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Benign Gynae Flashcards

1
Q

Name 8 gynae causes of pelvic pain

A
  • Endometriosis
  • Adenomysosis
  • PID
  • Primary dysmenorrhoea (outlet obstruction)
  • Ovarian cyst accident (torsion, haemorrhage, rupture)
  • Fallopian tube torsion
  • Salpingo-ovarian abscess
  • Pregnancy complications (ectopic/miscarriage/ovarian hyperstimulsation syndrome/ligament stretch)
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2
Q

Define adenomyosis

A

a disease that occurs when the cells that normally line the uterus grow into the muscular tissue of the uterine wall. It occurs most often in women older than 30 who have had a full-term pregnancy. It is rare in women who have not had a full-term pregnancy.

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3
Q

Causes of non-cyclical pelvic pain

A
  • Gynae (PID, adhesions, hydrosalpinges, tumours, necrotic fibroids)
  • Gastro (IBS, appendicitis, IBD, mesenteric adenitis, diverticulitis, strangulated hernia)
  • Urological (recurrent UTIs, interstitial cysts, renal calculi)
  • Neurological (nerve injury, entrapment)
  • Musculoskeletal pain (myofascial pain)
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4
Q

What Qs should you ask in a female pt with pelvic pain?

A

• Chronicity
• Dysmenorrhoea
• Dysparaeunia, dyschesia
• Affected by micturition
• Associated with bloating/diarrhoea/constipation/nausea
• Recent weight change/appetite change
Gynae hx (IUD insertion, hysteroscopy, TOP, miscarriage, fibroid necrosis)

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5
Q

What should be assessed on examination on someone with pelvic pain?

A

Abdominal
• Trigger points
• Masses

Bimanual
• Size and mobility of uterus
• Uterosacral ligaments (palpable, nodules?)
• Adnexal masses

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6
Q

What investiagtions should be done for someone with pelvic pain?

A 
•	Triple swabs (infection)
•	MSU (UTI)
•	Pelvic USS (scarring/mass/cyst)
FBC& group and save (ruptured ectopic/ovarian cyst)
WCC & CRP (infection)
Pregnancy test
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7
Q

Define endometrioisis

A

The presence of normal endometrial mucosa (glands and stroma) abnormally implanted in locations other than the uterine cavity. Approximately 30-40% of women with endometriosis will be subfertile.

The presence of endometrial-like tissue outside the uterus that induces a chronic, inflammatory reaction.

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8
Q

Common sites of endometriosis

A
  • Ovaries
  • Uterosacral ligaments
  • Pouch of Douglas (space between uterus and rectum)
  • Broad ligament (fold of peritoneum that runs between uterus and pelvic side wall)
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9
Q

Uncommon sites of endometriosis

A
  • Lung (cyclical haemoptysis)
  • Nasal septum
  • CNS
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10
Q

Presentation of endometriosis

A

• In up to 50% of women presenting with infertility (due to scarring in tubes)
• Pain (cyclical, dysmenorrhoea, dyspareunia, chronic pelvic pain, dyschesia)
• Pain starts up to 2 weeks before menstruation, exacerbated during menstruation
Peritonism is chocolate cyst ruptures

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11
Q

How is endometriosis diagnosed?

A
  • Laparoscopy (chocolate cysts/gunshot lesions)

* Transvaginal ultrasound (ground glass cyst appearance of old clot material)

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12
Q

Medical treatment of endometriosis

A 
Non­hormonal (simple analgesia)
Hormonal
• Progestogens
• Combined oral contraceptive
• Mirena
• Gonadotrophin releasing hormone agonists +/­ add back HRT
(all are contraceptive)
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13
Q

Surgical management of endometriosis

A 
Conservative ablation (diathermy/laser) or excision of visible endometriosis
Radical (remove uterus, ovaries, nodules)
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14
Q

Short term management of ovarian cysts

A

COCP

Monitor for several cycles

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15
Q

Management of ovarian cysts in post menopausal women

A

In postmenopausal women, <10cm diameter and normal CA-125 should be monitored with serial ultrasounds. BSO and hysterectomy is sometimes indicated as these cysts have a higher rate of being neoplastic.

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16
Q

Management of ovarian cysts in pregnant women

A

In pregnant women, corpus luteal and follicular cysts should resolve by about 14 weeks. Less than 6cm cysts have a malignancy rate of <1%. CA-125 not recommended. Usually wait until after birth for surgical removal, but if symptomatic or rapid growth may operate in pregnancy.

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17
Q

Functions of a laparoscopy in ovarian cyst management

A

Minimally invasive (keyhole) technique
• To confirm the diagnosis of an ovarian cyst
• To assess whether the cyst appears to be malignant
• To obtain fluid from peritoneal washings for cytologic assessment
• To remove the entire cyst intact for pathologic analysis - This may mean removing the entire ovary
• To assess the opposite ovary and other abdominal organs
• To perform additional surgery as indicated

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18
Q

Define salpingitis

A

Inflammation of the fallopian tube, usually due to infection. i.e. PID

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19
Q

Risk factors for salpingitis

A
  • Young
  • Age of first sexual intercourse
  • Multiple sexual partners
  • Unprotected sexual intercourse
  • Never marrying
  • Lower socioeconomic status
20
Q

Common pathogens for salpingitis

A
  • Chlaymydia trachomatis
  • Neisseria gonorrhoeae
  • Gardnerella vaginalis
  • E.coli
  • H. influenzae
  • Group B strep
21
Q

