OB week 4
What are the treatments of endometrial carcinoma?
-Biopsies should be performed for all symptomatic patients -Transvaginal examination is helpful in screening for early changes of endometrial hyperplasia or carcinoma by accurately measuring endometrial thickness
What are the symptoms of endometritis?
-Lower back pain -fever -lower abdominal pain -dysmennorhea & menorrhagia -sterility -constipation
What is the possible pathology of hydrometra and hematometra for endometrial fluid?
-May be acquired as a result of cervical stenosis -May also be caused by uterine, cervical,tubal, or ovarian carcinoma
What is tamoxifen?
-Nonsteroidal antiestrogen compound
What are the sonographic findings of endometrial polyps?
-Represented by hypoechoic or isoechoic region within the hyperechoic endometrium -may appear as a nonspecific echogenic endometrial thickening -may appear as a round echogenic mass within the endometrial cavity -may be predunculated, broad based -have a thin stalk.
What is the obstruction of the genital tract resulting in for endometrial fluid collection?
-accumulation of secretions -blood -or both
What is the possible pathology of obstruction for endometrial fluid?
-congenital -imperforate hymen -vaginal septum -vaginal atresia -rudimentary uterine horn
What can small endometrial fluids collections occur with?
-ectopic pregnancy -endometritis -degenerating myoma -recent abortion
What are the sonographic findings of endometritis?
-endometrium appears prominent, irregular or both with a small amount of endometrial fluid -pus may be seen in the cul-de-sac echogenic particles or debris -enlarged ovaries with multiple cysts and indistinct margins -dilation of the fallopian tubes shows fluid filled tubular shapes in a folded configuration and well-defined echogenic wall -thickened tubal wall of greater than 5mm indicates acute disease -Adhesions may fuse the tube and ovaries as infections worsen
What are the sonographic findings of endometrial carcinoma?
-prominent endometrial complex -enlarged uterus with irregular areas of low and level echoes -enlarged with lobular contour of the uterus and mixed echogenitcity are correlated with more advance stages of disease -cystic changes within the endometrium can also be seen with carcinoma
What is the treatment for IUD?
-ultrasound is often performed for "IUD position" or "Lost IUD string"
What is leiomysarcoma accounted for?
1.3% of uterine malignancies
How many patients are diagnosed correctly before surgery?
10-20%
How many percentages of polyps are multiple?
20%
What are the causes of postmenopausal women in endometrial hyperplasia?
40% of causes of postmenopausal bleeding are caused by endometrial hyperplasia
What happens to a postmenopausal women during endometrial hyperplasia?
8mm is the upper limit of normal
What is IUD?
A device placed in the uterine cavity during menses for the purpose of birth control
If ultrasound cannot located the IUD, what happens?
A radiograph is performed
What is considered cancer until proven otherwise in endometrial carcinoma?
A thickened endometrial GREATER than 4-5mm
What does 60% of women with adenomyosis experience?
Abnormal uterine bleeding (hypermenorrhea), prolonged/profused uterine bleeding (menorrhagia), Irregular, acyrlic bleeding (metrorrhea)
What is tamoxifen used for?
Adjuvant therapy in premenopausal and postmenopausal women with BREAST CANCER
What is endometritis?
An infection within the endometrium of the uterus
What are the sonographic findings of arteriovenous malformations?
Anechoic structures seen with pelvis, subtle myometrium in homogenicity, tubular spaces within the myometrium, intramural uterine mass, endometrial or cervical mass and sometimes as prominent parametrical vessels
What are the treatments for arteriovenous malformations?
Angiography with embolic therapy, color doppler is diagnostic to show blood flow within the anechoic structure so we dont nick it causing internal bleeding
What is the risk factors in premenopausal women?
Anovulatory cycles and obesity are considered risk factors
What is another name for synechiae?
Asherman's syndrome
What is endometrial carcinoma associated with?
Associated with estrogen replacement therapy
What are the symptoms for endometrial polyps?
Asymptomatic, and abnormal uterine bleeding
What are the symptoms for leiosarcoma?
Asymptomatic, pelvic pain, abnormal vaginal bleeding, and uterus enlargement
When sequential hormones are used when should they be evaluated?
At the beginning or end of her hormone cycles, because it's when the endometrium is at it's thickest
Why is diagnosis critical for arteriovenous malformations?
Dilation and curettage may lead to catastrophic hemmorrhaging
When is endometrial hyperplasia less common in?
During the reproductive years
Who does the endometritis occur in?
