Gynae Flashcards
What is a prolapse ?
A descent of the uterus and or vaginal walls from their normal anatomical confines.
Due to a weakness of the supporting structures.
Who are prolapses com on in? 2 groups
Parous
Old people
What two ligaments support the upper 1/3rd of the vagina and the uterus?
- Cardinal ligaments
2. Uterosacral ligaments
What are the following types of prolapse?
Urethrocele Cystocele Apical prolapse Entercocele Rectrocele
Urethrocele: prolapse of the lower anterior vaginal wall (involves urethra)
Cystocele (prolapse of the bladder)
Apical prolapse of the uterus, cervix and upper vagina
Entercocele prolapse of the small bowel loops
Rectrocele prolapse of the rectum
What grading scale is used to grade prolapse?
Braden Walker Classification
Give 3 aetiology causes of prolapses?
- Vagina delivery and pregnancy
- Constipation
- Pelvic Surgery
What are the general symptoms of the different types of prolapse?
Cystocele: urinary frequency and urgency, incomplete bladder emptying.
Dragging down sensation, feeling of a lump falling down or generalised ache.
tends to be worse with standing and as the day goes on.
What are 3 ways to manage prolapses?
- Pelvic Floor exercises
- Vaginal Pessaries
- Surgery i.e. anterior or posterior repair. If an apical prolapse a vaginal hysterectomy may be indicated.
What is a genital tract fistula ?
An abnormal opening between the vagina and another organ i.e. bladder or bowel
How does a genital tract fistula occur? What are 2 causes?
Pregnancy
IBD
Radiotherapy
How does a genital tract fistula present?
- Vaginal or UTI infection
- Stool, urine or gas leak through the vagina
- Irritated or inflamed skin and/or abscess/
How can you heal a genital tract fistula involving the bladder?
- But a Catheter in until the bladder can repair
However, most of the time they just need surgery
What are the 4 pathophysiology processes behind PCOS?
- Excessive androgen production by theca cells
- Insulin resistance leads to increased androgen + sHBG production leading to higher levels of testosterone.
- Higher LH from anterior pituitary.
What investigations would you do on someone with PCOS?
- Basal Days 2-5 (LH and FSH) + testosterone + SHBG
2. Pelvic US
What are 5 symptoms of PCOS?
Irregular periods <9 in a year Infertility/Sub fertility Acne Hirsutism Mood swings, depression or anxiety
What are 3 signs of PCOS?
Acanthosis Nigricans
Central obesity
Male pattern balding
Hirsutism
What is the name of the criteria used for PCOS?
Rotterdam Criteria
What are the 3 criteria in the Rotterdam Criteria that need to be satisfied?
- Irregular/absent ovulation
- Clinical hyperandrogenism (alopecia, hirsutism and acne)
- Poly cystic ovaries on pelvic USS.
What are the 4 levels fo management for PCOS?
- Weight loss, exercise and low sugar
- COCP
- Metformin
- Co-cyprindrol for hirsutism
What two medications can be used to improve fertility in PCOS?
Metformin
Clomifene
How do COCP work?
They inhibit ovulation
Reduces LH and prevents surge that comes with ovulation.
Thickens the cervical mucosa and prevents proliferation of the endometrium.
What are 3 SE of the COCP
Breast tenderness
Mood Swings
Worse BP
What are 4 CI of COCP?
BMI > 35
Smoker over 35
Breast Feeding
Breast cancer
How does the progesterone only pill work?
Thickens the cervical mucosa
Thins the endometrium inhibiting implantation. Inhibits ovulation (no potentially no periods)
