Gynae P2 Flashcards
Def Endometriosis
Progressive and benign oestrogen dependent diseases defined by presence of endometrial glands and stroma outside the uterine cavity
Prevalence endometriosis
10% pop
What % of infertile F have endometriosis
40%
What are the 3 types of endometriosis externa
Superficial endometriosis
Ovarian endometriosis
DIE
What is the most common type of external endometriosis
Superficial endometriosis
What is endometriosis interna
Adenomyosis
What is the pain in endometriosis dependent on?
infiltration
What are the 2 main theories about how endometriosis comes about
Sampson endometrial reflux theory
Coeliac metaplasia theory
What is the Sampson endometrial reflux theory?
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)
What is the coeliac metaplassia theory?
1 type of adult cell turns into another type of adult cells
What is the 3rd endometriosis theory
Halban lymphohaemotagenous theory
Where are the most common sites of endometriosis?
Ovaries
Uterosacral ligaments
Sx endometriosis
Cyclical pain \+ Deep dyspaerunia Chronic pelvic pain Dysmenorrhoea Infertility Abdominal bloating Chronic fatigue
GIT Sx endometriosis (6)
Dyschezia Haematochezia diarrhoea cyclical rectal bleed Constipation Cramping (mimics ibs)
Urinary tract Sx endometriosis (5)
Frequency Dysuria Haematuria Ureteric obstruction Hydronephrosis
Endometriosis and fertility (4)
Blocks tubes
Tubes become > fixed + rigid, lacking persitalsis
Scar tissue
Dyspaeruniea
Diagnosis endometriosis (5)
Hx Physical exam - tender nodules post fornix, uterus fixed, retroverted Pelvic USS MRI Diagnostic lapro + biopsy
DDx endometriosis (5)
PID Pelvic pain syndrome Submucus fibroids Ovarian accident Adhesions
Aims of Mx endomtriosis
Alleviate pain
Stop progression disease/development complications
Mx endometriosis - med
analgesia OCP / mirena Progrestogens Danzol? GnRH analogues
Why do progestogens work for endometriosis Mx
Induces state of pseudopregancy –> endometrium regresses
SE Danzol Tx
Oily skin
Acne
Deepening voice
W gain
How effective is Danzol for endometriosis Tx?
90% pain free
Surgical Mx endometriosis
Ablation Excision Surgical resection Adhesiolysis Nodulectomy TAH + BSO (if don't want kids)
What is adenomyosis
Presence of endometrial glands and stroma within the myometrium
Sx adenomyosis (3)
Parous middle aged F w/ menorrhagia
Dysmenorrhoea
Dyspareurnia
O/E adenomyosis
Uterus tender + bulky
What is a key sign someone may have adenomyosis?
Failed ablation
USS findings adenomyosis
Diffuse uterine enlargement Thickened posterior wall Eccentric endometrial cavity Irreg cystic spaces Disruption homogenous pattern in myometrium
Tx adenomyosis
Hysterectomy
What % of western pop suffer from menorrhagia
9-15%
Extracephalic causes of menorrhagia (4)
Liver disease
Thyroid disease
Dx
Bleeding comditions (vwD)
Pelvic causes of menorrhagia (4)
Fibroids
Polyps
Adenomyosis
DUB
What is the most common cause of menorrhagia
DUB - dysfunctional uterine bleeding (75%)
What is a polyp
Discrete growth on endometrium
Tx of polyp
Hysteroscope
Tx of DUB
Mirena coil
COC
POP
How is menorrhagia diagnosed? (3)
Subjective assessment
Pictorial blood loss assessment charts
Objective assessment
Ix menorrhagia (4)
FBC
Pelvic USS
EM biopsy
Hysteroscopy
Non-hormonal Mx menorrhagia
Transenamic acid
NSAIDS e.g. mefanamic acid/ibuprofen
Surgical Mx menorrhagia
Ablation
Hysterectomy
Risks of ablation Mx menorrhagia (5)
20% failure rate Uterine perforation Fl overload Haemorrhage Infection
What is anovulatory DUB
Pt has heavy periods but doesn’t ovulate
Causes of anovulatory DUB
PCOS
Thyroid dysfunction
Adolescents
Perimenopausal F
Def fibroids
Benign uterine tumours of the myometrium
What % of F have fibroids
70%
What age are typically affected by fibroids
30-40 y/o
What are fibroids dependent on?
Oestrogen and progesterone
Sx fibroids (8)
Heavy + prolonged bleeding Menstrual and lower abdominal pain + bloating Pain on intercourse Pelvic pain Lower back pain Constipation Polyuria Chronic vaginal discharge
RF fibroids
Obesity Black Nulliparity PCOS HTN
What classification is now used for fibroids
Wamstekers
Ix fibroids
Hx Exam Laparo USS MRI/CT?
Indications for Tx fibroids (3)
Symptomatic
Rapidly enlarging
If thought to be causing infertility
Medical Mx fibroids
GnRH
Surgical Mx fibroids
Hysterectomy
Myomectomy (if still want babies)
Emobilization
Fibroids + pregnancy - what can go wrong (11)
IUGR Placenta accreta Obstruction Foetal malabsorption Placenta praevia PPH Miscarriage Pre-term labour Red degeneration Labour dystocia Uterine atony post partum
PS red degeneration
Severe localised pain
+ pointing finger sign
Causes of endometritis
STI
Post op complications
Foreign tissue
IUD
Features of endometritis (3)
Tender uterus
Pelvic/systemic infection
Accumulation of pus
Mx endometritis
ABX
ERPC
Cause of intrauterine polyps
Increased oestrogen
Features of intrauterine polyps
Asymptomatic
Menorrhagia
IMB
Prolapse of cervix
Mx of intrauterine polyps
USS, hysteroscopy + resect
What is haematometra
Menstrual blood accumulates in the uterus due to outflow obstruction
Cause of uterine shape abnormalities
Failure of 2 mullerian ducts to fuse c9 w gesation
