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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
What is the blood supply and lymph drainage of the cervix?
Upper vaginal branches and uterine artery -> obturator and iliac nodes -> para-aortic nodes
26
What is cervical ectropion?
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
How does ectropion present and how is it managed?
Vaginal discharge or PCB | Cryotherapy after smear and colposcopy
28
What is cervicitis?
Acute from STI | Chronic from infection of an ectropion
29
What are cervical polyps?
>40yrs | Asymptomatic or IMB
30
What are Nabothian follicles?
Squamous epithelium formed by metaplasia over endocervical cells Columnar cell secretions are trapped and form cycts
31
What are the attachments of the ovaries?
Mesovarium -> broad ligament Infundibulopelvic ligament -> pelvic side wall Ovarian ligament -> uterus
32
What are the layers of the ovary?
Outermost layer - germinal epithelium Middle - cortex containing follicles and theca cells Inner medulla contains connective tissue and blood vessels
33
How do ovarian masses present acutely?
Rupture of cyst - intense pain Haemorrhage - pain, hypovolaemic shock Torsion - infarction of ovary +/- tube and severe pain
34
What commonly causes ovarian masses in premenopausal women?
Follicular/lutein cysts Dermoid cysts Endometriomas Benign epithelial tumour Malignant tumour - dysgerminoma
35
What commonly causes ovarian masses in postmenopausal women?
Benign epithelial tumour | Malignancy - primary or secondary from breast or GI tract
36
What tissue lines the vagina?
Squamous epithelium
37
What is the lymph node drainage of the vulva?
Inguinal -> femoral -> external iliac nodes
38
What causes pruritus of the vulva?
``` Candidiasis +/- vaginal discharge Vulval warts Pubic lice/scabies Eczema Psoriasis Lichen simplex/scelrosus/planus Contact dermatitis Carcinoma Vulval intraepithelial neoplasia (VIN) ```
39
What is lichen simplex?
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
How is lichen simplex treated?
Potent topical steroids and antihistamines to break itch-scratch cycle
41
What is lichen planus and how is it treated?
May affect mucosal surfaces anywhere Flat, papular, purple lesions Can be errosive - PAIN Potent topical steroids
42
What is lichen sclerosus and how is it treated?
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
What is vulvodynia and how is it treated?
Diagnosis of exclusion Associated with GTI, former OCP, psychosexual disorders, IBS, CFS, endometriosis Tx: amitriptyline or gabapentin
44
What infections can affect the vulva?
Herpes simplex Vulval warts Syphilis Candidiasis
45
What is a Bartholin's gland abscess and how is it treated?
If cyst is infection with staph or E. coli an abscess forms Very painful and red Tx: incision and drainage and marsupiasation
46
What is introital damage?
Commonly following childbirth - overtightening, extensive scar tissue
47
What are vaginal cysts?
Congenital, smooth white Can be mistaken for prolapse Excised if they cause dyspareunia
48
What is vaginal adenosis?
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
What is vulval intraepithelial neoplasia?
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
How is VIN treated?
Emolients/mild topical steroid | Local surgical excision to relieve symptoms, confirm histology and exclude invasive disease

Obs & Gynae (20 decks)

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