Signs and symptoms of salpingitis

A
  • Asymptommatic-> severe pelvic pain due to peritonitis
  • Fever (>38º)
  • Elevated ESR
  • Adnexal tenderness/mass
  • Lower abdominal tenderness
  • Cervical motion tenderness (on bimanual)
22
Q

Diagnosis of salpingitis

A
  • Histopathologic evidence of endometritis on endometrial biopsy
  • Tubo-ovarian abscess (TOA) or thickened fluid-filled tubes with or without free-fluid on ultrasonography or other imaging techniques
  • Laparoscopic findings
23
Q

Treatment of salpingitis

A
  • CEFRTRIAXONE 250mg IM once

* DOXYCYCLINE BD 14 days

24
Q

Complications of salpingitis

A
  • Ectopic pregnancy
  • Chronic pelvic pain
  • Tubo-ovarian abscess
  • Hydrosalpinx
  • Tubal infertility
25
Difference between didelphic uterus and bicornuate uterus
Didlephic is 2 uteruses, 2 vaginas | Bicornuate uterus is 1 uterus but heart shaped (+/- septum)
26
Issues with septate uterus?
Septate uterus can increase miscarriage rate and cause placental problems. Surgical separation of the septum is possible but can decrease fertility due to scarring. General rule is to watch and wait until 2 miscarriages. If an abnormality in the uterine/cervical anatomy is picked up, an USS screen for kidney location and ureter formation needs to be done. (mullerian duct formation, mesonephric duct)
27
Define endocervical polyp
* Benign neoplasms of the cervix | * Focal hyperplastic protrusions of the endocervical folds, including the epithelium and substantia propria
28
Symptoms of endocervical polyps
* Most common in the fourth to sixth decades of life | * Usually are asymptomatic but may cause profuse leucorrhoea or postcoital spotting
29
Histological subtypes of endocervical polyp
* Typical endocervical mucosal * Inflammatory (granulation tissue) * Fibrous * Vascular * Pseudodecidual * Mixed endocervical and endometrial * Pseudosarcomatou
30
Treatment of endocervical polyps
* Twisted with ringed forceps | * Punch biopsy forceps
31
Define ectropion
Presence of endocervical glandular epithelium on the cervix surface Dynamic process
32
Treatment of ectropion?
* Usually no treatment is necessary, glandular epithelium will undergo dysplasia to form squamous epithelium * Cautery if severe bleeding due to a particular fragile vessel (may not solve problem)
33
Tips for vulval irritation
* Avoid pads * Cotton knickers * Keep a spare pair in a ziplock bag in case of dampness * Epaderm 2x daily * Topical oestrogen if postmenopausal atrophy
34
Define vulva
Contains the labia majora, labia minora, clitoris, vestibule, urinary meatus, vaginal orifice, hymen, Bartholin glands, and Skene ducts
35
Define fibroids | Common?
Uterine fibroids are benign smooth muscles tumours, also known as leiomyomas, which grow in the wall of the uterus. They are a common occurrence and have been reported in up to 75% of women.
36
Symptoms of fibroids
``` • Asymptomatic • Menorrhagia • Frequent urination • Lower back pain • Constipation • Dyspareunia Subfertility? Acute pain if degenerating ```
37
Medical treatment of fibroids
* Analgesia (NSAIDs, PARACETAMOL) * Tranexamic acid (if don’t need contraception, taken during periods) * Mirena IUD (for heavy bleeding) * COCP (for dysmenorrhoea) * Selective progesterone receptor modulators (SPRMs) eg ULIPRISTAL ACETATE (reduces size, bleeding and pain, used in 3 month cycles) * GnRH agonists (reduce size, menstruation halted to allow recovery from anaemia but temporary post-menopausal state and bone loss) Used pre-surgery
38
Surgical/procedure management of fibroids
* Uterine artery embolisation (interventional radiology, ischaemia->shrinkage) * MRI guided focused ultrasound (thermal ablation) * Transcervical/laparoscopic ablation * Hysterectomy (vaginal, laparoscopic, abdominal) * Myomectomy (hysteroscopically if submucousal, laparoscopically if intramural, abdominally)
39
Name 12 causes of dyspareunia
Congenital (vaginal atresia, vaginal septum) Infection (vulvovaginitis, PID) Post surgery (childbirth, pelvic floor repair) Vulval disease (cysts, dystophy, SCC) Pelvic disease (endometriosis, fibroids, ovarian cyst/tumour) Psychosexual (vaginismus) Atrophy (post menopausal)
40
Types of fibroids (4)
Submucous Subserous Intramural Pedunculated
41
Risk factors for fibroids
Afro-caribbean heritage Increasing age Nulligravidity Obesity
42
Decreased incidence of fibroids with:
Smoking COCP Full term pregnancy
43
Name some benign ovarian cysts
``` Follicular Luteal Theca lutein (w/pregnancy) Serous cystadenoma Mucinous cysadenoma Mature cystic teratoma (germ cell) Theca cell Fibroma ```
44
Symptoms of ovarian cyst
Pain (esp torsion/haemorrhage) Abdominal swelling Pressure on bowel/bladder Hormonal effects of oestrogen secretion
45
What is seen in lichen sclerosus?
``` Vulval leukoplakia Labial fusion Adhesions Atrophic changes (thin, shiny skin) Thickened plaques Pruritis-> excoriation ```

O&G (12 decks)

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