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CP2 OBGYN > Gynae P2 > Flashcards

Gynae P2 Flashcards

1
Q

Def Endometriosis

A

Progressive and benign oestrogen dependent diseases defined by presence of endometrial glands and stroma outside the uterine cavity

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2
Q

Prevalence endometriosis

A

10% pop

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3
Q

What % of infertile F have endometriosis

A

40%

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4
Q

What are the 3 types of endometriosis externa

A

Superficial endometriosis
Ovarian endometriosis
DIE

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5
Q

What is the most common type of external endometriosis

A

Superficial endometriosis

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6
Q

What is endometriosis interna

A

Adenomyosis

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7
Q

What is the pain in endometriosis dependent on?

A

infiltration

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8
Q

What are the 2 main theories about how endometriosis comes about

A

Sampson endometrial reflux theory

Coeliac metaplasia theory

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9
Q

What is the Sampson endometrial reflux theory?

A

Blood from menses doesn’t all leave vagina and –> pelvic cavity
Shed endometrium attaches to surface of abdominal structures
After invasion, ectopic endometrium needs to recruit adjacent vascularisation (angiogenesis)

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10
Q

What is the coeliac metaplassia theory?

A

1 type of adult cell turns into another type of adult cells

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11
Q

What is the 3rd endometriosis theory

A

Halban lymphohaemotagenous theory

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12
Q

Where are the most common sites of endometriosis?

A

Ovaries

Uterosacral ligaments

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13
Q

Sx endometriosis

A 
Cyclical pain 
\+ 
Deep dyspaerunia 
Chronic pelvic pain 
Dysmenorrhoea 
Infertility 
Abdominal bloating 
Chronic fatigue
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14
Q

GIT Sx endometriosis (6)

A 
Dyschezia 
Haematochezia 
diarrhoea 
cyclical rectal bleed 
Constipation 
Cramping (mimics ibs)
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15
Q

Urinary tract Sx endometriosis (5)

A 
Frequency 
Dysuria 
Haematuria 
Ureteric obstruction 
Hydronephrosis
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16
Q

Endometriosis and fertility (4)

A

Blocks tubes
Tubes become > fixed + rigid, lacking persitalsis
Scar tissue
Dyspaeruniea

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17
Q

Diagnosis endometriosis (5)

A 
Hx 
Physical exam - tender nodules post fornix, uterus fixed, retroverted 
Pelvic USS 
MRI
Diagnostic lapro + biopsy
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18
Q

DDx endometriosis (5)

A 
PID
Pelvic pain syndrome 
Submucus fibroids 
Ovarian accident 
Adhesions
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19
Q

Aims of Mx endomtriosis

A

Alleviate pain

Stop progression disease/development complications

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20
Q

Mx endometriosis - med

A 
analgesia 
OCP / mirena 
Progrestogens 
Danzol? 
GnRH analogues
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21
Q

Why do progestogens work for endometriosis Mx

A

Induces state of pseudopregancy –> endometrium regresses

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22
Q

SE Danzol Tx

A

Oily skin
Acne
Deepening voice
W gain

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23
Q

How effective is Danzol for endometriosis Tx?

A

90% pain free

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24
Q

Surgical Mx endometriosis

A 
Ablation 
Excision 
Surgical resection 
Adhesiolysis 
Nodulectomy 
TAH + BSO (if don't want kids)
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25
Q

What is adenomyosis

A

Presence of endometrial glands and stroma within the myometrium

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26
Q

Sx adenomyosis (3)

A

Parous middle aged F w/ menorrhagia
Dysmenorrhoea
Dyspareurnia

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27
Q

O/E adenomyosis

A

Uterus tender + bulky

28
Q

What is a key sign someone may have adenomyosis?

