Gynae Flashcards
Define Pelvic Inflammatory Disease
inflammation of the female genital tract, accompanied by fever and lower abdominal pain. Infection ascends from vagina and cervix, up to the uterus and tubes, leading to inflammation (endometritis, salpingitis) and formation of adhesions.
Common organisms causing PID
In UK:
1) Chlamydia trachomatis
2) Neisseria gonorrhoea
Elsewhere:
1) TB
2) SchistosomiasisIn UK:
1) Chlamydia trachomatis
2) Neisseria gonorrhoea
Elsewhere:
1) TB
2) SchistosomiasisIn UK:
1) Chlamydia trachomatis
2) Neisseria gonorrhoea
Elsewhere:
1) TB
2) SchistosomiasisIn UK:
1) Chlamydia trachomatis
2) Neisseria gonorrhoea
Elsewhere:
1) TB
2) Schistosomiasis
SIgns & Symptoms of PID:
Lower abdo pain Dyspareunia (difficult or painful sexual intercourse) Vaginal bleeding/discharge Fever Adnexal (the appendages of the uterus, namely the ovaries, the Fallopian tubes, and the ligaments that hold the uterus in place) tenderness Cervical excitationLower abdo pain Dyspareunia (difficult or painful sexual intercourse) Vaginal bleeding/discharge Fever Adnexal (the appendages of the uterus, namely the ovaries, the Fallopian tubes, and the ligaments that hold the uterus in place) tenderness Cervical excitationLower abdo pain Dyspareunia (difficult or painful sexual intercourse) Vaginal bleeding/discharge Fever Adnexal (the appendages of the uterus, namely the ovaries, the Fallopian tubes, and the ligaments that hold the uterus in place) tenderness Cervical excitationLower abdo pain Dyspareunia (difficult or painful sexual intercourse) Vaginal bleeding/discharge Fever Adnexal (the appendages of the uterus, namely the ovaries, the Fallopian tubes, and the ligaments that hold the uterus in place) tenderness Cervical excitation
Complications of PID:
1) Infertility
2) Increased risk of ectopic pregnancy
3) Intestinal obstruction –> bacteraemia
4) Tubo-ovarian abscess
5) Chronic pelvic pain
6) Peritonitis
7) Plical (fold of tissue) fusion
8) Fitz Hugh Curtis syndrome - RUQ from peri-hepatitis + violin string peri-hepatic adhesions1) Infertility
2) Increased risk of ectopic pregnancy
3) Intestinal obstruction –> bacteraemia
4) Tubo-ovarian abscess
5) Chronic pelvic pain
6) Peritonitis
7) Plical (fold of tissue) fusion
8) Fitz Hugh Curtis syndrome - RUQ from peri-hepatitis + violin string peri-hepatic adhesions1) Infertility
2) Increased risk of ectopic pregnancy
3) Intestinal obstruction –> bacteraemia
4) Tubo-ovarian abscess
5) Chronic pelvic pain
6) Peritonitis
7) Plical (fold of tissue) fusion
8) Fitz Hugh Curtis syndrome - RUQ from peri-hepatitis + violin string peri-hepatic adhesions1) Infertility
2) Increased risk of ectopic pregnancy
3) Intestinal obstruction –> bacteraemia
4) Tubo-ovarian abscess
5) Chronic pelvic pain
6) Peritonitis
7) Plical (fold of tissue) fusion
8) Fitz Hugh Curtis syndrome - RUQ from peri-hepatitis + violin string peri-hepatic adhesions
Define endometriosis
an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus (endometrial implant). Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis.
What are the 3 theories of endometriosis
1) Regurgitant/implantation
2) Metaplastic
3) Vascular or lymphatic dissemination1) Regurgitant/implantation
2) Metaplastic
3) Vascular or lymphatic dissemination1) Regurgitant/implantation
2) Metaplastic
3) Vascular or lymphatic dissemination1) Regurgitant/implantation
2) Metaplastic
3) Vascular or lymphatic dissemination
What happens in endometriosis?
Ectopic tissue is still functional, therefore undergoes cyclical bleeding –> pain, scarring and infertility
Signs & symptoms of endometriosis
Pelvic pain Dsymenorrhoea deep dyspareunia Decreased fertilityPelvic pain Dsymenorrhoea deep dyspareunia Decreased fertilityPelvic pain Dsymenorrhoea deep dyspareunia Decreased fertilityPelvic pain Dsymenorrhoea deep dyspareunia Decreased fertility
Clinical findings in endometriosis:
Nodules/tenderness in vagina, posterior fornix or uterus
Immobile uterus which is retroverted in advanced diseaseNodules/tenderness in vagina, posterior fornix or uterus
Immobile uterus which is retroverted in advanced diseaseNodules/tenderness in vagina, posterior fornix or uterus
Immobile uterus which is retroverted in advanced diseaseNodules/tenderness in vagina, posterior fornix or uterus
Immobile uterus which is retroverted in advanced disease
Macroscopic findings in endometriosis
Red-blue to brown nodules - “powder burns”
“Chocolate cysts” in ovaries (endometriomas)Red-blue to brown nodules - “powder burns”
“Chocolate cysts” in ovaries (endometriomas)Red-blue to brown nodules - “powder burns”
“Chocolate cysts” in ovaries (endometriomas)Red-blue to brown nodules - “powder burns”
“Chocolate cysts” in ovaries (endometriomas)
Microscopic findings in endometriosis
Endometrial glands and stroma
Define Adenomyosis
Adenomyosis is a condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus (the myometrium). Similar to endometriosis
Symptoms of adenomyosis
Adenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods.
