Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Extra 5 (e) > Gynae 2 > Flashcards

Gynae 2 Flashcards

1
Q

What is an ectopic pregnancy?

A

Implantation of a conceptus outside the uterine cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where do ectopic pregnancies usually occur?

A

98% are in the Fallopian tubes = mostly ampulla or isthmus portions

Others can be abdo, ovarian, cervical or rarely in CS scars

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are 3 possible consequences of the implantation of a gestational sac in the Fallopian tube?

A

1) Extrusion (tubal abortion) into the peritoneal cavity
2) Spontaneous involution of pregnancy
3) Rupture through the tube causing pain and bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where is it particularly dangerous for an ectopic pregnancy to be located? Why?

A

The uterine horn - pregnancy may reach 10-14 weeks before rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Which ectopic pregnancies can proceed almost to term?

A

Intraperitoneal pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How common are ectopic pregnancies? What is the mortality?

A

11 per 1,000 pregnancies

0.2% are fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List some risk factors for ectopic pregnancy (10)

A

1) Hx of infertility or assisted conception (esp IVF)
2) Hx of PID
3) Endometriosis
4) Pelvic or tubal surgery
5) Previous ectopic (recurrence risk 10-20%)
6) IUCD in situ
7) Higher maternal age
8) Lower SES
7) Smoking
8) Prev ectopic
9) Damage to tubes (salpingitis) eg previous surgery
10) POP = does not cause an ectopic pregnancy but if a woman conceives whilst using it, the pregnancy is more likely to be ectopic as progesterone decreases tubal motility

NB anything that slows the ovum’s passage to the uterus is a predisposing factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some symptoms of an ectopic pregnancy? (6)

A
  • Often asymptomatic
  • Amenorrhoea (usually 6-8wks)
  • Pain = lower abdo, often mild and vague, classically unilateral
  • Vaginal bleeding = often small amount and brown
  • Shoulder tip pain = diaphragmatic irritation of intra-abdo blood
  • Collapse = if ruptures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some signs of an ectopic pregnancy? (5)

A

Often no specific signs

  • Uterus usually normal size
  • Cervical excitation/tenderness occasionally
  • Adnexal tenderness
  • Adnexal mass (rarely)
  • Peritonism (due to intra-abdo blood if ruptured)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What investigations are done for an ectopic pregnancy?

A

TV USS = establish location of pregnancy, the presence of adnexal masses or free fluid
- If there is a hCG serum level of >1500 IU, a viable intrauterine pregnancy should be seen with a TV USS

Serum progesterone = helpful to distinguish if a pregnancy is failing (<20nmol/L suggests this)

Serum hCG repeated after 48hrs

  • Rate of rise important = should double in 28hrs
  • A rise of >66% suggests intrauterine pregnancy
  • A suboptimal rise is suggestive of an ectopic pregnancy

Laparoscopy = gold standard (but invasive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List some Ddx for ectopic pregnancy (4)

A

1) Threatened or complete miscarriage
2) Bleeding corpus luteal cyst
3) Ovarian cyst accident
4) Pelvic inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the strict criteria for expectant and medical management of a diagnosed ectopic pregnancy?

A
  • Clinically stable
  • Asymptomatic / minimal symptoms
  • hCG initially <3000 IU
  • EP <3cm and no fetal cardiac activity on TV USS
  • No haemoperitoneum on TV USS
  • Live in close proximity to hospital and have support at home
  • Pt deemed reliable to return for follow up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the expectant management of an ectopic pregnancy?

A
  • With a falling hCG and fulfilling the required strict criteria
  • Requires serum hCG initially every 48hrs until repeated fall in level, then weekly until <15IU

(basically the body is expelling it anyway you let it continue)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the medical management of an ectopic pregnancy?