A

Failed ablation

29
Q

USS findings adenomyosis

A 
Diffuse uterine enlargement 
Thickened posterior wall 
Eccentric endometrial cavity 
Irreg cystic spaces 
Disruption homogenous pattern in myometrium
30
Q

Tx adenomyosis

A

Hysterectomy

31
Q

What % of western pop suffer from menorrhagia

A

9-15%

32
Q

Extracephalic causes of menorrhagia (4)

A

Liver disease
Thyroid disease
Dx
Bleeding comditions (vwD)

33
Q

Pelvic causes of menorrhagia (4)

A

Fibroids
Polyps
Adenomyosis
DUB

34
Q

What is the most common cause of menorrhagia

A

DUB - dysfunctional uterine bleeding (75%)

35
Q

What is a polyp

A

Discrete growth on endometrium

36
Q

Tx of polyp

A

Hysteroscope

37
Q

Tx of DUB

A

Mirena coil
COC
POP

38
Q

How is menorrhagia diagnosed? (3)

A

Subjective assessment
Pictorial blood loss assessment charts
Objective assessment

39
Q

Ix menorrhagia (4)

A

FBC
Pelvic USS
EM biopsy
Hysteroscopy

40
Q

Non-hormonal Mx menorrhagia

A

Transenamic acid

NSAIDS e.g. mefanamic acid/ibuprofen

41
Q

Surgical Mx menorrhagia

A

Ablation

Hysterectomy

42
Q

Risks of ablation Mx menorrhagia (5)

A 
20% failure rate
Uterine perforation 
Fl overload 
Haemorrhage 
Infection
43
Q

What is anovulatory DUB

A

Pt has heavy periods but doesn’t ovulate

44
Q

Causes of anovulatory DUB

A

PCOS
Thyroid dysfunction
Adolescents
Perimenopausal F

45
Q

Def fibroids

A

Benign uterine tumours of the myometrium

46
Q

What % of F have fibroids

A

70%

47
Q

What age are typically affected by fibroids

A

30-40 y/o

48
Q

What are fibroids dependent on?

A

Oestrogen and progesterone

49
Q

Sx fibroids (8)

A 
Heavy + prolonged bleeding 
Menstrual and lower abdominal pain + bloating 
Pain on intercourse 
Pelvic pain 
Lower back pain 
Constipation 
Polyuria 
Chronic vaginal discharge
50
Q

RF fibroids

A 
Obesity 
Black 
Nulliparity 
PCOS 
HTN
51
Q

What classification is now used for fibroids

A

Wamstekers

52
Q

Ix fibroids

A 
Hx 
Exam 
Laparo
USS
MRI/CT?
53
Q

Indications for Tx fibroids (3)

A

Symptomatic
Rapidly enlarging
If thought to be causing infertility

54
Q

Medical Mx fibroids

A

GnRH

55
Q

Surgical Mx fibroids

A

Hysterectomy
Myomectomy (if still want babies)
Emobilization

56
Q

Fibroids + pregnancy - what can go wrong (11)

A 
IUGR
Placenta accreta
Obstruction 
Foetal malabsorption 
Placenta praevia 
PPH 
Miscarriage 
Pre-term labour 
Red degeneration 
Labour dystocia 
Uterine atony post partum
57
Q

PS red degeneration

A

Severe localised pain

+ pointing finger sign

58
Q

Causes of endometritis

A

STI
Post op complications
Foreign tissue
IUD

59
Q

Features of endometritis (3)

A

Tender uterus
Pelvic/systemic infection
Accumulation of pus

60
Q

Mx endometritis

A

ABX

ERPC

61
Q

Cause of intrauterine polyps

A

Increased oestrogen

62
Q

Features of intrauterine polyps

A

Asymptomatic
Menorrhagia
IMB
Prolapse of cervix

63
Q

Mx of intrauterine polyps

A

USS, hysteroscopy + resect

64
Q

What is haematometra

A

Menstrual blood accumulates in the uterus due to outflow obstruction

65
Q

Cause of uterine shape abnormalities

A

Failure of 2 mullerian ducts to fuse c9 w gesation

CP2 OBGYN (21 decks)

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