Core Conditions Flashcards
What are the causes of miscarriage?
Loss of pregnancy <24weeks Most common: Unknown cause 2. Foetal abnormalities (Chr/structural) -Primary embryonic disease -Embryonic malformation -Maternal systemic illness -Maternal genital tract dysfunction -Maternal exposure to high dose toxins -Trans-placental fetal infection
How is a miscarriage investigated?
Pregnancy test
TVUS/abdoUSS
beta hCG: falling titre
Progesterone: Low titre
How is a threatened/complete miscarriage managed?
Analgesic
Counselling
Anti-D immunoglobulin
How is an inevitable/missed/ incomplete miscarriage managed?
Analgesia
Misoprostol: 800micro vaginally
Anti-D immunoG
LA/GA manual vacuum evacuation of retained POC
What does Climacteric mean?
The time within which the transition occurs from pre-post menopausal
How does the menstrual cycle of a woman change in the early & late menopausal transition?
Early: Variabe cycle length >7days different from normal
Late: >2 skipped cycles & an interval of amenorrhoea (>60days)
How is the menopause triggered?
LH & FSH levels increased by falling oestrogen levels
What are the early symptoms of the menopause?
- Vasomotor
- Periods altered
- Insomnia: Tiredness, irritability, poor concentration
- Mood swings
- Cognitive function: Coping
- CT/loss of collagen: Skin, hair, joint/muscle aches
- Fat redistribution
What are the medium term symptoms of the menopause?
- Vaginal: Dryness, soreness
- Dyspareunia
- Bladder: Frequency, urgency, dysuria, UTIs
How is dyspepsia caused during pregnancy?
- Inc level of hormones has relaxing effect on duodenal sphincter
- Size of the foetus causes increased pressure on the stomach
What makes someone more likely to get gestational dyspepsia?
Prev dyspepsia in pregnancy
What are the signs of gestational dyspepsia?
Symptoms come and go not present all the time
Usually more frequent/severe in 3rd trimester
Symptoms disappear quickly after birth
Why is constipation common in pregnancy?
Bowels are more relaxed so increased transit time due to stretched abdominal muscles, hormones & growing uterus putting pressure on the bowels
What is PCOS?
a syndrome of polycystic ovaries, in association with systemic symptoms causing reproductive, metabolic and psychological disturbances. These most commonly present with infertility, amenorrhoea, acne or hirsutism
What are the causes of PCOS?
Genetics
Defects in hypothalamic-pituitary axis
When should PCOS be suspected?
One or more:
- Infrequent/no ovulation (infertility, ameno/oligomenorrhoea)
- Adolescents <18 2 years of irregular cycles
- After menarche/1year of irregularity on OCP
- Hyperandrogenism
How is PCOS investigated?
Testosterone: ↑ SHBG: ↓ Free androgen: n/- LH & FSH: ++ Prolactin: + Pelvic USS
What is the Rotterdam criteria?
Diagnose PCOS if 2-3 of the following:
- Infrequent/no ovulation
- Clinical/biochemical signs of hyperandrogenism/elevated levels of total/free testosterone
- Polycystic ovaries on USS (>12 follicles in one ovary OR large ovary >10cm diameter)
What are the complications of PCOS?
- Pregnancy complications
- CVD
- NAFLD
- Malignancy
- DM2
- Infertility
What are the causes of chronic pelvic pain?
Gynae: Endometriosis, Physical/sexual abuse, fibroids, cervical stenosis, Asherman’s, adhesions,
Non-Gynae: Interstitial cystitis, pelvic adhesions, Multifactorial, constipation, IBS/IBD, hernias, calculi
How is chronic pelvic pain investigated?
Urinalysis & MSU (Sterile UTI consider interstitial cystitis) TVUS STI screen Bloods: FBC, CRP, Ca125
How is chronic pelvic pain managed?
Trial of OCP/GnRH analogues Antispasmodics Analgesia Refer to pain clinic Laparoscopy
What are acute causes of pelvic pain?
Gynae: Ectopic, ovarian cyst, 1. dysmenorrhoea, Mittleschmerz
Non-gynae: UTI, strangulated hernia, calculi, IBS/IBD, appendicitis
What are the types of incontinence? What are there mechanisms?
Stress: Leakage on effort, increased intra-abdominal pressure
Urge: Leakage accompanied by urgency to urinate
Mixed: Stress & urge
Overflow: Leakage from over-distended bladder
Describe the normal mechanism of urine storage
1) Internal & external urethral sphincters closed & bladder relaxed
2) Involuntary & voluntary input to nerves & musculature= increase in outlet resistance to maintain urinary continence
3) Voiding= coordination between urethral sphincter relaxation & bladder contraction by parasympathetic NS
What nerves control the internal & external urethral sphincters?
I: Sympathetic nerves = contraction
E: Somatic nerves = contraction, pudendal nerve= relaxation
How is the bladder supported?
Lateral vaginal wall on either side
Levator Ani muscle & fascia
Ligamentous attachments
What are the causes of urinary incontinence?
Weakened muscles (loss of pelvic floor support)
Stretched muscles
Pudendal & pelvic nerve damage
Chronic urinary retention
Involuntary contractions of the detrusor (OAB)
How is incontinence diagnosed?
Pelvic exam
Assess pelvic floor muscle contractions
Urodynamics
How are pelvic floor muscle contractions graded?
0= No contraction 1= Flicker/pulsation 2= Weak, inc in tension detected without lift 3= Moderate, lifting of muscle belly & elevation of post vaginal wall 4= Good, inc tension & good contraction elevation of post vaginal wall against resistance 5= Strong, strong resistance applied, examiner's finger squeezed & drawn into the vagina
How is stress incontinence managed?
Lifestyle Pelvic floor training for 3months Mid-urethral/TV tape Artificial urinary sphincter Urethral bulking agents Colposuspension
How is urge incontinence managed?
Lifestyle Bladder drill Antimuscarinics: Oxybutynin Botulism injection Percutaneous nerve stimulation Other: nocturne- Desmopressin vaginal atrophy- intravaginal OE therapy
How is PCOS managed?
Clomiphene Citrate
Metformin
Hirtuism: OCP & hair removal
Restoration of regular periods: Mirena/OCP