Occurs most often in associated with pelvic inflammatory disease (PID) in postpartum state, or following instrumentation of the uterus
Who are the patients for adenomyosis?
Often multiparous and older than patients with endometriosis
What does 25% of women with adenomyosis experience?
Pelvic pain during menstruation (dysmenorrhea)
What is endometrial polyp?
Polyps are overgrowths of endometrial tissue covered by epithelium
Who is the endometrial carcinoma aimed towards?
Postmenopausal patients and premenopausal patients
What is the cause of endometritis?
Postpartum patients may develop endometritis after -prolonged labor -vaginitis -premature rupture of the membranes or retained products of conception
When is proper placement done for an IUD?
Proper placement is verified by weekly palpation of the string in the cervix, done by the patient
What is progesterone therapy?
Provera, prometrium
How is arteriovenous malformations?
Rare and can be congenital but mostly acquired
What are the sonographic findings of leiomysarcoma?
Resemble myomas, fibriod or mixed cystic textures,
What are the causes of arteriovenous malformations?
Resulting from pelvic trauma, surgery and gestational trophoblastic neoplasia
What does hydrometrocolops result in?
Results from the retention of menstrual blood
What is an increased risk of patients using tamoxifen therapy?
Risk of endometrial carcinoma, hyperplasia, and polyps
Who are polyps most often aimed towards?
Seen in perimenopausal women and postmenopausal women
What are the estrogen and progesterone replacement regiments?
Sequential estrogen and progesterone replacement regiments may have endometrial thickness up to 15 mm during the estrogen phase, thickness is then decreased after progesterone is added
What can sonography demonstrate for an IUD?
Sonography can demonstrate malposition perforation and incomplete removal
What is the treatment for endometritis?
Sonography is useful in following the response to antibotic therapy
What are the treatments of endometrial polyps?
Sonohysterography can be a value to better delinate borders and attchment site
What are the treatments of synechiae?
Sonohysterography is an excellent technique for demonstrating on-strating adhesions
What is the cause of endometrial carcinoma?
The risk of malignancy increases with large endometrial fluid collection or clinical symptoms such as abdominal pain or bleeding
What is the theory of adenomyosis?
Theory suggests of a compromised of the natural barrier between the endometrium and the myometrium which allows for growth of the ectopic endometrial bands and stroma within the uterine myometrium
What can synechiae prevent?
Thick, broad-based adhesions may prevent distention of the uterine cavity
What is the earliest changes of endometrial in endometrial carcinoma?
Thickened endometrium
What is the cause of leiosarcoma?
Thought to arise from pre-existing leiomyomas
When does endometrial polyps appear?
Towards the end of the luteal phase
What is tissue penetration for adenomyosis?
Usually reaches a depth of at least 2.5mm from the basal layers of the endometrium because the tissue arises from the stratum basalis component of the endometrium, it does not bleed in response to hormone stimulation
What are the symptoms with women with postmenopausal?
Uterine bleeding are experiencing endometrial atrophy
What can adenomyosis mimic?
Uterine myomas, muscular hypertrophy, myometrial contractions, endometritis, endometrial carcinoma & increased endometrial secretions
What is arteriovenous malformations?
Vascular plexus of arteries and veins without an intervening capillary network
Who are arteriovenous malformations aimed towards?
Women of child bearing years who have metrorrhagia with blood loss and anemia
What is the primary cause of endometrial fluid collections?
before menstruation, the accumulation of secretions is referred to as HYDROMETROCOLPOS
What is adenomyosis?
commonly diffused with global infilaration with the endometrium
Where is arteriovenous malformations located?
involving the myometrium and rarely the endometrium
How many percentage of women with postmenopausal bleeding will have endometrial carcinoma?
only 10%
Who is endometrial hyperplasia aimed towards?
premenopausal and postmenopausal women, obese women with increased production of endogenous estrogen, women with estrogen producing tumors
What is diffuse adenomyosis?
represents reactive hypertrophy of the myometrial muscle, which produces uterine enlargement but not to the extent seen with leiomyomas
What is the most common symptoms of endometrial carcinoma?
uterine bleeding
What may promote growth of the myometrial islands of endometrial in adenomyosis?
Elevated estrogen levels
What is synechiae?
Endometrial adhesions
What are the treatments for endometrial hyperplasia?
Endometrial biopsy is necessary for diagnosis, SONOHYSTEROGRAPHY can also be performed to evaluate the internal structure of the endometrium canal, dilatation and curettage, hysterectomy, mirena IUD, and progesterone therapy
What happens to a premenopausal women during endometrial hyperplasia?