A

Methotrexate IM single dose 50mg/m2

hCG levels should be measured at 4 and 7 days and another dose of methotrexate given (up to 25% of cases) if the fall in hCG is <15% on days 4-7

Sexual intercourse should be a avoided during treatment and reliable contraception used for 3 months as methotrexate = teratogenic

SE = conjunctivitis, stomatitis, GI upset - stomach pain may be difficult to differentiate from pain of rupturing an ectopic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When should an ectopic pregnancy be managed surgically? (4)

A

Surgery should be offered to those women who cannot return for follow-up after methotrexate or if they have:

  • Significant pain
  • Adnexal mass >35mm
  • Fetal heartbeat visible on scan
  • Serum hCG >5000 IU/L
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the surgical management is preferred for an ectopic pregnancy? What medication should be given?

A

Laparoscopy preferred vs laparotomy:

  • Shorter operating time and hospital stay
  • Less analgesia requirements
  • Less blood loss

In haemodynamically unstable its, laparotomy more appropriate as quicker

Anti-D should be given to all rhesus negative women who have a surgical procedure to remove an ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the treatment of an ectopic pregnancy if haemodynamically unstable?

A

Resuscitation:

  • 2 large bore IV lines and IV fluids
  • Cross match 6 units of blood
  • Call senior help and anaesthetic assistance urgently

Surgery:
- Laparotomy with salpingectomy once the pt has been resuscitated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can happen if an ectopic pregnancy is not correctly treated?

A

Tubal or uterine rupture (depending on location of pregnancy), which can lead to massive haemorrhage, shock, DIC and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a molar pregnancy?

A

The placenta is made of millions of cells called trophoblasts

In trophoblastic disease - abnormal overgrowth of all / part of the placenta causing what is called a molar pregnancy or hydatidiform mole

A hydatidiform mole is not a cancer and rarely becomes cancerous, but it can behave in similar ways = most treatment is aimed at stopping the disease process long before any of these changes can happen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a hydatidiform mole?

A

Hydatidifom mole = the commonest kind of trophoblastic disease

Overgrowth is benign but may spread to other parts of the body if not treated

Subdivided into partial mole and complete mole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is gestational trophoblastic disease (GTD)?

A

A group of disorders which range from molar pregnancies to malignant conditions such as choriocarcinoma

Any evidence of persistence of GTD, the condition is referred to as gestational trophoblastic neoplasia (GTN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Are there good cure rates of GTD? Why?

A

Excellent cure rates

Due to central registration and monitoring in UK, use of beta-hCG as a biomarker and the development of effective treatments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the classification of GTD?

A

Premalignant = hydatidiform mole

  • Complete hydatifiform mole
  • Partial hydatidiform mole

Malignant = GTN

  • Invasive mole
  • Choriocarcinoma
  • Placental site trophoblastic tumour
  • Epithelioid trophoblastic tumour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the aetiology of a complete molar pregnancy?

A

All the genetic material comes from the father. An empty oocyte lacking maternal genes is fertilised. This most commonly (75-80%) arises from a single sperm duplicating with an empty ovum, but can also occur when an empty ovum is fertilised by two sperm

The whole placenta is abnormal and usually grows very quickly

There is no developing fetus in these pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the aetiology of a partial molar pregnancy?

A

The trophoblast cells have 3 sets of chromosomes = triploid. Two sperm fertilise the ovum at the same time, leading to one set of maternal and two sets of paternal chromosomes (instead of forming twins an abnormal fetus forms)

Approx 10% of partial moles are tetraploid or mosaic in nature

Part of an apparently normal placenta overgrows (proliferates) and part develops normally

Usually evidence of fetal tissue or fetal blood cells in a partial molar pregnancy. An embryo may be present from the start. However this developing fetus is genetically abnormal and would not be able to survive outside of the womb

69 XXX, XXY, XXY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is an invasive mole?

A

Develops from a complete mole and invades the myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is a choriocarcinoma?

A

Most often follows a molar pregnancy but can follow a normal pregnancy, ectopic pregnancy or abortion

Should always be considered when a pt has continued vaginal bleeding after the end of pregnancy. It has the ability to spread locally as well as metastasise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are placental site trophoblastic tumours?

