GYN CHAPTER 5

Start Studying!

Terms

undefined, object

copy deck

THE UTERUS, FALLOPIAN TUBES AND UPPER VAGINA DEVELOPE FROM WHAT?: THE MULLARIAN DUCT
THE MULLERIAN DUCTS ARE AKA WHAT?: THE PARAMESONRPHRIC DUCTS
MOST UTERINE AND CERVICAL ANOTOMIC VARITANTS ARE CAUSED BY FAILURE OF DEVELOPMENT OF ?: THE MULLERIAN DUCTS AT SOME STAGE OF DEVELOPMENT AND ARE THEREFORE CALLED MULLERIAN DUCT ANOMALIES.
TRUE OR FALSE IT IS NOT NESSASARY TO EVALUATE THE URINARY TRACT IN ALL CASES OF UTERINE ANOMALIES.: FALSE. IT IS IMPORTANT TO ALWAYS EVAL THE URINARY TRACT IN ALL CASES OF UTERINE ANOMALIES.
DO OVARIES DEVELOPE FROM THE MULLARIAN DUCTS?: NO. THEREFORE BOTH OVARIES ARE GENERALLY NORMAL IN CASES WITH MULLERIAN DUCT ANOMALIES.
NAME THE 4 CATAGORIES OF ANOMALOUS INTERNAL:: 1.)FAILURE OF FORMATION
NAME THE 4 CATEGORIES OF ANOMALOUS INTERNAL GENETALIA DEVELOPMENT:: 1.)FAILURE OF FORMATION
2.)FAILURE OF FUSION
3.)FAILURE OF DISSOLUTION
4.)FAILURE OF STRUCTURE TO DISAPPEAR.
FAILURE OF FORMATION AKA COMPLETE AGENISIS:: RESULTS IN COMPLETE ABSECNCE OF VAGINA, CERVIX, UTERUS AND FALLOPIAN TUBES.
WHAT IS PARTIAL AGENISIS?: RESULTS IN A RANGE OF ANOMALIES, INCLUDING ABSENCE OF THE UPPER VAGINA AND CERVIX, WITH PERSISITANCE OF THE UTERUS AND FALLOPIAN TUBES OR THE MORE COMMON UNICORNATE UTERUS AND SINGLE FALLOPIAN TUBE.
WHAT IS DIDELPHYS UTERUS(FAILURE OF FUSION)?: COMPLETE DUPLICATION OF UTERUS, CERVIX, AND VAGINA.
WHAT IS BICORNUATE UTERUS(FAILURE OF FUSION)?: MOST COMMON MULLERIAN ANOMALY IN WHICH THERE IS A SINGLE VAGINA AND 1 OR 2 CERVICES AND VARIABLE LACK OF FUSION OF THE UPPER UTERINE CAVITY.
WHAT IS FAILURE OF DISSOLUTION (SEPTATE UTERUS)?: THE MEDIAN SEPTUM FAILS TO DISSOLVE AFTER FUSION OF THE 2 SEPERATE MULLARIAN DUCTS AND RESULTS IN A SINGLE VAGINA, CERVIX AND UTERUS WITH AN INTRAUTERINE SEPTUM. THIS IS KNOWN AS SEPTATE UTERUS.
WHAT IS THE LEAST SEVERE MULLERIAN ANAOMALY?: ARCUATE UTERUS-I WHICH A SEPTUM SLIGHTLY PROTRUDES INTO THE UTERINE CAVITY.
WHAT IS A GARTNER'S DUCT CYST?: *ITS THE MOST COMMON EXAMPLE OF AN ABNORMALITY THAT CAN RESULT FROM FAILURE OF DISSAPPEATANCE OF STRUCTURES THAT DO NOT NORMALLY PERSIST.

*THIS CYST OCCURS ON THE ANTEROLATERAL WALL OF THE VAGINA AND ARISES FROM THE CAUDAL REMMNANTS OF THE MESONEPHRIC(WOLLFIAN)DUCT.
WHAT IS DES(DIETHYLSTILBESTROL) SYNDROME?: GENITAL ABNORMALITIES THAT OCCURED DUE TO IN UTERO EXPOSURE TO DES.