Deep dyspareunia
Globular uterus
Dysmenorrhoea (painful menstruation, typically involving abdominal cramps) is the major complaintAdenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods.
Deep dyspareunia
Globular uterus
Dysmenorrhoea (painful menstruation, typically involving abdominal cramps) is the major complaintAdenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods.
Deep dyspareunia
Globular uterus
Dysmenorrhoea (painful menstruation, typically involving abdominal cramps) is the major complaintAdenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods.
Deep dyspareunia
Globular uterus
Dysmenorrhoea (painful menstruation, typically involving abdominal cramps) is the major complaint
Define Leiomyoma (fibroid)
a benign tumour of smooth muscle origin.A leiomyoma of the uterus is commonly called a fibroid.
It is the most common tumour of the female genital tract - occuring in 20% of women >35a benign tumour of smooth muscle origin.A leiomyoma of the uterus is commonly called a fibroid.
It is the most common tumour of the female genital tract - occuring in 20% of women >35a benign tumour of smooth muscle origin.A leiomyoma of the uterus is commonly called a fibroid.
It is the most common tumour of the female genital tract - occuring in 20% of women >35a benign tumour of smooth muscle origin.A leiomyoma of the uterus is commonly called a fibroid.
It is the most common tumour of the female genital tract - occuring in 20% of women >35
Where can fibroids occur?
Intramural Submucosal SubserosalIntramural Submucosal SubserosalIntramural Submucosal SubserosalIntramural Submucosal Subserosal
How are fibroids affected by oestrogen?
Fibroids are stimulated by oestrogen.
Enlarge during pregnancy
Regress post-menopauseFibroids are stimulated by oestrogen.
Enlarge during pregnancy
Regress post-menopauseFibroids are stimulated by oestrogen.
Enlarge during pregnancy
Regress post-menopauseFibroids are stimulated by oestrogen.
Enlarge during pregnancy
Regress post-menopause
How do fibroids look?
Macroscopically: sharply circumscribed, discrete, round, firm, gray-white tumours. The size is variable
Microscopically: bundles of smooth muscle cellsMacroscopically: sharply circumscribed, discrete, round, firm, gray-white tumours. The size is variable
Microscopically: bundles of smooth muscle cellsMacroscopically: sharply circumscribed, discrete, round, firm, gray-white tumours. The size is variable
Microscopically: bundles of smooth muscle cells
How do fibroids present clinically?
Heavy menstrual bleeding
Dysmenorrhoea
Pressure effects (i.e. urinary frequency, tenesmus)
Subfertility
In pregnancy: red degeneration of fibroids (Due to pressure in the abdomen, the blood supply to the fibroid can be restricted or cut off, causing it to eventually die. This can cause severe abdominal pain and possible contractions in the uterus)Heavy menstrual bleeding
Dysmenorrhoea
Pressure effects (i.e. urinary frequency, tenesmus)
Subfertility
In pregnancy: red degeneration of fibroids (Due to pressure in the abdomen, the blood supply to the fibroid can be restricted or cut off, causing it to eventually die. This can cause severe abdominal pain and possible contractions in the uterus)Heavy menstrual bleeding
Dysmenorrhoea
Pressure effects (i.e. urinary frequency, tenesmus)
Subfertility
In pregnancy: red degeneration of fibroids (Due to pressure in the abdomen, the blood supply to the fibroid can be restricted or cut off, causing it to eventually die. This can cause severe abdominal pain and possible contractions in the uterus)
What is red degeneration of a fibroid and when does it occur usually?
This happens in pregnancy. Due to pressure in the abdomen, the blood supply to the fibroid can be restricted or cut off, causing it to eventually die. This can cause severe abdominal pain and possible contractions in the uterus.
Can fibroids be malignant?
They are most often benign.
It is very rare to transform to malignant (leiomyosarcoma)
Leiomyosarcomas likely arise de novo and usually occur in post-menopausal women.They are most often benign.
It is very rare to transform to malignant (leiomyosarcoma)
Leiomyosarcomas likely arise de novo and usually occur in post-menopausal women.They are most often benign.
It is very rare to transform to malignant (leiomyosarcoma)
Leiomyosarcomas likely arise de novo and usually occur in post-menopausal women.
