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
2
Q
important benign gynaecology conditions regarding the
cervix 2
A
ectopy
polyps
3
Q
important benign gynaecology conditions regarding the uterus 2
A
fibroids
polyps
4
Q
important benign gynaecology conditions regarding the fallopian tubes
A
PID
hydrosalpinx
5
Q
important benign gynaecology conditions regarding the ovary
A
cysts
6
Q
important benign gynaecology conditions regarding the all pelvic organs 1
A
endometriosis
7
Q
define bartholin abscess
A
acute infection of teh bartholin gland duct by bacteria
-bartholin gland - inferior border of vagina
8
Q
define bartholin cyst
A
chronic swelling after previous acute infection
painless
9
Q
managemnt of bartholin cyst/ abcess
A
prescribe broad spec ABx
marsupliasation with GA
or
word catheter with LA
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
11
Q
symptoms of lichen sclerosus 2
A
itching - pruritus vulvae
excoriation- pain, dysparenunia
12
Q
signs of lichen sclerosus 3
A
whitening of vulval skin
loss of labial & clitoral contours
narrowing of entry to the vagina
13
Q
diagnosis of lichen sclerosus 1
A
usually typical apperarnce {1}
biopsy if unsure/suspcicious area
14
Q
treatment for lichen sclerosus 1
A
potent steroid topically
-CLOBETASOL- Dermovate
15
Q
cause of genital herpes
A
STD- usually HSV-2
16
Q
sx and syx of genital herpes 3
A
painful vesicular rash
dysuria
dyspareunia
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
18
Q
define cervical ectopy
A
columnar cells from canal everted to cervix
19
Q
syx of cervical ectopy
A
usually none
-maybe chronic discharge/post-coital bleeding (PCB)
*-has. a typical appearance of speculum exam {2}
20
Q
treatemnt of cervical ectopy 1
A
only if symptomatic
-cuatery/cryotherapy/AgNO3
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}
22
Q
define fibroids
A
benign tumours of the myometrium
-have several locations {4}
-malignacy rare
23
Q
incidence of fibroids
A
70-80% of fifty year olds
24
Q
what are fibroids dependent on
A
oestrogen
-grow during pregnancy
-shrink affter menopause
25
symptoms of fibroids 6
heavy menstrual bleeding
abdo swelling
pressure symptoms ie ureteric obstruction
subfertility
difficulties in pregnancy (miscarriage, red degeneration)
pain (rare)
26
signs of fibroids 1
abdo or pelvic mass
27
diagnosis of fibroids 3
clinical suspicion
confirm by ultrasound (transvaginal)
MRI to plan management
28
management options for fibroids
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
29
types of hysterectomy
see {5}
29
types of hysterectomy
see {5}
30
signs, sympotms and diagnosisi of endometrial polpys
common and rarely serious condition
syx- PMB, IMB, HMB
diagnosis
-may be suspected by TVU
-hysterscopy & histology
31
endometrial polyps management
hysteroscopy and polypectomy
32
name 2 fallopian tube abnormaliteis
pelvic inflamatory disease (PID)
hyrosalpinx
33
define pelvic inflammatory disease
inflammation and infection of teh organs of the pelvis
-caused by infection spreading up through the cervix
34
why is pelvic inflammatory disease a significnat concern 2
risk of tubular blockage and subfertility
-infertility -20%
-ectopic pregnancy -10%
-chronic pelvic pain- 20%
35
state the inflammatory name of the following sites:
-endometrium
endometritis
36
state the inflammatory name of the following sites:
-fallopian tubes
salpingitis
37
state the inflammatory name of the following sites:
-ovaries
oophoritis
38
state the inflammatory name of the following sites:
parametrium (connective tissue around the uterus)
parametritis
39
state the inflammatory name of the following sites:
peritoneal membrane
peritonitis
40
common causes of pelvic inflammatory disease 3
neisseria gonorrhhoea
chlamydia trachomatis
mycoplasma genitalium
41
less common causes of pelvic inflammatory disease 3
gardneerall vaginalis (assoc w bacterial vaginosis)
haemophiuls inflenzuae (often a respiratory infection)
escherichia coli (assoc w UTIs)
42
risk factors for pelvic inflammatory disease 6
not using barrier contrapcetion
multiple sexual partners
younger age
exististing STI
previous PID
IUD
43
symptoms of pelvic inflammatory disease 6
