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Obs & Gynae > Genital Tract Disorders > Flashcards

Genital Tract Disorders Flashcards

1
Q

What is the blood supply to the uterus?

A

Ovarian artery comes from aorta, lies in suspensory ligament of ovary
Uterine artery arises from internal iliac and anastamoses with ovarian artery

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2
Q

What is the lymph drainage from the uterus?

A

Uterus -> common iliac nodes

Cervix -> internal iliac nodes

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3
Q

What supports the uterus?

A

Uterosacral and cardinal ligaments

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4
Q

What are the layers of the uterus?

A 
Outside - serosa is continuous with posterior peritoneum
Smooth muscle (tissue of origin for fibroids)
Lined by glandular epithelium (tissue of origin of endometrial carcinomas)
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5
Q

What is the blood supply to the endometrium?

A

Spiral and basal arterioles

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6
Q

What are fibroids?

A

Leiomyomata

Benign tumours of myometrium

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7
Q

What are risk factors for fibroids?

A 
Afro-Caribbean
Family history
Pre-menopause
Obesity
Early onset and late menopause
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8
Q

What are protective factors for fibroids?

A

Parity

COCP (low levels of oestrogen cause negative feedback)

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9
Q

What are types of fibroids?

A

Intramural
Subserosal
Submucosal ->intracavity polyps

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10
Q

What causes fibroids?

A

Oestrogen and progesterone dependent

During pregnancy can grow, shrink or show no change

Regress after menopause due to reduction in oestrogen

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11
Q

How do fibroids present?

A

50% asymptomatic - discovered at pelvic or abdo exam
30% menorrhagia
Dysmenorrhoea if torsion
If pressing on bladder - frequency and retention
Fertility if tubes are blocked

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12
Q

What are complications of a fibroid?

A 
Torsion of pedunculated fibroid
Degenerations:
- red (painful, in pregnancy)
-  hyaline/cyctic
- calcification (asymptomatic)

Malignancy - leiomyosarcomaata

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13
Q

What effect do fibroid have on pregnancy?

A

Premature labour
Transverse lie
Obstructed labour
PPH

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14
Q

How are fibroids investigated?

A

Bloods - Hb may be raised or low

Imaging

  • USS doesn’t differentiate from mass
  • MRI or laparoscopy
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15
Q

How are fibroids medically treated?

A

Tranexamic acid, NSAIDs and progestogens

GnRH cause temporary menopausal state (pre surgery or menopause)

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16
Q

What is the surgical treatment for fibroids?

A

Hysteroscopic removal
Myomectomy
Hysterectomy

Uterine artery embolism

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17
Q

What is adenomyosis?

A

Presence of endometrium and stroma within myometrium -> bleeds with menstrual cycle
Associated with endometriosis and fibroids

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18
Q

How does adenomyosis present and how is it treated?

A

Painful, regular, heavy menstruation

IUS and COCP
Trial of GnRH analogue to see if hysterectomy will work

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19
Q

What is endometritis?

A

Type of PID
Caused by: STI, surgery (c-section), IUD, retained products of conception

Post-menopausal - MALIGNANCY

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20
Q

What are intrauterine polyps?

A

Small, benign tumours that grow into uterine cavity
Most are endometrial but some are submucosal fibroids

In postmenopausal - patients taking tamoxifen for breast cancer

Cause: menorrhagia, intermenstrual bleeding

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21
Q

What is a haematometra?

A 
Menstrual blood accumulating in uterus 
Canal occluded:
- fibrosis after resection
- carcinoma
- congenital abnormalities
22
Q

What congenital uterine malformations present?

A

Result from failure of Mullerian ducts to fuse

Total failure

  • > 2 uterine cavities (didelphys) with longitudinal vaginal septum
  • > unicornuate if one duct fails

Fundal septum

Linked to renal abnormalities

23
Q

How can congenital uterine malformations affect pregnancy?

A

Transverse lie
Preterm labour
Recurrent miscarriage
Retained placenta

24
Q

What is the histology of the cervix?

A

Endocervix lined by columnar epithelium

Ectocervix covered in squamous epithelium

25
Q

What is the blood supply and lymph drainage of the cervix?

A

Upper vaginal branches and uterine artery

-> obturator and iliac nodes -> para-aortic nodes

26
Q

What is cervical ectropion?

A

During puberty and pregnancy, eversion of cervix occurs and columnar epithelium is visible as red area around os
Lower pH so columnar epithelium metaplases to squamous and is vulnerable to neoplastic change

27
Q

How does ectropion present and how is it managed?

