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cOGTEXT > Gynae Emergencies > Flashcards

Gynae Emergencies Flashcards

1
Q

what can cause pelvic infection?

A

PID from STIs such as chlamydia or gonorrhoea
following insertion of intrauterine devices
from organisms not sexually contracted

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2
Q

risk factors associated with pelvic infection?

A 
age <25
multiple sexual factors
unprotected sex
recent insertion of IUD
recent change in sexual partner
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3
Q

how might pelvic infection due to PID present?

A

irregular menstrual bleeding
abnormal vaginal discharge
chronic pelvic pain
infertility

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4
Q

how can ascending genital tract infection cause PID/pelvic infectoin?

A

can ascend to cause cervivitis, endometritis, salpingitis

can lead to development of tubo-ovarian abscesses

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5
Q

what might help with diagnosis of pelvic infection?

A

vaginal and endocervical swabs

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6
Q

signs and symptoms of pelvic infection?

A 
lower abdominal pain
fever
abnormal vaginal bleeding
offensive vaginal discharge
deep dyspareuinia
dysuria or mestrual irregularities
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7
Q

examination findings in pelvic infection?

A

cervical motion tenderness

adnexal tenderness

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8
Q

how is pelvic infection managed?

A 
if acutely unwell - manage via sepsis 6
partner notification (PID)
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9
Q

empirical antibiotics in pelvic infection?

A

oral orofloxacin + metronidazole
or
IM ceftriaxone + oral doxycycline + oral metronidazole

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10
Q

how are post benign ovarian cysts diagnosed?

A

presence of pelvic/abdominal mass by symptoms such as pain or incidentally on US

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11
Q

how big are benign cysts usually?

A

<5cm in diameter

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12
Q

how do benign ovarian cysts usually resolve?

A

spontaneously over 2-3 cycles

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13
Q

how might an ovarian cyst present acutely?

A

“cyst accidents”

  • haemorrhage within the cysts
  • rupture of cyst
  • torsion of cyst
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14
Q

more long term/insidious features of ovarian cyst?

A

features of pressure on the bowel or bladder (depending on size)
can have disturbance in menstrual cycle or virilisation depending on type of cyst

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15
Q

categories of causes of ovarian cysts?

A

physiological/functional
benign germ cell tumours
benign epithelial tumours
benign sex cord stromal tumours

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16
Q

who does each type of ovarian cyst most commonly occur in?

A

physiological/functional = young women in reproductive years
germ cell = young women
epithelial = older women

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17
Q

microscopic features of most cysts?

A

thin wall with no solid or papillary projections into the cystic cavity

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18
Q

what concerning features may a cyst develop if it increases in size?

A

thick wall septa etc

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19
Q

what tumour markers should be tested if cyst develops concerning features?

A

inhibin
AFP
bHCG
CA125

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20
Q

other tests on concerning cyst?

A

US
CT
MRI inflammatory markers if suspicious of appendicitis or tubo-ovarian abscess

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21
Q

commonest type of ovarian cyst?

A

functional

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22
Q

describe functional cysts?

A

simple uniloculated cysts on US measuring >3cm

23
Q

what causes functional cyst?

A

non-rupture of dominant follicle or failure of atresia in a non-dominant follicle
usually regress after several cycles

24
Q

types of functional cyst?

A

follicular
corpus luteal
theca luteal

25
Q

management of functional cyst?

A

depends on symptoms
asymptomatic = observation and repeat US to assess changes
symptomatic = laparoscopic cystectomy

26
Q

most common benign ovarian tumour in women <30?

A

germ cell

27
Q

types of benign germ cell tumour?

A

dermoid cysts (mature cystic teratoma)

28
Q

describe benign germ cell tumours

A

often lined with epithelial tissue and hence may contain hair, teeth etc
tend to be very big
can present with torsion

29
Q

types of benign epithelial ovarian tumours?

A 
endometrioid
mucinous
serous
clear cell
brenner
30
Q

where do epithelial ovarian tumours arise?

A

ovarian surface epithelium

31
Q

most common benign epithelial ovarian tumour?

A

serous cysadenoma (benign version of serous carcinoma)

32
Q

2nd most common benign epithelial ovarian tumour?

A

mucinous cystadenoma

33
Q

what problem might occur with rupture of mucinous cystadenoma?

A

pseudomyxoma peritoneii

34
Q

where are bartholin cysts/abscesses found?

A

next to entrance to vagina at 5 and 7 o clock positions

35
Q

normal size of bartholin glands?

A

pea sized

become enlarged if infected

36
Q

management of bartholin cysts/abscesses?

A

can sometimes settle with antibiotics

may require surgical procedure called marsupialization

37
Q

gynae causes of acute abdominal/pelvic pain?

A 
ectopic pregnancy
ovarian torsion
ovarian cyst rupture or haemorrhage 
PID
tubo-ovarian abscess
endometriosis
fibroids
miscarriage
mittelschmerz (ovulation pain)
38
Q

GI/GU causes of acute abdo/pelvic pain?

A

appendicitis
diverticulitis
UTI
bowel obstruction

39
Q

signs and symptoms of fibroids?

A 
can be asymptomatic
menorrhagia and dysmenorrhoea
lower abdo pain during menstruation
subfertility
pressure symptoms (urinary)
bulky uterus
40
Q

fibroids diagnosis?

A

TV US

41
Q

management of fibroids?

A 
1st line = mirena (only if no uterine abnormality)
mymectomy
hysterectomy
short term GnRH analogues
uterine artery embolisation
42
Q

signs and symptoms of endometriosis?

A

dysmenorrhoea
deep dyspareunia
subfertility
non-gynae signs (dysuria, urgency etc)

43
Q

diagnosis of endometriosis?

A

often via laparoscopy

tender nodularity on posterior fournix

44
Q

management of endometriosis?

A

NSAIDs and paracetamol for symptomatic relief
COCP or progestogens
surgery (laparoscopic excision of lesions)

45
Q

signs and symptoms of ovarian torsion?

A

sudden onset of deep colickly pain
associated with vomiting and distress
adnexal tenderness/acute abdomen

46
Q

US signs of ovarian torsion for diagnosis?

A

whirlpool sign on US

47
Q

management of ovarian torsion?

A

laparoscopy to untwist ovary and remove cyst

remove ovary if necrotic

48
Q

signs and symptoms of PID?

A

vaginal discharge

bilateral lower abdo pain

49
Q

diagnosis of PID?

A

FBC
high vaginal or endocervical swabs
pelvic imaging if needed

50
Q

when is pelvic imaging needed in PID?

A

if it doesnt settle with antibiotics

acute abdomen or palpable mass

51
Q

management of PID?

A

antibiotics

surgical drainage of abscess if present

52
Q

signs and symptoms of mittelschmerz?

A

mid cycle pain

often

53
Q

management of mittelschmerz?

A

simple analgesia and reassurance

cOGTEXT (17 decks)

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