Gynaecology Pg No 121 -130
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Gynaecology Pg No 121 -130

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Questions and Answers

Which of the following conditions is NOT associated with medical management?

  • Chocolate Cyst (correct)
  • Bowel Endometriosis (correct)
  • Bladder Endometriosis (correct)
  • None of the above

    • Cyclical hematuria is specifically associated with bladder endometriosis.

    True

    What imaging technique is advised for assessing deep endometriosis and bladder or bowel involvement?

    MRI

    The __________ sign refers to an imaging finding associated with certain endometriosis presentations.

    <p>mushroom cap</p> Signup and view all the answers

    Match the following endometriosis-related features with their descriptions:

    <p>Cyclical Hematuria = Hematuria coinciding with menstruation CA 125 = Tumor marker related to endometriosis MRI = Imaging method for assessing endometriosis Mushroom Cap Sign = Specific imaging finding in endometriosis</p> Signup and view all the answers

    What is the recommended management for symptomatic fibroids?

    <p>Continuous GnRH agonists</p> Signup and view all the answers

    Adenomyosis can only be definitively diagnosed through imaging techniques.

    <p>False</p> Signup and view all the answers

    What is the gold standard investigation for adenomyosis?

    <p>Histopathological Examination</p> Signup and view all the answers

    To manage an endometrial polyp, the procedure of ________ is often performed.

    <p>Hysteroscopic Polypectomy</p> Signup and view all the answers

    Match the following conditions with their management:

    <p>Fibroid = Continuous GnRH agonists Polyp = Hysteroscopic Polypectomy Adenomyosis = TAH (Total Abdominal Hysterectomy)</p> Signup and view all the answers

    Which of the following is a characteristic finding in fibroid on per abdominal examination?

    <p>Firm midline mass</p> Signup and view all the answers

    Adenomyosis can be identified by the presence of a mass with a texture similar to myometrium on ultrasound.

    <p>False</p> Signup and view all the answers

    What is the maximum size of a uterus affected by fibroid during examination?

    <p>Up to 20 weeks pregnant uterus</p> Signup and view all the answers

    A solid mass arising from a narrow base is characteristic of a ______.

    <p>polyp</p> Signup and view all the answers

    Match the following examination findings with the correct condition:

    <p>Fibroid = Mass distorting uterine cavity Polyp = Feeder vessel sign Adenomyosis = Tender globular uterus</p> Signup and view all the answers

    What condition is associated with pedunculated fibroids?

    <p>Pseudo Meig's Syndrome</p> Signup and view all the answers

    Hyaline degeneration leads to a whorled appearance of the fibroid.

    <p>False</p> Signup and view all the answers

    What type of degeneration begins from the periphery of the fibroid?

    <p>Calcareous degeneration</p> Signup and view all the answers

    The least common type of fibroid degeneration is known as __________.

    <p>Sarcomatous degeneration</p> Signup and view all the answers

    Match the types of degeneration with their characteristics:

    <p>Hyaline degeneration = Most common degeneration Calcareous degeneration = Popcorn calcification appearance Sarcomatous degeneration = Least common degeneration</p> Signup and view all the answers

    What is a common clinical presentation of red degeneration in fibroids during pregnancy?

    <p>Fever</p> Signup and view all the answers

    Red degeneration is exclusively observed in pregnant women.

    <p>True</p> Signup and view all the answers

    What is the primary cause of red degeneration in fibroids?

    <p>Thrombosis of blood vessels supplying the fibroid</p> Signup and view all the answers

    A painful fibroid in a peri/post menopausal female may indicate __________.

    <p>red degeneration</p> Signup and view all the answers

    Match the following features of red degeneration with their descriptions:

    <p>Soft fibroid = Indicates red degeneration 210 mitoses/HPF = Suggests increased cellular activity Salmon-pink color = Characteristic appearance due to blood pigments Fishy odor = Associated with necrotic tissue changes</p> Signup and view all the answers

    What is the most common symptom associated with heavy menstrual bleeding (HMB)?

    <p>Heavy menstrual bleeding</p> Signup and view all the answers

    Submucosal fibroids are the primary cause of both heavy menstrual bleeding and subfertility.

