63. Non-inflammatory diseases of external and internal female genital organs. Flashcards
what are the non inflammatory diseases of the female genital tract ?
uterus : asherman syndrome endometriosis endometrial polyps retroverted uterus dysmenorrhea
ovarian:
ovarian cysts
pcos
external
female genital prolapse
vaginismus
vesicovaginal fistula
what is asherman syndrome ?
uterine condition that occurs when scar tissue (adhesions) form inside the uterus and/or the cervix.
in many cases the front and back walls of the uterus stick to one another
what is the cause of asherman syndrome ?
Trauma to the basal layer, after a dilation and curettage (D&C) performed after a miscarriage, or delivery, or for surgical termination of pregnancy
C section
myomectomy
IUD
chronic endometritis - from genital tuberculosis
what are the signs and symptoms of asherman syndrome
secondary amenorrhea or
oligomenorrhoea
abnormal uterine bleeding
periodic abdominal pain due to retention of blood in the uterus
pain during menstruation or ovulation
infertility
recurrent miscarriage
what are the complications of asherman syndrome ?
infertility
miscarriage
how is asherman syndrome diagnosed ?
Progesterone withdrawal test: bleeding does not occur following progestin withdrawal
hysterosalpingography will reveal the extend of the scar - honeycomb appearance of uterus
hystereoscopy
treatment for asherman syndrome ?
operative hysteroscopy during adhesion dissection
give antibiotic afterwards
estrogen to improve quality of uterine lining
repeat hysteroscopy check that your uterus is free from adhesions.
It’s possible for adhesions to reoccur following treatment, so doctors recommend waiting a year before trying to conceive
what are the signs and symptoms of ovarian cysts
asymptomatic
tender adnexa
palpable cyst
lower abdominal pain
metrorrhagia or pain with menstruation (dysmenorrhea)
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if PCOS -virilisation infertility , acne , obesity and metabolic syndrome acnathosis nigiricans androgenic alopecia
what are the different types of ovarian cysts ?
functional cysts :
follicular cysts
corpus luteum cysts
theca lutein cysts
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non functional
endometriosis - choc cyst
dermoid cysts - dermoid is composed only of dermal and epidermal elements (which are both ectodermal in origin) = hair follicles, skin tissue, and glands
cystadenomas.
in polycystic ovary syndrome (PCOS) - are actually immature follicles not cysts. The follicles have developed from primordial follicles and have arrested
cysts caused by hypothyroidism
what are the complication of ovarian cysts and their treatmnet ?
ruptured ovarian cyst - corpus lute cyst
= sudden onset of unilateral abdominal pain
minimal vaginal bleeding
severe hemorrhage - hypovolemic shock (rare)
Hemodynamically unstable patients: blood transfusion ringer saline
emergency exploratory laparoscopy - suturing and cauterisation
oophorectomy if only intractable hemorrhage
Hemodynamically stable patients - analgesics and monitoring
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ovarian torsion
Ovarian cysts, especially: Cysts > 5 cm Dermoid cysts (teratoma)
obstruction of ovarian veins - edema of fallopian tubes and ovary
worsening of the edema of fallopian tube - compression of ovarian artery - ovarian necrosis - which is uncommon because th ovaries receive dual blood supply fro ovarian and uterine artery
Sudden-onset unilateral lower abdominal and/or pelvic pain
Nausea and vomiting
in all cases - emergency laparoscopy
Oophorectomy should only be performed if the ovary is frankly necrotic or gangrenous
Ovarian cystectomy or drainage
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infertility
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benign cyst adenoma can develop into malignant
diagnosis for ovarian cysts ?
bimanual examination
ultrasound
CT scan
to see if ruptured - culdocentesis
needle biopsy if needed to know the type of cyst
what are the treatment for ovarian cysts
pcos- explained
NSAIDs or paracetamol if painful
functional cysts resolves spontaneously
Treatment for dermoid cyst is complete surgical removal
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chocolate cysts - explained
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hypothyroidism -synthetic long-acting form of thyroxine, known as levothyroxine
when do functional cysts occur
before menopause
what is endometriosis ?
the endometrium tissue — seen outside your uterus.
most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis
what are the signs and symptoms of endometriosis ?
Up to one-third of patients are asymptomatic.
Chronic pelvic pain that worsens before the onset of menses.
Dysmenorrhea
Pre- or postmenstrual bleeding
Dyspareunia
Infertility
Dyschezia
cause of endometriosis?
