is an indication that your incontinence should be categorized as stress.

Front 59

What are non surgical treatments for stress incontinence?

Back 59

pelvic floor exercises

pharmacological: estrogen, alpha-agonists, tricyclic antidepressants

Front 60

What is the goal of surgery for stress incontinence?

Back 60

to prevent descent of the urethrovesical junction during increases in intra-abdominal pressure

Front 61

What is the most successful surgery for stress incontinence?

Back 61

suburethral slings

Front 62

What happens in detrusor instability/overactive bladder?

Back 62

The detrusor muscle contracts upon bladder filling while the patient attempts to inhibition micturtion

Front 63

T/F Overactive bladder is more common than stress incontinence

Back 63

F.

Front 64

What is the first line of non-surgical treatment for overactive bladder?

Back 64

Bladder-retraining/behavior modication: a formal program

Front 65

What are pharmacologic therapies for overactive bladder?

Back 65

Anti-cholinergics

Front 66

What are signs/sx of Pelvic organ prolapse?

Back 66

Vaginal pressure/heaviness (>90%)
Sensation of “something” protruding through the vagina (>90%)
Dyspareunia/ impaired coitus
Pain

Front 67

Rectocele: defn

Back 67

protrusion of posterior vaginal wall and anterior rectal wall. look for a bulging of posterior vaginal wall with valsalva maneuver

Front 68

Enterocele: defn

Back 68

elongation of posterior cul-de-sac along rectovaginal septum.

Front 69

What maneuver are patients asked to do to demonstrate prolapse?

Back 69

valsalva

Front 70

First line treatment of pelvic organ prolapse?

Back 70

pessary

(may have surgery with/out graft augmentation_

Front 71

Pelvic organ prolapse of anterior wall is aka:

Back 71

cystocele; Cystourethrocele

Front 72

Pelvic organ prolapse of posterior wall is aka:

Back 72

rectocele, enterocele

Front 73

Pelvic organ prolapse of apex is aka:

Back 73

Uterine prolapse/Procidentia OR Vaginal Vault Prolapse

Front 74

Anticholinergics inhibit activity of _______ to cause bladder to inhibit emptying

Back 74

detrusor

Front 75

T/F Sympathetics cause the bladder/detrusor to relax

Back 75

T

Front 76

T/F Urge incontinence is more common than stress

Back 76

F. only 10% of incontinence is pure urge incontinence; whereas 90% have at least a component of stress incontinence.

Front 77

T/F Both stress and urge incontinence respond to Kegel pelvic muscle exercises

Back 77

T . Should be offered before more invasive options

Front 78

Surgery that supports the ________________ has the best long-term cure rate for stress incontinence.

Back 78

urethrovesicle junction

Front 79

What is the key to successfull reconstructive pelvic surgery repairs?

Back 79

Apical SUpport (level 1)