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GYNAE Y5 > AUB in premenarchal girls > Flashcards

AUB in premenarchal girls Flashcards

1
Q
A
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2
Q

What does aginal bleeding in early childhood indicate ?

A

Vaginal bleeding in early childhood, regardless of its duration and quantity, is always indicative of pathology.

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3
Q

what could cause aginal bleeding in early childhood / when can it arise from ?

A
  • a local vulvar, or vaginal or cervical lesion
  • the endometrium as a manifestation of precocious puberty
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4
Q

what is precocious puberty?

A

Precocious puberty is (1) the appearance of secondary sexual characteristics before 8 years of age, or (2) the onset of menarche before 9 years of age.

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5
Q

what are the local causes for vaginal bleeding ?

A
  1. Vulvovaginitis /inection( bacteria,parasite)
  2. Foreign body
  3. Trauma ( inclu sexual abuse )
  4. Urethral prolapse
  5. hymenal tags
  6. Sarcoma Botryoides
  7. othe rare malignancies o the genital tract
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6
Q

what are the causes for endometrial shedding ?

A
  1. Physiological (neonatal withdrawal bleeding due to the circulating oestrogen left over from the mother’s circulation)
  2. Premature menarche
  3. Exogenous oestrogens (pills, food)
  4. Endogenous oestrogen (functional cyst, an oestrogen-producing tumour)
  5. Precocious puberty (a) idiopathic (b) central nervous system lesion
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7
Q

what are the 3 aspects o management of a premenarchal girl presenting with vaginal bleeding ?

A
  1. Detailed history
  2. Careful inspection
    3.Treatment
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8
Q

what to include when taking detailed history ?

A
  • Medical and surgical history, especially CNS problems
  • Associated trauma (including sexual abuse)
  • Duration
  • Offensive or not
  • Other relevant systemic symtoms: weight loss etc
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9
Q

why is the examination done under anaesthesia ?

A

Because vaginal bleeding in a premenarchal girl is one of the main indications for a examination under anaesthesia in order to inspect the lower genital tract thoroughly

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10
Q

during the examination when to suspect precocios puberty ?

A

If there are any signs of secondary sex characteristics

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11
Q

during examination what do you do i there are no signs of secondary sex characteristics ?

A

do genital examination - look for any signs of trauma or lesions (warts, polyps, urethral prolapse, skin lesions, lichen sclerosis, tumours)

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12
Q

What is one of the main indications for examination under anaesthesia in premenarchal girls?

A

Vaginal bleeding in a premenarchal girl - this requires thorough inspection of the lower genital tract.

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13
Q

When examining a premenarchal girl with vaginal bleeding who shows signs of secondary sex characteristics, what should you suspect?

A

Precocious puberty should be suspected.

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14
Q

In a premenarchal girl with vaginal bleeding but NO secondary sex characteristics, what should the examination focus on?

A

Perform genital examination looking for:

Signs of trauma
Lesions (warts, polyps)
Urethral prolapse
Skin lesions
Lichen sclerosis
Tumours

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15
Q

If no lesions or trauma are found during examination, what does offensive bleeding suggest?

A

Offensive bleeding suggests a foreign body

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16
Q

If bleeding is NOT offensive and no lesions/trauma are found, what are the likely diagnoses?

A

Two possibilities:

Vulvovaginitis
Rarer tumours

17
Q

What is the treatment for idiopathic precocious puberty and why is it important?

A

Treatment: Suppress the GNRH
Rationale: To prevent premature closure of long bones which would stop growth (Treatment: Suppress the GNRH
Rationale: To prevent premature closure of long bones which would stop growth)

18
Q

Name 3 possible valvulal lesions ?

A

Lichen sclerosis
Warts
Urethral prolapse

19
Q

what is the treatment for

A

Lichen sclerosis

20
Q

what is the treatment for Warts?

A

Cautery, excision, or laser

21
Q

what is the treatment for Urethral prolapse?

A

oestrogen cream (Premarin) or excision

22
Q

what is tthe treatment for other valval lesions ?

A

excision biopsy and/or biopsies

23
Q

How should vulvovaginitis be managed in premenarchal girls?

A
  1. Take pus swab for microscopy, sensitivity and culture
  2. Apply Premarin cream for 2 weeks (changes vaginal pH)
  3. Treat according to microscopy and sensitivity results
24
Q

What is the approach to managing a suspected foreign body?

A

Perform examination under anaesthesia (EUA) and remove foreign body if present

25
Q

What key considerations should clinicians keep in mind when evaluating premenarchal vaginal bleeding?

A
  1. Always consider sexual abuse as a possibility
    2.Candidiasis is rare (requires estrogen for growth)- it is rarely seen in premenarchal girls as the presence of oestrogen is necessary for the growth of this organism.
  2. Consider parasitic infestations as a cause - treat for worms if uncertain
  3. Any abnormal mass/tumor seen during EUA requires biopsy
    Confirmed malignancies need referral to appropriate center

GYNAE Y5 (8 decks)

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