Endometrial Conditions/IUD Complications – Flashcards

question
What is Endometrial Hyperplasia, and when does it usually occur?
answer
Endometrial hyperplasia is the overgrowth of ENDOMETRIAL GLANDS & STROMA. It usually occurs around Menopause.
question
List two forms of Endometrial Hyperplasia, and which type can be malignant?
answer
Endometrial Hyperplasia with cytological atypia and without cytological atypia. Endometrial Hyperplasia with cytological atypia may progress into invasive endometrial malignancy.
question
What is major symptom of Endometrial Hyperplasia?
answer
All endometrial hyperplasias, regardless of their malignant potential, may cause significant blood loss through heavy and irregular vaginal bleeding.
question
What causes or conditions are risk factors for Endometrial Hyperplasia, and what do they all have in common?
answer
-Women near menopause -anovulation -being overweight -diabetes -polycystic ovarian syndrome -unopposed estrogen hormone therapy *All of these factors, similar to edometrial cancer, are caused by medications or conditions that continuously produce estrogen.
question
What specific medication causes Endometrial Hyperplasia, and what are the symptoms?
answer
Tamoxifen is a mixed estrogen agonist-antagonist used extensively in the treatment of postmenopausal women with estrogen receptor-postive breast cancers. Symptoms: -Abnormal bleeding -Enlarged uterus -Pelvic mass (estrogen-producing ovarian tumor)
question
What is the ultrasound appearance of endometrial hyperplasia?
answer
-Enlarged thickened endometrial stripe -Postmenopausal w/ no HRT >5mm -Postmenopausal with HRT >8mm -Inhomogenous (malignancy risk) -Tiny internal cysts
question
Who needs an endometrial biopsy?
answer
Patients presenting with: -Posmenopausal bleeding -Postmenopausal endometrial cells on Pap smear -Perimenopausal intramenstrual bleeding -Abnormal bleeding w/ history of anovulation -Thickened endometrial stripe via sonography -Infertility
question
What percentage of cancers affecting the uterine body are endometrial carcinomas?
answer
90%!!!!!!!!
question
Describe endometrial cancer, and what causes it?
answer
Endometrial cancer is an invasive cancer of the endometrial lining of the uterus that most commonly arises from a background of endometrial hyperplasia. It is a consequence of unopposed endogenous or exogenous estrogen on a hormonally responsive endometrium.
question
What is the most common gynecological malignancy? Who most commonly gets endometrial cancer?
answer
ENDOMETRIAL CANCER Perimenopausal and postmenopausal women are predominantly affected.
question
What is the HALLMARK symptom of endometrial cancer?
answer
Perimenopausal or postmenopausal bleeding.
question
What tests are warranted when someone presents with perimenopausal or postmenopausal bleeding?
answer
The doctor will perhaps order a transvaginal ultrasound in order to measure the endometrial stripe and possibly perform endometrial biopsies.
question
What percentage of endometrial cancer has abnormal results on PAP SMEAR?
answer
50%
question
What is the standard treatment for endometrial cancer?
answer
Hysterectomy, further treatment depends on the pathological and surgicall findings.
question
What is the ultrasound appearance of Endometrial Cancer?
answer
-Prominent, abnormally enlarged, inhomogenous endometrium. -Indistinct and distorted endometrial-myometrial border(measuring is hard) -Increased uterine size -Bulbous lobulated contour - Focal areas of thickness -Increased vascularity
question
What is Asherman's Syndrome?
answer
Also known as Intrauterine adhesions. Asherman's Syndrome is partial or complete obliteration of the endometrial cavity by adherance of the uterine walls from scarring. Scarring causes fibrous adhesions or synechiae, which can obliterate the endometrial cavity.
question
What are some causes of Asherman's Syndrome?
answer
Patients may have a history of instrumentation or illness that has scarred the endometrial canal. Can be a cause of secondary infertility following therapeutic abortions.
question
What should arouse suspicion of Asherman's syndrome?
answer
Amenorrhea following D&C or endometritis.
question
What exam is used to visualize the endometrium better for people that have Asherman's Syndrome?
answer
A Hysterossalpingogram can be used to visualize these intrauterine adhesions.
question
What are signs and symptoms of Asherman's Syndrome? What would a patient with Asherman's be at risk for if they conceive?
answer
Menstrual or reproductive abnormalities (amenorrhea, hypoomenorrhea, dysmenorrhea infertility, and recurrent abortion) If a person with Asherman's conceives there is a high incidence of complications including premature labor, placenta accreta, placenta previa, and postpartum hemorrhage.
question
What is the ultrasound appearance of Asherman's syndrome?
answer
-Echogenic endometrium due to the presence of mutliple adhesive bands. -Endometrium can be normal or thickened. -Adhesionscan appear hypechoic when contrasted against the background of a secretory endometrium. -Adhesions can cause a discontinuity of the normal endometrial stripe.
