Adnexal Masses, Incontinence, GYN infections, Infertility Flashcards
Simple ovarian cyst pathogenesis
Fluid filled follicle that is FSH/LH responsive
How to diagnose adnexal mass
Transvaginal US
How to treat simple ovarian cyst?
Put patient on OCP for 2 months, check for resolution. If it doesn’t resolve, get a CT scan
How to treat simple ovarian cyst that doesn’t resolve on 2 months of OCP or is >7 cm?
Get a ct scan
Endometrioma/endometriosis pathogenesis?
Retrograde flow, glandular tissue deposits outside of endometrial cavity. Estrogen responsive
How does patient with endometriosis present?
Dysmenorrhea, dyspareunia, infertility
How to diagnosis endometriosis
OCP trial, then laparoscopy
How to treat endometriosis?
Scope with laser ablation (if OCP/leuprolide doesn’t work)
Ectopic pregnancy pathogenesis
Salpingitis leads to stricture, egg fertilized and implants there.
How does patient with ectopic pregnancy present?
With vaginal bleeding and a positive urine pregnancy test
Tuboovarian abscess pathogenesis?
PID, normal flora leads to abscess
How does a patient with a tuboovarian abscess present?
Lower abdominal pain, fever, and leukocytosis
How to treat tuboovarian abscess?
Amp-gent and flagyl
Torsion pathogenesis
Cyst in ovary causes it to twist and have ischemia
How does patient present with torsion?
With sudden onset pain with fever and leukocytosis
How to diagnose torsion
US
How to treat torsion
Untwist, if pinks up, nothing, if doesn’t pink up, take it out.
Stress incontinence pathogenesis
Big or multiple births that stretch cardinal ligament. Causes cystocele or rectocele where pressure is transferred to bladder. Patient sneezes and pees.
How to treat stress incontinence
Pelvic sling
Hypertonic/urge incontinence
You know this
Hypotonic/overflow incontinence
You know this
How to treat hypotonic/overflow incontinence?
Bethanecol or catheterization
Can vaginal atrophy cause incontinence?
Yup
Irritative bladder pathogenesis
Irritation or inflammation caused by stones, UTI, or cancer. No nocturnal symptoms but urge present.
Difference in treating trichomonas vs gardnerella?
Can treat trich only with ORAL metronidazole. Gardnerella can be treated with cream.
Infertility algorithm
Look at male factors first, then do post coital test. If cervical mucus doesn’t stretch past 6 in middle of cycle then there is hostile mucus which must be treated with estrogen or artificial insemination. If mucus is normal, assess ovulation. If anovulatory use clomiphene or pergenol. If ovulation normal (withdrawal bleeding with progestin challenge), assess anatomy with hysterosalpingogram. If that’s normal, look for endometriosis with ex-laparoscopy.
How does clomiphene work?
Disinhibits GnRH to stimulate HPOE axis
How does pergenol work?
Acts like FSH/LH
