Benign Gynaecological Tumours & Prolapse Flashcards
What are the main risk factors for the development of a prolapse?
Childbirth, ageing and family history
What structures may be damaged in pregnancy and childbirth, which contribute to the development of a prolapse?
Levator ani muscle and pudendal nerve
Why does post-menopausal oestrogen deficiency lead to an increased risk of prolapse?
Atrophy of pelvic support
What is the main symptom of a prolapse?
Dragging sensation or a lump coming down
What happens to the symptoms of a prolapse as the day progresses?
They get worse
Why may prolapses result in bleeding/discharge?
Ulceration from friction
What are some features specific to a cystocele?
Incomplete emptying, frequency/hesitancy, recurrent UTIs
What are some features specific to a rectocele?
Constipation, digitation, faecal incontinence
What should always be examined first in a patient with a suspected prolapse and why?
The abdomen, to check for masses
How is a prolapse diagnosed?
On clinical examination, as the patient coughs
What are some conservative management options for a prolapse?
Weight loss, smoking cessation, pelvic floor exercises, pessaries
What is the most commonly used type of pessary?
Ring
Can you have sex with a ring pessary in?
Yes
How often should pessaries be changed?
Every 6 months
What is the biggest problem if a woman forgets that she has a pessary in?
Erosion
What medical treatment may be useful for post-menopausal women with a prolapse?
Low dose oestrogen pessaries or creams
Surgical treatment should not be offered for a prolapse unless the prolapse is below what level?
The introitus
Anterior colporrhaphy is used for which type of prolapse?
Cystocele
What are some surgical management options that could be used for a uterine prolapse?
Hysterectomy or sacrohysteropexy
Posterior colporrhaphy is used for which type of prolapse?
Rectocele
What surgical management option is available for a vaginal prolapse?
Sacrospinous fixation
What are uterine fibroids?
Benign leiomyomas (benign smooth muscle tumours)
Within which layer of the uterine wall do fibroids develop?
Myometrium
It is unclear what causes fibroids to start growing, but once they have grown they are responsive to what?
Oestrogen and progesterone
Fibroids are known for growing significantly when? And shrinking significantly when?
Growing in pregnancy and shrinking after the menopause
Fibroid degeneration is a common cause of abdominal pain when?
In mid-pregnancy
How does fibroid degeneration typically present?
Low grade fever, pain and vomiting
How is fibroid degeneration managed?
Rest and analgesia (it will resolve spontaneously in 4-7 days)
Rapid growth of a uterine mass is concerning, particularly in post-menopausal women, because it raises suspicion of what?
Uterine sarcoma
What effect do fibroids have on the menstrual cycle?
Menorrhagia
What is the imaging investigation of choice for uterine fibroids?
Trans-vaginal ultrasound
What medical treatment can be offered to women with symptomatic fibroids?
COCP, POP, Mirena-IUS
What medication can be given for 6 months to shrink fibroids before surgical resection?
GnRH analogues
What interventional radiological procedure is a treatment option for for fibroids?
Uterine artery embolisation
What is the first line surgical treatment for fibroids in women who want to preserve their fertility?
Myomectomy (hysteroscopically or laparoscopically)
What is the first line surgical treatment for fibroids in women who do not want children or who have completed their families?
Hysterectomy
What are the two types of physiological ovarian cysts?
Follicular and corpus luteum cysts
Which type of ovarian cyst is this describing: common, small, fluid-filled cysts which are generally asymptomatic and resolve spontaneously?
Physiological cysts
Which type of ovarian cyst is this describing: common cyst filled with altered blood at different stages of clot formation and breakdown, may present with pelvic pain?
Endometrioma
What is the origin of an ovarian teratoma?
Germ cell tumour
Which type of ovarian cyst is this describing: very common with a thick capsule, may contain fat, hair, teeth, bone etc and can be very large- 10% are bilateral?
Mature teratoma
Which type of ovarian cyst is this describing: common, may grow very large, can be complex and multi-locular and filled with thin, clear or thick, mucoid fluid?
Cystadenoma
What are the three features of the RMI tool used to differentiate between benign and malignant ovarian masses?
Menopausal status, CA125 and ultrasound appearance
How should simple ovarian cysts < 5cm be managed?
Serial ultrasound scans
How are symptomatic ovarian cysts or those > 5cm diameter managed?
Surgical excision
When should endometriomas > 6cm diameter be removed?
If the woman is undergoing asssisted conception treatment
What are some risk factors for ovarian torsion?
Ovarian mass, reproductive age, pregnancy
Patients presenting with sudden onset, deep-seated, colicky abdominal pain associated with vomiting and distress should raise suspicion of what diagnosis?
Ovarian torsion
A whirlpool pattern on ultrasound is suggestive of what diagnosis?
Ovarian torsion
What procedure is both diagnostic and therapeutic for an ovarian torsion?
Laparoscopy
Rokitansky’s protruberance is associated with which benign ovarian cyst?
Dermoid cyst
Which type of benign ovarian cyst will cause pseudomyxoma peritonei if it ruptures?
Mucinous cystadenoma
What type of ovarian cyst is most commonly associated with Meig’s syndrome?
Fibroma
What is the most common benign ovarian tumour in those aged < 25?
Dermoid cyst
