2024-
2025
Gynaecologie
PROF DR D. TIMMERMAN, PROF DR T. VAN GORP
,Inleiding ......................................................................................................................................................... 10
Anatomie .......................................................................................................................................................... 10
Technieken........................................................................................................................................................ 10
Ingrepen ........................................................................................................................................................... 11
Hysterectomie ............................................................................................................................................. 11
Nieuwe ingrepen ......................................................................................................................................... 11
Abnormaal uterien bloedverlies ..................................................................................................................... 11
Definities........................................................................................................................................................... 11
Methodologische aspecten............................................................................................................................... 12
Anamnese .................................................................................................................................................... 12
Cycluslengte ............................................................................................................................................ 13
Structuur ................................................................................................................................................. 13
Gynaecologisch onderzoek .......................................................................................................................... 14
Bijkomende onderzoeken ....................................................................................................................... 14
Oorzaken .......................................................................................................................................................... 14
Belangrijkste oorzaken ................................................................................................................................ 14
Coagulopathie ......................................................................................................................................... 15
Ovulatoire dysfunctie.............................................................................................................................. 15
Endometriaal .......................................................................................................................................... 15
Iatrogeen................................................................................................................................................. 15
Andere .................................................................................................................................................... 16
Behandeling ...................................................................................................................................................... 16
Medicamenteus ........................................................................................................................................... 16
Complicaties ..................................................................................................................................................... 16
Corpus uteri ................................................................................................................................................... 16
Endometriale pathologie .................................................................................................................................. 16
Asherman syndroom ................................................................................................................................... 17
Endometriale poliep .................................................................................................................................... 17
Algemeen ................................................................................................................................................ 17
Endometriumhyperplasie ............................................................................................................................ 17
Eenvoudige hyperplasie .......................................................................................................................... 17
Complexe hyperplasie............................................................................................................................. 18
Atypische hyperplasie ............................................................................................................................. 18
Myometriale pathologie ................................................................................................................................... 18
Leiomyoom .................................................................................................................................................. 18
Definitie .................................................................................................................................................. 18
Symptomen ............................................................................................................................................. 18
Types ....................................................................................................................................................... 19
Risicofactoren ......................................................................................................................................... 19
Behandeling ............................................................................................................................................ 19
FIGO classificatie ..................................................................................................................................... 20
DD/ leiomyosarcoom .............................................................................................................................. 20
Adenomyose ................................................................................................................................................ 20
Sarcomen ..................................................................................................................................................... 20
Borstafwijkingen: theorieles .......................................................................................................................... 21
Inleiding ............................................................................................................................................................ 21
Anatomie .......................................................................................................................................................... 21
Bezenuwing ................................................................................................................................................. 21
1
, Lymfedrainage ............................................................................................................................................. 21
Fysiologie ..................................................................................................................................................... 21
Diagnostiek ....................................................................................................................................................... 22
Anamnese .................................................................................................................................................... 22
Klinisch onderzoek ....................................................................................................................................... 22
Algemeen ................................................................................................................................................ 22
Inspectie.................................................................................................................................................. 22
Palpatie ................................................................................................................................................... 23
Beeldvorming .............................................................................................................................................. 23
Mammografie ......................................................................................................................................... 23
Echo ........................................................................................................................................................ 24
MRI.......................................................................................................................................................... 24
Screening metastasen ................................................................................................................................. 24
Puncties ....................................................................................................................................................... 24
Triple diagnostiek ........................................................................................................................................ 25
Goedaardige bortsproblemen .......................................................................................................................... 25
(Voelbare) massa ......................................................................................................................................... 25
Fibroadenomen ...................................................................................................................................... 25
Borstcyste ............................................................................................................................................... 25
Phylodes tumor ....................................................................................................................................... 25
Intraductaal papilloom ........................................................................................................................... 26
Radial scar ............................................................................................................................................... 26
Infecties ....................................................................................................................................................... 26
Tijdens lactatie ........................................................................................................................................ 26
Buiten lactatie ......................................................................................................................................... 26
Tepelvochtverlies......................................................................................................................................... 27
Gynaecomastie ............................................................................................................................................ 27
Soorten ................................................................................................................................................... 27