    <p>True</p> Signup and view all the answers

    What are common pressure symptoms associated with cervical fibroids?

    <p>Urinary symptoms</p> Signup and view all the answers

    The main cause of subfertility related to fibroids is __________ interference with implantation.

    <p>distorted uterine cavity</p> Signup and view all the answers

    Match the types of fibroids with their associated symptoms:

    <p>Submucosal fibroid = Heavy menstrual bleeding, subfertility Cervical fibroid = Urinary symptoms Postcervical fibroid = Rectal pressure symptoms Fibroid degeneration = Acute pain abdomen</p> Signup and view all the answers

    What is the most common type of fibroid?

    <p>Intramural fibroid</p> Signup and view all the answers

    Fibroids exhibit a decrease in size during menopause.

    <p>True</p> Signup and view all the answers

    Name two hormones that fibroids are dependent on.

    <p>Estrogen, Progesterone</p> Signup and view all the answers

    All fibroids initially develop as __________ fibroids.

    <p>intramural</p> Signup and view all the answers

    Match the following fibroid types with their locations:

    <p>Intramural = Within the uterine wall Submucosal = Just beneath the endometrial lining Subserosal = On the outer surface of the uterus Uterine fibroid = Most common fibroid type</p> Signup and view all the answers

    What characterizes a submucous fibroid on Hysteroscopy?

    <p>White, whorled mass with surface blood vessels and broad base</p> Signup and view all the answers

    An endometrial biopsy is the first investigation for Abnormal Uterine Bleeding.

    <p>False</p> Signup and view all the answers

    What is the best investigation method for diagnosing a submucous fibroid?

    <p>Hysteroscopy</p> Signup and view all the answers

    An adenomyosis diagnosis is suggested if the T2 measurement is greater than or equal to ____ mm.

    <p>12</p> Signup and view all the answers

    Match the conditions with their characteristics based on HSG findings:

    <p>Fibroid = White, whorled mass with surface blood vessels Polyp = Fleshy red mass with smooth surface Adenomyosis = Not specifically characterized on HSG</p> Signup and view all the answers

    Which symptom is primarily associated with fibroids?

    <p>Menorrhagia</p> Signup and view all the answers

    Adenomyosis primarily occurs in nulliparous women.

    <p>False</p> Signup and view all the answers

    What type of tumor is a fibroid?

    <p>Smooth muscle tumor</p> Signup and view all the answers

    The most common cause of post-menopausal bleeding is a __________.

    <p>Polyp</p> Signup and view all the answers

    Which of the following is a common appearance feature of adenomyosis?

    <p>Symmetrically enlarged uterus</p> Signup and view all the answers

    Match each condition with its corresponding characteristics:

    <p>Fibroid = Estrogen + Progesterone dependent tumor Polyp = Found in all age groups, increases with age Adenomyosis = Endometrial tissue inside myometrium</p> Signup and view all the answers

    Polyps most often cause irregular intra-menstrual bleeding in perimenopausal women.

    <p>True</p> Signup and view all the answers

    What is the primary incidence age range for polyps?

    <p>40-49 years</p> Signup and view all the answers

    What type of fibroid originates from within the uterus?

    <p>Intrauterine Fibroid</p> Signup and view all the answers

    A posterior cervical fibroid presses against the bladder.

    <p>False</p> Signup and view all the answers

    What is the significance of submucosal fibroids regarding treatment?

    <p>They can be removed hysteroscopically if classified as Type 0 or Type 1.</p> Signup and view all the answers

    A __________ fibroid arises from the broad ligament.

    <p>pseudo BL</p> Signup and view all the answers

    Match the fibroid types with their characteristics:

    <p>Submucosal = Totally inside the uterine cavity; generally pedunculated Intramural = Inside cavity greater than or equal to 50% Subserosal = Inside cavity less than 50% Broad Ligament = Originates from the broad ligament</p> Signup and view all the answers

    Study Notes

    Medical Management

    • Medical management is not useful for chocolate cysts, bladder endometriosis, or bowel endometriosis.

