Gynae emergencies

Question 1

If a patient complains of ‘abnormal’ vaginal discharge that changes cyclically, what is it likely to be?

Answer 1

normal

Question 2

What are 7 ovarian cyst ‘events’

Answer 2

rupture

haemorrhage

torsion

infection

secondary DVT

acute urinary obstruction

bowel onstruction

Question 3

Presentation of haemorrhage/ruptured ovarian cyst

Answer 3

Sudden onset lower abdo pain aggravated by movement

Vomiting

Like ectopic but negative PT

Question 4

Presentation of ovarian torsion

Answer 4

Pain can be acute onset or gradually worsening

Generalised distention, peritonism

May be loss of bowel sounds

Cervical motion tenderness, adnexal tenderness, adnexal mass

Maybe systemic symptoms: peripheral vasoconstriction, tachypnoea, decreased O2 sats, metabolic acidosis

Question 5

Why do you get systemic features in ovarian torsion?

Answer 5

Tissue necrosis. Could check lactate

Question 6

What is a rare differential for haemorragic ovarian cyst?

Answer 6

Splenic artery rupture- sometimes occurs in pregnancy and has very high mortality in pregnancy

Question 7

Investigation for ovarian event

Answer 7

USS- look for fluid…(?)

Question 8

Management of ovarian cyst rupture or haemorrhage

Answer 8

Conservative plus analgesia

Surgical if bleed

Question 9

Management of ovarian torsion

Answer 9

Laparoscopic detorsion

Could fix the ovary to prevent recurrence

Question 10

Can you preserve ovarian function in lap detorsion?

Answer 10

Yes in 88-100% cases

Question 11

What sort of cyst is more likely to torsion and why?

Answer 11

Dermoid as heavier