Acute Gynaecology Flashcards

1
Q

What is an ectopic pregnancy?

A

Pregnancy outwit the endometrial cavity - majority are in the tube

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2
Q

State the risk factors for an ectopic pregnancy

A

Previous ectopic, tubal damage, IUD, smoking (kills microvilli), infertility/IVF (fluid can travel past the uterus and into the tubes), extremes of age and sterilisation

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3
Q

What investigations should be done in suspected ectopic pregnancy?

A

FBC, Group and save

US/FAST - donut sign due to thickening of sac, free fluid

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4
Q

How is an ectopic pregnancy managed?

A

Resuscitation, laparoscopy, better
- salpingectomy if other tube is normal
- salpingostomy if worries over fertility
Anti-D vaccine

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5
Q

What dictates the management in pregnancy of unknown location?

A

HCG - will decrease in miscarriage, normally will double but can be static

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6
Q

How is a pregnancy of unknown location treated medically?

A

Methotrexate

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7
Q

What surgery can be done in pregnancy of unknown location?

A

Diagnostic laparoscopy - uterus can be washed out simultaneously

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8
Q

At what size of cyst is ovarian torsion likely?

A

> 5cm

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9
Q

Is an ovarian cyst likely to be benign or malignant?

A

Premenopause - benign

Postmenopause - malignant

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10
Q

Describe the investigations in ovarian torsion

A

Palpable mass on examination
FBC, CRP, group and save
Ultrasound - arterial gorging
AXR - mass, calcification in dermoid cyst

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11
Q

What is a dermoid cyst?

A

Cyst with hair/teeth can have any cell from the body

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12
Q

How are ovarian torsions managed?

A

Laparoscopy, bag and take out via umbilicus (detort without bursting)

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13
Q

How does a cyst rupture present?

A

Unilateral pain often bleeding after sex/contact sport

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14
Q

What kind of cyst commonly ruptures?

A

Functional
Dermoid
Endometrioma

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15
Q

What investigations are done in cyst rupture?

A

FBC, CRP, Ultrasound - free fluid in pelvis

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16
Q

How is a cyst rupture managed?

A

Conservative

Laparoscopy - lavage and stop bleeding with diathermy

17
Q

What is PID?

A

Pelvic Inflammatory Disease - caused by ascending infection from the endocervix

18
Q

What are the causes of PID?

A
Endometritis 
Abscess
Chlamydia 
Gonorrhoea 
Gardenella 
Anaerobes
19
Q

What are the consequences of PID?

A

Infertility
Chronic pelvic pain
Ectopic pregnancy

20
Q

State the investigations that should be carried out in PID

A

FBC, CRP, LFT, cervical motion tenderness, gonorrhoea and chlamydia swabs

21
Q

How is PID managed?

A

Ceftriaxone, metronidazole and doxycycline

22
Q

What are the menstrual related causes of acute bleeding?

A

Anovulatory
Fibroids
Anticoagulant
Van Willebrands Disease

23
Q

What are the non-menstrual related causes of acute bleeding?

A

Miscarriage
Cervical cancer
Endometrial cancer
Vaginal trauma

24
Q

What investigations should be done in acute gynae bleeding?

A
FBC, CRP, HCG, coagulation, GandS
LFT, ferritin 
Endometrial/cervical biopsy 
Ultrasound 
Examine pad
25
Q

How is acute gynae bleeding managed?

A

ABCDE
Tanexamic acid - fibrinolytic
Mefanamic acid - NSAID reduces blood supply
Norethisterone - progesterone stabilises endometrium
IUS - stabilises lining to stop period
COCP
GnRH analogue - temporary menopause

26
Q

How will an infected Bartholin’s abscess present?

A

Painful swelling - unable to sit down

27
Q

What causes bartholin’s abscess?

A

E.coli

Anaerobes

28
Q

How can Bartholin’s abscess be treated?

A

Conservative
Broad Spec antibiotics
Incision and drainage with word catheter
Marsupialisation - suture backwards to drain freely