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Obs and Gynae Y4 > 8. Common Gynaecological Disorders > Flashcards

8. Common Gynaecological Disorders Flashcards

1
Q

Menstrual blood loss

A

35-45mls per cycle

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2
Q

Prostaglandins controlling uterine vasoconstriction

A
  • PG F2a – causes vasoconstriction
  • PG E2 and Prostacyclin (PGI2) – causes vasodilatation
  • Prostacyclin (PGI2) – inhibits platelet aggregation
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3
Q

List 7 menstrual disorders

A
  • Amenorrhoea
  • Menorrhagia
  • Metrorrhagia
  • Intermenstrual bleeding
  • Polymenorrhoea
  • Oligo/Amenorrhoea
  • Dysmenorrhoea
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4
Q

Primary amenorrhoea

A

Temporary or permanent absence of menses due to dysfunction of hypothalamus /pituitary /ovaries /uterus/ vagina.

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5
Q

Puberty stages

A
  • Growth spurt
  • Axillary and pubic hair development
  • Apocrine sweat glands, breast development
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6
Q

1* Amenorrhoea and short statue

A

–> Turner syndrome or growth hormone deficiency

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7
Q

1* Amenorrhoea and Galactorrhoea

A

Hypothalamic or pituitary disease, or drug induced (metoclopramide)

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8
Q

1* Amenorrhoea and PCOS + hyper-androgenism (acne, hirsutism)

A

Adrenal tumour

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9
Q

Kallmann’s syndrome and amenorrhoea

A

Kallmann;s causes 1* amenorrhoea - absence of GnRH neurons. (associated with ansomnia and colour-blindness)

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10
Q

Kallmann’s Syndrome inheritance

A

Autosomal dominant or X-linked recessive

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11
Q

Anatomical abnormalities in primary amenorrhoea

A
  • Intact hymen
  • Transverse vaginal septum
  • Mullerian/vaginal agenesis
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12
Q

Tanner staging

A

Rates development of 2ndary sexual characteristics; Sexual Maturity Rating

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13
Q

Treatment for 1* Amenorrhoea in Primary Ovarian Insufficiency

A

Give HRT to prevent bone loss or premature coronary heart disease

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14
Q

Treatment for 1* amenorrhoea for pts to get pregnant

A

Exogenous GnRH or pulsatile GnRH

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15
Q

Secondary amenorrhoea

A

Absence of Menses for >6 moths in someone with previous regular periods

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16
Q

2* amenorrhoea and hypothalamic-pituitary involvement

A

Polyuria, polydipsia, fatigue, visual defects, headaches

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17
Q

2* amenorrhoea and oestrogen deficiency

A

hot flushes, vaginal dryness, poor sleep, decreased libido

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18
Q

Laboratory test for 2* amenorrhoea

A

hCG, FSH, TSH, Prolactin

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19
Q

How to manage low bone density in 2* amenorrhoea?

A

Oestrogen replacement

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20
Q

Menorrhagia

A

Ovulatory heavy menstrual bleeding

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21
Q

Investigations in menorrhagia

A

Pelvic USS, FBC, TFT, Clotting screen, endometrial biopsy (all women >45yo)

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22
Q

Medical therapies for Menorrhagia

A

NSAIDs, Haemostatics, Hormones, IUS

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23
Q

Menorrhagia and NSAIDs drugs

A

Mefenamic acid, Indomethacin, Ibuprofen, Naproxen

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24
Q

Menorrhagia and NSAIDs

A
  • Taken only during menstruation
  • 50% reduction in menstruation volume loss
  • Improves dysmenorrhoea and dyspareunia
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25
Q

Menorrhagia and haemostatics drugs

A
  • Antifibronolytics (tranexamic acid - cyclokapron)

- Capillary wall stabiliser (ethamsylate - dicynene)

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26
Q

Antifibrinolytics for menorrhagia

A
  • Taken only during menstruation
  • > 50% reduction in mestruation volume loss
  • Superior to NSAIDs controlling the loss, but not the pain
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27
Q

Capillary wall stabiliser for menorrhagia

A
  • Taken only during menstruation
  • No contraindications
  • 20-30% blood loss reduction
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28
Q

Menorrhagia and hormones

A
  • Oral contraceptives (cycle regulation, reduction of loss and dysmenorrhoea)
  • HRT (cycle regulation only)
  • Synthetic progestagens (cycle regulation, loss reduction)
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29
Q

Menorrhagia and hormones HPO axis regulation

A
  • Danazol (reduces flow, lots of side effects and expensive)
  • Gestrinone (similar to danazol)
  • GnRH analogues (induce menopause, lots of side effects and expensive)
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30
Q

IUS for Menorrhagia

A

Levonorgesterol

31
Q

Surgical therapy for menorrhagia

A

Hysteroscopy, Hysterectomy, Endometrial destruction

32
Q

Menorrhagia and hysteroscopy

A
  • Endometrial resection (TCRE)

- Endometrial ablation (ELA, RFA)

33
Q

Endometrial resection

A

TCRE - transcervical resection of the endometrium

34
Q

Endometrial ablation

A

ELA - endometrial laser ablation

RFA - radiofrequency ablation

35
Q

Hysterectomy

A

TAH - total abdominal hysterectomy
VH - vaginal hysterectomy
LAVH - laparoscopy assisted vaginal hysterectomy

36
Q

Endometrial destruction

A
  • No risk of menopause induction

- Intra and post operative complications

37
Q

Indication for therapy in menorrhagia

A

Women <40 yo, Regular cycles and no IMB, no risk factors for malignancy, clinically normal pelvis

38
Q

Metrorrhagia definition

A

An-ovulatory Heavy Menstrual Bleeding

39
Q

Intermenstrual bleeding differential diagnosis

A

ovulatory dysfunction, neoplasia, uterine structural pathology, disorders of haemostasis

40
Q

Disorders that cause Abnormal Uterine Bleeding

A
  • Bleeding disorders, Endocrine disorders, Coeliac disease, Anticoagulant use, hyperprolactinemia
41
Q

AUB: PALM - COEIN

A

Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not classified

42
Q

Fibroids treatment:

A
  • conservative management
  • uterine artery embolisation
  • MRI-guided ultrasound coagulation
  • Myomectomy (surgical removal of fibroids)
  • Hysterectomy
43
Q

Fibroid treatment

A
  • Uterine artery embolization
  • Ultrasound coagulation
  • Myomectomy (surgical removal of fibroids)
  • Hysterectomy
44
Q

Vaginal epithelium

A

Non-keratinized, stratified squamous; rich in glycogen.

45
Q

Doderlein Lactobacilli

A

Convert glucose (from glycogen from sloughed cells) into lactate to provide acidic environment (pH 4.0-4.5)

46
Q

The role of acidic pH in the vagina

A
  • Maintain vaginal flora

- Inhibit growth of pathogens

47
Q

Non-specific vulvovaginal symptoms:

A
  • Change in volume, colour, or odour of vaginal discharge
  • Pruritis
  • Burning and irritation
  • Erythema
  • Dyspareunia
  • Spotting
  • Dysuria
48
Q

Symptoms of bacterial vaginosis (BV)

A

Malodorous, thin grey discharge, symptoms during and just after period

49
Q

Symptoms of vaginal candidiasis

A

Scant thick white, odourless discharge

50
Q

Symptoms of trichomoniasis

A

Purulent, malodorous discharge + burning, pruritis, dysuria, dyspareunia, symptoms during and just after period

51
Q

Pruritis characteristics

A

Diffuse infection and allergy; chronic -> malignancy or neoplasia

52
Q

Burning and irritation – diseases:

A
  • Candida vulvo-vaginitis

- Vulvodynia

53
Q

Candida vulvo-vaginitis:

A

Inflammation, pruritis and soreness (premenstruation symptoms)

54
Q

Vulvodynia:

A

Non-infectious disorder

55
Q

Erosive vulvo-vaginitis

A

Multifocal rounded macular erythematous lesions (burises/spotter rash-like), purulent discharge and tenderness

56
Q

BV discharge

A

Fishy-smelling, grey thin, homogenous discharge

57
Q

Trichomoniasis discharge

A

Greenish-yellow purulent discharge

58
Q

Candidiasis discharge:

A

Thick white, adherent, ‘cottage cheese like’ discharge

59
Q

What do chocolate cysts suggest?

A

Endometrioma

60
Q

Endometriosis treatment

A
  • Continuous COCP or POP
  • Mirena IUS
  • GnRH agonists
  • Surgery (ablation and pelvic clearance)
61
Q

Differential diagnosis in Pelvic Inflammatory Disease

A
  • Ectopic pregnancy
  • Acute appendicitis
  • Endometriosis
  • Ovarian torsion
  • Ovarian cyst rupture
  • UTI
62
Q

Symptoms of PID

A
  • Lower abdominal pain
  • Dyspareunia
  • Abnormal vaginal bleeding
  • Dysmenorrhoea
  • Abnormal discharge
  • Fever, positive test for gonorrhoea, chlamydia, or M genitalium
63
Q

Outpatient treatment for PID

A

IM ceftriaxone 1000mg (Single dose), Doxycycline PO BD 100mg (14 days), Metronidazole PO BD 400mg (14 days)

64
Q

Inpatient treatment for PID

A
  • IV continued for 24h post improvement and switched to oral
  • IV ceftriaxone 2g daily
  • IV doxycycline 100mg BD
    NEXT:
  • Doxycycline PO BD 100mg (14 days)
  • Metronidazole PO BD 400mg (14 days)
65
Q

Chronic PID treatment

A
  • Abx
  • Anaelgesia
  • Adhesiolysis
  • Hysterectomy and bilateral salpingectomy
66
Q

Ovarian cysts blood tests:

A
  • FBC
  • CA125
  • Lactate dehydrogenase
  • A-FP and hCG
67
Q

RMI (Risk of Malignancy Index)

A

U x M x CA-125

U – ultrasound (1 for: multilocular cysts, solid areas, metastases, ascites, bilateral lesions)
M – menopausal status (1 – premenopause, 3 – postmenopause)
Serum CA125 – IU (0-1000s)

68
Q

Ovarian cyst management

A

<5cm no treatment
5-7cm yearly USS
>7cm MRI/surgical intervention (laparoscopic cystectomy but no aspiration!)

69
Q

Bartholin glands (greater vestibular glands)

A

Secretes mucus and lubricates vulva and vagina (Bartholin ducts drain here – if blocked - vulvar mass)

70
Q

Bartholin cyst

A

If Bartholin duct is obstructed, mucus accumulates -> dilatation of duct -> obstruction causes a cyst

71
Q

Bartholin abscess

A

Obstructed duct becomes infected and forms an abscess

72
Q

Fluid from Bartholins mass:

A

Cyst: clear or white fluid
Abscess: yellow or green

73
Q

Bartholin abscess/cyst management

A

Abx, word’s catheter, marsupialisation

Obs and Gynae Y4 (22 decks)

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