Disorders of the Adnexa Flashcards
What are the Adnexa?
Fallopian tubes and uterus
When the corpus luteum does not involute after ovulation, but instead continues to enlarge
Corpus luteum syst
Enlarged tender adnexae. US shows smooth, thin walled unilocular mass
Follicular cyst, occurs when follicle fails to rupture and ovulation does not occur
Pt presents w/ Oligomenorrhea, acne and what appears to be excess body hair. What labs do you start w/? Imaging?
PCOS:
Labs: HcG, Thyroid, FSH, serum insulin level +…
Imaging: Pelvic US
What criteria is used to dx PCOS?
Rotterdam Criteria: 2 of 3
- Oligomenorrhea and or anovulation
- Hyperandrogensim
- Polycistic ovaries on US
Tx for pt w/ Hirsutism?
OCP: ethinyl estriadiol 30-35mcg / norethindrone 1-1.5
- Spironolactone 50-100 MG bid
Most effective tx for infertility related to PCOS?
Weight loss
Pt presents w/ temperature of 38 C, in acute abdominal pain, w/ nausea, breast tenderness and mild spotting (vaginal bleeding). How do you confirm your ddx? What will change in your next best step if pt is cool, pale, diaphoretic?
Ectopic Pregnancy: Hcg + Transvaginal US
Unstable pt: Immediate culdocentesis will confirm hematoperitoneum. Immediate surgical intervention. Medical emergency!
Pt presents with pelvic pain, dysmenorrhea, dyspreunia. PE shows enlarged ovary, US shows complex mass. Top 3 ddx? Tx?
Cystadenoma, Endometrioma, Mature cycstic teratoma (dermoid cyst) - All are benign ovarian neoplasms
Tx: surgical removal
Pt presents w/ vague GI sx, PE shows ascites, pleural effusion, and groin lymphadenopathy. Next best step?
Pelvic US.
If complex adnexal mass accompanied by ascites = Suspect Malignant Ovarian Neoplasm
When do sx present for pts w/ malignant ovarian neoplasms?
Time of metastasis to other abdominal organs. 70% present w/ advance dz at time of dx. Rarely symptomatic in early treatable stage.
Strongest RF for ovarian cancer?
Family hx in 10-15% of cases
Ovarian CA tx?
Stage IA + IB : TAH +BSO w/ omentectomy if well differentiated tumor
Later stages: systemic chemotherapy
What is a TAH +BSO?
Total abdominal hysterectomy-bilateral salpingo-oophorectomy
6 causes of increased CA - 125
1) Endometreiosis
2) Uterine Leiomyoma
3) Cirrhosis
4) PID
5) Cancers of endometrium, breast, lung, or pancreas
6) Pleural or Peritoneal fluid
Screening for Low risk vs High risk pt for ovarian carcinoma
Low risk (isolated family member w/o hereditary pattern): refer to genetic counselor + post menopausal annual screening of CA 125 High Risk family hx (suspect Hereditary): Genetic testing + prophylactic oophrectomy
A 26-year old woman with a 2-year history of increased acne, abnormal hair growth, menstrual abnormalities presents to her obstetrician for an infertility workup. A pelvic ultrasound reveals enlarged cystic ovaries. She desires to become pregnant. What is the first line treatment?
Weight reduction
A 32-year-old woman presents with fever and lower abdominal pain. She has a history of pelvic inflammatory disease. Her vitals are T 38.4°C, HR 133, and BP 101/60. On examination, the patient is toxic appearing and has marked lower abdominal tenderness to palpation with rebound and guarding. Pelvic examination reveals cervical motion tenderness, scant discharge, and left adnexal tenderness. The patient’s urine beta-hCG is negative. A transvaginal ultrasound is performed and reveals a complex cystic, thick-walled, well-defined mass in the left adnexa. Which of the following is the most appropriate next step in management?
Begin intravenous antibiotics and admit for possible drainage.
A tubo-ovarian abscess (TOA) typically results as a complication of pelvic inflammatory disease (PID) and is most commonly seen in sexually active women. Since it is a complication of PID, patients typically present with lower abdominal and pelvic pain, fever, vaginal discharge, and cervical motion or adnexal tenderness. Pelvic exam may reveal a palpable mass in the adnexa. Ultrasound is the test of choice for suspected TOA
Which of the following is the greatest risk factor for an ectopic pregnancy?
Previous ectopic pregnancy
