Ob/gyn 1, Chapter 41 part 1 (week 6) – Flashcards
Unlock all answers in this set
Unlock answersquestion
We assess the female pelvis for
answer
Size Texture Vascularity Structure; Homogeneity, Endometrium, Vagina and Cervix
question
What are the 3 main pathologies of the vagina
answer
Vaginal cuff Gartner's Duct Cyst Imperforate Hymen
question
When is a vaginal cuff seen in patients
answer
After hysterectomy
question
The upper size limit of a normal vaginal cuff is
answer
2.1 cm without a cervix, more if cervical remnant
question
If the cuff is larger than normal or it contains a mass it should be regarded with
answer
Suspicion for malignancy, especially in patients with a previous history of cancer
question
What is the most common cystic lesion of the vagina
answer
Gartner's Duct Cyst
question
What are the symptoms of Gartner's Duct Cysts
answer
None, they are usually an incidental finding
question
Solid masses of the vagina are rare, what are they
answer
Adenocarcinoma Rhabdomyosarcoma
question
What is the most common congenital abnormality of the female genital tract, resulting in what
answer
Imperforate hymen, resulting in obstruction
question
Obstruction of the uterus and/or the vagina may result in an accumulation of fluid in the uterus and vaginal canal. Give the classifications of fluid
answer
Accumulation of fluid is Hydrometra Accumulation of blood is hematometra Accumulation of pus is pyometra
question
If accumulation of fluid reaches the cervix, then we add _____ to the name
answer
Colpos i.e. Hydrometracolpos
question
What does a patient with Imperforate hymen present with
answer
Abdominal/pelvic pain and distension Primary amenorrhea Palpable midline pelvic mass
question
What are the 5 main pathologies of the cervix
answer
Nabothian cysts Cervical polyps Cervical stenosis Cervical Leiomyoma Cervical Dysplasia/Carcinoma
question
How is cervical pathology detected
answer
The tissue posterior to the cervical canal is larger than the tissue anterior to the cervical canal
question
What is the most common cervical finding
answer
Nabothian cysts
question
What is another name for Nabothian cyst
answer
Epithelial inclusion cyst
question
What are the symptoms of Nabothian cysts
answer
None, they are usually an incidental finding
question
What is the usual status of women who have Nabothian cysts
answer
Menarchal - women of reproductive age
question
How are Nabothian cysts formed
answer
The cervical canal is lined with glandular (Nabothian) cells that normally secrete mucus. The Nabothian glands may become filled with secretions
question
Describe a Nabothian cyst
answer
- Discrete, round, fluid-filled, anechoic structures Usually less than 2 cm - May be multiple - Sometimes have internal echoes that may be caused by hemmorrhage or infection, which should be noted
question
What is cervical stenosis
answer
Obstruction of the cervical canal at the internal or external OS
question
What are the causes of cervical stenosis
answer
Radiation therapy Previous cone biopsy (or any biopsy) Postmenopausal cervical atrophy Chronic infection Laser Cryosurgery Cervical CA
question
What does a patient with cervical stenosis present with
answer
Distended, fluid-filled uterus as a result of uterine secretions, fluid, pus, or blood
question
What are the clinical presentations of cervical stenosis
answer
In postmenopausal women - asymptomatic In menarchal women - Abnormal bleeding Oligomenorrhea or amenorrhea Cramping Dysmenorrhea Infertility
question
What is another name for Leiomyoma
answer
Myoma, Fibroid
question
How often do fibroids occur in the cervix
answer
A small percentage
question
What can be the result of a cervical leiomyoma
answer
Bowel or bladder obstruction
question
If a cervical leiomyoma becomes pedunculated what might happen
answer
It could prolapse into the vagina
question
What is cervical dysplasia
answer
The abnormal growth of cells on the surface of the cervix
question
Is cervical dysplasia cancer
answer
No, but it is considered to be pre-cancerous
question
Cervical dysplasia is grouped into 3 catagories
answer
Mild Moderate severe
question
How is cervical dysplasia treated
answer
Treatment depends on the degree of dysplasia. - Mild dysplasia may go away on its own; possibly only needing careful observation by your doctor with repeat Pap smears every 3-6 months - Treatment for moderate and severe dysplasia may include a more invasive procedure
question
What causes cervical dysplasia
answer
All causes are not known, but most cases of severe dysplasia and cervical cancer are caused by infection of the cervix with a persistent, high-risk strain of human papilloma virus (HPV)
question
What is HPV
answer
A very common infection that is transmitted through sexual contact.
