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Acute Gynaecological Conditions Flashcards

1
Q

What are the symptoms of an ectopic pregnancy?

A

Unilateral pain, positive pregnancy test, hypotensive, tachycardic, collapse, apyrexial

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2
Q

What investigations are done for a suspected ectopic pregnancy?

A

FBC and group & save

US = FAST scan or trans-vaginal

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3
Q

What is the appearance of an ectopic pregnancy on a USS?

A

Doughnut sign

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4
Q

Where do ectopic pregnancies occur?

A

98% occur in fallopian tubes

Also get C-section scar, cervical, ovarian or cornual ectopics

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5
Q

Can ectopic pregnancies be heteroscopic?

A

Yes = one in tube and one in uterus

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6
Q

What are the risk factors for an ectopic pregnancy?

A

Previous ectopic, tubal damage (e.g endometriosis), smoking, infertility and its treatment, extremes of reproductive age, intrauterine contraceptive devices

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7
Q

What is the management for an ectopic pregnancy?

A

Resuscitation and ABCDE
Laparotomy or laparoscopy = laparoscopy is better
Salphingetomy or salphingotomy
Anti-D if rhesus negative = due to presence of paternal rhesus positive blood in foetus

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8
Q

What are some features of a pregnancy of unknown location?

A

Static HCG and clinically well

May give methotrexate to lower hormone levels

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9
Q

How does ovarian torsion present?

A

Unilateral pain, apyrexial, normotensive, tachycardia, nausea/vomiting, HCG negative

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10
Q

What investigations are done for ovarian torsion?

A

FBC, CRP, group & save

Do US if palpable mass on vaginal examination

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11
Q

What are some features of ovarian torsion?

A

More likely in cysts >5cm
Dermoid cysts more likely to twist
10% are dermoid, 25% adnexal torsion occurs in children

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12
Q

How does the prognosis change for ovarian torsion depending on age?

A

Premenopausal more likely to be benign

Postmenopausal more likely to be malignant

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13
Q

How is ovarian torsion managed?

A 
Resuscitation and ABCDE
Laparoscopy = remove cyst through umbilical cord
Laparotomy if large cyst
Oophrectomy or cystectomy
May do hysterectomy if postmenopausal
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14
Q

What are the symptoms of appendicitus?

A

Gradual onset RIF pain, anorexia, nausea/vomiting, diarrhoea, HCG negative, normal HR and BP, Rosving’s positive, rebound and guarding, raised WCC and CRP

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15
Q

Why do you do a USS in suspected appendicitus?

A

To rule out gynaecological cause

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16
Q

What are the symptoms of a cyst accident?

A

Sudden onset unilateral pain occurring after sex, HCG negative, tachycardic, hypotensive, apyrexial

17
Q

What investigations would be done for a cyst accident?

A

FBC, CRP, group & save, USS

18
Q

What cysts tend to be implicated in cyst accidents?

A

Commonly occur in functional cysts = may also be dermoid or endometrioma

19
Q

What causes cyst accidents?

A

May be spontaneous or due to trauma (e.g sport, sex) = have potential for haemorrhage

20
Q

What is the management of a cyst accident?

A

Conservative management if stable
Laparoscopy if patient needed resuscitation
Lavage and stop bleeding

21
Q

What are the symptoms of pelvic inflammatory disease?

A

Gradual onset lower abdominal pain, anorexia, intermenstrual and post-coital bleeding, discharge, HCG negative, normal BP and HR, pyrexial

22
Q

What investigations are done for pelvic inflammatory disease?

A

FBC and CRP
2x genital swabs = for chlamydia and gonorrhoea
LFTs = to look for Fitz-Hugh Curtis syndrome

23
Q

What causes pelvic inflammatory disease?

A

Ascending infection from endocervix = chlamydia, gonorrhoea, gardenella, anaerobes

24
Q

What occurs in pelvic inflammatory disease?

A

Endometritis, salphingitis and tubo-ovarian abscess

25
Q

What can pelvic inflammatory disease lead to?

A

Infertility, chronic pelvic pain or ectopic pregnancy

26
Q

What is the management of pelvic inflammatory disease?

A

Need to take 6 swabs
14 days metronidazole and doxycycline = IV if vomiting
May need to remove IUD
Laparoscopy if not cleared by antibiotics

27
Q

Do you need to do contact tracing for pelvic inflammatory disease?

A

Yes

28
Q

What reduces the incidence of pelvic inflammatory disease?

A

Use of barrier contraception

29
Q

What are the menstrual causes of acute bleeding?

A

Anovulatory cycle, fibroids, anticoagulation, Von-Willebrand’s disease (especially if young)

30
Q

What are the non-menstrual causes of acute bleeding?

A

Miscarriage, cervical cancer, endometrial cancer, vaginal trauma

31
Q

What investigations are done for acute bleeding?

A

FBC, coagulation screen, CRP, group & save
HCG, LFTs, ferritin, US
Endometrial or cervical biopsy
Look for prolapsed fibroid = won’t stop bleeding

32
Q

What is the management for acute bleeding?

A 
Resuscitation and ABCDE
Tranexamic acid = anti-fibrinolytic 
Mefenamic acid = reduces prostaglandins
Norethisterone, IUS, COCP
GnRH analogues = for fibroids/uncontrolled bleeding
33
Q

What are some causes of a painful vulva?

A

HSV infection = due t infection with HSV 1 or 2 Bartholin’s gland abscess = due to blocked duct

34
Q

What are the symptoms of HSV infection?

A

Pain, ulceration, discharge, dysuria, urinary retention, inguinal lymphadenopathy

35
Q

How is HSV infection diagnosed?

A

Do viral swab for PCR

36
Q

What is the management for HSV infection?

A

Aciclovir, bladder catheter, local anaesthetic gel

37
Q

What are Bartholin’s glands?

A

Bilateral glands at 5 and 7 o’clock positions = located within vagina, produce vaginal lubrication

38
Q

What are the symptoms of a Bartholin’s gland abscess?

A

Infection, pain, swelling

39
Q

How are Bartholin’s gland abscesses managed?

A 
Do swab to diagnose
Conservative if not severe 
Broad spectrum antibiotics 
Drainage with Word catheter
Marsupialisation = recurrent/not cleared with antibiotics

Reproduction (62 decks)

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