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Obs & Gynae > Disorders of the ovary > Flashcards

Disorders of the ovary Flashcards

1
Q

Pathophys of polycystic ovary syndrome

A

Disordered LH production creates hyperinsulinaemia..
Increased adrenal and ovarian androgen production and lower SHBG production.
Disruption of folliculogenesis and raised serum androgens.

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2
Q

Clinical features of PCOS

A

Signs of hyperadrongenism - acne, hirsutism.
Irregular or absent menses.
Obesity (sign of insulin resistance).
Acanthosis nigricans (dry rough, dark skin).
Sleep apnoea.
Alopecia.
Mood abnormalities.

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3
Q

Criteria for PCOS diagnosis

A

Rotterdam Diagnostic Criteria.
2 out of 3 of:
oligo or a-menorrhoea
Polycystic ovaries on USS (>12 peripheral follicles or ovarian volume >10ml in one ovary)
Biochemical or clinical Signs of hyperadrogenism (hirsutism, acne, alopecia, raised testosterone)

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4
Q

Investigations for PCOS

A

Total testosteron (normal or middle high)
Sex hormone-binding globulin -SHBG (normal or low)
Calculate free androgen index
Lh and FSH
TSH
Prolactin
USS of ovaries (<12 follicles in at least one ovary or <10ml ovarian volume)
OGTT and fasting BM
Exclude other causes of irregular menses.

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5
Q

Management of PCOS

A

Lifestyle advice - loose weight, improve diet and regular exercise.
Symptomatic control.
Regular menses = COCP, IUS, metformin.
Hyperadrogenism: acne = COCP. Hirsutism = wax, laser, COCP.
Subfertility = weight loss, Clomiphene.

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6
Q

Complications of PCOS

A 
Diabetes mellitus.
Endometrial cancer.
CVD.
Infertility.
Pregnancy complications e.g. gestational diabetes, pre-eclampsia.
Psychological disorders.
Obstructive sleep apnoea.
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7
Q

Meig’s syndrome

A 
Benign ovarian tumour
Ascites
Pleural effusion.
mostly in females over 40yrs.
Rx = drainage of ascites and effusion + surgical removal of tumour.
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8
Q

Chocolate cyst

A

endometriomas - filled with old blood

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9
Q

Functional cyst

A

Arise from follicle or corpus luteum. Normal and small if <5cm. Resolve over menstrual cycles.

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10
Q

Chronic symptoms of a benign cyst

A 
Asymptomatic
Chronic dull achey pain.
Dyspareunia
Irregular PV bleeding
Abdominal swelling or mass
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11
Q

Acute symptoms of benign cysts

A

Acute pain - bleeding/rupture, torsion of cyst.

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12
Q

Ovarian torsion or cyst rupture

A

Torsion = Sever lower abdo pain and vomiting.
Pain improves over 24hrs as ovary necrotises and dies.
Rupture = similar pain, may not improve and signs of haemorrhagic shock

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13
Q

Concerning features of a mass on a TVUS

A 
Multilocular
Large papillary cyst wall projections
Solid areas
Metastases
Ascites
Bilateral lesions
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14
Q

Management of cyst

A

Acute: if stable TVUS If unstable laparoscopy. If cyst >5cm laparoscopic ovarian cystectomy. If post-menopausal monitor CA125 closely.

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15
Q

Pelvic inflammatory disease possible areas

A 
Endometritis
Salpingitis
Oophoritis
Tubo-ovarian abscess
Pelvic peritonitis
Parametritis
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16
Q

Causes of PID

A

STI - Chlamydia, gonorrhoeae.

17
Q

Risk factors for PID

A 
Young age
Early first sexual intercourse
Multiple sexual partners
STI history in female or partner
Recent interruption in cervical barrier: TOP, insertion of IUD or IUS, IVF, hysterosalpingpgraphy.
18
Q

Complications of PID

A

Infertility
Ectopic
Chronic pelvic pain
Fitz-Hugh Curtis syndrome

19
Q

Fitz-Hugh Curtis syndrome

A

Right upper quadrant pain + Peri-hepitits

20
Q

Clinical features of PID

A 
Bilateral lower abod pain
Deep dyspareunia
Intermenstrual PV bleeding
Post-coital bleeding
Menorrhagia
Purulent PV discharge.
Examination - bilateral tenderness at adnexal and abdo, cervical excitation.
Can have fever
21
Q

Investigations for PID

A

STI screen
High vaginal swab
ESR and CRP raised (non-specific)
Pregnancy test

22
Q

Management of PID

A 
Antibiotics = 1xIM Ceftriaxone, oral doxycycline and metronidazole for 14days.
Analgesia = paracetamol.
23
Q

Red flag symptoms with chronic pelvic pain

A 
Bleeding PR
New bowel symptoms over age of 50
New pain after menopause
Pelvic mass
Suicidal ideation
Excessive weight loss
Irregular PV bleeding over 40yrs
Postcoital bleeding.
24
Q

Chronic pelvic pain definition

A

Intermittent or constant pain in the pelvis of a female for at least 6 months. It does not occur exclusively with menstruation, intercourse or potential pregnancy.

25
Q

Pelvic pain with variation during cycle, dysmenorrhoea and dyspareunia

A

Endometriosis or adenomyosis

26
Q

Dragging pelvic pain, dyspareunia, bladder or rectal problems

A

Prolapse

27
Q

Other causes of chronic pelvic pain

A 
Adhesions.
IBS and interstitial cystitis
Nerve entrapment
PID
Mittelschmerz pain
28
Q

Causes of post-coital bleeding

A

CERVICAL SQUAMOUS CELL CARCINOMA
Cervical polyp
Cervical ectropion
STI

29
Q

Differentials for acute pelvic pain

A 
Ovarian torsion
Cyst rupture
Appendicitis
Ectropic pregnancy
Incomplete miscarriage
30
Q

Rokitansky’s protuberance on histopathology

A

Teratoma/dermoid cyst. Arise from germ cells

Obs & Gynae (17 decks)

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