Gynae 1&2 Flashcards
Endometriosis is Prostgesterone / Oestrogen dependent
Endometriosis is Oestrogen Dependent
What’re the symptoms of endometriosis?
Secondary Dyspareunia
Pelvic pain inbetween periods
Menstrual irregularity
Bladder and bowel symptoms
What does a balck gun metal appearance on laperscopy indicate?
Endometriosis
What’s the management of endometriosis?
NSAIDs for pain relief
Suppression of cyclical hormone production therefore menstruation (OCP)
Surgery
What is Adenomyosis?
Ectopic glandual tissue found in muscle
Hyperplasia and fibrous tissue
What’re the symptoms of Adenomyosis?
Worsening Heavy Periods
Secondary Dysmonorrhoea (period pain)
Gradually enlarging tender uterus
What is Adenomyosis difficult to differenterate from?
Fibroids and DUB (Dysfunctional Uterine Bleeding)
How do you treat Adenomyosis?
Hysterectomy with conservation of the ovaries
Endometriosis of the ovary
Endometriosis
What’s the definition of infertility?
Inibility to conceieve after 2 years, with regular inprotected sex
What’re the main causes of infertility?
Unexplained (30%)
Ovulatory (27%)
Male factor (19%)
Tubal (14%)
Indications for early referral?
>25
Amenorrhoea / Oligomenorrhoea
Previous abdo/ pelvic surgery
Previous PID
Abnormal pelvic examination
What’s the commonest cause of oligo/azoospermia?
Primary testicular failure
What’re the important factors in increasing female feritlity
Fertility declines with age
Decline in oocyte number
Increased rate in higher aneuploidy and mascarriage rates
What female assesments are done?
Day 2 - FSH, LH and oestrogen
Ovulation - regular menstrual cycles, ovulation kits
Mid luteal progesterone (>30 nmol/L) - evidence for ovulation
USS follicular tracking is more reliable but costly and labour intensives
How do you differentiate PCOS and Premature Ovarian Failure?
PCOS (high LH, lower FSH, high testosterone)
Premature ovarian failure (high FSH, Low LH)
How do you diagnose tubal patency?
Hysterosalpingogram
What’re some uterine abnormalities?
Adhesions, Polyps, Submucus Fibroids
Cystocele
Bladder Herniates into the Vagina
Occurs after childbirth
What is a Rectocele?
Rectal herniation into the vagina
What’re the causes of prolapse?
Pregnancy and delivery
Menopause
Pressure - ovarian mass, straining
Uterine Prolapse
Valt Prolapse
What’s the symptoms of prolapse?
Prolapse Symptoms (Lump down below, Bearing Down, Fullness / Heaviness)
Urinary Symptoms (urgency, voiding dysfunction, stress incontinence)
Bowel Symptoms (obstructed, incontinence)
Sexual Dysfunction
Pain (backache)
What’s the treament of Prolapse?
No symptoms don’t treat
Pessary
Surgery
What’re the different types of pessary?
Ring
Gellhorn
Replace every 3-9 months
Pts who can’t have surgery
The anterior repair is an operation to correct?
Cystocele
Posterior vaginal wall prolapse
Rectocele
Posterior repair is an operation to correct?
Rectocele
Vaginal Hysterectomy treats?
Uterine Prolapse
Sacrospinous Fixation treats?
Treats a vault prolapse due to previous hysterecomy
Urinary Incontinence
Stress
Urgency
Overflow
Nocturnal Enuresis
What causes of Stress Incontinence?
Pregnancy and child bearing
Menopause
Pressure - bearing, smoking, high BMI
What’re the investigations for stress incontinence?
Urodynamics: Cystometry / Pas test / Residual volume
What’s the conversative management of urinary incontinence?
Pelvic floor muscle training
Smoking cessation
Weight loss
HRT / Local Oestrogen
What’s the surgical management of stress incontinence?
Mid-urethral tapes
Urethral bulking agents
Colposuspension
Autologous sling
What’re the symptoms of an Overactive Bladder?
Nocturia
Urinary Incontinence
Frequency
What’re the causes of an overactive bladder?
Menopause
Irritants (smoking / caddiene / alcohol)
Masses (pressure)
Neurogenic spinal cord / parkinsonism
What does a bladder drill treat?
An overactive bladder
What’s the conservative management of an overactive bladder?
Fluid advice
Bladder drill
Weight loss
HRT / Local oestrogen
Medication
What medication is used to treat an overactive bladder?
Anticholinergics - Oxybutinin
B-3 agonist - Mirabegron
What surgical intervation is used in an overactive bladder?
Botulinum toxin A bladder wall injection
Tibial nerve stimulation
Detrusor myotomy
Topical vaginal oestrogen is a treatment of?
Overactive bladder