question
What are endometrial polys?
answer
Endometrial Polyps are hyperplastic overgrowths of glands and stroma that are localized to form a projection from the basal layer of the endometrium, this is why they do not slough off during menstruation.
question
What are polyps usually attached by, and how much do they usually measure?
answer
Polyps are usually connected by a stalk, pedunculated. (If no stalk is present is called sessile.) They can range in size from 0.5cm-3.0 cm in size. (Can be single or multiple)
question
In what age group are polyps least common, and most common?
answer
Incidence of endometrial polyps are rare in anyone younger than 20 years old. They are more common in increasing age, peaking in the fifth decade of life. The incidence declines after menopause.
question
What kind of cancer rarely develops in a endometrial polyps?
answer
Adenocarcinoma
question
What are some signs and symptoms of endometrial polyps?
answer
-Endo polyps can be asymptomatic if small. -Symptoms can include: excessive bleeding during menstrual period, or bleeding between periods, or even spotting after intercourse. -Bleeding symptoms may be from the polyps dangling from their stalks, irritating the surrounding tissue, it can cause the tissue to rub off, exposing tiny blood vessels.
question
What is the ultrasound appearance of Endometrial Polyps?
answer
-Most are hyperechoic (compared to proliferative endometrium) discrete focal masses within the endometrial canal. -The best time to view a polyp is during the proliferative phase bc they will appear hyperechoic compared to the normal endo & will cause localized thickening. -During secretory phase the polyp can blend in with the background. -Color DOPPLER will demonstrate a VASCULAR STALK -Similar in appearance to submucosal fibriods.
question
Which exam can be used to differentiate a polyp from a uterine fibroid?
answer
Hysterosonography
question
What things can be associated with Endometrial Fluid?
answer
It can be normal in trace amounts, but it may be associated with other pathological processes
question
What is the term used to describe retained secretions within the endometrial cavity secondary to obstruction.
answer
Hydrometra
question
When fluid is in the endometrial canal how do you measure the endometrium?
answer
DO NOT INCLUDE THE FLUID! Measure each layer of endometrium separately, and then add together.
question
What are some differentials for Endometrial Fluid?
answer
-Pregnancy/Ectopic pregnancy -Obstructive process (congenital, malignant, or iatrogenic) -Menstrual blood, pus or serous fluid -Semen
question
What is the oldest form of birth control, and in what year did its popularity peak in the US?
answer
IUD intrauterine devices or intrauterine contraceptive devices. Their popularity peaked in 1960
question
When and how are the IUDs placed?
answer
IUDs are inserted through the cervix during menstruation and are placed in the endometrial canal. In order to be effective, IUDs need to be placed in the fundus of the uterus.
question
How do IUDs work?
answer
They work by creating a sterile inflammatory reaction in the endometrium, which prevents implantation.
question
What are some complications related to IUDs?
answer
-Malposition (Can travel to peritoneal cavity) anywhere that is not the endometrial canal or fundus. -Perforation, myometrial penetration, bc of improper insertion. -Infection -Ectopic pregnancy -PID -Intrauterine pregnancy, in order to prevent torch infections it is taken out in the 1st trimester. -Expelled IUD if string is not located
question
What are some indications for an ultrasound exam for an IUD?
answer
-An ultrasound demonstrates malposition, perforation, and incomplete removal. Also, it would demonstrate if there is a coexisting intrauterine pregnancy or ectopic pregnancy.
question
What are synechiae?
answer
Permanent endometrial adhesions to the endometrial walls.
question
What are the stages of endometrial cancer?
answer
Stage 1-Confined to uterus Stage 2- Spreads to involve uterus Stage 3- Spreads beyond uterus but confined to true pelvis Stage 4-METS or bowel/bladder involvement
question
What is endometritis? What causes it?
answer
Inflammation/infection of the endometrium. Occurs with PID, after delivery, after prolonged labor,chorioamnionitis, after D&C, with retained products of conception. Most common in post partum patients (following c-section)
question
What are the symptoms of endometritis?
answer
-Post partum fever, fever in general -pain -irregular discharge -bleeding -elevated WBC count -odorous discharge
question
What will you see on ultrasound of endometritis?
answer
-Prominent or irreg endometrium -Endo may contain fluid, debris, or gas (dirty shadow is a diagnostic sign) -May see retain products of conception (hyperechoic & vascularity) -Abscess
question
What are some causes of endometrial calcifications?
answer
-Endometrial trauma -Retained products of conception -From degenerated fibroids
question
How can you tell the difference between a endometrial polyp or a submucosal fibroid?
answer
Polyp arises from the endometrium. Fibroid has an endometrial layer seen overlying the submucosal fibroid.
