Uterine Disorders ppt

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Questions and Answers

What is the volume threshold for blood loss to classify as menorrhagia?

120 ml

80 ml (correct)

100 ml

50 ml

Which symptom is NOT typically associated with heavy menstrual bleeding?

Soaking through tampons or pads every hour

Bleeding lasting more than 7 days

Slight spotting between periods (correct)

Needing to wear multiple pads at once

What imaging tool involves the injection of dye to assess the uterine cavity?

Hysterosalpingogram (correct)

Saline infusion sonography

Hysteroscopy

Ultrasound

Which procedure is performed to obtain a sample of endometrial tissue?

Endometrial biopsy Signup and view all the answers

What is a common complication of a didelphic uterus?

Conflicting menstrual patterns Signup and view all the answers

What is one downside of using saline infusion sonography (SIS)?

Limited visual information on tubes and ovaries Signup and view all the answers

Which statement about adenomyosis is true?

It can cause heavy menstrual bleeding. Signup and view all the answers

What method is used in hysteroscopy to visualize the uterine cavity?

Inflation with saline or a dextrose solution Signup and view all the answers

What is the most common etiology associated with endometrial cancer?

Unopposed estrogen Signup and view all the answers

In which scenario is a hysterectomy usually sufficient as treatment for endometrial cancer?

Low-grade cancer diagnosed by biopsy Signup and view all the answers

What is the five-year survival rate for patients with stage 1 and 2 endometroid endometrial cancer?

95% Signup and view all the answers

Which type of endometrial cancer generally presents at a more advanced stage and has a poor prognosis?

Endometroid grade III Signup and view all the answers

What is the recommended first step when atypical or heavy bleeding occurs?

Perform a biopsy Signup and view all the answers

Which of the following statements about adenomyosis is TRUE?

Menorrhagia in adenomyosis is due to inadequate muscular contraction. Signup and view all the answers

What is the definitive diagnosis for adenomyosis?

Pathology report. Signup and view all the answers

Which risk factor is associated with endometrial hyperplasia?

Obesity, especially morbid obesity. Signup and view all the answers

Which type of hyperplasia is concerning due to its potential to progress to endometrial cancer?

Complex hyperplasia with atypia. Signup and view all the answers

How can benign endometrial polyps be accurately diagnosed?

Sonohysteroscopy or office hysteroscopy. Signup and view all the answers

What is the most common solid pelvic tumor in women?

Leiomyomata uteri. Signup and view all the answers

What signifies a complex endometrial hyperplasia diagnosis requiring further evaluation?

Thickness of the endometrial stripe. Signup and view all the answers

What common symptom is often associated with leiomyomata uteri?

Menorrhagia. Signup and view all the answers

Which of the following is NOT a typical treatment for symptomatic leiomyomata uteri?

Chemotherapy. Signup and view all the answers

Which situation would likely necessitate a hysterectomy in cases of leiomyomata uteri?

Obstructive hydronephrosis. Signup and view all the answers

When is endometrial hyperplasia typically diagnosed?

Following abnormal uterine bleeding. Signup and view all the answers

What is the recommended initial management for simple hyperplasia without atypia?

Addition of progesterone and monitoring. Signup and view all the answers

Which symptom is NOT typically associated with adenomyosis?

Episodic severe headaches. Signup and view all the answers

Which imaging technique is most effective for evaluating the size and number of fibroids?

Transvaginal ultrasound. Signup and view all the answers

Study Notes

Menorrhagia

Blood loss greater than 80 ml (~3 ounces)
Signs include bleeding lasting more than 7 days, soaking through more than one tampon or pad every hour for several hours, needing to wear double protection, needing to change pads/tampons during the night, and blood clots larger than a quarter.

Diagnostic Procedures

Hysterosalpingogram (HSG): Injection of contrast dye into the cervix, uterine cavity, and fallopian tubes.
- Pros: Shows uterine cavity shape, fallopian tube diameter, and patency.
- Cons: No information about external appearance of structures.
Saline Infusion Sonography (SIS): Injection of sterile saline transcervically while performing vaginal ultrasound.
- Pros: Visualizes the uterine cavity.
- Cons: No information about fallopian tubes, ovaries, or uterine contour.
Endometrial Biopsy: Catheter is inserted into the uterus through the vagina to remove cells from the uterine lining.
Hysteroscopy: A camera is placed through the cervix to visualize the uterine cavity.
- Medium like saline or dextrose is used to inflate the cavity

Mullerian Variations

Didelphic Uterus and Vagina: Two separate uteri and vaginas.
Adenomyosis: Endometrial lining grows into the uterine wall.
- Symptoms: Often asymptomatic, secondary dysmenorrhea, abdominal pressure, bloating, menorrhagia, dyspareunia, and chronic pelvic pain.
- Signs: Diffusely enlarged, globular, tender uterus.
- Diagnosis: High index of suspicion based on clinical history and exam findings, characteristic findings on ultrasound and MRI, definitive diagnosis through pathology report.
- Management: Medical (NSAIDS, hormonal therapy, await menopause), Surgical (hysterectomy).

Benign Endometrial Polyps

Focal overgrowths of endometrial tissue.
Soft, fleshy, and typically dangle into the uterine cavity.
Can be visualized with sonohysteroscopy or office hysteroscopy.
Easily removed with hysteroscopy.
Tissue should be sent to pathology for examination.

Leiomyomata Uteri (Fibroids)

Benign tumors of smooth muscle cells that arise in the myometrium.
Most common solid pelvic tumor in women.
Most frequent indication for benign hysterectomy.
Incidence: 20-50% of women in the United States, increases with age, peak in the 40s, sharp decrease after menopause.
Symptoms: Can be asymptomatic, menorrhagia, infertility, abdominal pressure/heaviness, constipation.
Evaluation: Abdominal exam, bimanual exam, transvaginal ultrasound, MRI, KUB.
Management: Asymptomatic – observation, symptomatic– medical management (COCs, progesterone), endometrial ablation, removal of submucous fibroids, hysterectomy.

Enlarged Uterus Differential Diagnosis

Pregnancy
Adenomyosis
Leiomyomata Uteri
Hematometra
Malignancy (rare)

Endometrial Hyperplasia

Overgrowth of proliferative endometrium due to prolonged estrogen stimulation without progesterone.
Risk Factors: Obesity, nulliparity, early menarche, late menopause onset, anovulation, breast cancer/Tamoxifen use, family history, smoking.
Symptoms: Abnormal uterine bleeding.
Diagnosis: Office endometrial biopsy, vaginal ultrasound, hysteroscopy with dilation and curettage (D&C).
Management: No atypia – add progesterone, repeat biopsy in 3-6 months. Atypia – refer, hysteroscopy/D&C, hysterectomy.

Endometrial Intraepithelial Lesion (EIN)

Same as endometrial hyperplasia with atypia.
Precancerous condition involving abnormal endometrial cell growth.
Risk Factors and Symptoms: Same as endometrial hyperplasia.
Treatment: Diagnose with biopsy, remove with hysterectomy.

Endometrial Cancer

Most frequent gynecological cancer in the United States.
Etiology: Unopposed estrogen.
Types: Endometroid (hormone-dependent), Non-endometroid (not hormone-dependent).
Treatment: Hysterectomy, removal of fallopian tubes and ovaries, surgical staging.

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Description

This quiz covers the definitions, signs, and diagnostic procedures related to menorrhagia. Participants will learn about various diagnostic methods such as Hysterosalpingogram, Saline Infusion Sonography, Endometrial Biopsy, and Hysteroscopy. Test your knowledge on the specifics of these procedures and their pros and cons.