    Imaging

    • MRI is recommended for:
      • Bladder endometriosis
      • Bowel endometriosis
      • Deep endometriosis of the rectosigmoid
      • Hypertrophy of the mucosa, submucosa, and muscularis propria (on MRI)

    Mushroom Cap Sign

    • This refers to an abnormality seen on an MRI scan, but the details of its appearance are not provided.

    Cyclical Hematuria

    • Occurrence of hematuria during menstruation can be caused by:
      • Bladder endometriosis
      • Uterovesical fistula (fistula between the uterus and bladder)

    Fibroid

    • Most common pelvic tumor in females.
    • Primarily found in reproductive-aged women (25-35 years)
    • More common in nulliparous women (women who have not given birth)
    • Estrogen and progesterone-dependent tumor
    • Symptoms include:
      • Heavy menstrual bleeding (HMB)
      • Earlier menorrhagia (excessive menstrual bleeding)
      • Regular cycles
      • Secondary dysmenorrhea (painful menstruation)
      • Infertility
      • Pressure symptoms
      • Pregnancy complications

    Polyp

    • Localized outgrowth of the endometrium
    • Can be seen in all age groups
    • Increased chance of polyps with age (most common age: 40-49 years)
    • Increased incidence in women using Tamoxifen
    • Most common cause of postmenopausal bleeding
    • Symptoms include:
      • Menorrhagia (HMB)
      • Secondary dysmenorrhea

    Adenomyosis

    • Endometrial tissue (glands + stroma) present within the myometrium (at least 2.5 mm deep from the basal layer of endometrium).
    • More common in women aged 40+
    • More common in multiparous women (women who have given birth multiple times)
    • Symptoms:
      • Endometriosis and fibroids
      • Menorrhagia (HMB)
      • Secondary dysmenorrhea
      • Chronic Pelvic Pain (CPP)

    Gross Appearance (Table Summary)

    Feature Fibroid Polyp Adenomyosis
    Appearance Rounded/oval & whorled, White, Firm Fleshy, Red, Smooth surface, broad base Symmetrically enlarged uterus: Globular uterus
    Arises Broad base, surrounded by pseudocapsule Hangs from narrow base in uterine cavity Basal layer of Endometrium infiltrates myometrium ; Cut section: multiple hemorrhages in myometrium
    Other Connective tissue, blood vessels Mucosal outgrowth Myometrial hypertrophy & hyperplasia

    General Gynaecology

    • Active space is a term mentioned, but without proper context, its meaning is unclear and cannot be explained further.

    Investigations

    • 1st Ix (Initial investigation)
      • AUB: Abnormal Uterine Bleeding
      • UPT: Urine Pregnancy Test
      • TVS: Transvaginal Sonography
    • 240 years - Endometrial Biopsy: (The text mentions "240 years" but this is likely a typo. It may be interpreted as an age range, but without further context, the exact meaning is unclear.)
    • INV (Investigation)
      • EST: Estrogen
      • IO: Imaging and Other
        • TVS: Transvaginal Sonography
          • Submucous fibroid
          • SIS > TVS (Saline Infusion Sonography is better than TVS in this case)
          • Best Ix: Hysteroscopy
      • N: Normal
      • S:
      • T:
      • I:
      • O:
      • N:
      • S:
      • LOC: Location
    • MRI: Usually not required.
      • T2: ≥ 12 mm: Adenomyosis; < 8 mm: Rules out Adenomyosis.
      • TZ: Blurry + Endometrial glands.

    Fibroid (Detailed)

    • On Per Abdominal (P/A) Examination:
      • Abdomino-pelvic lump
      • Midline mass
      • Mobile
      • Firm
      • Size: Up to 20 weeks pregnant uterus
    • On Per vaginal (P/v) Examination:
      • Bimanual palpation: Abdomino pelvic mass: Firm, mobile
      • Cannot separate from uterus
      • Asymmetrically enlarged, non-tender uterus
      • Movement of Transmitted to cervix
    • On USG:
      • Mass distorting uterine cavity
      • Posterior acoustic shadow
      • Texture: Similar to myometrium
      • Fibroid with texture of myometrium on SIS (Saline Infusion Sonography)
      • On Doppler: Vascularity around fibroid periphery