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
44
examination findings in pelvic inflammatory disease 4
pelvic tenderness -rebound and guarding, distension, sometimes RUQ pain
cervical motion tenderness (cerivcla excitation)
inflamed cervix (cervicitis)
purluent discharge on speculum view [6]
45
investigations for pelvic inflammatory disease 7
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
46
describe STI swabs, their types and specific STIs 5
NAAT swab- gonorrhoea, chlamydia, mycoplasma genitalium
HIV test
Syphililis test
47
what are high vaignal swabs testing for 3
bacterial vaginosis
candidiasis
trichomoniasis
48
how can swab testing be used to rule out PID
if swab looked at under microspope (both kinds) - absence of pus cells -> NO PID
49
inital managemnt of pelvic inflammatory disease 3
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
emperical ABx regime for PID 4
STAT ceftrixone
doxy
metro
ofloxacin
51
regarding emperical ABx for PID
-what does ceftriaxone cover
gonorrhoea
52
regarding emperical ABx for PID
-what does doxy cover
chlamydia and myocoplasma genitalium
53
regarding emperical ABx for PID
-what does metro cover
bacterial vaginosisi
-gardnerella vaginalis
trichomonas vaginalis
54
regarding emperical ABx for PID
-what does doxy and ceftriaxone also cover
many other bacteria
incld H. influenzae and E Coli.
55
complications for PID
sepsis
abscess
infertility
chronic pelvic pain
ectopic pregnancy
fitz-hugh-curtiz syndrome
56
symptoms of hydrosalpinx 3
usually none after acute infective phase
occ. pelvic pain
often subfertility/ infertility
57
investigations for hydrosalpinx 3
may be susepcted by TVU
laparoscopy
hysterossalpingogram (HSG)
58
define hydrosalpinx
fallpoain tubes are blocked and fill with serous or clear fluid near the ovaries
59
define fitz-hugh-curtis syndrom
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
presenation and mangemnt of fits-hugh curtis syndrome
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
treatment of hydrosalpinx 3
if syx free->conservative
if pelvic pain-> bilateral salpingectomy
if invertility-> IVF, usually after salpingectomy
62
define functional ovarian cysts
functional ovarian cysts- fluid filled sacs related to fluctuating hormones of the menstrual cycle
63
who is more likely to suffer from benign vs malignant ovarian cysts
premenopausal ovarian cysts- vast majority bening
-very common
postmenopausal ovarian cysts- more ceoncering for malginancy ad need further investigation
64
types of ovarian cysts 4
functional cysts
dermoid cysts
epithelial cysts
endometriotic cysts
65
signs and syx of ovarian cysts 3
none usually
pain
abod or pelvic swelling
66
diagnosis of ovarian cysts (3 imaging 4 tests)
US or CT or MRI
CA125, CEA, aFP hCG
67
what influences mangemnt of ovarian cysts 2
if ptx symptomatic
size -
68
what size of ovarian cysts are usualy removed
if over 6cm
69
management of ovarian cysts if syx free and <6cm
conservative
-consider Ca125 and followup scan
70
managment of ovarian cyst if symptomamtic ± >6cm
ovarian cystectomy or oophorectomy
-laparsocpic preferred over open if possible
NEED HISTOLOGY
71
types of functional ovarian cysts 2
follicular or luteal
-both related to mensutral cycsle and usually resove within 6-12 weeks
AVOID UNNECESSARY INTERVETNION
-v common & often 'incidental'
72
describe dermoid cysts
benign cystic teratoma
account for 10% of ovarian neoplasms
variable size
often grow hair,bone, teeth etc
73
investigations and manaegment for dermoid cysts (2,2)
Ix- US ± CT
Mx- ovarian cystectomy or oophorectomy
-lapraoscop or open
74
types of epithelial ovarian cysts 2
serous or muinos cystadeomas
-often grow v large and do not resolve spontaneously
75
syx of epithelial ovarian cysts
abdo sweeling
pain (torsion)
76
Ix and Mx for epithelial ovarian cysts (3,1)
imaging- Us, Ct/MRI
tumour markers- CA125
Mx- surgical- usually open
77
complications of ovarian cysts
mainly torsion
rarely rupture,haemorrhea, infection
78
signs and syx of ovarian torsion
lower abdo pain - UNILATERAL
abdo and PV tenderness
79
Ix for ovarion torsion 6
preg test
MSU rule out UTI
vaginal/cervical swabs -?PID