Endometriosis is a heritable condition that is influenced by both genetic and environmental factors.
Retrograde menstruation
prolonged exposure to estrogen; for example, in late menopauseor early menarche
After a surgery, such as a hysterectomy or C-section, endometrial cells may attach
a complication of endometriosis?
INFERTILITY
Endometriosis in the uterotubal junction - ectopic
adenomyosis
HOW DO WE DIAGNOSE endometriosis?
ultrasound - identify chocolate cysts
Nodules in bladder or rectovaginal septum
laparoscopy - biopsy taken to confirm
and, once ovarian cancer has been ruled out, a positive CA-125 may confirm the diagnosis
treatment of endometriosis?
pain - NSAIDS
continuous combined hormonal contraceptives
intrauterine device with levonorgestrel - progestin therapy
if severe symptoms add
gnrh agonist (buserelin)
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if wanting to be pregnant - laparoscopic excision and ablation of endometrial tissue and cyst
gnrh agonist or IVF
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Second-line: open surgery with hysterectomy
what is the cause of endometrial polyps
there have been no definitive cause
have been linked to grow in response to circulating estrogen
risk: hypertension women over 40 obesity tamoxifen or hormone replacement therapy lynch syndrome
what are the symptoms of endometrial polyps ?
often cause no symptoms
metrorrhagia
hypermenorrhea
If the polyp protrudes through the cervix into the vagina, pain (dysmenorrhea)
infertility
what are the diagnosis of endometrial polyps ?
vaginal ultrasound
hysterosalpingography
hysteroscopy- biopsy is needed
what is the treatment of uterine polyps ?
waiting on small polyps resolve on their own , and also asymptomatic just need follow up observation
Polyps can be surgically removed using hysteroscopy and curettage
complications of uterine polyps ?
usually benign some may become precancerous or cancerous
increase risk of misscarrge in women undergoing IVF
also in pregnancy it can cause problems with presentation
infertility if the develop near fallopian tubes
there can be torsion or necrosis of the uterine polyp which can cause acute abdomen
what are the reasons for anterior vaginal wall prolapse ? and complications
cystocele - bladder into vagina
urethrocel - urethera into vagina
child birth , heavy lifting , marfan syndrome , chronic cough
wearing of the connective tissue between the vagina and bladder
urinary retention
what are the reasons for posterior vagina wall prolapse ? and what are the complication ?
enterocoele - small intestine into vagina
retrocele -rectum into vagina
caused by child birth
chronic constipation
weight lifting
chronic cough in smokers and copd
defection problems
atypical vaginal prolapsed are ?
uterine prolapse prolapse (childbirth , menopause loss of estrogen) - uterus into vagina
vaginal vault prolapse (roof of vagina) - after hysterectomy MAJOR PROBLEM DUE TO THE UTEROSACRAL LIGAMENT not being reattached to the vagina
diagnosis of genital prolapse ?
pelvic examination
CT
what is the management of these prolapses ?
non surgical - kegel excersises
pessary
surgical - colporrhaphy
what is a retroverted uterus ?
a uterus that is orientated posteriorly in respect to the normal slightly anteverted uterus (towards the bladder
what is the cause of retroverted uterus ?
from birth pelvic surgery pelvic adhesion endometriosis endometrial fibroids PID labour and child birth
what is the diagnosis of retroverted uterus ?
routine pelvic examination
TVS ultrasound
what are the symptoms of of retroverted uterus ?
usually no symptoms pain with sexual intercurse
dysmenorrhea, intestinal problems
what is the treatment fro retroverted uterus
treatment rarely needed
kegel excercises,
vaginal pessary ,
laparoscopic
reposition
what is vaginismus ?
condition in which involuntary muscle spasm prevents vaginal penetration.
This often results in pain with attempts at sex.
what are the causes of vaginismus ?
fear that penetration will hurt
risk factors : sexual assault
vaginitis
prior episiotomy
what are the treatment of vaginismus ?
psychological
kegel expressies
hegar dilators
what is a vesicovaginal fistula ?
abnormal tract extending between the bladder and the vagina that allows the continuous involuntary discharge of urine into the vaginal vault.
causes of vesicovaginal fistula ?
congenital anomaly
prolonged labor presses the unborn child tightly against the pelvis, cutting off blood flow to the vesicovaginal wall. The affected tissue may necrotize leaving a hole.
rape
treatment for vesicovaginal fistula ?
typically repaired either transvaginally or laparoscopically