    Polyp

    • Normal:
      • Solid mass arising from a narrow base
      • Polyp texture: Not the same as myometrium
    • On USG:
      • Polyp supplied by a single blood vessel upto the centre → Feeder vessel sign
      • Enlarged uterus
      • Venetian blind appearance (alternate dark & light bands)

    Adenomyosis

    • On Per Abdominal (P/A) Examination:
      • Uterus: Symmetrically enlarged, globular
      • Size: 10-12 weeks pregnant uterus (Never 24 weeks)
      • Tender: Halban sign
      • Adnexal tenderness
    • On USG:
      • Thickening of wall of uterus: Posterior > Anterior
      • Most specific sign: Collection of blood in myometrium = myometrial cyst
    • Histology::
      • Loss of demarcation between endometrium & myometrium
      • Endometrium
      • Transition zone (T2)
      • Myometrium
      • Hazy, irregular T2

    General Gynaecology (Presentation)

    • Most common: Asymptomatic
    • Most common symptom: Heavy menstrual bleeding (HMB)
    • Other symptoms:
      • Secondary dysmenorrhea
      • Subfertility
      • Pressure symptoms
    • Pain can occur
    • Adverse pregnancy outcomes are possible

    Cause of HMB

    • Increased surface area of endometrium
    • Increased vascularity of the uterus (increased estrogen)
    • Interference with uterine contractility
    • Ulceration of Submucosal fibroid
    • Most common fibroid causing HMB: Submucosal fibroid

    Cause of Subfertility

    • Impaired gamete transport (due to impaired):
      • Tubal motility
      • Uterine contractility
    • Interference with implantation (due to distorted uterine cavity)
    • Displacement of the cervix away from the vaginal pool of semen
    • Most common fibroid causing subfertility: Submucosal fibroid

    Pain

    • Usually painless
    • If painful: Pelvic pressure/pain
    • Acute pain in the abdomen with fibroids:
      • Torsion
      • Red degeneration of fibroid

    Pressure symptoms:

    • Urinary: Cervical fibroid
    • Rectal: Post cervical fibroid (rare)

    Endocrine symptoms:

    • Polycythaemia
    • Hypercalcemia
    • Increased PRL levels

    Extra-uterine Fibroids

    • These fibroids originate outside of the uterus.
    • Cervical Fibroids:
      • Anterior Cervical Fibroid: Presses against and irritates the bladder.
      • Posterior Cervical Fibroid: Puts pressure on the urethra.
    • Broad Ligament (BL) Fibroids:
      • True BL Fibroid: Originates from the broad ligament.
      • Pseudo BL Fibroid: Arises from the broad ligament.
    • Intrauterine Fibroids: Originate from within the uterus.

    FIGO Classification of Fibroids

    • Subtypes are defined based on their position within the uterine wall. | Subtype | Characteristics | Significance | |---|---|---| | Submucosal | Totally inside uterine cavity; generally pedunculated | Type 0 or Type 1: Removed hysteroscopically; Type 2 or beyond: Removed via laparoscopy | | Intramural | Inside cavity greater than or equal to 50% | | | Subserosal | Inside cavity less than 50% | |

    Fibroid (Additional Information)

    • The text mentions a diagram, but it is unavailable in this response.

    Pseudo Meig's Syndrome

    • Pedunculated fibroid
    • Right-sided pleural effusion
    • Ascites
    • Myomectomy
    • Spontaneous resolution

    Pregnancy Complications

    • Pre-term labor
    • IUGR (intrauterine growth restriction)
    • Abruptio placentae

    Degeneration of Fibroid

    • Physiology of Degeneration:
      • Most vascular part: Periphery
      • Least vascular part: Central
      • Degeneration begins from the center of the fibroid.
    • Hyaline Degeneration:
      • Most common degeneration
      • Homogenous appearance of fibroid
      • Whorled appearance is lost
    • Calcareous Degeneration:
      • Most common in subserosal fibroids
      • Begins from the periphery
      • X-Ray: Popcorn calcification/womb stone appearance
    • Sarcomatous Degeneration:
      • Least common (less than 0.5%)
      • Most commonly seen in intramural fibroids
      • Mimics: Malignant ovarian tumor
    • Not seen in fibroid:
      • Amenorrhoea
      • Malpresentation
      • PPH (Postpartum hemorrhage)
      • Subinvolution