Oorzaken bij volwassenen ...................................................................................................................... 27
Diagnose ................................................................................................................................................. 27
Behandeling ............................................................................................................................................ 28
Pijn in de borst ............................................................................................................................................. 28
Borstkanker ...................................................................................................................................................... 28
Epidemiologie en pathologie ....................................................................................................................... 28
Risicofactoren .............................................................................................................................................. 29
Beschermende factoren .............................................................................................................................. 29
Erfelijke borstkanker.................................................................................................................................... 29
Beleid hoog risico ........................................................................................................................................ 30
Prognose ...................................................................................................................................................... 30
RF herval ................................................................................................................................................. 30
Stadiëring ................................................................................................................................................ 30
Behandeling ................................................................................................................................................. 30
Chirurgie ................................................................................................................................................. 30
Radiotherapie ......................................................................................................................................... 31
Systeemtherapie ..................................................................................................................................... 32
Winst adjuvante therapie ....................................................................................................................... 33
Carcinoma in situ ......................................................................................................................................... 33
Opvolging ......................................................................................................................................................... 33
Lokaal/locoregionaal herval ........................................................................................................................ 34
Gemetastaseerd .......................................................................................................................................... 34
Goedaardige letsels baarmoederhals ............................................................................................................. 34
Fysiologische veranderingen ............................................................................................................................ 34
Cervicale transformatiezone en metaplasie ................................................................................................ 34
2
, Cervicale ectopie of ectropion ..................................................................................................................... 35
Naboth cyste................................................................................................................................................ 35
Niet-fysiologisch ............................................................................................................................................... 35
Cervicale erosie ........................................................................................................................................... 35
Cervicale wratten......................................................................................................................................... 35
Cervicale poliepen ....................................................................................................................................... 35
Premaligne letsels van baarmoederhals ......................................................................................................... 35
Dysplasie........................................................................................................................................................... 35
Definitie ....................................................................................................................................................... 35
Risicofactoren HPV.................................................................................................................................. 36
Preventie ..................................................................................................................................................... 36
Vaccinatie................................................................................................................................................ 37
Screening ................................................................................................................................................ 37
Diagnostiek .................................................................................................................................................. 38
Colposcopie............................................................................................................................................. 38
Behandeling ................................................................................................................................................. 39
HSIL ......................................................................................................................................................... 39
Cervixcarcinoom ............................................................................................................................................... 39
Epidemiologie .............................................................................................................................................. 39
Symptomen ................................................................................................................................................. 40
Stadia ........................................................................................................................................................... 40
Workup ........................................................................................................................................................ 41
Behandeling ................................................................................................................................................. 41
Stadium I ................................................................................................................................................. 41
Hogere stadia (fout in cursus) ................................................................................................................. 42
Recidief ................................................................................................................................................... 42
Opvolging ..................................................................................................................................................... 42
Endometriose en adenomyose ....................................................................................................................... 42
Endometriose.................................................................................................................................................... 42
Definitie ....................................................................................................................................................... 42
Pathogenese ................................................................................................................................................ 42
Prevalentie ................................................................................................................................................... 43
Symptomen ................................................................................................................................................. 43
Klinisch onderzoek ....................................................................................................................................... 43
Technische onderzoeken ............................................................................................................................. 44
Verschijningsvormen ................................................................................................................................... 44
Peritoneale endometriose ...................................................................................................................... 44
Ovariële endometriose ........................................................................................................................... 44
Diep infiltrerende endometriose ............................................................................................................ 44
Diagnose ...................................................................................................................................................... 44
Echo ........................................................................................................................................................ 45
Behandeling ................................................................................................................................................. 45
Chirurgisch .............................................................................................................................................. 45
Medisch .................................................................................................................................................. 45
Adenomyosis uteri ............................................................................................................................................ 46
Definitie ....................................................................................................................................................... 46
Symptomen ................................................................................................................................................. 46
Behandeling ................................................................................................................................................. 46
Onderzoek en behandeling van verminderde vruchtbaarheid ........................................................................ 47
Onderzoek verminderde vruchtbaarheid .......................................................................................................... 47
Definities ...................................................................................................................................................... 47
