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Obs & Gyn > Benign gynaecology and pelvic pain > Flashcards

Benign gynaecology and pelvic pain Flashcards

1
Q

important benign gynaecology conditions regarding the vulva 3

A

bartholin cyst and abscess

lichen sclerosis

genital herpes

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2
Q

important benign gynaecology conditions regarding the
cervix 2

A

ectopy

polyps

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3
Q

important benign gynaecology conditions regarding the uterus 2

A

fibroids

polyps

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4
Q

important benign gynaecology conditions regarding the fallopian tubes

A

PID

hydrosalpinx

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5
Q

important benign gynaecology conditions regarding the ovary

A

cysts

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6
Q

important benign gynaecology conditions regarding the all pelvic organs 1

A

endometriosis

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7
Q

define bartholin abscess

A

acute infection of teh bartholin gland duct by bacteria
-bartholin gland - inferior border of vagina

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8
Q

define bartholin cyst

A

chronic swelling after previous acute infection

painless

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9
Q

managemnt of bartholin cyst/ abcess

A

prescribe broad spec ABx

marsupliasation with GA
or
word catheter with LA

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10
Q

define lichen sclerosus

A

autoimmune condition primarly affecting post-menopausal women
-skin conduation causing itchy white plaques on genitals or other parts of body

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11
Q

symptoms of lichen sclerosus 2

A

itching - pruritus vulvae

excoriation- pain, dysparenunia

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12
Q

signs of lichen sclerosus 3

A

whitening of vulval skin

loss of labial & clitoral contours

narrowing of entry to the vagina

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13
Q

diagnosis of lichen sclerosus 1

A

usually typical apperarnce {1}

biopsy if unsure/suspcicious area

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14
Q

treatment for lichen sclerosus 1

A

potent steroid topically
-CLOBETASOL- Dermovate

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15
Q

cause of genital herpes

A

STD- usually HSV-2

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16
Q

sx and syx of genital herpes 3

A

painful vesicular rash

dysuria

dyspareunia

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17
Q

manaegmnt of genital herpes 5

A

oral aciclovier 400mg TID 5-10 days

self care measures
-apply salt water to prevent infection nd promote healing
-vaseline or lidocaine 5% to help w painful micturiion
-Incerase fluid intake
-urinate in bath to reduce stinging

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18
Q

define cervical ectopy

A

columnar cells from canal everted to cervix

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19
Q

syx of cervical ectopy

A

usually none

-maybe chronic discharge/post-coital bleeding (PCB)

*-has. a typical appearance of speculum exam {2}

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20
Q

treatemnt of cervical ectopy 1

A

only if symptomatic
-cuatery/cryotherapy/AgNO3

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21
Q

signs an dsymptoms of cervical polyps

A

usualy no syx
-maybe PCB or PMB
-only seen in secondary care if sympotmatice

-diagnosisi by typical appearance {3}

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22
Q

define fibroids

A

benign tumours of the myometrium
-have several locations {4}
-malignacy rare

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23
Q

incidence of fibroids

A

70-80% of fifty year olds

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24
Q

what are fibroids dependent on

A

oestrogen
-grow during pregnancy
-shrink affter menopause

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25
Q

symptoms of fibroids 6

A

heavy menstrual bleeding

abdo swelling

pressure symptoms ie ureteric obstruction

subfertility

difficulties in pregnancy (miscarriage, red degeneration)

pain (rare)

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26
Q

signs of fibroids 1

A

abdo or pelvic mass

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27
Q

diagnosis of fibroids 3

A

clinical suspicion

confirm by ultrasound (transvaginal)

MRI to plan management

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28
Q

management options for fibroids

A

conservative-makority of cases

medical
-control syx
-prior to surgery GnRH analogous

surgical
-hysterectomy (usually subtotal)
-myomectomy (to preserve fertility)

uterine artery embolisation
-minimally invases radiological procedure

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29
Q

types of hysterectomy

A

see {5}

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29
Q

types of hysterectomy

A

see {5}

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30
Q

signs, sympotms and diagnosisi of endometrial polpys

A

common and rarely serious condition

syx- PMB, IMB, HMB

diagnosis
-may be suspected by TVU
-hysterscopy & histology

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31
Q

endometrial polyps management

A

hysteroscopy and polypectomy

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32
Q

name 2 fallopian tube abnormaliteis

A

pelvic inflamatory disease (PID)

hyrosalpinx

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33
Q

define pelvic inflammatory disease

A

inflammation and infection of teh organs of the pelvis

-caused by infection spreading up through the cervix

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34
Q

why is pelvic inflammatory disease a significnat concern 2

A

risk of tubular blockage and subfertility
-infertility -20%
-ectopic pregnancy -10%
-chronic pelvic pain- 20%

