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57 Cards in this Set
- Front
- Back
Objectives for endometriosis:
- define endometriosis - common differentials - diagnostic modalities - hormonal v surgery tx |
Objectives Fibroid:
- define leiomyomata - common differentiral dx - diagnostic modalities - hormonal v surgery tx |
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What is Endometriosis?****
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Misplaced uterine tissue
- glands and stroma |
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What is endosalpingiosis?****
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Misplacement of endometrial tissue
glands only! |
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If we have endometriosis what do we call it?
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Ovaries – endometrioma (chocolate cyst)
***Chocolate syrup |
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What do we call endometriosis in the the myometrium?
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Myometrium – adenomyosis*****
glands grow into the wall of the uterus big swollen tender |
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Where is a place in the thorax where endometriosis may appear but in real life never seen
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Lung – pneumothorax Bowel
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What is common symptoms of endometriosis?
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pain with sex
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On physical exam what is the BUZZWORD***EXAM
for endometriosis? |
Powderburn lesions
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What are symptoms on presentation for endometriosis?
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Dysmenorrhea
Menorrhagia Dyspareunia Chronic Pelvic Pain Infertility Incidental finding on laparoscopy |
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What is dysmenorrhea?
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pain w/ periods
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What is menorrhagia?
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excess amount of bleeding
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What is Dyspareunia?
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pain with sex
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Does the # of symptoms tell you the amount of disease for endometriosis
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Amount of disease does not necessarily correlate with symptoms
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Will a women be infertile if she has endometriosis?
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Endometriosis does not necessarily mean infertility
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What are the 3 pathogenesis theories for endometriosis?
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Lymphatic or hematogenous
Retrograde flow Hereditary / embryologic |
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What are 3 clinical findings for endometriosis?
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Uterosacral nodularity
Cervical motion tenderness Boggy uterus |
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What are the 2 ways to diagnose endometriosis?
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Laparoscopic proven with or without biopsies
Response to Depo lupron |
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What is Depo lupron?
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GnRH agonist!
down regulates GnRH receptor decreases estrogen levels aka Medical hysterectomy |
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How long do you use depo lupron and what side effect do you look for?
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6 months limit – osteoporosis
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How can depo lupron be used as an adjunct in infertility cases?
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Can help quiet the inflammation as an adjunct in infertility cases
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What are treatment options for endometriosis?
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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 Laparoscopy – 2 year improvement with slow return Presacral neurectomy Total hysterectomy with bilateral salpingoophorectomy – cures |
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What is goal of medical management for treatement of endometriosis?
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anovulation
anovulatory cycle is a menstrual cycle during which the ovaries do not release an oocyte. Therefore, ovulation does not take place. |
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What is the only CURE for endometriosis?
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Total hysterectomy with bilateral salpingoophorectomy – cures*****EXAM
just a hysterectomy is NOT enough |
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After you remove the endometriosis tissue what can you give the women?
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*******Consider estrogen – will not stimulate regrowth
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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? |
Assessment:
Dysparenia Dysmenorrhea Menorrhagia Complex ovarian cyst Likely endometriosis***** |
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EXAM****
WHAT IS THE MOST COMMON FEMALE TUMOR? |
fibroids
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This is a smooth muscle tumors of fibroids?
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Leiomyomata
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Are most leiomyomata's benign or malignant?
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benign
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How do Fibroid leiomyomata's present?
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Bleeding
and pain |
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What race are leiomyomata common in?
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black women
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Where do leiomyomata occur?
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can occur anywhere in the pelvis
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Where do uterine fibroid occur:
intraligamentary |
outside the uterus near ligaments
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Where do uterine fibroid occur:
Protruding submucosal |
In the submucosal of the uterus
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Where do uterine fibroid occur:
submucosal |
In the submucosa of the uterus
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Where do uterine fibroid occur:
subserosal |
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How do MOST fibroids present?
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Pain – usually dysmenorrhea
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What are other symptoms of fibroids?
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Back pain
Pelvic fullness Urinary frequency Heavy menses Sometimes intermenstrual bleeding |
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How do we diagnose fibroids?
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Pelvic mass on bimanual exam
Pelvic ultrasound Incidental finding at laparoscopy or c – section |
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What is a sessile fibroid?
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Flat
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What is pedunclulated fibroid?
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Mushroom like
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how can pregnancy affect fibroids?
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High estrogen causes growth
Shrink spontaneously |
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What are treatment options for fibroids?
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Myomectomy
Uterine artery embolization Hysterectomy Depo lupron - decrease estrogen which causes firboid to grow |
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What is a myomectomy?
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Used as an adjunct to infertility or recurrent miscarriages
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If you have a fibroid in the myometrium of the uterus how can you remove this?
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Myomectomy
Hysteroscopic resection – submucosal |
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What if you have a transmural fibroid, how would you treat this?
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Myomectomy
treat like a classical c-section…15% uterine rupture if labored…labor is contraindicated |
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What is another way to decrease growth of a fibroid?
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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. |
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What is uterine artery embolization?
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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 women would you NEVER do uterine artery embolization
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In a women who wants to become pregnant
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ON EXAM******
What is the most common cause of Hysterectomy? |
F*&king
FIBROID |
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How are hysterectomys most commonly done?
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abdominally
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What is a great drug for fibroids?
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Depo Lupron
Estrogen feeds fibroids, causes growth Shrinks fibroids |
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How long does it take for optimal shrinkage of a fibroid with depo lupron?
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Optimal shrinkage occurs after 3 months of treatment
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What happens after you stop depo lupron for fibroid treatment?
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Not a long term treatment option – rapid regrowth after stopping
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ON EXAM*****
How long do you treat endometriosis with depo lupron? |
6 months
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ON EXAM*****
How long do you treat fibroids with depo lupron? |
3 months
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What is the tx for fibroids?
*****EXAM |
Hysterectomy - uterus only
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What is the tx for Endometriosis?
*****EXAM |
Hysterectomy + Ovaries
Uterus + Ovaries must go! |