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Y5 Gynae & Obstetrics > Benign conditions of ovary and pelvis > Flashcards

Benign conditions of ovary and pelvis Flashcards

1
Q

What categories differentials for a pelvic mass

A

Gynae
GI
Urological
Other (lymph issue, cyst)

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2
Q

What are gynaecologist differentials for a pelvic mass?

A

Ovarian

  • cyst / para ovarian cyst
  • torsion
  • malignancy

FT

  • ectopic preg
  • abscess
  • malignancy
  • Hydrosalpinx/pyosalpinx

Uterus

  • fibroid
  • pregnancy
  • malignancy
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3
Q

What is a para ovarian cyst?

A

Abdominal cyst near ovary

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4
Q

What is a Hydrosalpinx?

A

blocked fallopian tube filled with fluid

Due to PID

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5
Q

What is Pyosalpinx?

A

blocked fallopian tube filled with pus

Due to PID

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6
Q

What are types of benign ovarian cysts?

A 
Functional /simple
Inflammatory
Germ cell 
Epithelial 
Sex cord
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7
Q

Who do functional ovarian cysts occur in?

A

Young girls

Women in reproductive years

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8
Q

What are types of functional ovarian cysts?

A

Follicular
Corpus luteal
Theca luteal

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9
Q

What medication reduces risk of functional ovarian cysts?

A

COCP

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10
Q

What is a cyst minumum diameter? (less than that is normal follicle?

A

Cyst: >3cm

Normal follicle <2.5cm

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11
Q

What is management of a SIMPLE FOLLICULAR cyst?

A

asymptomatic: reassure, repeat USS
symptomatic: laparoscopic cystectomy

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12
Q

What are investigations for suspected ovarian cyst?

A

TVUSS (TAUSS if never sexually active)
CT, MRI
Pregnancy scan
Inflamm markers

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13
Q

What is ovarian torsion?

A

Rotation of the vascular pedicle supplying the ovary, cutting off the blood supply and risking necrosis

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14
Q

What is the cause for ovarian torsion?

A

A large heavy cyst

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15
Q

What are presenting symptoms for ovarian torsion?

A

Acute onset lower abdominal pain

Nausea and vomiting

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16
Q

What is investigations for ovarian torsion

A

Pregnancy test !
TVUSS + Doppler (looking for blood flow)
CT/MRI if in doubt
DIAGNOSTIC LAPAROSCOPY**

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17
Q

How do you manage ovarian torsion=?

A

IMMEDIATE diagnostic laparoscopy + treat
Untwist ovary, reattach pedicle
Remove cyst

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18
Q

What condition are inflammatory ovarian cysts associate with?

A

PID

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19
Q

How do you treat a tube ovarian abscess ( inflammatory ovarian cysts )

A

Antibiotics
Surgical drainage
Surgical excision

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20
Q

What are the two types of inflammatory ovarian cysts

A

Tubo ovarian abscess n

Endometrioma

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21
Q

What does an endometrioma look like on USS

A

ground glass appearance

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22
Q

Who are germ cell tumours common in?

A

Young women

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23
Q

How do you diagnose germ cell tumours?

A

Pelvic USS

24
Q

Who are epithelial tumours more common in?

A

Perimenopausal

25
Q

Who are sex cord stromal tumours more common in=?

26
Q

What is the most common type of sex cord stromal tumour’

A

Ovarian fibroma

27
Q

What is Ca 125 a marker for?

A

Epithelial ovarian cancer (serous)

28
Q

What is Ca 19-9 a marker for=

A

Epithelial ovarian cancer (mucinous)

29
Q

What is inhibin a marker for?

A

Sex cord stromal tumour (granulose cell)

30
Q

What is beta HCG a marker for ?

A

Germ cell tumour

- choriocarcinoma, dysgerminoma

31
Q

What is AFP a marker for?

A

Germ cell tumour

  • endodermal yolk sac
  • Immature teratoma
32
Q

What is endometriosis?

A

Endometrial tissue lying outside the uterine cavity

33
Q

What are possible locations for endometriosis?

A

Peritoneum ( pelvic side walls, pouch of Douglas, uterosacral ligament, bladder)
Ovary (endometrioma)
FT
Umbilicus, abdo scar, pleural cavity

34
Q

What is a poor consequence of endometriosis?

A

INFERTILITY (due to fibrosis and adhesion formation each month, as the endometrial tissue responds to hormonal changed)

35
Q

What is adenomyositis?

A

Endometrial tissue penetrating through into myometrium

36
Q

What are clinical features of endometriosis?

A

Severe cyclclical pelvic pain
HMB , dysmenorrhoea
dyspareunia
low back pain severe fatigue

37
Q

What are clinical exam factors suggestive of endometriosis?

A

Tenderness in pouch of Douglas
Adnexal mass
Fixed retroverted uterus
thick uterosacral ligament

38
Q

How do you dx endometriosis?

A

TVUSS
MRI
Laparoscopy

39
Q

How do you manage endometriosis ?

A

Medical

  • analgesics (NSAIDS, avoid opiates)
  • COCP (tricycle)
  • progestogens
  • GnRH agonist

Surgical

  • Excision of endometrial tissue
  • oophorectomy / FT removal / hysterectomy
40
Q

Why should you tricycle COCP

A

Better at alleviating symptoms (induces amenorrhoea)

41
Q

How long max can you give GnRH agonist, and why?

A

6 months max

risk of osteoporosis

42
Q

What is surgical tx for endometriosis?

A

Fertility sparing
- ablate/excise endometriosis

Hysterectomy, oophorectomy + immediate oestrogen only HRT

43
Q

What is chronic pelvic pain=

A

Intermittent /constant pain in lower abdo of a woman of min 6 month duration, that is NOT dysmenorrhoea or dyspareunia or due to pregnancy

44
Q

What are gynaecological causes of chronic pelvic pain?

A 
Endometriosis 
Adenomyosis 
Adhesions - chronic PID 
uterine fibroids 
ovarian cyst
45
Q

When do corpus luteal cysts occur?

A

Following ovulation

46
Q

How do you manage corpus luteal cysts?

A

Expectant (with analgesia)

They usually self resolve in 2-3 months (like all simple cysts) if they are not excessively big

47
Q

Who do theca luteal cysts occur in?

A

Pregnant women

48
Q

What is the outcome of theca luteal cysts?

A

They usually self resolve

49
Q

What is Meig Syndrome?

A

TRIAD:

  • Ovarian fibroma
  • Ascites
  • Pleural effusion
50
Q

Who does Meig Syndrome usually occur in?

A

Women over 40

51
Q

How do you manage Meig Syndrome?

A

Drain ascites and pleural effusion
THEN
Surgically remove the fibroma

52
Q

What is a thecoma?

A

A benign oestrogen secreting tumour

Presents after menopause

53
Q

What symptoms can a thecoma cause?

A

Symptoms of excess oestrogen

e.g. PMB

54
Q

What are the two theories for endometriosis?

A

Samson’s Theory - retrograde menstruation along FT and subsequent implantation on pelvic peritoneum

Meyer’s Coelomic Metaplasia Theory - De-differentiation of peritoneal cells to primitive origin, then into endometrial cells

55
Q

What are endometriosis findings on examination?

A

Thickening/nodularity of uterosacral ligaments
Tenderness in Pouch of Douglas
Adnexal mass
Fixed retroverted uterus

56
Q

What is the gold standard diagnostic method for endometriosis?

A

LAPAROSCOPY

Y5 Gynae & Obstetrics (34 decks)

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