A

Most often follow a normal pregnancy but can occasionally arise from molar pregnancies, they may also be metastatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How common is GTD?

A

Rare - 1 in every 714 live births

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are some risk factors for molar pregnancies? (6)

A

1) Aged >45yr or <16yr
2) Multiple pregnancy
3) Menarche >12yr
4) Light menstruation
5) OCP
6) Asian ethnicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How does GTD present?

A

Irregular vaginal bleeding in the first trimester (>90%)

Pain from large theca lutein cysts resulting from ovarian hyperstimulation from high hCG (20%)

Features such as hyperemesis, abnormal uterine enlargement, hyperthyroidism, anaemia, respiratory distress and pre-eclampsia are rare as a result of routine USS in early pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

When should metastatic disease in GTD be suspected?

A

Can rarely present with dyspnoea or abnormal neurology, including seizures

33
Q

Why should women who have persistent abnormal vaginal bleeding after a non-molar pregnancy undergo a pregnancy test?

A

To exclude persistent GTN

It should also be considered in any woman developing acute respiratory or neurological symptoms after any pregnancy

34
Q

What investigations should be done for GTN?

A

hCG:

  • Urine and blood levels
  • A urine pregnancy test should be performed in all cases of persistent or irregular vaginal bleeding after a pregnancy event
  • Trophoblastic tissues secrete hCG, so serum levels are high and may lead to exaggerated symptoms of pregnancy (eg hyperemesis)
  • Once surgical evacuation has been completed, serum hCG must be taken every 14 days to make sure levels are falling (confirms the trophoblastic tissue is regressing)
  • Once levels normal, urine samples tested every month in case of reactivation of trophoblastic tissue

USS:

  • Not reliable in 1st trimester
  • Complete mole shows “snowstorm” appearance in send trimester = heterogenous mass with no fetal development and theca-lutein ovarian cysts
  • Partial mole may show viable fetus with early signs of growth restriction or structural abnormalities
  • As USS not diagnostically reliable so all products of conception from a non-viable pregnancy should undergo histological examination
  • If doubt as to whether there is a viable pregnancy along side a molar pregnancy, an USS should be repeated before intervention

Staging for metastatic disease:

  • Doppler pelvic USS for local spread and vascularity
  • CXR or lung CT for lung mets
  • CT scanning for liver / intra-abdo masses
  • MRI for brain mets
35
Q

What is the FIGO staging for GTD? (I-IV)

A

Stage I - confined to uterus
Stage II - extends outside the uterus but is limited to genital structures eg adnexa, vagina, broad ligament
Stage III - extends to the lungs with or without genital tract involvement
Stage IV - all other metastatic sites

36
Q

What is the management of hydatidiform moles?

A

Suction curettage:

  • Complete molar pregnancies
  • Partial molar pregnancies except where the size is too big, where a medical evacuation is used

Follow up - 6 months if urine hCG levels return to normal within 8wks, 2 years if not

Anti-D prophylaxis needed after an evacuation of a partial hydadiform mole

A single dose of oxytocin can be used following evacuation if there is excessive bleeding (but not recommended prior to the evacuation)

Woman advised not to use hormonal contraceptives or become pregnant until levels have been normal for 6 months

If hCG levels rise, plateau or are still abnormal 6 months after surgical evacuation, chemo is started:

  • Most are given methotrexate and folinic acid
  • Survival 94%
37
Q

What is the management of twin pregnancies with a viable fetus and a molar pregnancy?

A

The pregnancy should be allowed to proceed if mother wishes to, with appropriate support

The probability of achieving a viable baby is poor (25%) and the is a high risk of complications such as premature delivery and pre-eclampsia

There is no risk of developing persistent GTD after this type of molar pregnancy

38
Q

How many molar pregnancies do not spontaneously regress?

A

3% - so require chemo

This is more common with complete than partial moles

39
Q

What are uterine fibroids?

A

Benign tumours arisng from the myometrium (also called leiomyomata and myomas)

Composed primarily of smooth muscle but can contain fibrous tissue

40
Q

How common are uterine fibroids?

