acute gynaecology Flashcards
what are the 2 main reasons for ovarian torsion
hypermobility of the ovary
adnexal mass
what is the most common adnexal mass to cause ovarian torsion
dermoid cyst
clinical presentation of ovarian torsion
severe lower abdo pain, nausea and vomiting
adnexal tenderness
what is the first line investigation for ovarian torsion
US
what investigation can be useful for ruling out ovarian torsion in a patient with normal ultrasound
CT
what is the most common cause of pelvic pain in an afebrile, premenopausal woman
ruptured ovarian cyst
clinical presentation of a ruptured ovarian cyst
acute unilateral pain, bloating ?rebound tenderness
investigations in suspected ruptured ovarian cyst
bimanual examination, pregnancy test
transvaginal ultrasound
how would we investigate a suspected ruptured ovarian cyst in an unstable patient
laporoscopy
management of recurrent or unresolved simple cysts
combined oral contraceptive pill
prevents ovulation so prevents the formation of new cysts
what is pelvic inflammatory disease
where an infection spreads from the vagina to the cervix and subsequently to the upper genital tract (ovaries, uterus etc.)
how is PID predominantly spread
sexual contact
organisms involved most commonly with PID
chlamydia, gonorrhoea, anaerobes
clinical presentation of PID
bilateral abdo pain, vaginal discharge, bleeding after sex, cervical motion tenderness, fever
investigations for PID
STI screen, dipstick, TVUS
management of PID
metronidazole + doxycycline
if risk of gonorrhoea or under 18: + ceftriaxone IM
name some complications of untreated PID
infertility, ectopic pregnancy, abscess formation, chronic pelvic pain
fitz-hugh-curtis syndrome
pathophysiology of fitz-hugh-curtis syndrome
ascending infection spreads to the liver capsule, causing violin-string adhesions between the liver and peritoneum
investigation for fitz-hugh-curtis syndrome
normal ones for PID + LFTs
symptoms of fitz-hugh-curtis syndrome
right upper quadrant pain + history of PID symptoms