3
2025
Gynaecologie
PROF DR D. TIMMERMAN, PROF DR T. VAN GORP
,Inleiding ......................................................................................................................................................... 10
Anatomie .......................................................................................................................................................... 10
Technieken........................................................................................................................................................ 10
Ingrepen ........................................................................................................................................................... 11
Hysterectomie ............................................................................................................................................. 11
Nieuwe ingrepen ......................................................................................................................................... 11
Abnormaal uterien bloedverlies ..................................................................................................................... 11
Definities........................................................................................................................................................... 11
Methodologische aspecten............................................................................................................................... 12
Anamnese .................................................................................................................................................... 12
Cycluslengte ............................................................................................................................................ 13
Structuur ................................................................................................................................................. 13
Gynaecologisch onderzoek .......................................................................................................................... 14
Bijkomende onderzoeken ....................................................................................................................... 14
Oorzaken .......................................................................................................................................................... 14
Belangrijkste oorzaken ................................................................................................................................ 14
Coagulopathie ......................................................................................................................................... 15
Ovulatoire dysfunctie.............................................................................................................................. 15
Endometriaal .......................................................................................................................................... 15
Iatrogeen................................................................................................................................................. 15
Andere .................................................................................................................................................... 16
Behandeling ...................................................................................................................................................... 16
Medicamenteus ........................................................................................................................................... 16
Complicaties ..................................................................................................................................................... 16
Corpus uteri ................................................................................................................................................... 16
Endometriale pathologie .................................................................................................................................. 16
Asherman syndroom ................................................................................................................................... 17
Endometriale poliep .................................................................................................................................... 17
Algemeen ................................................................................................................................................ 17
Endometriumhyperplasie ............................................................................................................................ 17
Eenvoudige hyperplasie .......................................................................................................................... 17
Complexe hyperplasie............................................................................................................................. 18
Atypische hyperplasie ............................................................................................................................. 18
Myometriale pathologie ................................................................................................................................... 18
Leiomyoom .................................................................................................................................................. 18
Definitie .................................................................................................................................................. 18
Symptomen ............................................................................................................................................. 18
Types ....................................................................................................................................................... 19
Risicofactoren ......................................................................................................................................... 19
Behandeling ............................................................................................................................................ 19
FIGO classificatie ..................................................................................................................................... 20
DD/ leiomyosarcoom .............................................................................................................................. 20
Adenomyose ................................................................................................................................................ 20
Sarcomen ..................................................................................................................................................... 20
Borstafwijkingen: theorieles .......................................................................................................................... 21
Inleiding ............................................................................................................................................................ 21
Anatomie .......................................................................................................................................................... 21
Bezenuwing ................................................................................................................................................. 21
1
, Lymfedrainage ............................................................................................................................................. 21
Fysiologie ..................................................................................................................................................... 21
Diagnostiek ....................................................................................................................................................... 22
Anamnese .................................................................................................................................................... 22
Klinisch onderzoek ....................................................................................................................................... 22
Algemeen ................................................................................................................................................ 22
Inspectie.................................................................................................................................................. 22
Palpatie ................................................................................................................................................... 23
Beeldvorming .............................................................................................................................................. 23
Mammografie ......................................................................................................................................... 23
Echo ........................................................................................................................................................ 24
MRI.......................................................................................................................................................... 24
Screening metastasen ................................................................................................................................. 24
Puncties ....................................................................................................................................................... 24
Triple diagnostiek ........................................................................................................................................ 25
Goedaardige bortsproblemen .......................................................................................................................... 25
(Voelbare) massa ......................................................................................................................................... 25
Fibroadenomen ...................................................................................................................................... 25
Borstcyste ............................................................................................................................................... 25
Phylodes tumor ....................................................................................................................................... 25
Intraductaal papilloom ........................................................................................................................... 26
Radial scar ............................................................................................................................................... 26
Infecties ....................................................................................................................................................... 26
Tijdens lactatie ........................................................................................................................................ 26
Buiten lactatie ......................................................................................................................................... 26
Tepelvochtverlies......................................................................................................................................... 27
Gynaecomastie ............................................................................................................................................ 27
Soorten ................................................................................................................................................... 27