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35
Q

state the inflammatory name of the following sites:
-endometrium

A

endometritis

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36
Q

state the inflammatory name of the following sites:
-fallopian tubes

A

salpingitis

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37
Q

state the inflammatory name of the following sites:
-ovaries

A

oophoritis

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38
Q

state the inflammatory name of the following sites:
parametrium (connective tissue around the uterus)

A

parametritis

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39
Q

state the inflammatory name of the following sites:
peritoneal membrane

A

peritonitis

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40
Q

common causes of pelvic inflammatory disease 3

A

neisseria gonorrhhoea

chlamydia trachomatis

mycoplasma genitalium

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41
Q

less common causes of pelvic inflammatory disease 3

A

gardneerall vaginalis (assoc w bacterial vaginosis)

haemophiuls inflenzuae (often a respiratory infection)

escherichia coli (assoc w UTIs)

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42
Q

risk factors for pelvic inflammatory disease 6

A

not using barrier contrapcetion

multiple sexual partners

younger age

exististing STI

previous PID

IUD

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43
Q

symptoms of pelvic inflammatory disease 6

A

pelvic or lower abod pain

abnormal vaginal discharge

abnormal bleeding (intermenstural or postcoital)

pain during sex (dysparenunia)

fever (may also have signs of sepsis)

dysuria

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44
Q

examination findings in pelvic inflammatory disease 4

A

pelvic tenderness -rebound and guarding, distension, sometimes RUQ pain

cervical motion tenderness (cerivcla excitation)

inflamed cervix (cervicitis)

purluent discharge on speculum view [6]

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45
Q

investigations for pelvic inflammatory disease 7

A

swabs for STIs

high vaginal swabs

pregnancy test

inflammtory markers (CRP & ESR)

MSU exclude UTI

TVS - tubo-ovarian abscess

laparoscopy if dx uncertain or no improvement w initial management

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46
Q

describe STI swabs, their types and specific STIs 5

A

NAAT swab- gonorrhoea, chlamydia, mycoplasma genitalium

HIV test

Syphililis test

47
Q

what are high vaignal swabs testing for 3

A

bacterial vaginosis

candidiasis

trichomoniasis

48
Q

how can swab testing be used to rule out PID

A

if swab looked at under microspope (both kinds) - absence of pus cells -> NO PID

49
Q

inital managemnt of pelvic inflammatory disease 3

A

emperical ABx for presumptive dx of PID
-DONT WAIT FOR SWAB RESULTS

pain relief w ibru or PCM

refer to GU medicine
-screen for other infections and contact tracing

50
Q

emperical ABx regime for PID 4

A

STAT ceftrixone

doxy

metro

ofloxacin

51
Q

regarding emperical ABx for PID
-what does ceftriaxone cover

A

gonorrhoea

52
Q

regarding emperical ABx for PID
-what does doxy cover

A

chlamydia and myocoplasma genitalium

53
Q

regarding emperical ABx for PID
-what does metro cover

A

bacterial vaginosisi
-gardnerella vaginalis

trichomonas vaginalis

54
Q

regarding emperical ABx for PID
-what does doxy and ceftriaxone also cover

A

many other bacteria
incld H. influenzae and E Coli.

55
Q

complications for PID

A

sepsis

abscess

infertility

chronic pelvic pain

ectopic pregnancy

fitz-hugh-curtiz syndrome

56
Q

symptoms of hydrosalpinx 3

A

usually none after acute infective phase

occ. pelvic pain

often subfertility/ infertility

57
Q

investigations for hydrosalpinx 3

A

may be susepcted by TVU

laparoscopy

hysterossalpingogram (HSG)

58
Q

define hydrosalpinx

A

fallpoain tubes are blocked and fill with serous or clear fluid near the ovaries

59
Q

define fitz-hugh-curtis syndrom

A

complication of PID

caues by inflam and infection of the liver capsule -> adhesion between the liver and the peritoneum

-bacteria soreads from the pevlis

60
Q

presenation and mangemnt of fits-hugh curtis syndrome

A

RUQ pain
-refered to the right shoulder tip if their is diaphragmatic irritation

laparoscopy can be used to visualise and treat adhesions by adhesiolysis

61
Q

treatment of hydrosalpinx 3

A

if syx free->conservative

if pelvic pain-> bilateral salpingectomy

if invertility-> IVF, usually after salpingectomy

62
Q

define functional ovarian cysts

A

functional ovarian cysts- fluid filled sacs related to fluctuating hormones of the menstrual cycle

63
Q

who is more likely to suffer from benign vs malignant ovarian cysts

A

premenopausal ovarian cysts- vast majority bening
-very common

postmenopausal ovarian cysts- more ceoncering for malginancy ad need further investigation

64
Q

types of ovarian cysts 4

A

functional cysts

dermoid cysts

epithelial cysts

endometriotic cysts

65
Q

signs and syx of ovarian cysts 3

A

none usually

pain

abod or pelvic swelling

66
Q

diagnosis of ovarian cysts (3 imaging 4 tests)

A

US or CT or MRI

CA125, CEA, aFP hCG

67
Q

what influences mangemnt of ovarian cysts 2

A

if ptx symptomatic

size -

68
Q

what size of ovarian cysts are usualy removed

A

if over 6cm

69
Q

management of ovarian cysts if syx free and <6cm

A

conservative
-consider Ca125 and followup scan

70
Q

managment of ovarian cyst if symptomamtic ± >6cm

A

ovarian cystectomy or oophorectomy

-laparsocpic preferred over open if possible

NEED HISTOLOGY

71
Q

types of functional ovarian cysts 2

A

follicular or luteal
-both related to mensutral cycsle and usually resove within 6-12 weeks

AVOID UNNECESSARY INTERVETNION
-v common & often ‘incidental’

72
Q

describe dermoid cysts

A

benign cystic teratoma

account for 10% of ovarian neoplasms

variable size

often grow hair,bone, teeth etc

73
Q

investigations and manaegment for dermoid cysts (2,2)

A

Ix- US ± CT

Mx- ovarian cystectomy or oophorectomy
-lapraoscop or open

74
Q

types of epithelial ovarian cysts 2

A

serous or muinos cystadeomas
-often grow v large and do not resolve spontaneously

75
Q

syx of epithelial ovarian cysts

A

abdo sweeling

pain (torsion)

76
Q

Ix and Mx for epithelial ovarian cysts (3,1)

A

imaging- Us, Ct/MRI

tumour markers- CA125

Mx- surgical- usually open

77
Q

complications of ovarian cysts

A

mainly torsion

rarely rupture,haemorrhea, infection

78
Q

signs and syx of ovarian torsion

A

lower abdo pain - UNILATERAL

abdo and PV tenderness

79
Q

Ix for ovarion torsion 6

A

preg test

MSU rule out UTI

vaginal/cervical swabs -?PID

FBC+ CRP

CA125

TVUS

80
Q

Mx of ovarian torsion

A

laparscopy/lapartomy
-oopherectomy or salpingo-oopherectomy

81
Q

define endometriosis

A

oestrogen-dendent beign inflammaotry diseae characterised by ecotpic endometirum

82
Q

what is endometriosis usually accompained by 2

A

cysts and fibrois

83
Q

what is endometriosis usually accompained by 2

A

cysts and fibrois

84
Q

endometriosis causes

A

uncertain
-heritable component

retrograde menstruation plays a part

85
Q

types of endometriosis 3

A

superficial peritoneal lesions (minimal and mild)

deep infiltrating lesions (moderate & severe)

ovarian cysts (endometriomas)

86
Q

problem with endometriosis

A

laparoscopy and biopsy only reliable Ix

women w syx suggestive of endometriosis often don’t have it and those that do are often Dx late