    General Gynaecology (Specific Degeneration)

    • Clinical Presentation:
      • Peri/post menopausal female
      • Sudden increase in size of fibroid
      • Painful fibroid
    • Histopathological Examination (HPE):
      • Fibroid becomes soft
      • Loose pseudocapsule
      • 210 mitoses/HPF

    Red Degeneration

    • Specific to pregnancy
    • Commonly seen in mid-pregnancy
    • Pathogenesis:
      • Thrombosis of blood vessels supplying the fibroid
      • Aseptic necrosis of fibroid + Peritoneal irritation
    • Clinical Presentation in Pregnancy:
      • Pain in the abdomen
      • Nausea and vomiting
      • Fever (possible)
    • Investigations:
      • Increased White Blood Cells (WBC)
      • Increased Erythrocyte Sedimentation Rate (ESR)
    • Management:
      • Conservative Management:
      • Analgesics
      • Antiemetics
      • IV fluids
    • Medical interventions (NO):
      • Antibiotics
      • Termination of pregnancy
      • Myectomy
    • Note on Red Degeneration:
      • Caused by thrombosed vessels releasing blood pigments
      • Results in a salmon-pink colored fibroid with a fishy odor

    Fibroid (Features)

    • Benign tumors arising from smooth muscle cells of the uterus.
    • Contain varying amounts of fibrous tissue.
    • Most common pelvic tumors in females.

    Etiopathogenesis

    • Estrogen + Progesterone dependent tumors
    • Receptors for:
      • Estrogen
      • Progesterone
      • Aromatase
    • Apoptosis
    • Angiogenic factors: TGF-β, EGF, etc.
    • Effect on fibroid:
      • Menopause: Regresses
      • Oral Contraceptives (OCPs): No effect on the size of the fibroid
      • Pregnancy: No effect on the size of the fibroid
    • Important Points:
      • Most common type of fibroid: Uterine fibroid (Type 4)
      • All fibroids begin as intramural fibroids
      • Associated with chromosomal anomalies
      • Familial predisposition

    Classification (Anatomical)

    • Uterine:
      • Intramural (most common)
      • Submucosal
      • Subserosal

    Comparison of Fibroid, Polyp & Adenomyosis

    Fibroid

    • AKA Leiomyoma
    • Smooth muscle tumor arising from myometrium
    • Incidence: Most common in reproductive age (25-35 years). Most common in nulliparous women. (Hyperestrogenic conditions)
    • Association: Estrogen + Progesterone dependent tumor
    • Symptoms: Heavy menstrual bleeding (HMB), earlier menorrhagia, regular cycles. Secondary dysmenorrhea, infertility, pressure symptoms, pregnancy complications.

    Polyp

    • Localized outgrowth of endometrium
    • Incidence: Seen in all age groups. Increased chance of polyps with age (most common age: 40-49 years).
    • Association: Increased incidence in women using Tamoxifen. Reproductive/Perimenopausal age: irregular/intermenstrual bleeding. Post-menopausal: post-menopausal bleeding (PMB). Most common cause of postmenopausal bleeding.
    • Symptoms: Menorrhagia (HMB) + secondary dysmenorrhea.
    Adenomyosis
    • Endometrial tissue (glands + stroma) inside myometrium (at least 2.5 mm deep from basal layer of endometrium).
    • Incidence: Women age 40+. Most common in multiparous women.
    • Symptoms: Endometriosis and fibroids. Menorrhagia (HMB) + secondary dysmenorrhea. Chronic Pelvic Pain (CPP).

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    Test your knowledge on medical management issues related to endometriosis and the characteristics of fibroids. This quiz covers imaging techniques, symptoms, and specific signs such as cyclical hematuria. Perfect for students in medical and health sciences.

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