Gynae Emergencies Flashcards
what are the main risk factors for developing pelvic inflammatory disease
age <25
multiple sexual partners contracting STIs
recent uterine instrumentation eg hysteroscopy, colposcopy, IUD insertion
how does PID present
lower abdominal pain fever change in bleeding - intermenstrual, postcoital and menorrhagia offensive vaginal discharge deep dysparenunia
what are the 2 main examination findings with PID
cervical motion tenderness
adnexal tenderness
what are the main investigations for PID
vulvovaginal swab for chlamydia and gonorrhoea
if acutely unwell check FBC
if tubo-ovarian abscess suspected, TVS
how is PID managed
doxycycline, metronidazole and ceftriaxone
if acutely unwell, manage via sepsis 6 guidelines
what are the main complications of PID
fitz-hugh-curtis syndrome recurrent abscess ectopic pregnancy subfertility from tubal blockage chronic PID causing fibrosis
what are the main types of ovarian cyst and who typically gets them
functional - young child-bearing age women
germ cell tumours - young women
benign epithelial tumours - older women
what are 3 concerning features of an ovarian cyst
increasing size
thick wall septa or papillary projections
presence of tumour markers such as AFP, b-HCG, CA125
what causes a functional ovarian cyst to occur
dominant follicle fails to rupture and failure of atresia in non-dominant follicle
how is an asymptomatic functional ovarian cyst managed
observe for changes with regular US, only intervene if there are changes
what type of cyst is a dermoid cyst
a benign germ cell tumour
derived from epithelial tissue so can contain hair and teeth
how does an ovarian cyst present
asymptomatic
chronic pain, dull ache, dysparenunia, cyclical pain
acute bleeding if rupture
hormonal effects eg androgenic features
which tumour marker is most important for ovarian cysts in over 40s
CA125 as increased risk of malignancy
which tumour markers are important for ovarian cysts in women under 40
AFP
b-HCG
CEA
what are the main investigations for ovarian cysts
bloods
TVS
MRI for staging of cyst if malignant
how is an ovarian cyst in pre-menopausal women managed
if <5cm and asymptomatic rescan in 6 weeks
cystectomy if larger and symptomatic
how is an ovarian cyst in post-menopausal women managed
calculate risk of malignancy
if low risk, manage conservatively
if moderate risk bilateral oophrectomy
if high risk urgent cancer referral
what is an ovarian torsion
ovary containing a cyst turns in on itself and venous return of the ovary is occluded
what are the clinical features of ovarian torsion
severe unilateral abdo pain
nausea, vomiting
pain improves after 24 hours as the ovary starts to die
adnexal tenderness and acute abdomen
what are the ultrasound features of ovarian torsion
classical whirlpool sign
how is ovarian torsion managed
laparoscopy to untwist ovary and remove cyst
remove ovary if necrotic
what is the function of Bartholins glands
to provide lubrication to the vagina
where are Bartholins glands located
next to the vagina around 5 and 7 o’clock
normally the size of a pea
what are the features of Bartholin’s cysts
soft painless lump
gland slightly enlarged from normal
how does Bartholin’s abscess present
red, swollen, tender lump
may be painful during sex
what are the two main management options for Bartholin’s abscess
antibiotics
surgical procedure called marsupilisation
what is an ectopic pregnancy
when embryo implants in a location outwith the endometrial cavity
where are the common sites for an ectopic pregnancy to implant
majority are tubal eg ampulla ovary c-section scar peritoneum pouch of douglas