A

Very common

Most common non-cancerous tumours in women of childbearing age - occurring in 77% women

Most common indication for hysterectomy

41
Q

What are some risk factors for developing uterine fibroids?

A
  • Increased lifetime exposure to oestrogen = obesity and early menarche
    (protective = exercise and inc parity, also ?smoking)
  • Afro-American ethnicity (3x more common than white American, also tend to present younger with worse symptoms)
  • FHx

NB similar genetics to keloids which also more prevalent in African-American women

42
Q

List the types of fibroids

A 
Submucosal = >50% projection into endometrial cavity
Intramural = located within the myometrium
Subserious = >50% fibroid mass extends outside the uterine contours
Cervical = relatively uncommon and can cause surgical difficulty due to the proximity to the bladder and ureters
Pedunculated = mobile and prone to torsion
Parasitic = have become detached from uterus and attached to other structures
43
Q

Which is the most common types of fibroid?

A

Intramural

44
Q

How do fibroids develop?

A

Start as multiple, single-cell seedlings distributed throughout the uterine wall. They increase in size very slowly over many years, stimulated by oestrogen and progestogens.

As the fibroid grows, the central areas may not receive adequate blood supply and so undergo benign degeneration often followed by calcification

Cause debated but thought to be a combination of acquired genetic change plus the effects of hormones and growth factors, possibly related to a response to ischaemic unjust at the time of menses

45
Q

What are the signs/symptoms of uterine fibroids? (5)

A

Up to half are asymptomatic but can cause major symptoms:

1) Dysmenorrhoea
2) Menorrhagia
3) Pressure symptoms esp freq
4) Pelvic pain
5) Infertility (<10% of cases)
6) Symptoms of anaemia due to menorrhagia

Larger fibroids = heavier bleeding due to a variety of factors promoting angiogenesis

Pedunculated submucosal fibroids can cause persistent IMB

46
Q

How may a uterine fibroid affect a pregnancy?

A

Can get pain from degeneration, abnormal lie and obstruction if cervical. Can cause difficulty in CS

48
Q

What is the management of fibroids?

A

No treatment may be required if minimal symptoms

  • GnRH analogues shrink fibroids but should only be used for this purpose prior to surgery
  • Myomectomy = open, laparocopic or hysterosccopic depending upon location
  • Hysterectomy = if woman have completed their family or >45yr, guaranteed cure
  • Uterine artery embolisation = artery catheterised using unilateral approach. Polyvinyl alcohol powder or gelatine sponge used as embolic material (minimal invasive procedure with avoidance of GA)

Antifibrinolytic agents eg tranexamic acid can reduce menorrhagia (can also try Mirena)

49
Q

What phramacological agents may be used to address the bleeding associated with fibroids?

A

COPC
LNG-IUS (Mirena)

Tranexamic aid - antifibrinolytic agent

Mifepristone - progesterone receptor inhibitor which reduces bleeding but as it results in exposure of the endometrium to unopposed oestrogen, it can cause endometrial hyperplasia

Ulipristal acetate - selective progesterone receptor modulator (SPRM) with predominantly inhibitory action. Inhibits cell proliferation and induces apoptosis

50
Q

What are some ddx for fibroids

A 
Endometrial polyps
Endometriosis
Chronic PID
Tuba-Ovarian abscess
Uterine sarcoma (very rarely fibroids can progress)
Ovarian tumour
Pregnancy
51
Q

What is an endometrial polyp?

Who are they more common in?

What is the treatment?

A

= Adenoma

These are focal overgrowth of endometrium and are malignant in <1%

More common in women >40yr but can occur at any age

Treatment is usually resection during hysteroscopy and sent to histology

52
Q

How common are ovarian cysts and why do they commonly arise?