question
How many women are affected by HPV
answer
Over 75% of sexually active women are thought to acquire the virus at one point or another. Over 6 million people become infected with HPV every year in the US, and approximately 50% of those infected are between the ages of 15 and 25
question
What happens if a women acquires HPV and is not treated
answer
30-50% of cases of severe cervical dysplasia may lead to invasive cancer. The risk of cancer is lower for mild dysplasia
question
What is the most common type of cervical cancer
answer
Squamous cell carcinoma
question
Who is affected by Squamous cell carcinoma
answer
Women of menstrual age
question
What is the best method of diagnosis for Squamous cell carcinoma
answer
Pap smear
question
What are the symptoms of squamous cell carcinoma
answer
It is asymptomatic until it becomes advanced and is slow growing
question
What are the symptoms in advanced squamous cell carcinoma
answer
Abnormal vaginal bleeding Pelvic pain Abnormal vaginal discharge
question
Is ultrasound the preferred method of staging of squamous cell carcinoma
answer
No, CT and MRI are preferred
question
What are the 2 main pathologies of the uterus
answer
Leiomyomas Arcuate Artery Calcification
question
What is the most common gynecologic tumor and how common is it
answer
Leiomyomas Occuring in 20-30% of women over age 30
question
Who is more likely to get leiomyomas
answer
African-American women are twice as likely as Caucasian women
question
What are other names for Leiomyomas
answer
Myoma Fibroid
question
What are leiomyomas composed of
answer
Spindle shaped smooth muscle cells with variable amounts of fibrous connective tissue; encapsulated in a pseudocapsule and separates easily from the surrounding myometrium
question
Are uterine leiomyomas usually found in multiples
answer
yes
question
Why do we rarely see leiomyomas develop in post-menopausal women
answer
They are estrogen dependant
question
When a leiomyomas vascular supply is compromised it will degenerate into several different histologic subtypes such as
answer
Liquefaction Necrosis Hemorrhage Calcification
question
During pregnancy leiomyomas can
answer
Increase in size
question
Leiomyomas identified in the first trimester of pregnancy are associated with
answer
Pregnancy loss
question
Most leiomyomas tend to stabilize or decrease in size in post-menopausal women because
answer
Lack of estrogen stimulation
question
What reasons would there be for leiomyomas to grow in post-menopausal women
answer
Hormone Replacement Therapy Tamoxifen Possible malignancy
question
What are the clinical indications for leiomyomas
answer
Uterine irregularity Uterine enlargement Sensation of pelvic pressure Pain Irregular bleeding (menorrhea) including: - menorrhagia - menometrarrhagia - Infertility Interference with vaginal delivery
question
Uterine locations of myomas
answer
Submucosal Intramural Subserosal
question
What is a submucosal myoma
answer
Displacing or distorting the endometrial cavity causing heavy or irregular bleeding, possibly infertility, and sponaneous abortion
question
What is an intramural myoma
answer
The most common location of a myoma Confined to the myometrium, can possibly lead to infertility
question
What is a subserosal myoma
answer
Projecting from the peritoneal surface of the uterus Sometimes pedunculated and appear as an extrauterine mass
question
What is the sonographic appearance of a uterine myoma
answer
- Uterine enlargement - Irregular uterine wall contour - Heterogenous myometrial texture pattern - Usually hypoechoic, but can sometimes be hyperechoic - Calcifications can appear bright and cause shadowing - Sometimes demonstrate an area of acoustic attenuation without a discrete mass
question
What does the sonographer do if they see a myoma
answer
Measure - Long, AP, Trans Multiple myomas should be numbered as you go through Measure all dimensions for each as you go Put color on each to assess vascularity
question
How are myomas treated
answer
Treatment depends on size, location, and clinical issues: Surgical Drug therapy Endometrial ablation and surrounding small myomas Uterine artery embolization HIFU - High intensity focused ultrasound
question
Surgical treatments of myomas include
answer
*Myomectomy - removal of myoma (reoccurance of 20-25%) *Hysterectomy - removal of uterus (curative but irreversible)
question
Drug therapy treatments of myomas include
answer
Pain relievers Hormone therapy to supress the myomas
question
Endometrial ablation and surrounding small myoma treatments include
answer
Radiofrequency Microwaves Freezing Heating
question
What are the causes of uterine calcifications
answer
Myomas Arcuate Artery Calcification
question
What is the most common cause of uterine calcifications
answer
Myomas
question
Where is an arcuate artery calcification found
answer
In the periphery of the uterus
question
What does a uterine calcification look like
answer
Focal areas of increased echogenicity with shadowing
