Gynae Emergencies Flashcards
what can cause pelvic infection?
PID from STIs such as chlamydia or gonorrhoea
following insertion of intrauterine devices
from organisms not sexually contracted
risk factors associated with pelvic infection?
age <25 multiple sexual factors unprotected sex recent insertion of IUD recent change in sexual partner
how might pelvic infection due to PID present?
irregular menstrual bleeding
abnormal vaginal discharge
chronic pelvic pain
infertility
how can ascending genital tract infection cause PID/pelvic infectoin?
can ascend to cause cervivitis, endometritis, salpingitis
can lead to development of tubo-ovarian abscesses
what might help with diagnosis of pelvic infection?
vaginal and endocervical swabs
signs and symptoms of pelvic infection?
lower abdominal pain fever abnormal vaginal bleeding offensive vaginal discharge deep dyspareuinia dysuria or mestrual irregularities
examination findings in pelvic infection?
cervical motion tenderness
adnexal tenderness
how is pelvic infection managed?
if acutely unwell - manage via sepsis 6 partner notification (PID)
empirical antibiotics in pelvic infection?
oral orofloxacin + metronidazole
or
IM ceftriaxone + oral doxycycline + oral metronidazole
how are post benign ovarian cysts diagnosed?
presence of pelvic/abdominal mass by symptoms such as pain or incidentally on US
how big are benign cysts usually?
<5cm in diameter
how do benign ovarian cysts usually resolve?
spontaneously over 2-3 cycles
how might an ovarian cyst present acutely?
“cyst accidents”
- haemorrhage within the cysts
- rupture of cyst
- torsion of cyst
more long term/insidious features of ovarian cyst?
features of pressure on the bowel or bladder (depending on size)
can have disturbance in menstrual cycle or virilisation depending on type of cyst
categories of causes of ovarian cysts?
physiological/functional
benign germ cell tumours
benign epithelial tumours
benign sex cord stromal tumours
who does each type of ovarian cyst most commonly occur in?
physiological/functional = young women in reproductive years
germ cell = young women
epithelial = older women
microscopic features of most cysts?
thin wall with no solid or papillary projections into the cystic cavity
what concerning features may a cyst develop if it increases in size?
thick wall septa etc
what tumour markers should be tested if cyst develops concerning features?
inhibin
AFP
bHCG
CA125
other tests on concerning cyst?
US
CT
MRI inflammatory markers if suspicious of appendicitis or tubo-ovarian abscess
commonest type of ovarian cyst?
functional
describe functional cysts?
simple uniloculated cysts on US measuring >3cm
what causes functional cyst?
non-rupture of dominant follicle or failure of atresia in a non-dominant follicle
usually regress after several cycles
types of functional cyst?
follicular
corpus luteal
theca luteal
management of functional cyst?
depends on symptoms
asymptomatic = observation and repeat US to assess changes
symptomatic = laparoscopic cystectomy
most common benign ovarian tumour in women <30?
germ cell
types of benign germ cell tumour?
dermoid cysts (mature cystic teratoma)
describe benign germ cell tumours
often lined with epithelial tissue and hence may contain hair, teeth etc
tend to be very big
can present with torsion
types of benign epithelial ovarian tumours?
endometrioid mucinous serous clear cell brenner
where do epithelial ovarian tumours arise?
ovarian surface epithelium
most common benign epithelial ovarian tumour?
serous cysadenoma (benign version of serous carcinoma)
2nd most common benign epithelial ovarian tumour?
mucinous cystadenoma
what problem might occur with rupture of mucinous cystadenoma?
pseudomyxoma peritoneii
where are bartholin cysts/abscesses found?
next to entrance to vagina at 5 and 7 o clock positions
normal size of bartholin glands?
pea sized
become enlarged if infected
management of bartholin cysts/abscesses?
can sometimes settle with antibiotics
may require surgical procedure called marsupialization
gynae causes of acute abdominal/pelvic pain?
ectopic pregnancy ovarian torsion ovarian cyst rupture or haemorrhage PID tubo-ovarian abscess endometriosis fibroids miscarriage mittelschmerz (ovulation pain)
GI/GU causes of acute abdo/pelvic pain?
appendicitis
diverticulitis
UTI
bowel obstruction
signs and symptoms of fibroids?
can be asymptomatic menorrhagia and dysmenorrhoea lower abdo pain during menstruation subfertility pressure symptoms (urinary) bulky uterus
fibroids diagnosis?
TV US
management of fibroids?
1st line = mirena (only if no uterine abnormality) mymectomy hysterectomy short term GnRH analogues uterine artery embolisation
signs and symptoms of endometriosis?
dysmenorrhoea
deep dyspareunia
subfertility
non-gynae signs (dysuria, urgency etc)
diagnosis of endometriosis?
often via laparoscopy
tender nodularity on posterior fournix
management of endometriosis?
NSAIDs and paracetamol for symptomatic relief
COCP or progestogens
surgery (laparoscopic excision of lesions)
signs and symptoms of ovarian torsion?
sudden onset of deep colickly pain
associated with vomiting and distress
adnexal tenderness/acute abdomen
US signs of ovarian torsion for diagnosis?
whirlpool sign on US
management of ovarian torsion?
laparoscopy to untwist ovary and remove cyst
remove ovary if necrotic
signs and symptoms of PID?
vaginal discharge
bilateral lower abdo pain
diagnosis of PID?
FBC
high vaginal or endocervical swabs
pelvic imaging if needed
when is pelvic imaging needed in PID?
if it doesnt settle with antibiotics
acute abdomen or palpable mass
management of PID?
antibiotics
surgical drainage of abscess if present
signs and symptoms of mittelschmerz?
mid cycle pain
often
management of mittelschmerz?
simple analgesia and reassurance
