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Obs & Gynae > Gynae 2 > Flashcards

Gynae 2 Flashcards

1
Q

What are the features, presentation, investigations and prognosis of vaginal cancer?

A

Squamous cell carcinoma affecting upper third of posterior vaginal wall
Initially spreads locally, then spreads to lungs and liver

Vaginal bleeding/bloody discharge

Investigations: colposcopy, biopsy, CT scan, CXR, cystoscopy

Management: carbon dioxide laser

Poor prognosis if >60, lesions in middle/lower sections, adenocarcinomas, symptomatic

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2
Q

what are the features of epithelial ovarian tumours

A

most common: 90% of all ovarian cancers
women >50 years

subtypes: serous, endometrioid, clear cell, mucinous (<30)

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3
Q

what are the features of germ cell ovarian tumours?

A

women <35

rapidly enlarging painful abdominal mass

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4
Q

what are the risk factors of ovarian cancer?

what are the protective factors?

A 
increased age
smoking/obesity
infertility/clomifene 
nulliparous women
early menarche/late menopause 
HRT
BRCA1

protective: childbearing, COCP, breast feeding, early menopause

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5
Q

how does ovarian cancer present?

A

abdominal distension/bloating/increased urinary frequency/ascites

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6
Q

where does ovarian cancer metastasise too?

A

pelvic/para-aortic nodes and over peritoneum

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7
Q

what are the risk factors for endometrial cancer?

A 
nulliparity
obesity
tamoxifen
endometrial hyperplasia
diabetes
PCOS
HNPCC
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8
Q

what is the treatment for endometrial cancer?

A

total hysterectomy with bilateral salpingo-oophrectomy

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9
Q

what are the risk factors for genitourinary prolapse?

what type of prolapse is the most common?

A 
increased age
vaginal delivery 
increased parity
obesity
previous hysterectomy

anterior vaginal wall prolapse

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10
Q

what different types of prolapses can occur in an anterior compartment prolapse?

A

urethrocele (prolapse of urethra into vagina = stress incontinence)
cystocele (prolapse of bladder into vagina)
urethrocystocele

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11
Q

what different types of prolapses can occur in a middle compartment prolapse?

A

uterine prolapse
vaginal vault prolapse (descent of vaginal vault post hysterectomy)
enterocele (herniation of small bowel behind vagina)

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12
Q

what is the classification for prolapses?

A

POPQ system

0) no prolapse
1) >1cm above hymen
2) within 1cm of hymen
3) >1cm below plane of hymen
4) complete eversion of hymen

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13
Q

what investigations would you do for a prolapse?

A 
speculum examination
urinalysis
post residual urine volume
anal manometry
defecography
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14
Q

what is the management of a prolapse?

A

conservative: stop smoking, decrease caffeine, decrease weight, pelvic floor exercises, vaginal oestrogen creams

vaginal pessaries
surgical: cystourethrocele: anterior colporrhaphy, colposuspension, transurethral sling
uterine prolapse: hysterectomy, sacrohysteropexy
rectocele: posterior colporrhaphy, retropubic sling

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15
Q

what are the features of detrusor overactivity?

what are the investigations for it?

A

urgency, increased frequency and nocturia

urine dipstick/MSSU
urodynamic studies
ultrasound

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16
Q

what is the management for detrusor overactivity?

A 
decrease caffeine intake/weight/stop smoking
first line: bladder training (minimum 6 weeks)
anticholinergic drugs (oxybutynin, tolteridone, darifenacin, fesoterodine). have a direct relaxant effect

secondary care:
botulinum toxin A (injection into bladder wall)
sacral nerve stimulation
last line: augmentation cystoplasty

17
Q

how does overflow, stress and mixed incontinence present?

A

overflow: due to chronic bladder outflow obstruction due to prostatic disease usually (dribbling, struggling to initiate etc)
stress: involuntary leakage of urine on effort or exertion or increased pressure e.g. coughing. due to an incompetent sphincter

18
Q

what are the risk factors for urinary incontinence?

A 
pregnancy
vaginal delivery
diabetes
oral oestrogen therapy 
high BMI
hysterectomy
forceps delivery
UTIs
19
Q

what are the investigations for urinary incontinence?

A 
bimanual/vaginal examination
urinalysis
MSSU
renal function tests
urodynamics
20
Q

what is the management of overflow incontinence?

A

relieve/treat obstruction

intermittent self catheterisation

21
Q

what is the management of stress incontinence?

A

pelvic floor exercises (3m trial), should include 8, 3x daily.
-duloxetine (second line for women who do not want surgery)

retropubic mid urethral tape
open colposuspension
intramural bulking agents

6m follow up

22
Q

what is the management of mixed incontinence?

A

pelvic floor exercises and bladder training

oxybutynin

23
Q

what investigation is needed if a woman has incontinence after labour?

A

urinary dye studies

suspect a vesicovaginal fistula

Obs & Gynae (10 decks)

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