Endometrial measures more than 14 mm, and hyperplasia is suggested
What can indicate endometritis?
Endometritis thickening or fluid may indicate endometritis
What are the sonographic findings of endometrial hyperplasia?
Endometrium is thickened, echogenic endometrium with well-defined margins, focal or asymmetrical thickening can occur, small cysts representing dilated cystic glands, may be seen within the endometrium
What happens to patients not taking HRT?
Enlargement of a myoma in perimenopausal or menopausal patients is NOT taking HRT raises concern about development of a malignancy
What can cause fibroids to grow in leiosarcoma?
Estrogen can cause fibroids to grow
The thickened wall of the adenomyosis can be mistaken for what?
Fibroids
What is the least common form of adenomyosis?
Focal adenomyosis
Who is synechiae usually aimed towards?
Found in women with post-traumatic or post surgical history including uterine curettage
How does the diffuse adenomyosis appear sonographically?
Globular shaped uterus, and more symetric than uterine enlargement due to fibroids
What are the symptoms for endometrial hyperplasia?
Has irregular bleeding, a thickened endometrium
What are the symptoms of arteriovenous malformations?
Heavy bleeding with anemia
What are the symptoms for adenomyosis?
Heavy, painful menses, enlarged uterus up to 3x it's normal size, gobular in coutour, boggy and tendy.
What are the differential considerations of endometrial polyps?
Hyperplasia, submucosal myomas, and less commonly-endometrial carcinoma
What do you do for endometrial fluid collections?
If measuring the endometrium, the AP diameter of the fluid should be subtracted from the endometrial thickness for a true assessment of endometrial thickness
What are the causes of an IUD?
If the string is not felt, it is not possible that the IUD has been expelled , or that the string has fallen off or retracted into the uterus
When is endometritis in patients?
In patients with pelvic infection, the uterus is a route for infection to the tubes and adnexa
What is an early finding of endometrial carcinoma?
Increased endometrial thickness
What is focal adenomyosis?
Isolated implants that cause reactive hypertrophy of the myometrium which produces diffuse uterine enlargement
How does focal adenomyosis appear sonographically?
Lacks hypoechoic borders that is seen with fibroids, not endometrosis
How aggressive is leiomysarcoma?
Lightly aggresive
What is adenomyosis characterized by?
MRI, not always reliably diagnosed by ultrasound
What are the treatments for adenomyosis?
Managed with hormone theraphy
What can adenomyosis arise from?
May arise from multiple pregnancies and deliveries with subsequent uterine shrinking
What is a possible cause for synechiae?
May cause infertility or recurrent pregnancy loss
When can endometrial hyperplasia occur?
May occur with persistent anovulatory cycles (not ovulating)
What is endometrial hyperplasia?
Most common cause of abnormal uterine bleeding
Where is endometrial carcinoma most common?
Most common malignancy in NORTH AMERICA
What is endometrial carcinoma?
Most endometrial malignancies are ADENOCARCINOMA
When are polyps more present?
Most often with one primarily feeding vessels, myomas typically have multiple
What are the sonographic findings of synechiae?
Demonstrate bright echoes within the endometrial cavity, more easily observed in the gravid uterus, appear as a hyperechoic band transversing the uterus from anterior to posterior
What is a clear evidence of endometrial carcinoma?
Demonstration of myometrial invasion
What is the most common form of adenomyosis?
Diffuse adenomyosis
What are the sonographic appearance of adenomyosis?
Diffuse uterine enlargement, thickened posterior myometrium, indistinct border between the endometrium and myometrium, involves the inner 2/3 of the myometrium, appears as a small myometrium cysts with "swiss cheese" or "honeycomb" pattern
Where is leiosarcoma located?
Derived from smooth muscle in the wall of the uterus, originate from the myometrium or the endometrial lining
What is endometrial hyperplasia developed from?
Developed from unopposed estrogen stimulation
What are the possible causes of adenomyosis?
Bearing children, previous uterine trauma or surgery, c-section, dilation curettage
What kind of disease is an Adenomyosis?
Benign
What is the cause of endometrial polyps?
Cause diffuse or focal endometrial thickening
What is the cause of adenomyosis?
Cause is unknown
What is the common cause of adenomyosis?
Commonly from uterine sugery
Where is adenomyosis located?
Commonly in the posterior aspect, etopic occurance of endometrial tissue within the myometrium
What is Mirena IUD?
Delivers small doses of progestin directly into the uterine lining decreasing the thickness and also estrogen free
