Acute Gynae Flashcards
What are investigations for unilateral abdo pain in female with suspicion of ectopic?
FBC, G&S, USS - FAST scan versus transvaginal
What is presentation of ectopic pregnancy? (8)
shoulder tip pain, bleeding, LMP, dyschezia, vomiting and diarrhoea, faint, hypotensive, tachycardia
Ectopic pregnancy risk factors (7)
previous ectopic, tubal damage, IUS/IUD, smoking, infertility, infertility treatment, odler reproductive age
Initial management of ectopic
resus, ABCDE
What are surgical managements options for ectopic
laparoscopic, laparotomy, salphingectomy, salphingotomy, anti D if necessary
Pregnancy of unknown location presentation in terms of HCG levels?
static HCG - if goes down then failing, if static then unknown location, if rising then normal pregnancy. , clinically well
What are management options for PUL?
expectant management, medical: methotrexate, consider surgical
Cyst presentation (4)
sudden onset unilateral fossa pain,
faint,
tachycardia,
normotensive
Cyst investigations? (3)
Bloods (FBC, CRP, G&S), palpable mass on vaginal exam, transvaginal ultrasound
Torsion is more likely with a cyst of what size?
more likely with a cyst >5cm
What percent of ovarian torsion are caused by dermoid cysts?
10%
What percent of adnexal torsions occur in children?
25%
Premenopausal ovarian torsion most likely ____ whereas postmenopausal ovarian torsion most likely ___
benign, malignant (shouldn’t be producing follicles)
Ovarian torsion treatment (5)
resus and ABCDE, laparoscopy/laparotomy, detorsion, cystectomy, oophrectomy (if necrotic)
Cyst accident presentation? (6)
sudden onset unilateral fossa pain, may be precipitated by sex, sports or spontaneous, tachycardic, hypotensive, apyrexial, HCG negative
Cyst accident investigations?
Bloods (FBC, CRP, G&S), peritonism, ultrasound
How does fluid in peritoneum appear on USS in cyst rupture in comparison to ectopic rupture?
Cyst rupture all black, watery fluids as opposed to different colours in ectopic pregnancy ruputre
Cyst rupture commonly occurs in what type of cyst and rarely in which?
common in functional cysts, rarely in dermoid or endometrioma
Management cyst accident?
Conservative if not that unwell. If unwell resus, laparoscopy, lavage, stop bleeding, oophrectomy if needed
Presentation PID? (7)
gradual onset generalised lower abdo pain, discharge, dyspareunia, intermenstrual & post coital bleeding, anorexia, n&v (but more likely with appendicitis) normal HR, BP, temp and HCG neg
PID investigations
Bloods: FBC, CRP, LFT (PIDs can irritate liver), Cervical motion tenderness, genital swabs x2
What is another word for cervical excitation?
cervical motion tenderness
What is PID and what can it cause inflammation of?
An ascending infection from endocervix that can cause endometritis, salphingtitis and tubo-ovarian abscess
List 4 organisms that can cause PID
Chlamydia, gonorrhoea, gardenella, anaerobes
What are some long term complications of PID? (3)
Infertility, chronic pelvic pain and ectopic pregnancy
Management of PID?
14 days metronidazole and doxycycline, IV if needed, remove IUD if can, laparoscopy if needed to drain abscess
What are 4 menstrual causes of acute bleeding?
If you get anovulatory periods e.g. puberty or premenopause, fibroids, on anticoagulant, von willebrand’s disease
What are 4 non menstrual causes of acute bleeding?
miscarriage, cervical causes, endometrial cancer, vaginal trauma
Why do fibroids cause acute bleeding?
Fibroids increase surface area of uterus so more area to bleed from
Acute vaginal bleeding investigations?
Bloods (FBC, CRP, Coag, G&S, HCG, LFTs, Ferritin), consider: endometrial biopsy (in 40s,50s), cervical biopsy, examine pad, ultrasound ( for thickened endometrium, fibroids)
What are management options for acute bleeding?
resus, tranexamic acid (antifibrinolytic to prevent clot breakdown), mefanamic acid (NSAID to reduce blood supply), norethisterone (synthetic progesterone, stabilises endometrium), IUS (stabilises endometrium), COC, GnRH analogues (overload system so downregulation of FSH and LH)
HSV Presentation?
vulval pain, ulceration, discharge, dyrsuria, urinary retention
Investigations HSV?
Viral swab
Treatment HSV?
aciclovir, consider bladder catheter if urinary retention, local anaesthetic gel
Bartholin’s glands are at 5 and 7 o clock. Bartholins gland cyst presentation?
Infection signs, swelling, pain, waddle into clinic and sit on one buttcheek
Bartholins abscess investigations?
swab
Bartholins cyst treatment?
Conservative if not infected (will drain itself), antibiotics - broad spectrum, incision and drainage, word catheter, marsupialisation
4 other considerations of acute gynae presentation causes?
retained tampon, foreign body in vagina, procidentia (prolapse), post colposcopy infection
Negative swabs exclude PID. True/false?
False - they don’t exclude
What is another name for fibroid?
Leiomyoma
How can anovulation cause acute bleeding?
Get a build up of a couple months of period coming out at once