A

= Benign ovarian tumour

Extremely common

Occur in 30% females with regular menses (eg luteal cysts as incidental findings on pelvic scans)

and 50% females with irregular menses

53
Q

List the three main groups of ovarian tumours and their relative %

A

1) Functional = 24%
2) Benign = 70%
3) Malignant = 6%

54
Q

What makes up 60% of all benign ovarian tumours?

A

Benign epithelial neoplastic cysts

55
Q

What are the two types of benign ovarian cysts?

A

Serous cystadenoma

Mucinous cystadenoma

56
Q

Serous cystadenoma:

  • How do they feel?
  • Most common in which age group?
  • What % bilateral?
  • What % malignant?
A

1) Serous cystadenoma
- Develop papillary growths that can be so prolific the cyst appears solid
- Most common in 40-50yr
- About 15-25% are bilateral
- 20-25% are malignant

57
Q

What are the most common cysts in pregnancy?

A

1) Functional ovarian cysts = follicular, corpus luteal and theca-lutein
2) Benign cystic teratomas = originate from the undifferentiated primordial germ cells of the gonad
3) Serous cystadenomas
4) Mucinous cystadenomas
5) Endometriomas = ‘chocolate cysts’ from endometriosis
6) Malignant tumours (2-3%)
7) Sex cord stromal tumours = originating from the stroma of the gonad

58
Q

What are the most common cysts in pregnancy? (7)

A

1) Functional ovarian cysts = follicular, corpus luteum and theca-lutein
2) Benign cystic teratomas = originate from the undifferentiated primordial germ cells of the gonad
3) Serous cystadenomas
4) Mucinous cystadenomas
5) Endometriomas = ‘chocolate cysts’ from endometriosis
6) Malignant tumours (2-3%)
7) Sex cord stromal tumours = originating from the stroma of the gonad

59
Q

What should be the management of a woman who is having periods with a cyst <5cm?

A

Not concerning or a cause for referral unless there are other suspicious features or she is symptomatic (eg pain)

Rescan at 6wks when she is at a different point in her cycle

Small cysts also freq seen in post-menopausal (approx 14% women) on TVUS

60
Q

List some risk factors for ovarian cysts

A

1) Obesity
2) Infertility
3) Hypothyroidism
4) Early menarche
5) Tamoxifen
6) Dermoid cysts can run in families

61
Q

What are some signs/symptoms of ovarian cysts?

A 
Asymptomatic (incidental finding)
Chronic pain:
- Dull ache in lower abdo/low back pain
- Pressure on other organs = urinary freq or CIBH
- Dyspareunia = endometrioma
- Cyclical pain = endometrioma

Abnormal uterine bleeding
Hormonal effects
Adnexal mass
Tenderness

Torsion, infarction or haemorrhage:

  • Severe pain
  • Torsion may be intermittent, presenting with intermittent episodes of severe pain
  • Ovarian torsion = complication for persistent masses in pregnancy

Rupture = peritonitis and shock

Ascites = malignancy or Meig’s syndrome

62
Q

Which type of cyst is most prone to rupture?

A

Most common in Endometrioma or dermoid cyst

63
Q

What happens in torsion of an ovarian cyst?

A

Infarction of the ovary (+/- tube) causing severe pain

64
Q

What investigations are done for ovarian cysts?

A

USS + CA125 to determine risk of malignancy index (RMI) = suspected ovarian cancer

Pregnancy test to rule out ectopic
FBC - infection / haemorrhage
CT or MRI if USS not definitive
CA 125:
- Not if premenopausal and US confirms simple ovarian cyst
- Unreliable from differentiating benign from malignant ovarian masses in premenopausal women due to high rate of false +ve and reduced specificity

Tumour markers = AFP, hCG, LDH (all done if <40yr with complex ovarian mass due to possibility of germ cell tumours)
Abdo/pelvic USS
Biopsy and histology

65
Q

How is the RMI calculated for ovarian masses?