Oorzaken bij volwassenen ...................................................................................................................... 27
Diagnose ................................................................................................................................................. 27
Behandeling ............................................................................................................................................ 28
Pijn in de borst ............................................................................................................................................. 28
Borstkanker ...................................................................................................................................................... 28
Epidemiologie en pathologie ....................................................................................................................... 28
Risicofactoren .............................................................................................................................................. 29
Beschermende factoren .............................................................................................................................. 29
Erfelijke borstkanker.................................................................................................................................... 29
Beleid hoog risico ........................................................................................................................................ 30
Prognose ...................................................................................................................................................... 30
RF herval ................................................................................................................................................. 30
Stadiëring ................................................................................................................................................ 30
Behandeling ................................................................................................................................................. 30
Chirurgie ................................................................................................................................................. 30
Radiotherapie ......................................................................................................................................... 31
Systeemtherapie ..................................................................................................................................... 32
Winst adjuvante therapie ....................................................................................................................... 33
Carcinoma in situ ......................................................................................................................................... 33
Opvolging ......................................................................................................................................................... 33
Lokaal/locoregionaal herval ........................................................................................................................ 34
Gemetastaseerd .......................................................................................................................................... 34
Goedaardige letsels baarmoederhals ............................................................................................................. 34
Fysiologische veranderingen ............................................................................................................................ 34
Cervicale transformatiezone en metaplasie ................................................................................................ 34
2
, Cervicale ectopie of ectropion ..................................................................................................................... 35
Naboth cyste................................................................................................................................................ 35
Niet-fysiologisch ............................................................................................................................................... 35
Cervicale erosie ........................................................................................................................................... 35
Cervicale wratten......................................................................................................................................... 35
Cervicale poliepen ....................................................................................................................................... 35
Premaligne letsels van baarmoederhals ......................................................................................................... 35
Dysplasie........................................................................................................................................................... 35
Definitie ....................................................................................................................................................... 35
Risicofactoren HPV.................................................................................................................................. 36
Preventie ..................................................................................................................................................... 36
Vaccinatie................................................................................................................................................ 37
Screening ................................................................................................................................................ 37
Diagnostiek .................................................................................................................................................. 38
Colposcopie............................................................................................................................................. 38
Behandeling ................................................................................................................................................. 39
HSIL ......................................................................................................................................................... 39
Cervixcarcinoom ............................................................................................................................................... 39
Epidemiologie .............................................................................................................................................. 39
Symptomen ................................................................................................................................................. 40
Stadia ........................................................................................................................................................... 40
Workup ........................................................................................................................................................ 41
Behandeling ................................................................................................................................................. 41
Stadium I ................................................................................................................................................. 41
Hogere stadia (fout in cursus) ................................................................................................................. 42
Recidief ................................................................................................................................................... 42
Opvolging ..................................................................................................................................................... 42
Endometriose en adenomyose ....................................................................................................................... 42
Endometriose.................................................................................................................................................... 42
Definitie ....................................................................................................................................................... 42
Pathogenese ................................................................................................................................................ 42
Prevalentie ................................................................................................................................................... 43
Symptomen ................................................................................................................................................. 43
Klinisch onderzoek ....................................................................................................................................... 43
Technische onderzoeken ............................................................................................................................. 44
Verschijningsvormen ................................................................................................................................... 44
Peritoneale endometriose ...................................................................................................................... 44
Ovariële endometriose ........................................................................................................................... 44
Diep infiltrerende endometriose ............................................................................................................ 44
Diagnose ...................................................................................................................................................... 44
Echo ........................................................................................................................................................ 45
Behandeling ................................................................................................................................................. 45
Chirurgisch .............................................................................................................................................. 45
Medisch .................................................................................................................................................. 45
Adenomyosis uteri ............................................................................................................................................ 46
Definitie ....................................................................................................................................................... 46
Symptomen ................................................................................................................................................. 46
Behandeling ................................................................................................................................................. 46
Onderzoek en behandeling van verminderde vruchtbaarheid ........................................................................ 47
Onderzoek verminderde vruchtbaarheid .......................................................................................................... 47
Definities ...................................................................................................................................................... 47
3