FBC+ CRP
CA125
TVUS
80
Mx of ovarian torsion
laparscopy/lapartomy
-oopherectomy or salpingo-oopherectomy
81
define endometriosis
oestrogen-dendent beign inflammaotry diseae characterised by ecotpic endometirum
82
what is endometriosis usually accompained by 2
cysts and fibrois
83
what is endometriosis usually accompained by 2
cysts and fibrois
84
endometriosis causes
uncertain
-heritable component
retrograde menstruation plays a part
85
types of endometriosis 3
superficial peritoneal lesions (minimal and mild)
deep infiltrating lesions (moderate & severe)
ovarian cysts (endometriomas)
86
problem with endometriosis
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
long term effects of endometriosis
personal relationships
QOL
work productivity
88
syx and sx of endometriosis 6
syx -may be syx free classically:
-dysmenorrhoea
-dysparenuia
-pelvic pain
-subfertility
sx- fixed tender retroverted uterus
89
investigations fof endometriosis 4
suspected w Hx and VE
TVU
CA125 often raised
laparsocpy + biopsy = gold standard
90
endometriosis mangemnt if syx free 1
conservative
91
endometriosis Mx for syx releif 4
NSAIDS
progestogens
COCP
mirena
92
endometriosis Mx prior to surgery 1
GnRH analouges
93
endometriosis defintive managemnt
surgery
-if trying to concieve- laparoscopic exicision or ablation of endometriosis plus adhesiolysis
-ovarian cystecotmy if endomtrioma
94
endometriosis managemnt for infertility 1
IVF
95
what dx to consider in acute pelvic pain 3
conisder cyst 'accidents' (torsion, infection, haemorrhea, rupture)
PID
ectopic
96
what dx to consider in chornic pelvic pain 2
enodmetrioiss
CPP (chronic pelvic pain)
97
regarding the following gynaecological site what could be causing BENIGN pelvic pain:
vulva 3
bartholin abscess
herpes -acute inflam
lichen sclerosus - chronic pruritus and excoiation
98
regarding the following gynaecological site what could be causing BENIGN pelvic pain:
uterus 1
fibroids - degeneration or torsion
99
regarding the following gynaecological site what could be causing BENIGN pelvic pain:
fallopian tubes 2
PID- acute inflam
hydrosalpinx - pelvic adhesion
100
regarding the following gynaecological site what could be causing BENIGN pelvic pain:
ovaries
ovarian cysts
-torsion, haemorrhea, rupture
101
regarding the following gynaecological site what could be causing BENIGN pelvic pain:
endometrium
enodmetrossis
-inflam, adhesions, ruptures
102
define dysmenorrhoea
pain coincides w meses
cramping lower abdo
radiates to lower back and legs
103
incidence of dysmenorrhoea
30-50%
104
define primary adn secondary dysmenorrhoea
-*what should always be considered with dysmenorrhea
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
define vulvodynia
sensation fo vulval burnig and sorenes
-
type of chronic pelvic pain with no identifiable cause
106
presnetiaon of vulvodynia
no obvious skin problem
provoked or unporvied
itching not a features
107
managment of vulvodynia 3
low dose Tricyclic antidepresant -may take weeks
lubricants
vulval care advice
108
chronic pelvic pain presenation
intermittent or constatn lwoer abdo pain
- >6 months
common in primary care -sgingicangt impact on functioning
multifactorial
-physical,psychological and social factors
109
chronic pelvic pain assessment
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
chronic pelivic pain Mx
IBS- antispasmiocs
NSAIDs- MSK
refer to approprate specialist if required
involve MDT
-chornic pain services
-psychology
-physio
-psychosexual therapy
-self help groups
111
compoenets of meigs syndrome 3
ovarina fibroma
pleural effusion
ascites
112
presentation of ovarian cyst torsion 3
acute onset of pelvic pain,
often with nausea and vomiting,
in a patient with an adnexal mas
113
presentation of ovarian cyst rupture 2
severe pain
bleeding within pelvis
114
presentation of ovarian cyst haemorrhage 2
sudden onset pelvic pain, pelvic mass
115
what does the risk of malignancy index estimate
-what are its components 3
risk of ovarian mass being maligant
-meopausal status
-US findings
-CA125 level
116
define adenomyosis
tissue that normally lines the uterus grows into the muscular wall of the uterus