THESE PATIENTS MAY HAVE
1.)VAGINAL EPITHELIAL CHANGES
2.)POOR PREGNANCY OUTCOME
3.)INCREASED RISK OF CERVICAL CARCINOMA
4.)T-SHAPED UTERUS WITH CONSTRICTING BANDS IN THE UTERUS AND INTRAUTERINE WALL DEFECTS.
VAGINAL ANOMALIES CAN BE A RESULT OF WHAT?: MULLERIAN DUCT AND/OR UROGENITAL SINUS MALFORMATIONS IN THE DEVELOPING EMBRYO.
WHAT 3 VAGINAL ANOMALIES THAT DEVELOPE FROM MULLERIAN DUCT AND/OR UROGENITAL SINUS MALFORMATIONS INCLUDE?: 1.)VAGINAL ATRESIA-THE CONGENITAL ABSENCE OF THE VAGINA
2.)VAGINAL SEPTA-THE PRESENCE OF TRANSVERSE SEPTATIONS WITHIN THE VAGINA
3.)THE PRESENCE OF 2 COMPLETE VAGINAS
WHAT ARE LEIOMYOMAS ALSO KNOWN AS?: 1.)FIBROIDS
2.)MYOMAS
3.)FIBROMYOMAS
THEY ARE THE MOST COMMON TUMOR OF THE FEMALE PELVIS.
WHAT ARE LEIOMYOMAS?: THEY ARE BENIGN SMOOTH MUSCLE TUMORS WHICH ARE USUALLY MULTIPLE AND ARE MORE COMMON IN BLACK NULLIPAROUS WOMEN.
WHERE ARE LEIOMYOMAS USUALLY LOCATED AND WHERE ELSE CAN THEY BE FOUND?: THEY ARE USUALLY LOCATED IN THE UTERINE CORPUS BUT CAN ALSO BE FOUND IN THE CERVIX AND BROAD LIGAMENT.
LIPOLEIOMYOMAS ARE RARE AND APPEAR HYPERECHOIC DUE TO THE PRESENCE OF ?: FAT
LEIOMYOMAS ARE DESCRIBED BY THEIR LOCATION IN RELATIONSHIP TO THE UTERINE WALL. NAME THE 6 TYPES:: 1.)SUBMUCOUS-BENEATH THE ENDO CAVITY
2.)INTRAMURAL/INTERSTITIAL-WITHIN THE MYOMETRIUM
3.)SUBSEROUS-BENEATH THE PERIMETRIUM
4.)INTRALIGAMETOUS-BETWEEN THE LAYERS OF THE BROAD LIG.
5.)CERVICAL-UNCOMMON
6.)PEDUNCULATED-ON A PEDICLE OR STALK; ONLY OCCURS SUBMUCOUS AND SUBSEROUS; TORSION MAY OCCUR
MYOMAS ARE OFTEN ASYMPTOMATIC. WHEN SYMPTOMS ARE PRESENT THEY MAY INCLUDE: NAME 6 CLINICAL SIGNS OF MYOMAS:: 1.)HEAVY PERIODS(MENOMETRORRHAGIA), ESPECIALLY WITH SUBMUCOSAL MYOMAS)
2.)FREQUENT URINATION
3.)ENLARGED UTERUS ON PELVIC EXAM.
4.)INCREASING PAIN W/DEGENERATIVE CHANGES
5.)INFERTILITY OR SPONTANEOUS ABORTIONS
6.)ALTERATION IN NORMAL MENSTRUAL FLOW.
SONOGRAPHIC APPEARANCE DEPENDS ON AMT OF DEGENERATION AS WELL AS SIZE AND LOCATION OF THE FIBROID. WHAT 6 OF SOME OF THE MOST COMMON SONOGRAPHIC FINDINGS?: 1.)WEL CIRCUMSCRIBED HYPOECHOIC MASS
2.)LOBULATED UTERINE CONTOUR
3.)SHADOWING(W/INCREASED ATTEN. AND W/ CALCIFIC DEGENERATION.)
4.)WHORLED INTERNAL ARCHITECTURE
5.)DISPLACEMENT OF ENDOMETRIAL ECHOS
6.)EXTRINSIC COMPRESSION OF POSTERIOR BLADDER WALL.
LEIOMYOSARCOMAS ARE AN EXTREMELY RARE OCCURANCE ANS IN A SARCOMATOUS CHANGE IN THE LEIOMYOMS.(CANCER) HOW DOES IT LOOK SONOGRAPHICALLY AND WHAT IS THE ONLY CLUE THAT IT MAY BE CANCER?: LOOKS JUST LIKE A FIBROID AND ONLY CLUE IS THE RELATIVELY RAPID GROWTH OF THE MASS IN A POST-MENOPAUSAL WOMAN.
WHAT IS ADENOMYOSIS?: BENIGN INVASION OF ENDOMETRIAL GLANDS AND STROMA INTO MYOMETRIUM. IT CAN BE DIFFUSE OR FOCAL, AND MOST OFTEN AFFECTS POSTERIOR MYOMETRIUM.
WHEN IS ADENOMYOSIS SUSPECTED?: IN 40-50YR OLD WOMEN WITH DYSMENORRHEA AND IRREGULAR BLEEDING.
WHAT ARE THE SONOGRAPHIC FINDINGS OF ADENOMYOSIS?: 1.)ENLARGED UTERUS W/NORMAL CONTOURS
2.)ASYMETRIC THICKENING OF THE ANTERIOR OR POSTERIRIOR UTERINE WALL.
3.)MYOMETRIAL CYSTS(2-6MM IN DIA.)
4.)MOTTLED INHOMOGENOUS MYOMETRIUM.
WHAT ARE NABOTHIAN CYSTS?: MUCUS RETENTION CYSTS DUE TO OBSTRUCTED AND DIALATED ENDOCERVICAL GLANDS.

