Appendix, PID, Ectopic Pregnancy, Ovarian Cysts Flashcards
32yr old woman with 8hr history abdomen pain
pain in RLQ
no fever or dysuria
menstrual hx - regular cycle 5/28
obstetric hx para 1 NVD
no surfers
young and fit
no smoking lies with partner and social drink
nothing on fam history
pain onset location type severity duration and modifying facotrs will help pin point
what systems should you check here
GI sx - N+V hematemesis, anoxeria, diarrhea and constatino blocco stools and meleana
GU sx - dysuria, frequency urgency and haematuria and icnotninence
gyn sx - vaginal discharge, vagianl bleeding
general - fever and lightheadedness
exmaianion of this patient what would you do
general - pallor appearance and distress
vital signs - pulse, BP temp and saturation
cardiac - arrhyias and lungs for pneumonia
abdomen - distension scares, masses, tenderness and rebound and guiding and masses, tympani , bowel sounds and rectal exam
pelvic exam for bleeding and vaginal examination and fullness and discharge
guarding - voluntary - contraction, diminish this by getting patient to flex knees
involuntary - suggests peritoneal irritation
rebound - roving sign appendicitis
what is rovsing sign
Rovsing’s sign (a.k.a. indirect tenderness) is a right lower quadrant pain elicited by pressure applied on the left lower quadran
investigations for this
urinalysis
preg test
IV fluids
NBM
FBC and beta Hcg
US scan
analgesia
eclectrolytes
appendicitis symptoms
periunmbilicla pain, anorexia and N+V
pain localises to RLQ
soem appendicitis are retroceal
pelvic appendicitis can cause suprapubic pain and dysuria
triad of symptoms fore ectopic pregnancy
amenorrhea ( irregular menses too)
pelvic or low abdominal pain
vaginal bleeding
findings on ectopic pregnancy
pelvic and abode pain
abnormal menstruation
aginal bleeding may be scanty or dark brown
abdominal and pelvic tenderness
tenders on abode and vaginal examination especially on motion of the cervix
US scan - absence of an intrauterine gestational sac
extrauterine sac with an embryo or embryonic remnants
free fluid/blood in peritoneum
what are the risk factors for an ectopic pregnancy
previous ectopic
assisted reproduction and infertility
intrauterine device
previous genital infection
previous pelvic or abdomen surgery e.g. ruptured appendices
smoking
c section
tubal surgery
ovarian cysts - torsion and haemorrhage present with what
might have history of it
acute onset severe pelvic pain
may wax and wane
may happen mid cycle or during pregnancy
may look like appendicitis
can have acute rigid abdomen and peritonitis , fever and tachycardia and decreased bowel sounds
important to exclude with US scan
may find mass on examination
US confirms cysts
therefore acute pain with scan showing ovarian cysts - torsion or bleeding into cysts is an emergency
pelvic inflammatory infection is an ascending infection - will have long lasting sequel such as ectopics, infertility or chronic pelvic pain
what are the findings of this
PV discharge with uterine tenderness
cervical motion tenderness on examination - i.e. worse if you move It
positive swab culture - swabs or from urine ?
temp- may not be raised
FBC - raised WBC
ectopic pregnancy you would expect positive pregnancy what is the investigation of choice
what would this show
transvagianl US - demonstatre no intra-uterine pregame, endometrial thickening, free fluid ,adnexal mass and foetal pole not usually visualised
mass separate to ovary
can occur on cerivx in ovaries - different areas
Use bladder to help see structures
negative pregnancy test now wha is causing pain - thinking ovarian cysts what examination
transvaginal( not used if never sexually active) or trans abdominal US
2nd line for clarity - MR used for problem solving and characterising masses
what method do you use for staging ovarian carcinoma
CT
ovarian cysts can be linked to the menstrual cycle - follicular cysts grow inside what happens when the egg is not released
becomes a cyst and swells and is greater than 30mm
this could haemorrhage tort or rupture
what are theca-luton cysts
excessive amounts of circulating gonatrophins such as beta HCG
corpus luteum cysts what hormone
corpus luteum cysts - occurs in ovulation - ring of fire ( blood supply) due to progesterone
what is a neoplasm
An abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should.
types of neoplasms
cystic neoplasms
- serous cyst adenoma - benign and nodular
mutinous cyst adenoma - multiple septations ( multiseptated cysts_
malignant - solid nodules in cyst, thick wall - obvious
dermoid cysts
- cystic mass containing fat hair bone and teeth and consists of many germ layers also called teratoma - see echogenic shadowing and mural nodules and blurring
- appear like they are floating on CT and MR due to fat
ovarian torsion may occur due to
cyst
neoplasm
pregnancy
hyperstimualtion - IVF treatment
imaging choice in ovarian torsion and what are the findings
trans vaginal
enlarged ovary
maybe a mass
free fluid
doppler finding can b variable - usually little or no flow
is PID related to STI
yes
what is PID
infection of uterus fallopian tubes ovaries and peritoneal cavity
pyosalpinx ( puss filled )
what is seen on US
infection within non-patent tube - blockage
use US which shows snake like dilated structure in pelvis or maybe cystic mass
if the fallopian tube is patent and you inject contrast in to see for hydrosalphinx if normal what do you see and what if blocked
starts of thin and then eventually contrast spreads out
if it is blocked look thick like a poo
difference between Pyosalpinx and Hydrosalpinx
Pyosalpinx is a condition in which the fallopian tube fills up and swells with pus
Hydrosalpinx is the blockage of a woman’s fallopian tube caused by a fluid buildup and dilation of the tube at its end. Most often it occurs at the fimbrial end of the tube next to the ovary, but it can also occur at the other end of the tube that attaches to the uterus.
what things can cause post coiltal bleeding
Cervical ectropion
Often asymptomatic, but may present with post-coital bleeding or vaginal discharge
Endocervical and cervical polyps
Often asymptomatic, but may present with abnormal vaginal bleeding such as post-coital bleeding, and additionally inter-menstrual bleeding or menorrhagia. They can be diagnosed by speculum examination
Cervical cancer
Can cause post-coital bleeding and well as bleeding at other times, such as spontaneously or after micturition. Other early signs of cervical cancer include urinary symptoms and vaginal discomfort
Sexually transmitted infections
With STIs such as gonorrhoea and chlamydia, discharge and pelvic pain are also common.
Atrophic vaginitis
Atrophic vaginitis is the most common cause of bleeding in postmenopausal women as the vaginal mucosa becomes drier and thinner. This can then bleed, especially when there is contact with the mucosa such as during intercourse
This patient has reduced flexion and adduction of their wrist. Both movements are carried out through the action of the
flexor carpi ulnaris