87
Q

long term effects of endometriosis

A

personal relationships

QOL

work productivity

88
Q

syx and sx of endometriosis 6

A

syx -may be syx free classically:
-dysmenorrhoea
-dysparenuia
-pelvic pain
-subfertility

sx- fixed tender retroverted uterus

89
Q

investigations fof endometriosis 4

A

suspected w Hx and VE

TVU

CA125 often raised

laparsocpy + biopsy = gold standard

90
Q

endometriosis mangemnt if syx free 1

A

conservative

91
Q

endometriosis Mx for syx releif 4

A

NSAIDS

progestogens

COCP

mirena

92
Q

endometriosis Mx prior to surgery 1

A

GnRH analouges

93
Q

endometriosis defintive managemnt

A

surgery
-if trying to concieve- laparoscopic exicision or ablation of endometriosis plus adhesiolysis

-ovarian cystecotmy if endomtrioma

94
Q

endometriosis managemnt for infertility 1

A

IVF

95
Q

what dx to consider in acute pelvic pain 3

A

conisder cyst ‘accidents’ (torsion, infection, haemorrhea, rupture)

PID

ectopic

96
Q

what dx to consider in chornic pelvic pain 2

A

enodmetrioiss

CPP (chronic pelvic pain)

97
Q

regarding the following gynaecological site what could be causing BENIGN pelvic pain:
vulva 3

A

bartholin abscess

herpes -acute inflam

lichen sclerosus - chronic pruritus and excoiation

98
Q

regarding the following gynaecological site what could be causing BENIGN pelvic pain:
uterus 1

A

fibroids - degeneration or torsion

99
Q

regarding the following gynaecological site what could be causing BENIGN pelvic pain:
fallopian tubes 2

A

PID- acute inflam

hydrosalpinx - pelvic adhesion

100
Q

regarding the following gynaecological site what could be causing BENIGN pelvic pain:
ovaries

A

ovarian cysts
-torsion, haemorrhea, rupture

101
Q

regarding the following gynaecological site what could be causing BENIGN pelvic pain:
endometrium

A

enodmetrossis
-inflam, adhesions, ruptures

102
Q

define dysmenorrhoea

A

pain coincides w meses

cramping lower abdo
radiates to lower back and legs

103
Q

incidence of dysmenorrhoea

A

30-50%

104
Q

define primary adn secondary dysmenorrhoea

-*what should always be considered with dysmenorrhea

A

primary
-idiopathic
-onset soon after strat of ovulatory cycles
-increased prostaglandin levels (contraction)

secondary
-onset usually years after menarche
-more likely to be due to pelvic pathology

*ALWAYS CONSIDER ENDOMETRIOSIS

105
Q

define vulvodynia

A

type of chronic pelvic pain with no identifiable cause

106
Q

presnetiaon of vulvodynia

A

no obvious skin problem

provoked or unporvied

itching not a features

107
Q

managment of vulvodynia 3

A

low dose Tricyclic antidepresant -may take weeks

lubricants

vulval care advice

108
Q

chronic pelvic pain presenation

A

intermittent or constatn lwoer abdo pain
- >6 months

common in primary care -sgingicangt impact on functioning

multifactorial
-physical,psychological and social factors

109
Q

chronic pelvic pain assessment

A

allow time
-need to feel listened too and believed

rule out gynae pathology- imaging, laparsocpy

consider
-IBS, intersitial cystitis, MSK, psych and social issues

110
Q

chronic pelivic pain Mx

A

IBS- antispasmiocs
NSAIDs- MSK

refer to approprate specialist if required

involve MDT
-chornic pain services
-psychology
-physio
-psychosexual therapy
-self help groups

111
Q

compoenets of meigs syndrome 3

A

ovarina fibroma

pleural effusion

ascites

112
Q

presentation of ovarian cyst torsion 3

A

acute onset of pelvic pain,

often with nausea and vomiting,

in a patient with an adnexal mas

113
Q

presentation of ovarian cyst rupture 2

A

severe pain

bleeding within pelvis

114
Q

presentation of ovarian cyst haemorrhage 2

A

sudden onset pelvic pain, pelvic mass

115
Q

what does the risk of malignancy index estimate
-what are its components 3

A

risk of ovarian mass being maligant

-meopausal status
-US findings
-CA125 level

116
Q

define adenomyosis

A

tissue that normally lines the uterus grows into the muscular wall of the uterus

Obs & Gyn (23 decks)

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