Acute Gynaecological Conditions Flashcards
What are the symptoms of an ectopic pregnancy?
Unilateral pain, positive pregnancy test, hypotensive, tachycardic, collapse, apyrexial
What investigations are done for a suspected ectopic pregnancy?
FBC and group & save
US = FAST scan or trans-vaginal
What is the appearance of an ectopic pregnancy on a USS?
Doughnut sign
Where do ectopic pregnancies occur?
98% occur in fallopian tubes
Also get C-section scar, cervical, ovarian or cornual ectopics
Can ectopic pregnancies be heteroscopic?
Yes = one in tube and one in uterus
What are the risk factors for an ectopic pregnancy?
Previous ectopic, tubal damage (e.g endometriosis), smoking, infertility and its treatment, extremes of reproductive age, intrauterine contraceptive devices
What is the management for an ectopic pregnancy?
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
What are some features of a pregnancy of unknown location?
Static HCG and clinically well
May give methotrexate to lower hormone levels
How does ovarian torsion present?
Unilateral pain, apyrexial, normotensive, tachycardia, nausea/vomiting, HCG negative
What investigations are done for ovarian torsion?
FBC, CRP, group & save
Do US if palpable mass on vaginal examination
What are some features of ovarian torsion?
More likely in cysts >5cm
Dermoid cysts more likely to twist
10% are dermoid, 25% adnexal torsion occurs in children
How does the prognosis change for ovarian torsion depending on age?
Premenopausal more likely to be benign
Postmenopausal more likely to be malignant
How is ovarian torsion managed?
Resuscitation and ABCDE Laparoscopy = remove cyst through umbilical cord Laparotomy if large cyst Oophrectomy or cystectomy May do hysterectomy if postmenopausal
What are the symptoms of appendicitus?
Gradual onset RIF pain, anorexia, nausea/vomiting, diarrhoea, HCG negative, normal HR and BP, Rosving’s positive, rebound and guarding, raised WCC and CRP
Why do you do a USS in suspected appendicitus?
To rule out gynaecological cause
What are the symptoms of a cyst accident?
Sudden onset unilateral pain occurring after sex, HCG negative, tachycardic, hypotensive, apyrexial
What investigations would be done for a cyst accident?
FBC, CRP, group & save, USS
What cysts tend to be implicated in cyst accidents?
Commonly occur in functional cysts = may also be dermoid or endometrioma
What causes cyst accidents?
May be spontaneous or due to trauma (e.g sport, sex) = have potential for haemorrhage
What is the management of a cyst accident?
Conservative management if stable
Laparoscopy if patient needed resuscitation
Lavage and stop bleeding
What are the symptoms of pelvic inflammatory disease?
Gradual onset lower abdominal pain, anorexia, intermenstrual and post-coital bleeding, discharge, HCG negative, normal BP and HR, pyrexial
What investigations are done for pelvic inflammatory disease?
FBC and CRP
2x genital swabs = for chlamydia and gonorrhoea
LFTs = to look for Fitz-Hugh Curtis syndrome
What causes pelvic inflammatory disease?
Ascending infection from endocervix = chlamydia, gonorrhoea, gardenella, anaerobes
What occurs in pelvic inflammatory disease?
Endometritis, salphingitis and tubo-ovarian abscess
What can pelvic inflammatory disease lead to?
Infertility, chronic pelvic pain or ectopic pregnancy
What is the management of pelvic inflammatory disease?
Need to take 6 swabs
14 days metronidazole and doxycycline = IV if vomiting
May need to remove IUD
Laparoscopy if not cleared by antibiotics
Do you need to do contact tracing for pelvic inflammatory disease?
Yes
What reduces the incidence of pelvic inflammatory disease?
Use of barrier contraception
What are the menstrual causes of acute bleeding?
Anovulatory cycle, fibroids, anticoagulation, Von-Willebrand’s disease (especially if young)
What are the non-menstrual causes of acute bleeding?
Miscarriage, cervical cancer, endometrial cancer, vaginal trauma
What investigations are done for acute bleeding?
FBC, coagulation screen, CRP, group & save
HCG, LFTs, ferritin, US
Endometrial or cervical biopsy
Look for prolapsed fibroid = won’t stop bleeding
What is the management for acute bleeding?
Resuscitation and ABCDE Tranexamic acid = anti-fibrinolytic Mefenamic acid = reduces prostaglandins Norethisterone, IUS, COCP GnRH analogues = for fibroids/uncontrolled bleeding
What are some causes of a painful vulva?
HSV infection = due t infection with HSV 1 or 2 Bartholin’s gland abscess = due to blocked duct
What are the symptoms of HSV infection?
Pain, ulceration, discharge, dysuria, urinary retention, inguinal lymphadenopathy
How is HSV infection diagnosed?
Do viral swab for PCR
What is the management for HSV infection?
Aciclovir, bladder catheter, local anaesthetic gel
What are Bartholin’s glands?
Bilateral glands at 5 and 7 o’clock positions = located within vagina, produce vaginal lubrication
What are the symptoms of a Bartholin’s gland abscess?
Infection, pain, swelling
How are Bartholin’s gland abscesses managed?
Do swab to diagnose Conservative if not severe Broad spectrum antibiotics Drainage with Word catheter Marsupialisation = recurrent/not cleared with antibiotics