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question
What is Endometrial Hyperplasia, and when does it usually occur?
answer
Endometrial hyperplasia is the overgrowth of ENDOMETRIAL GLANDS & STROMA. It usually occurs around Menopause.
question
List two forms of Endometrial Hyperplasia, and which type can be malignant?
answer
Endometrial Hyperplasia with cytological atypia and without cytological atypia. Endometrial Hyperplasia with cytological atypia may progress into invasive endometrial malignancy.
question
What is major symptom of Endometrial Hyperplasia?
answer
All endometrial hyperplasias, regardless of their malignant potential, may cause significant blood loss through heavy and irregular vaginal bleeding.
question
What causes or conditions are risk factors for Endometrial Hyperplasia, and what do they all have in common?
answer
-Women near menopause -anovulation -being overweight -diabetes -polycystic ovarian syndrome -unopposed estrogen hormone therapy *All of these factors, similar to edometrial cancer, are caused by medications or conditions that continuously produce estrogen.
question
What specific medication causes Endometrial Hyperplasia, and what are the symptoms?
answer
Tamoxifen is a mixed estrogen agonist-antagonist used extensively in the treatment of postmenopausal women with estrogen receptor-postive breast cancers. Symptoms: -Abnormal bleeding -Enlarged uterus -Pelvic mass (estrogen-producing ovarian tumor)
question
What is the ultrasound appearance of endometrial hyperplasia?
answer
-Enlarged thickened endometrial stripe -Postmenopausal w/ no HRT >5mm -Postmenopausal with HRT >8mm -Inhomogenous (malignancy risk) -Tiny internal cysts
question
Who needs an endometrial biopsy?
answer
Patients presenting with: -Posmenopausal bleeding -Postmenopausal endometrial cells on Pap smear -Perimenopausal intramenstrual bleeding -Abnormal bleeding w/ history of anovulation -Thickened endometrial stripe via sonography -Infertility
question
What percentage of cancers affecting the uterine body are endometrial carcinomas?
answer
90%!!!!!!!!
question
Describe endometrial cancer, and what causes it?
answer
Endometrial cancer is an invasive cancer of the endometrial lining of the uterus that most commonly arises from a background of endometrial hyperplasia. It is a consequence of unopposed endogenous or exogenous estrogen on a hormonally responsive endometrium.
question
What is the most common gynecological malignancy? Who most commonly gets endometrial cancer?
answer
ENDOMETRIAL CANCER Perimenopausal and postmenopausal women are predominantly affected.
question
What is the HALLMARK symptom of endometrial cancer?
answer
Perimenopausal or postmenopausal bleeding.
question
What tests are warranted when someone presents with perimenopausal or postmenopausal bleeding?
answer
The doctor will perhaps order a transvaginal ultrasound in order to measure the endometrial stripe and possibly perform endometrial biopsies.
question
What percentage of endometrial cancer has abnormal results on PAP SMEAR?
answer
50%
question
What is the standard treatment for endometrial cancer?
answer
Hysterectomy, further treatment depends on the pathological and surgicall findings.
question
What is the ultrasound appearance of Endometrial Cancer?
answer
-Prominent, abnormally enlarged, inhomogenous endometrium. -Indistinct and distorted endometrial-myometrial border(measuring is hard) -Increased uterine size -Bulbous lobulated contour - Focal areas of thickness -Increased vascularity
question
What is Asherman's Syndrome?
answer
Also known as Intrauterine adhesions. Asherman's Syndrome is partial or complete obliteration of the endometrial cavity by adherance of the uterine walls from scarring. Scarring causes fibrous adhesions or synechiae, which can obliterate the endometrial cavity.
question
What are some causes of Asherman's Syndrome?
answer
Patients may have a history of instrumentation or illness that has scarred the endometrial canal. Can be a cause of secondary infertility following therapeutic abortions.
question
What should arouse suspicion of Asherman's syndrome?
answer
Amenorrhea following D&C or endometritis.
question
What exam is used to visualize the endometrium better for people that have Asherman's Syndrome?
answer
A Hysterossalpingogram can be used to visualize these intrauterine adhesions.
question
What are signs and symptoms of Asherman's Syndrome? What would a patient with Asherman's be at risk for if they conceive?
answer
Menstrual or reproductive abnormalities (amenorrhea, hypoomenorrhea, dysmenorrhea infertility, and recurrent abortion) If a person with Asherman's conceives there is a high incidence of complications including premature labor, placenta accreta, placenta previa, and postpartum hemorrhage.
question
What is the ultrasound appearance of Asherman's syndrome?
answer
-Echogenic endometrium due to the presence of mutliple adhesive bands. -Endometrium can be normal or thickened. -Adhesionscan appear hypechoic when contrasted against the background of a secretory endometrium. -Adhesions can cause a discontinuity of the normal endometrial stripe.