A

RMI = U x M x CA125

U = US score, 1 point for each: multilocular cyst, mets, solid areas, ascites, bilateral lesions
(U=0 for 0, U=1 for US=1, U3 for US=2-5)

M = pre-menopause (1) or post-menopausal (3)

CA125 = serum CA125 level

RMI >200 should have CT abdo and pelvis and referred to secondary care

66
Q

List some ddx for ovarian cysts

A

Non-neoplastic functional cyst eg follicle cyst
Other causes of pelvic pain
PCOS
Endometrioma
Ovarian malignant tumour
Bowel - colonic tumour, appendicitis, diverticulitis
Gynae- PID, tuba-ovarian abscess, uterine tumour eg fibroids, ectopic pregnancy
Pelvic malignancy eg retroperitoneal tumour

67
Q

What is the management of ovarian cysts?

A

Most cysts presenting acutely are managed with analgesia as most will resolve spontaneously

However, if the woman presents with an acute abdo, or signs off systemic upset due to ovarian torsion, rupture or haemorrhage of a cyst, urgent diagnostic laparoscopy or laparotomy may be required (NB blood should be sent for biomarkers at this time as it will aid follow up)

68
Q

What is the management of an ovarian cyst in postmenopausal women? (Low RMI, Moderate RMI, Severe RMI)

A

Low RMI (<25), simple, <5cm cyst and normal CA125 = follow up for 1yr with USS and CA125 every 4 months

Moderate RMI (25-250) = oophorectomy (usually bilateral recommended

Severe RMI (>250) = refer to cancer centre for full staging and laparotomy

69
Q

In which population do ovarian cysts most commonly arise in?

A

Predominantly premenopausal women

Can occur perinatally

Uncommon in premenarchal and postmenopausal women

70
Q

What course do ovarian cysts in women of childbearing age usually take?

A

Usually of functional origin and tend to resolve over time - likelihood of malignancy is low

71
Q

What can result in elevated CA125 levels?

A

Primarily a marker for epithelial ovarian carcinoma (only raised in 50% of early-stage disease)

Also: diverticulitis, endometriosis, liver cirrhosis, uterine fibroids, menstruation, pregnancy, benign ovarian neoplasms and other malignancies (eg pancreatic, bladder, breast, liver, lung)

72
Q

What is the management of simple ovarian cysts <50mm?

A

Do not require follow-up, likely to be physiological and usually resolve within 3 menstrual cycles = expectant management

TV cyst aspiration can be performed under US guidance (but no advantage over expectant management)

73
Q

What is the management of simple ovarian cysts 50-70mm?

A

Yearly USS follow-up and those with larger simple cysts considered for further imaging (MRI) / surgical intervention

74
Q

When may a cyst be considered not to be physiological?

A

Those that persist, increase in size

However, even in postmenopausal woman, persistent, unchanged, <10cm with normal CA125, likelihood of invasive cancer is low enough that observation is sufficient

75
Q

When is management of ovarian cysts surgical?

A

If conservative measures fail or criteria for surgery met eg persistent ovarian cysts larger than 5-10cm, esp if symptomatic, and complex ovarian cysts

76
Q

What type of surgery is appropriate for ovarian cyst management?

A

Cystectomy preferred over oophorectomy in children and younger women (preserves fertility)

Lapaoscopic usually preferred over open

77
Q

How is ovarian torsion managed?

A

Usually initially by laparoscopy with uncoiling of affected every and possibly oophoropexy

Salpingo-oophorectomy indicated if severe vascular compromise, peritonitis or tissue necrosis

Intervention within 6hrs means tissue will remain viable

78
Q

What is the management of haemorrhage cyst? Which ovary is this more common in?

A

Immediate surgical intervention

More common in right ovary

79
Q

What investigations are done for fibroids? (7)

A
  • Bimanual pelvic examination (hard, irregular uterine mass) may be sufficient
  • TV or abdo USS can differentiate types and dimensions
  • Saline infusion US better than TVUS and hysteroscopy in detecting submucous fibroids
  • Endometrial sampling (Pipelle) for histology
  • Hysteroscopy with biopsy
  • FBC for anaemia
  • MRI needed if US not definitive

Extra 5 (e) (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions