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Gynaecology > Abnormal Bleeding and Findings > Flashcards

Abnormal Bleeding and Findings Flashcards

1
Q

What is cervical ectropion

A

Occurs when the columnar epithelium of the endocervix has extended to the ectocervix

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2
Q

What is the finding on speculum examination of ectropion

A

Lining of endocervix is visible on exam which has a different appearance to the normal endocervix

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3
Q

What are the properties of endocervix

A

more fragile and prone to trauma, more likely to bleed with sexual intercourse.

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4
Q

Which populations is cervical ectropion more common in

A

Associated wit high oestrogen levels so more common in younger women, those taking COCP and pregnancy

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5
Q

Presentation of cervical ectopion

A

Asymptomatic
Increased vaginal discharge
Vaginal bleeding
Dysparenuria
Postcoital bleeding

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6
Q

Treatment of cervical ectopion

A

Asymptomatic - no treatment
Usually resolves as patient gets older, stops taking pill or is no longer pregnant.
Cauterisation using silver nitrate or cold coagulation during colposcopy

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7
Q

What is a nabothian cyst

A

Fluid filled cyst on the surface of the cervix - usually up to 1cm in size

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8
Q

How do nabothian cysts form

A

The squamous epithelium of the ectocervix slightly coverse the mucus secreting columnar epithelial cells, so the mucus becomes trapped and forms a cyst

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9
Q

When do nabothian cysts mainly form

A

After childbirth, minor trauma, or cervicitis secondary to infection

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10
Q

Presentation of nabothian cysts

A

Rarely cause symptoms and found incidentally as smooth white round lumps on the cervix typically near Os.

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11
Q

Management of nabothian cysts

A

Reassurance and no treatment, do not cause harm and often resolve spontaneously

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12
Q

What is a Bartholins cyst

A

When the ducts become blocked the swell and fill with fluid, they are located on either side of the posterior part of the vaginus introitus - usually 1-4cm

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13
Q

Complication of bartholins cyst

A

Can become infected and cause abscess which will be hot, red, tender and drain pus. This will require abx and swab of pus

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14
Q

Management of Bartholins cyst

A

Hygiene, analgesia, warm compresses
Can be treated surgically with word catheter or marsupialisation

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15
Q

What is FGM

A

Involves surgically changing the genitals of a female for non-medical reasons. Cultural practises which usually occur in girls before puberty. Form of child abuse and safeguarding issue.

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16
Q

Types of FGM

A

Removal of part of all of clitoris
Removal of part or all of clitoris and labia minora, labia majora may also be removed
Narrowing or closing of the vaginal orifice (infibulation)
All other unnecessary procedures to female genitalia

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17
Q

Immediate complications of FGM

A

Pain, bleeding, infection, swelling, urinary retention, urethral damage and incontinence

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18
Q

Long term complications of FGM

A

Vaginal infections, pelvic infections, UTIs, dysmenorrhoea, sexual dysfunction, dysparenuria, infertility, pregnancy related complications, psychological issues, reduced engagement with healthcare and screening

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19
Q

Management of FGM

A

Education
Report case if below 18 years old
De-infibulation - correcting the narrowing or closure of the vaginal orifice, improving symptoms and restoring normal function

20
Q

Causes of pelvic inflammatory disease (PID)

A

Neisseria gonorrhoea
Chlamydia trachomitis
Mycoplasma genitalium
Gardenella vaginalis
Haemophilus influenza
E coli
Most commonly STIs

21
Q

Risk factors for PID

A

No barrier protection
Multiple sexual partners
Younger age
Existing STI
Previous PID
IUD

22
Q

Presentation of PID

A

Pelvic or lower abdominal pain
Abnormal vaginal discharge
Abnormal bleeding
Pain during sex
Fever
Dysuria

23
Q

Examination of PID

A

Pelvic tenderness
Cervical motion tenderness
Inflamed cervix
Purulent discharge
fever and signs of sepsis

24
Q

Investigations into PID

A

NAAT swabs
HIV test
Syphilis test
High vaginal swab
Microscope to look for pus cells
Pregnancy test
Inflammatory markers

25
Q

Management of PID

A

GUM service
Contact tracing
Abx started empirically
More severe cases may require admission to hospital

26
Q

Complications of PID

A

Sepsis
Abscess
Infertility
Tubular infertility
Chronic pelvic pain
Ectopic pregnancy
Fitz-Hugh-Curtis Syndrome

27
Q

Which group are ovarian cysts most common in

A

Premenopausal women

28
Q

Presentation of ovarian cyst

A

Mostly asymptomatic
Pelvic pain, bloating, fullness in abdomen, palpable pelvic mass, acute pelvic pain if there is torsion, haemorrhage or rupture of cyst

29
Q

What are functional / follicular cysts

A

When the follicle fails to rupture and release the egg, the cyst can persist. They are harmless and tend to disappear within few menstrual cycles

30
Q

What are corpus luteum / functional cysts

A

When the corpus luteum fails to break down and instead fills with fluid - may cause pelvic pain, discomfort, or delayed menstruation. Often seen in early pregnancy

31
Q

Examples of other types of ovarian cysts

A

Serous cystadenoma
Mucinous cystadenoma
Endometrioma
Dermoid cyst/germ cell tumour
Sex cord stromal tumour

32
Q

Management of cyst less than 5cm

A

Do not require follow up scan

33
Q

Management of cysts 5-7 cm

A

Referral to gynae and yearly US monitoring

34
Q

Management of cysts >7cm

A

MRi scana nd surgical evaluation

35
Q

What presentation of cyst needs a 2 week wait referral

A

Cyst in postmenopausal woman

36
Q

Complications of ovarian cyst

A

Ovarian torsion
HAemorrhage into cyst
Rupture with bleeding into peritoneum

37
Q

What is the triad in Meig’s syndrome

A

Overian fibroma
Pleural effusion
Ascites

38
Q

Who does Meig’s syndrome typically occur in

A

Older women

39
Q

What is ovarian torsion

A

Condition where the ovary twists in relation to the surrounding connective tissue, fallopian tube and blood supply (adnexa)

40
Q

What is an ovarian torsion usually due to

A

Mass larger than 5cm such as cyst or tumour, more likely to occur with benign tumours and during pregnancy

41
Q

Presentation of ovarian torsion

A

Sudden onset severe unilateral pelvic pain
Constant pain getting progressively worse
Associated with severe nausea and vomiting
Pain is not always severe and can take a milder more prolonged course - occasionally the ovary can twist and untwist intermittently causing pain that comes and goes.

42
Q

Examination findings of ovarian torsion

A

Localised tenderness, palpable mass in pelvic, but not always

43
Q

Diagnosis of ovarian torsion

A

Pelvic US is first investigaion of choice
Shows whirlpool sign, free fluid in pelvis and oedema of the ovary
Doppler studies may show lack of blood flow
Definitive diagnosis is made with laparoscopic surgery

44
Q

Management of ovarian torsion

A

Emegency admission - laparoscopic surgery to untwist ovary and fix in place. Or removal of the affected ovary - oophrectomy

45
Q

Complications of ovarian torsion

A

Delay in treatment can cause loss of ovarian function
Fertility not affected as other ovary can compensate
If necrotic ovary is not removed, it may become infected, develop abscess and lead to sepsis. Can rupture causing peritonitis and adhesions

Gynaecology (7 decks)

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