gyn2 Flashcards
how might ovarian cyst present?
swollen abdo palpable pelvic mass abdo pain tender adenxae dyspareunia bloating, nausea
how can ovarian cysts affect ureters?
hydronephrosis
recurrent UTI
haematuria
how might ovarian cyst rupture present?
shock
peritonism
torsion - severe pain
how might functional ovarian cyst present?
virilization
altered menstruation
post-menopausal bleeding
how is ovarian cyst investigated?
TVUSS
CA125 in all post menopausal women
other basic: pregnancy, inc WCC in infection/torsion,
low Hb if bleed
how is ovarian cyst managed?
conservative or surgical - cystectomy if wants kids
surgical mgmt of cyst?
bilateral oophorectomy or cystectomy if wants kids
what is the most common type of ovarian cancer?
cystadenocarcinoma (serous/mucinous)
what are the symptoms of ovarian cancer?
abdo pain + distension bloating - new IBS in pts over 50 nausea early satiety weight loss
what are the signs of ovarian cancer?
palpable pelvic mass
tender adnexae
what are symptoms of metastatic ovarian cancer?
back pain ascites right pleural effusion torsion/rupture DVT
what are the environmental risk factors for ovarian cancer?
oestrogen exposure:
early menarche late menopause HRT nulliparity obesity
smoking
what are the genetic risk factors for ovarian cancer?
fam hx
BRCA1/2
HNPCC
what reduces the risk of ovarian cancer?
breastfeeding
COCP
many pregnancies
how is ovarian ca investigated?
TVUSS
Serum CA-125 >30 suggestive
RMI
what does raised ALP suggest in a patient with Ov Ca?
liver mets
how is ovarian cancer diagnosed?
- histologically during surgery
- no needle biopsy as risk spreading
what is figo staging for Ov Ca?
- ovaries only
- pelvis
- early mets - superficial mets
- distant mets - liver parenchyma
how is ov ca treated?
surgery then adjuvant chemo
bilateral hystero-salpingo-oophorectomy (HSO), omentectomy, appendectomy
what chemo is used for ov ca?
carboplatin + paclitaxel 6months
how is ov ca prevented?
prophylactic surgery in brca1/2, high risk pts
which lymph nodes for ovarian cancer?
paraortic
inguinal/femoral suggest other gynae cancer
what is Pseudomyxoma peritonei
mucinous cystadenoma rupture in ov ca - mucin in peritoneum
does being brca positive give you better prognosis if ov ca?
yes
how does ovarian torsion present?
adnexal mass nausea/vomiting severe pelvic pain fever abnormal bleeding
how is ovarian torsion diagnosed?
TVUS
what is lichen sclerosus?
chronic inflammatory skin disease in anogenital region
what can lichen sclerosus become?
can progress to squamous cell carcinoma
how is lichen sclerosus treated?
steroids topical
what are the risk factors for endometriosis
early menarche fam hx short menstrual cycles long/heavy periods defects in uterus/fallopian tubes
symptoms of endometriosis?
cyclical pelvic pain dysmenorrhoea dyspareunia menorrhagia subfertility dyschezia (pain defecating)
what is the main dd for endometriosis?
PID, similar symptoms, subacute onset
what is gold standard diagnostic procedure for endometriosis?
laparoscopy
what are typical findings on laparoscopy in endometriosis?
chocolate cysts
adhesions
peritoneal cysts
what is the treatment for endometriosis?
- NSAIDS
- COCP/Mirena to prevent ovulation and cause atrophy of lesions
- surgery
- hysterectomy and HRT
what is the benefit of using mirena over cocp in endometriosis?
lower dose of hormone?
aside from laparoscopy how is endometriosis investigated>
bimanual exam
- fixed retroverted uterus
- uterosacral ligament nodules
what is adenomyosis?
presence of endometrial tissue in the myometrium
how does adenomyosis present?
dysmenorrhoea
menorrhagia
deep dyspareunia
irregular bleeding
what can cause adenomyosis?
myometrium coming in contact with endometrium:
- pregnancy and childbirth
- c-section
- uterine surgery
- surgical management of miscarriage/termination
how is adenomyosis diagnosed?
definitive - histological post-hysterectomy
clinically: tvus
how is adenomyosis managed?
definitive - hysterectomy
symptom: NSAIDs,
hormone therapy for reduction of bleeding/cycle control
uterine artery embolisation for those wanting kids
what hormonal therapies for adenomyosis?
COCP
progestogens - mirena
GnRH
aromatase inhibitors
what is the aetiology of PCOS?
elevated LH - stimulates androgen production
insulin resistance
where is LH produced?
anterior pituitary
what are the risk factors for PCOS?
diabetes
fam hx
irregular periods
which criteria is used for diagnosing PCOS?
rotterdam, 2/3 minimum for diagnosis
what is the rotterdam criteria?
- oligo/anovulation
- clinical/biochemical signs of hyperandrogenism
- polycystic ovaries on imaging
what blood tests for PCOS?
- LH (high)
- FSH (normal)
- Sex-hormone binding globulin (SHBG) (Low)
- Testosterone (high)
- Progesterone (low)
what will FSH levels be like in PCOS?
normal!
what will shbg levels be like in pcos?
low
what will progesterone be like in pcos?
low
which levels will be high in PCOS?
LH and testosterone only
how do you prevent endometrial hyperplasia in PCOS?
inducing at least 3 bleeds per year
- COCP
- Dydrogesterone
how is pcos managed?
lifestyle - lose weight
how is subfertility in PCOS managed?
clomifene/metformin
women with low BMI may have laparoscopic ovarian drilling.
what are the risks associated with clomifene
risk of multiple pregnancies ovarian hyperstimulation syndrome ovarian cancer (limited for 6 cycles)
with what is hirsutism treated?
antiandrogens:
cyproterone
spironolactone
finasteride
Eflornithine topical cream for facial hair
what type of amenorrhoea is caused by turner syndrome?
1 X chromosome
- primary amenorrhoea
what are the characteristic features of turner syndrome?
short stature
webbed neck
broad chest
wide carrying angle (cubitus valgus)
what do the ovaries look like in turner syndrome?
underdeveloped streak ovaries
what do the kidneys look like in turner’s?
horseshoe
how do you induce puberty in turner’s?
HRT
Name 3 congenital heart problems that are often associated with Turner syndrome.
- coarctation of aorta
- aortic stenosis
- aortic dissection
what is tanner stage 1?
pre-pubertal
what is tanner stage 2?
breast buds form, few long hairs at labia
what is tanner stage 3?
breast buds larger, pubic hair continues, mainly central
what is tanner stage 4?
breasts in mound form, pubic hair in triangle adult shape, but smaller
what is tanner stage 5?
breasts fully formed, pubic hair adult
what does fixed retroverted uterus suggest?
endometriosis
what do Uterosacral nodularity and tenderness suggest?
endometriosis
may be accompanied by bladder symptoms
what is the first investigation that must be done in a woman with stress incontinence?
urinalysis to rule out UTI/diabetes
where to report FGM?
police