THEY ARE COMMON, BENIGN AND OF NO CLINICAL SIGNIFICANCE.
THE MOST COMMONLY ENCOUNTERED GYNECOLOGIC MALIGNANCY IS WHAT?: ENDOMETRIAL CARCINOMA
75-80 PERCENT OF ENDOMETRIAL CARCINOMA OCCUR IN?: POSTMENOPAUSAL WOMEN WHO USUALLY PRESENT EARLY W/POSTMENOPAUSAL BLEEDING.
A RELATIONSHIP EXISTS BTWN INCRESED ESTROGEN AND DEVELOPMENT OF ENDOMERTIAL CANCER. NAME 5 ASSOC. RISK FACTORS:: 1.)OBESITY AND ANOVULATORY CYCLES IN PREMENOPAUSAL WOMAN.
2.)POSTMENOPAUSAL, AND ON ESTROGEN REPLACEMENT THERAPY
3.)HISTORY OF ATYPICAL HYPERPLASIA OF ENDOMETRIUM
4.)HISTORY OF TAMOXIFEN THERAPY
5.)STRONG FAMILY HISTORY OF UTERINE CANCER.
HOW DOES THE CANCER TUMOR USUALLY GROW?: INTO THE UTERINE CAVITY.

IT INVADES AND SPREADS THROUGH MYOMETRIUM, TO CERVIX AND INTO ADNEXA.

DISTANT METASTASES MAY OCCUR IF THE PELVIC LYMPHATIC SYSTEM IS AFFECTED.
NAME 3 CLINICAL SIGNS OF ENDOMETRIAL CARCINOMA:: 1.)POSTMENOPAUSAL VAGINAL BLEEDING
2.)HYPERMENORRHEA, INTERMENSTRUAL FLOW IN PATIENTS STILL HAVING PERIODS.
3.)PAIN AS A RESULT OF UTERINE DISTENTION
WHAT ARE 4 SONOGRAPHOC FINDINGS OF ENDOMETRIAL CARCINOMA?: 1.)ALTERATION IN SIZE, SHAPE AND SONOGRAPHIC TEXTURE OF UTERINE PARENCHYMA
2.)INCREASED UTERINE SIZE
3.)INHOMOGENEITY AND THICKENING OF ENDOMETRIAL ECHOES((GREATER THAN 5MM) ESPECIALLY IN POSTMENOPAUSAL WOMEN. (VARIES W/PATIENT HORMONE STATUS)
4.)FLUID IN ENDO CAVITY.
WHAT IS ENDOMETRIAL HYPERPLASIA?: IS PROLIFERATION OF THE ENDOMETRIAL GLANDULAR TISSUE. IT MAY BE FOCAL OF DIFFUSE.
WHAT IS THE PERCENTAGE OF PATIENTS WITH ATYPICAL HYPERPLASIA THAT WILL UNDERGO MALIGNANT CHANGE AND PROGRESS TO ENDOMETRIAL CARCINOMA?: ABOUT 25%

