Blood supply anatomy, imaging, HRT, premature ovarian failure Flashcards
obturator foramen covered in?
obturator memrane
in the male, which artery supplies the majority of the male perineum?
internal pudendal
dorsal artery of the penis, is it on the front or the back?
front
most arteries supplying the penis come from the ?
internal pudendal
ovarian artery has 2 branches…name them?
tubal branch supplies fallopian tube and ovarian branch supplies ovary
in the pelvis, the veins form a number of plexus, , where do they mainly drain?
internal iliac
disease can penetrate through the peritoneal layer, and disseminate into the peritoneal cavity. which cancer does this, and can end up depositing in liver, under diaphragm and forming a malignant effusion in the lungs?
ovarian
is ultrasound in gynae safe?
yes, no ionising radiation
what are the two types of ultrasound used
transabdominal and transvaginal
frequency comparison?
transvaginal is high frequency
in transabdominal, why do you need a full bladder/
it acts as an acoustic window, displaces gas filled bowel loops out of the pelvis
transabdominal, is there any ionising radiation?
no
transvaginal, gives better spatial resolution, why does the transducer have to be close to the target organ?
higher frequencies are more likely t be scattered in the body
bladder in transvaginal?
empty, is uncomfortable if bladder is full
who is unsuitable for trans v us?
those who have not been sexually active
what is often used 2nd line in patients with abdominal pain?
CT
Ct scan is used to stage gynae malignancies
also assess response to chemo/radiotherapy
whats the downside of CT? where in particular is a significant dose delivered to?
high radiation dose (equivalent to 160 cxrs)
what does MRI use instead of radiation?
radio frequency (window)
how can different tissue compositions be defined in different parts of the body
can be weighted
benefit of MRI?
no ionising radation
what can it give an idea of?
composition of soft tissue masses (chopping board)
MRI is suitable for women of repro age and children
gives poor definition of lung parenchyma
some uses of MRI in gynae? (scroll)
cancer staging, further investigation of masses (after us), evaluation of fertility and imaging of the pituitary gland in suspected prolactinoma
endometriosis - why is it able to be picked up on MRI?
it has altered blood due to haemoglobin breakdown products, this causes characteristic MR changes
it returns a high signal on t1 (white) and a low signal on t2 (grey)
y
where can you get endometriosis?
bowel/bladder, uterine tunes, ovaries
dermoid cysts - how is it diagnosed?
predictable changes on MR but can also be diagnosed on CT
what is HSG used for and what is it?
close off the cervix and fill uterus with fluid, used to assess tube potency. real time image on x ray
ascites, peritoneal and omental nodules, liver and sub diaphragmatic deposits seen in?
ovarian cancer
malgnant pleural effusions can result from?
pleural peritoneal communications
what is the parametrium?
connective tissue and fat around the uterus and cervix
***what imaging is better for looking at local disease?
MRI
mets?
CT
what is the best imaging technique to establish a thickened endometrium in a post menopausal woman with PMB?
transvaginal us (hock st)
MRI used to look for local myometrial spread but CT used to look for distant nodal and pulmonary mets
y
what is the most common age to get endometrial cancer.uncommon below what age?
60 uncommon under 40
e1 name? e2?
oestrogen one 1, estradiol e2 di
e1 seen more in ?
post menopausal women (oneoone)
which is less biologically active? e1 or e2?
e1
what happens in menopause?
ovaries contain a finite number of eggs. ovaries start to become less sensitive to lh and fsh. when the serum fsh is above 30 on two separate occasions = menopause
loss of ovarian function leads to _______depletion?
oestradiol
average age of menopause?
52
adipocytes convert androgens into?
e1
why do you get dyspareunia?
vaginal dryness
long term effects of menopause?
COC - cardiovascular disease, cerebrovascular disease and osteoperosis
oestrogen effects on LDL, hdl, cholesterol and fat distribution?
decreases LDL, increases HDL, reduces cholesterol and fat distribution. also protective in terms of bone density.
who are the only patients suitable for an oestrogen only hormone replacement therapy?
TOTAL hystorectomy
if they’ve had a subtotal hysterectomy, they may also need progesterones
y
who is sequential combined given to?
perimenopausal
who is continuous combined given to?
post menopausal bleed free
what contains more synthetic oestrogen at higher dose? HRT or OCP?
HRT
what does progesterone reduce?
the risk of endometrial cancer
progesterone protects the uterus and leads to regular bleed in sequential
progesterone ogven for 10-14 days
which one mimics the normal cycle?
sequential
what hormones are given in continuous combined?
oestrogen and prog for 28 days
no monthly bleed after first 6 months
y
when should sequential treatment be started?
when required, women may still be having periods
why do you want them to switch to continuous asap?
prolonged use can increase risk of endometrial cancer
continuous should not be started until __________after LMP or after 2 year __________
1 year 2 years taking sequential if under 54
continuous shouldn’t be taken under the age of 54, unless?
been on sequential for 2 years
tibolone - weak oestrogenic, progestrogenic and androgenic properties. licensed for ? (3)
vasomotor, psychological and libido problems
increased risk of what in over 60s
stroke
what does the oestrogen have a protective effect on?
bone mass
increased risk of?
endometrial cancer
broadly what does testosterone do?
helps general feeling of wellbeing and improves libido
HRT patient assessment at 3, 6 and 12 months
in most cases less than 5 years is sufficient
what sort of thing do women get checked/check themselves?
annual BP, self examination breast, cervical smears every 3 years, mammography every 3 years,
what cancer does HRT reduce the risk of?
colorectal. also reduces osteoporotic fractures
combined HRT, risk of breast cancer, returns to normal within how long stopping?
5 years
increased risk of VTE. which HRT and when?
combined, in the first year
stroke?
increased risk of stroke
**risk of endometrial cancer in oestrgen only, seq and con?
increased in oestrogen only, lower in seq and eliminated in continuous
small increased risk of ovarian cancer, but eliminated once it is stopped
y
pof - cessation of ovarian activity before the age of
45
long term effects if untreated?
cerebrovascular and cardiovascular disease, osteoporosis, infertility, reduced life ex, dementia and cognitive decline
causes?
chromosome and enzyme deficiency
treatment ?
COCP or HRT