question
What are endometrial polys?
answer
Endometrial Polyps are hyperplastic overgrowths of glands and stroma that are localized to form a projection from the basal layer of the endometrium, this is why they do not slough off during menstruation.
question
What are polyps usually attached by, and how much do they usually measure?
answer
Polyps are usually connected by a stalk, pedunculated. (If no stalk is present is called sessile.) They can range in size from 0.5cm-3.0 cm in size. (Can be single or multiple)
question
In what age group are polyps least common, and most common?
answer
Incidence of endometrial polyps are rare in anyone younger than 20 years old. They are more common in increasing age, peaking in the fifth decade of life. The incidence declines after menopause.
question
What kind of cancer rarely develops in a endometrial polyps?
answer
Adenocarcinoma
question
What are some signs and symptoms of endometrial polyps?
answer
-Endo polyps can be asymptomatic if small. -Symptoms can include: excessive bleeding during menstrual period, or bleeding between periods, or even spotting after intercourse. -Bleeding symptoms may be from the polyps dangling from their stalks, irritating the surrounding tissue, it can cause the tissue to rub off, exposing tiny blood vessels.
question
What is the ultrasound appearance of Endometrial Polyps?
answer
-Most are hyperechoic (compared to proliferative endometrium) discrete focal masses within the endometrial canal. -The best time to view a polyp is during the proliferative phase bc they will appear hyperechoic compared to the normal endo & will cause localized thickening. -During secretory phase the polyp can blend in with the background. -Color DOPPLER will demonstrate a VASCULAR STALK -Similar in appearance to submucosal fibriods.
question
Which exam can be used to differentiate a polyp from a uterine fibroid?
answer
Hysterosonography
question
What things can be associated with Endometrial Fluid?
answer
It can be normal in trace amounts, but it may be associated with other pathological processes
question
What is the term used to describe retained secretions within the endometrial cavity secondary to obstruction.
answer
Hydrometra
question
When fluid is in the endometrial canal how do you measure the endometrium?
answer
DO NOT INCLUDE THE FLUID! Measure each layer of endometrium separately, and then add together.
question
What are some differentials for Endometrial Fluid?
answer
-Pregnancy/Ectopic pregnancy -Obstructive process (congenital, malignant, or iatrogenic) -Menstrual blood, pus or serous fluid -Semen
question
What is the oldest form of birth control, and in what year did its popularity peak in the US?
answer
IUD intrauterine devices or intrauterine contraceptive devices. Their popularity peaked in 1960
question
When and how are the IUDs placed?
answer
IUDs are inserted through the cervix during menstruation and are placed in the endometrial canal. In order to be effective, IUDs need to be placed in the fundus of the uterus.
question
How do IUDs work?
answer
They work by creating a sterile inflammatory reaction in the endometrium, which prevents implantation.
question
What are some complications related to IUDs?
answer
-Malposition (Can travel to peritoneal cavity) anywhere that is not the endometrial canal or fundus. -Perforation, myometrial penetration, bc of improper insertion. -Infection -Ectopic pregnancy -PID -Intrauterine pregnancy, in order to prevent torch infections it is taken out in the 1st trimester. -Expelled IUD if string is not located
question
What are some indications for an ultrasound exam for an IUD?
answer
-An ultrasound demonstrates malposition, perforation, and incomplete removal. Also, it would demonstrate if there is a coexisting intrauterine pregnancy or ectopic pregnancy.
question
What are synechiae?
answer
Permanent endometrial adhesions to the endometrial walls.
question
What are the stages of endometrial cancer?
answer
Stage 1-Confined to uterus Stage 2- Spreads to involve uterus Stage 3- Spreads beyond uterus but confined to true pelvis Stage 4-METS or bowel/bladder involvement
question
What is endometritis? What causes it?
answer
Inflammation/infection of the endometrium. Occurs with PID, after delivery, after prolonged labor,chorioamnionitis, after D&C, with retained products of conception. Most common in post partum patients (following c-section)
question
What are the symptoms of endometritis?
answer
-Post partum fever, fever in general -pain -irregular discharge -bleeding -elevated WBC count -odorous discharge
question
What will you see on ultrasound of endometritis?
answer
-Prominent or irreg endometrium -Endo may contain fluid, debris, or gas (dirty shadow is a diagnostic sign) -May see retain products of conception (hyperechoic & vascularity) -Abscess
question
What are some causes of endometrial calcifications?
answer
-Endometrial trauma -Retained products of conception -From degenerated fibroids
question
How can you tell the difference between a endometrial polyp or a submucosal fibroid?
answer
Polyp arises from the endometrium. Fibroid has an endometrial layer seen overlying the submucosal fibroid.