HYPERPLASIA IS A COMMON CAUSE OG ABNORMAL UTERINE BLEEDING.
NAME 5 CAUSES OF ENDOMETRIAL HYPERPLASIA IN BOTH PERI AND POSTMENOPAUSAL WOMEN:: 1.)UNOPPOSED ESTROGEN HRT.
2.)PERSISTENT ANOVULATORY CYCLES
3.)PCOD
4.)OBESITY
5.)ESTROGEN PRODUCING TUMORS OF THE OVARY SUCH AS: GRANULOSA CELL TUMOR AND THECOMAS.
CLINICAL SIGNS OF ENDOMETRIAL HYPERPLASIA ARE SIMILAR TO THOSE IN PATIENTS WITH ENDOMETRIAL CARCINOMA. WHAT IS REQUIRED TO MAKE A DEFINITIVE DIAGNOSIS?: HISTOLOGIC EVALUATION OF ENDOMETRIAL SAMPLE FROM CURETTAGE.

IDEALLY, U/S SHOULD BE DONE IMMEDIATELY FOLLOWING MENSES.
WHAT ARE THE SONOGRAPHIC FINDINGS OF ENDOMETRIAL HYPERPLASIA? NAME 5:: 1.)SMOOTH BORDERS
2.)MORE HOMOGENOUS TEXTURE BUT POSSIBLY CYSTIC CHANGES
3.)PREMENOPAUSAL WOMEN, IF EC IS GREATER THAN 14MM
4.)POSTMENOPAUSAL WOMEN ON ESTROGEN ONLY IF EC IS GREATER THAN 5MM.
5.)POSTMENOPAUSAL WOMEN IN ESTROGEN PHASE, EC CAN BE UP TO 8MM THEN IN PROGESTERONE PHASE, EC DECREASES.
WHAT ARE ENDOMETRIAL POLYPS?: LOCALIZED OVERGROWTHS OF ENDOMETRIAL TISSUE.

THEY MAY BE PEDUNCULATED, BROAD BASED, OR HAVE A THIN STALK.

OCCASIONALLY A POLYP WILL HAVE A LONG STALK AND PROLAPSE INTO THE CERVIX OR EVEN VAGINA.

COLOR DOPPLER MAY REVEAL A FEEDING ARTERY IN THE STALK OR PEDICLE.

SONOHYSTEROGRAPHY IS IDEAL FOR DEMONSTRATING POLYPS.
NAME 5 CLINICAL SIGNS OF ENDOMETRIAL POLYPS:: 1.)USUALLY ASYMPTOMATIC
2.)INFERTILITY
3.)ABNORMAL UTERINE BLEEDING
4.)USUALLY DISCOVERED INCIDENTALLY IN D&C
5.)OCCASIONALLY CAUSES POSTMENOPAUSAL BLEEDING.
NAME 5 SONOGRAPHIC FINDINGS OF ENDOMETRIAL POLYPS:: 1.)NON SPECIFIC THICKENED ENDO, USUALLY FOCAL BUT OCCASIONALLY DIFFUSE.
2.)DISCRETE MASS IN THE ENDO, FOCAL, ROUND AND ECHOGENIC.
3.)POSSIBLE VASCULAR STALK DEMONSTRATED WITH COLOR DOPPLER.
4.)MAY BE INDISTIGUISHABLE FROM ENDOMETRIAL HYPERPLASIA
5.)SONOHYSTEROGRAPHY IS IDEAL FOR DEMONSTRATING POLYP SIZE AND LOCATION.
WHAT IS SALINE INFUSION SONOHYSTEROGRAPHY(SIS)?: ALSO CALLED HYSTEROSONOGRAPHY, IT IS A TECHIQUE OF INTRODUCING SALINE INTO THE ENDO CAVITY TO EVALUATE ENDO SONOGRAPHICALLY.
NAME 5 INDICATIONS FOR SIS:: 1.)INFERTILITY AND HABITUAL ABORTION
2.)CONGENITAL ANOMALIES AND OR ANATOMIC VARIANTS OF THE UTERINE CAVITY.
3.)PRE AND POST OPERATIVE EVALUATION OF THE UTERINE CAVITY(ESPECIALLY WITH REGAURD TO MYOMAS, POLYPS AND CYSTS.)
4.)SUSPECTED UTERINE CAVITY SYNECHIAE(I.E., SCARRING ASSOC. W/ASHERMAN'S SYNDROME)
5.)FURTHER EVAL OF ABMORMALITIES DETECTED SONOGRAPHICALLY.

Start Studying!

Deck Info

Number of cards 45

Created By TANMEN