Ch. 16 Common Gyn Pelvic Disorders Flashcards
What are 8 common causes of GYN acute Pelvic Pain
1-Ectopic Pregnancy 2- Abortion 3- Menstruation 4- Ovulation Pain 5- Endometriosis 6- Salpingitis 7- Ruptured Ovarian Cyst 8-Adnexal Torsion
What are some common causes of Chronic Pelvic Pain in GYN (12)
1- Endometriosis 2- Adenomyosis 3- Uterine Fibroids 4- Chronic Salpingitis 5- Adhesions 6- Dysmenorrhea 7- Pelvic relaxation 8- Recurrent Ovarian Cyst 9- Hydrosalpinx 10-Post-tubal ligation pain syndrome 11- Psychopathology 12- Dyspareunia
What are some common causes of Non-GYN Acute Pelvic Pain? (6)
1- Appendicitis 2- Cystitis 3- Diverticulitis 4- Urethral Calculus 5- Gastroenteritis 6- Trauma
What are some common non-GYN causes of chronic pelvic pain? (12)
1- Chronic appendicitis 2- IBS 3- Ulcerative Colitis 4- Diverticulosis 5- Interstitial Colitis 6- Radiation Cystitis 7- Bladder cancer 8- Urethral syndrome 9- Chronic constipation 10- Colorectal carcinoma 11- Celiac Disease 12- Fibromyalgia
What is the diagnosis when there is endometrial glands and stroma found outside of the endometrial cavity?
Endometriosis
What are the risk factors of endometriosis? (3)
1- Menarche before 11
2- Cycle length less than 27 days
3- heavy and prolonged cycles
What are the diagnostic test for endometriosis With the first 2 being the gold standard of Diagnosis (6)
1-Visualization via laparoscopy or laparotomy 2- May also use ultrasound as diagnosis 3- History of lesions 4- Imaging (CT scan, MRI, Sono) 5- Endometrial biopsy 6-CA-125
What are some differentials with endometriosis? (7)
1- PID 2- Pelvic Adhesions 3- Ovarian Cyst 4- Ovarian Masses 5- Leiomyomas 6- depression 7- sexual abuse
What is the plan of care for endometriosis(4)
1- First line of treatment: NSAIDS for pain reduction with Combined Oral Contraceptives to suppress menstruation
2- A diet in increased omega 3 fatty acids
3- Decreased animal fats
4- discussion on fertility plans
What is the main cause of PID?
STIs
What are the main causes of STI causes of PID?
Gonorrhea and Chlamydia
What are the 2 risk factors for PID
STIs and Race of African American Women
What are the Signs and Symptoms of PID?
1- Abdominal Discharge 2- Post Coital Bleeding 3- Intermenstrual bleeding 4- Fever 5- nausea 6- Vomiting 7- UTI symptoms 8- Low back pain
What is a protective factor against PID
Hormonal Contraceptives
There is a minimal criteria for PID. What are the requirements to empirically treat?
-Pelvic/lower abdominal pain plus:
1- Cervical Motion Tenderness
2- Uterine Tenderness
3- Adnexal tenderness
What are some indications for hospitalization with PID? (3)
1- no improvement of symptoms within 72 hours of ABX therapy.
2- The patient presents with high fever
3- Positive for HIV or another immunodeficiency
How is PID diagnosed? (4)
1- Nucleic Acid Amplification Test (NAAT) from vaginal or cervical swabs
2- Wet Prep
3- Urinalysis to R/O UTI
4- Transvaginal Ultrasound
What are some common differentials of PID? (8)
1- Acute Appendicitis 2- Ectopic Pregnancy 3- Ovarian Torsion 4- UTI/Pyelonephritis 5- Vaginal infections 6- Endometriosis 7- Ovarian cyst/mass 8- Degeneration of Leiomyoma
How is PID treated? (3)
1- Ceftriaxone 250mg IM x1 then doxycycline 100mg po BID x 14 days
2- may consider adding flagyl 500mg BID x 14 days
3- Treat partner if Gonorrhea and Chlamydia
What percentage of adnexal masses are malignant?
10%
What diagnostic test is recommended when it comes to suspected pelvic mass?
Transvaginal Pelvic Ultrasound
What are some common differentials for adnexal masses? (3)
1- Benign cyst
2- metastatic ovarian malignancy
3- Primary ovarian malignancy
What are some common risk factors for Adnexal Masses? (2)
1- BRCA 1 & 2 mutations
2- Lynch syndrome
What is the mechanism of action when using oral contraceptives for the treatment/prevention of forming new cyst?
The oral contraception inhibits ovulation which also inhibits the formation of the new cyst
What is an indication for surgery with adnexal cyst? (4)
1- If cyst persist for more than a few months
2- > or equal to 5cm in postmenopausal women
3- fail symptom control with medical treatment.
4- If the mass persist beyond 12 weeks, refer to GYN
What is the cause of inflammation in endometriosis?
The endometrial tissue responds cyclically to estrogen which causes swelling and local inflammation
What are the key components of endometriosis development?