A

Vaginal discharge or PCB

Cryotherapy after smear and colposcopy

28
Q

What is cervicitis?

A

Acute from STI

Chronic from infection of an ectropion

29
Q

What are cervical polyps?

A

> 40yrs

Asymptomatic or IMB

30
Q

What are Nabothian follicles?

A

Squamous epithelium formed by metaplasia over endocervical cells
Columnar cell secretions are trapped and form cycts

31
Q

What are the attachments of the ovaries?

A

Mesovarium -> broad ligament
Infundibulopelvic ligament -> pelvic side wall
Ovarian ligament -> uterus

32
Q

What are the layers of the ovary?

A

Outermost layer - germinal epithelium

Middle - cortex containing follicles and theca cells

Inner medulla contains connective tissue and blood vessels

33
Q

How do ovarian masses present acutely?

A

Rupture of cyst - intense pain

Haemorrhage - pain, hypovolaemic shock

Torsion - infarction of ovary +/- tube and severe pain

34
Q

What commonly causes ovarian masses in premenopausal women?

A

Follicular/lutein cysts
Dermoid cysts
Endometriomas
Benign epithelial tumour

Malignant tumour - dysgerminoma

35
Q

What commonly causes ovarian masses in postmenopausal women?

A

Benign epithelial tumour

Malignancy - primary or secondary from breast or GI tract

36
Q

What tissue lines the vagina?

A

Squamous epithelium

37
Q

What is the lymph node drainage of the vulva?

A

Inguinal -> femoral -> external iliac nodes

38
Q

What causes pruritus of the vulva?

A 
Candidiasis +/- vaginal discharge
Vulval warts
Pubic lice/scabies
Eczema
Psoriasis
Lichen simplex/scelrosus/planus
Contact dermatitis
Carcinoma
Vulval intraepithelial neoplasia (VIN)
39
Q

What is lichen simplex?

A

Chronic vulval dermatitis
Severe pruritis at night
Thickened labia majora with hyper and hypoPIGMENTATION
Exarcerbated by chemical or contact dermatitis, stress or low iron stores

40
Q

How is lichen simplex treated?

A

Potent topical steroids and antihistamines to break itch-scratch cycle

41
Q

What is lichen planus and how is it treated?

A

May affect mucosal surfaces anywhere
Flat, papular, purple lesions
Can be errosive - PAIN

Potent topical steroids

42
Q

What is lichen sclerosus and how is it treated?

A

Thin vulval epithelium with loss of collagen
Associated with AUTOIMMUNE (thyroid disease/vitiligo)
Typically postmenopausal
Scratching -> bleeding, skin splitting
Pink/white papules -> parchment like skin
Can cause fusion of labia
5% develop vulval carcinoma

Tx: high potency topical steroids

43
Q

What is vulvodynia and how is it treated?

A

Diagnosis of exclusion
Associated with GTI, former OCP, psychosexual disorders, IBS, CFS, endometriosis

Tx: amitriptyline or gabapentin

44
Q

What infections can affect the vulva?

A

Herpes simplex
Vulval warts
Syphilis
Candidiasis

45
Q

What is a Bartholin’s gland abscess and how is it treated?

A

If cyst is infection with staph or E. coli an abscess forms
Very painful and red

Tx: incision and drainage and marsupiasation

46
Q

What is introital damage?

A

Commonly following childbirth - overtightening, extensive scar tissue

47
Q

What are vaginal cysts?

A

Congenital, smooth white
Can be mistaken for prolapse
Excised if they cause dyspareunia

48
Q

What is vaginal adenosis?

A

Columnar epithelium is found in squamous epithelium of vagina
Occurs when mother received DES in pregnancy -> genital tract abnormalities
Occasionally becomes malignant (clear cell carcinoma)

49
Q

What is vulval intraepithelial neoplasia?

A

Atypical cells in vulval epithelium

Usual - warty/basaloid/mixed SCC

  • 35-55yrs
  • associated with HPV 16, CIN, smoking and immunosupression
  • multifocal

Differentiated - keratinising SCC

  • older women
  • associated with lichen sclerosis
  • unifocal ulcer/plaque
  • higher risk of Ca
50
Q

How is VIN treated?

A

Emolients/mild topical steroid

Local surgical excision to relieve symptoms, confirm histology and exclude invasive disease

Obs & Gynae (20 decks)

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