Common gynaecological conditions Flashcards
What is PID and what exam+investigation findings are required for clinical diagnosis?
Ascending infection. Typically STI. Inflammation within pelvic girdle i.e endometritis, salpingitis, oophritis, peritonitis.
1) Abdo pain
2) Adenexal tenderness
3) Cervical motion tenderness
& 1 or more of: elevated CRP, ESR, Leukocytosis, fever or purulent cervical d/c
What are the most common organisms to cause PID? and thus what are the treatments?
Neisseria gonorrhorea and chlamydia trachomatis.
Follow local abx guidelines but its multiple covers i.e Ceftriaxone + doxycycline
What is endometriosis? What are the signs and symptoms?
- Endometriosis is the presence of endometrial gland tissue outside of the endometrium
Signs and symptoms:
- Dysmennorhoea (pain)
- Dyspareunia (pain sex)
- Dyschezia (Pain poop)
Commonly on ovaries = adenexal tenderness
How is candida treated?
Topical or oral antifungals
What can PID progress to?
Repetative scarring can lead to tuboovarian abscess.. This can rupture. -> Laparotomy
How is a diagnosis of endometriosis made?
Laproscopic visualisation is the gold standard.
Second most common cause of infertility following PID
How is trichomonas vaginalis treated?
Metronidazole
How is herpes treated?
Acyclovir or valacyclovir
How is syphillis stage 1 and 2 treated?
Penicillin
How is chlamydia treated?
Most common STI
- Doxycycline
- Azithromycin (if pregnant)
How is neisseria gonorrhoea treated?
Ceftriaxone
Whats typically the best course of action for someone with gonorrhoea?
Ceftriaxone and doxycycline for presumed co-infection of chlamydia.
Not true for the reverse
What is adenomyosis? Whats the common exam findings?
Endometrial glands in the uterine musculature.
Large boggy uterus with hx of dysmenorrhorea or menorraghia
How is adenomyosis treated?
Dilatation and curetage to rule out endometrial cancer.
Hysterectomy for symptom relief.
What are uterine fibroids? What are they dependent on and what is curative?
Fibroids i.e leiomyomas are benign uterine tumors. ESTROGEN DEPENDENT
If grow too large or cause symptoms (menorrhagia -> bleeding) then hysterectomy is curative
1% malignant transformation.
What can cause dysfunctional uterine bleeding other than PCOS?
DUB - Bleeding not associated with tumor, inflammation or pregnancy.
Commonly caused by unopposed estrogen.
-> PCOS
-> Thyroid
-> Adrenal
-> Pituitary / prolactin
-> Coag issues
-> Estrogen producing neoplasms
Always check for uterine cancer if >35
Define PCOS:
Characterised androgen excess with LH:FSH ratio of 2:1
- Polycystic ovaries (US)
- Hirsutism
- Amenorrhoea
- Acne
- Overweight
How is PCOS treated?
- COCP
- Metformin
Distinguish primary and secondary amenorrhoea:
Primary: Never mensturated
Secondary: Has stopped
What is primary dysmenorrhoea?
Painful periods in the absence of pathology
Commonly treated with NSAIDS, warm packs etc
What is secondary dysmenorrhoea?
Painful mensturation caused by organic cause i.e PID, Ectopic pregnancy
What is the acronym for abnormal uterine bleeding?
Structural:
P - Polyp
A - Adenomyosis
L - Leiomyoma (Fibroid)
M - Malignancy / endometrial hyperplasia
Non-Structural:
C - Coagulopathy
O - Ovulatory dysfunction
E - Endometrial
I - Iatrogenic
N - Not yet classified
What are the investigations utilised in the work up for abnormal uterine bleeding?
- Cervical smear
- Swabs - STI
- FBC (anaemia)
- Coags
- TFT
- Prolactin
- Imaging
When a woman presents with nipple discharge what are important aspects of the hx to attain?
- OCP use
- Hormone therapies
- Antipsychotic medications
- Hypothyroidism symptoms.
- Colour of d/c
- Uni or bilateral
What is the most common cause of a breast mass in a woman <35 years of age?
- Fibrocystic disease
- Fibroadenoma
- Mastitis / abscess
- Fat necrosis
How is mastitis managed?
- Continue breast feeding always to prevent duct blockage and abscess formation.
- Analgesic + Anti-staph i.e cephalexin
- if MRSA: Clindamycin or trimethoprim
- If fluctuant mass and no improving it will be an abscess that needs draining.
What is the usual cause of vaginal bleeding in the neonate?
- Vaginal bleeding in neonates is usually physiological and as a result of maternal estrogen withdraw. Self resolving.
What are absolute contraindications to hormone replacement therapy?
- Unexplained vaginal bleeding
- Acute liver disease
- History of thromboembolism
- CAD
- Hx of endometrial or breast cancer
- Pregnancy
What are the relative contraindications to hormone replacement therapy?
- Seizure disorder
- HTN
- Uterine leiomyomas
- Familial hyperlipidaemia
- Migraine headaches
- Thrombophlebitis
- Endometriosis
- Gallbladder disease
What are the absolute contraindications to the COCP?
- VTE, DVT, or PE
- Stroke
- CAD
- Valvular disease
- Db with complications
- Breast cancer
- Pregnancy
- Lactation
- Liver disease
- Headaches with focal neurology
- Smoking 15+ and are 35+
- HTN with vascular disease
Whats the relationship with the COCP and BP?
OCP is the most common cause of secondary HTN
How does the oral contraceptive pill relate to surgery?
Pill should be stopped 1 month before surgery and no restarted until one month after