Overproduction of prostaglandins and local estrogen
What are some common symptoms of endometriosis? (4)
1-Very painful menstrual cramps
2-Very heavy menstrual bleeding
3- Heavy spotting, or bleeding between periods
4- Inability or difficulty in becoming pregnant
What are some signs of endometriosis? (4)
1- rapid or irregular heartbeat
2- Fluctuating blood pressure
3- Slightly elevated or reduced body temperature
4- Abnormal blood levels of reproductive hormones
What are the risk factors for PID? (8)
1- Age <25 2-Multiple sex partners 3- Sexual activity at an early age 4- douching 5- inconsistent condom use 6- smoking, alcohol 7- sex workers 8- prior history
What sub diagnosis fall under PID (4)
1- Cervicitis
2- Endometritis
3- Salpingitis
4- Oophoritis
What are some short term concerns with PID (2)
1- Peritonitis
2- Pelvic Abscess
What are some long term concerns with PID? (2)
1- Infertility
2- High risk of ectopic pregnancy
What are the signs and symptoms of PID?
1- (first indication) Lower abdominal pain 2- tenderness during pelvic exams 3- Purulent discharge at cervix 4- Dysuria 5- Fever and leukocytosis
What are the common diagnostic test ordered when diagnosing someone with PID?
1- pregnancy test 2- Vaginal smear and cervical culture 3- CBC, ESR and CRP 4- Pelvic Sono 5- Laparoscopy
What are some educational tips for a patient with PID? (3)
1- adherence to the medication
2- Avoidance of intercourse until ABX complete
3- evaluation and treatment of partners
What are the follow up and referral directions for a patient with PID? (2)
1- re-evaluate in 48-72 hours then 1-2 weeks after start of antibiotics
2- repeat GC/CT cultures 3-6 months after completion of antibiotics
What are adnexal masses present?
During reproductive years
What are the symptoms of adnexal masses? (6)
1- Pelvic pain that is a "dull" ache 2- Dyspareunia 3- Constipation 4- Nausea, vomiting, loss of appetite 5- heavy feeling in abdomen 6- pressure on the bladder
How with the patient present upon palpation of the abdomen when there is an adnexal mass?
1- Guarding
2- rebound tenderness
What is found upon the pelvic exam when there is an adnexal mass? (3)
1- Cervical motion tenderness
2- Adnexal tenderness
3- Palpable mass
What are the common diagnostic test that are ordered when working up a patient with a potential adnexal mass (6)
1- pregnancy test 2- STI testing 3- Cervical and vaginal cultures 4- Trans vaginal Sono 5- Pelvic MRI 6- Laparoscopy
What indications of adnexal mass needs to be present for surgery to be considered? (2)
1- >7mm
2- nonfunctional symptoms
What are the differential diagnoses with adnexal mass (8)
1- Ectopic pregnancy 2- PID 3- Tubo-ovarian cyst 4- Uterine Leiomyomas 5- Appendicitis 6- Diverticulitis 7- UTI 8- Renal Calculi
What is Dyspareunia?
Painful Coitus (sexual intercourse)
What does intromission mean
action or process of inserting the penis into the vagina
What are the common diagnostic test ordered when working up a patient for dyspareunia? (5)
1- Pregnancy test 2- vaginal smear/cervical culture 3- Sonogram 4- CBC and ESR 5- Diagnostic laparoscopy
What is another name for Fibroid?
Leimymoma
What are risk factors for Fibroids (5)
1- Advancing age 2- Hyper-estrogen states 3- African Americans 4- HTN 5- Nulliparity
What are the clinical presentations of fibroids (3)
1- Menorrhagia
2- Pelvic Pain
3- Palpable uterus above symphysis pubis
What is the management of Fibroids? (3)
1- Myomectomy
2- Embolization
3- Hysterectomy
What are the presenting symptoms with Fibroids? (5)
1- Dyspareunia 2- bloating 3- Menorrhagia 4- Pelvic pressure 5- Urinary urgency and frequency
What are the presenting symptoms with Adenomyosis? (4)
1- Menorrhagia
2- Chronic pelvic pain
3- Dysmenorrhea
4- Infertility
Upon the pelvic exam in a patient with adenomyosis what will be present?
Enlarged/symmetrical uterus
What are the different types of pelvic organ prolapses? (6)
1- uterine 2- vaginal vault 3- cystocele 4- urethrocele 5- enterocele 6- rectocele
What is ovarian cancer known as?
The silent killer
What are the risk factors for ovarian cancer?
1- Inherited gene mutation (BRCA1 & 2) 2- Increased age (post menopause) 3- early menarche 4- Late menopause 5- nulliparity 6- no breast feeding 7- obesity
What is the screening method for ovarian cancer
There is none
For patients with known family history of ovarian cancer what test can be done to potentially screen for ovarian cancer (2)
1- Pelvic sonogram
2- genetic mutation testing
What are some symptoms of endometrial cancer? (6)
1- Heavy periods 2- Pelvic lump 3- abnormal vaginal bleeding 4- changed bowel habits 5- difficulty in urination 6- pain during intercourse
What is the most common GYN cancer?
Uterine cancer
What are some common risk factors for endometrial cancer? (13)
1- Early menarche (<12)
2- Late menopause (>52)
3- infertility or nulliparity
4- obesity
5- treatment with tamoxifen for breast cancer
6- Estrogen replacement therapy after menopause
7- diet high in animal fat
8- diabetes
9- age greater than 40
10- Caucasian women
11- family history of endometrial cancer
12- prior treatment of breast and/or ovarian cancer
13- prior radiation therapy for pelvic cancer
What is the most common cause of cervical cancer
HPV
What is the HPV vaccination called
Gardasil Quadrivalent
What is the maximum age Gardasil has been approved for
45
