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B - Gynaecology > Fibroids > Flashcards

Flashcards in Fibroids Deck (52)
1

What are uterine fibroids also known as?

Leiomyomas

2

What are uterine fibroids?

Benign smooth muscle tumours of the uterus

3

How common are uterine fibroids compared to other benign tumours in women?

They are the most common

4

What is the estimated incidence of fibroids?

20-40%

5

What is the risk of a fibroid becoming malignant?

0.1%

6

What do fibroids arise from?

The myometrium of the uterus

7

What are fibroids classified based on?

Their position in the uterine wall

8

What are the classifications of fibroids?

- Intramural
- Submucosal
- Subserosal

9

What is the most common type of fibroid?

Intramural

10

Where is an intramural fibroid found?

Confined to myometrium of the uterus

11

Where is a submucosal fibroid?

Develops immediately underneath the endometrium of the uterus, and protrudes into the uterine cavity

12

Where is a subserosal fibroid?

Protrudes into and distorts the serosal surface of the uterus

13

What is the serosal surface of the uterus?

The outer surface

14

What might be a feature of subserosal fibroids?

May be pedunculated (on a stalk)

15

Describe the pathogenesis of fibroids?

Poorly understood, but their growth is thought to be stimulated by oestrogen

16

What are the risk factors for fibroids?

- Obesity
- Early menarche
- Increasing age
- Family history
- Ethnicity

17

How much does a family history of fibroids increase the risk?

Women with a 1st degree relative carry a 2.5x increased risk

18

How does ethnicity affect the risk of fibroids?

African-Americans are 3x more likely than Caucasians

19

How are the majority of cases of fibroids discovered?

Women are asymptomatic, and the fibroids are discovered incidentally on pelvic or abdominal examination

20

If symptomatic, how may fibroids present?

- Pressure symptoms +/- abdominal distention
- Heavy menstrual bleeding
- Subfertility
- Acute pelvic pain (rare)

21

What pressure symptoms may be present in fibroids?

- Urinary frequency
- Chronic retention

22

Why might sub fertility be a sign of fibroids?

Due to the obstructive effect of the fibroid

23

What might cause acute pelvic pain in fibroids?

- Red degeneration
- Pedunculated fibroids can undergo torsion

24

When can red degeneration of fibroids occur?

In pregnancy

25

What is red degeneration of fibroids?

Where rapidly growing fibroid undergoes necrosis and haemorrhage

26

What may be found on examination in fibroids?

A solid mass or enlarged uterus may be palpable on abdominal or bimanual examination. The uterus is normally non-tender

27

What are the differential diagnoses of fibroids?

- Endometrial polyp
- Ovarian tumours
- Leiomyosarcoma
- Adenomyosis

28

What is leiomyosarcoma?

Malignancy of myometrium

29

What is adenomyosis?

Presence of functional endometrial tissue within the myometrium

30

What is the main investigation for suspected fibroids?

Imaging

31

What imaging may be done in suspected fibroids?

- Pelvic ultrasound
- MRI

32

When is MRI used in suspected fibroids?

Rarely used, unless sarcoma is suspected

33

When are blood tests used in fibroids?

Usually reserved for patients where the diagnosis is unclear, or as a pre-operative work-up if surgery is indicated

34

What can the management of fibroids be divided into?

- Medical
- Surgical

35

What is involved in the medical management of fibroids?

- Transexamic or mefanamic acid
- Hormonal contraceptives
- GnRH analogues
- Selective Progesterone Receptor Modulators

36

What are hormonal contraceptives useful for in fibroids?

Controlling menorrhagia

37

What hormonal contraceptives can be used in fibroids?

- COCP
- POP
- Mirena IUS

38

Give an example of a GnRH analogue

Zolidex

39

What do GnRH analogues do?

Suppress ovulation, inducing a temporary menopausal state

40

When are GnRH analogues useful in fibroids?

Pre-operatively

41

Why are GnRH analogues useful pre-operatively in fibroids?

They reduce fibroid size and lower complications

42

How long can GnRH analogues be used for?

6 months

43

Why can GnRH analogues only be used for 6 months?

Due to risk of osteoporosis

44

Give 2 examples of selective progesterone receptor modulators (SERMs)

- Ulipristal
- Esmya

45

What do SERMs do in fibroids?

Reduces size of fibroid and menorrhagia

46

When are SERMs useful in the management of fibroids?

Pre-operatively or as an alternative to surgery

47

What are the surgical options for the treatment of fibroids?

- Hysteroscopy and transcervical resection of fibroid (TCRF)
- Myomectomy
- Uterine artery embolism (UAE)
- Hysteroscopy

48

What is TCRF useful for?

Submucosal fibroids

49

Who is myomectomy a good option for?

Women wanting to preserve their uterus

50

Who performs uterine artery embolism?

Radiologists

51

What artery is used for uterine artery embolisation?

Femoral artery

52

What does UAE commonly cause post-operatively?

- Pain
- Fever