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Year 4 - Womens Health > Gynaecological Abnormalities And Pregnancy Loss > Flashcards

Gynaecological Abnormalities And Pregnancy Loss Flashcards

1
Q

What is endometriosis

A

Where endometrium cells migrate spontaneously or due to reasons implant and cause prolifertion of endometrium fibroids in that area

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2
Q

Where does endometriosis usually occur?

A

Ovaries and ligaments

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3
Q

Can peritoneal cells transform into endometrial cells?

A

Yes

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4
Q

First line of treatment for endometriosis?

A

Paracetamol/nsaids

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5
Q

Secondary line of tx for endometriosis

A

COCP/POP

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6
Q

when is COCP for endometriosis tx contraindicated

A

Migraine with aura

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7
Q

What is GnRH analogue

A

Induce a menopausal state third line tx for endometriosis

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8
Q

Last tx for endometriosis

A

Laparoscopic excision or ablation

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9
Q

What is a common site of ectopic pregnancy

A

Ampulla

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10
Q

What tests are used to verify ectopic pregnancy

A

Pregnancy test positive and TVUS

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11
Q

What 3 types of management is used for ectopics

A
  1. Expectant - close monitoring over 48hrs if b-hCG rises or Sx manifest interventions performed
  2. Medical - methotrexate + follow up
  3. Surgical - salpingectomy for no risk for infertility, salpingotomy for risk of infertility
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12
Q

When is an open salpingectomy used

A

Emergency cases with ruptured fallopian tube

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13
Q

<35mm unruptured and asymptomatic with hCG <1000?

A

Expectant management of ectopic pregnancy

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14
Q

<35mm unruptured no significant pain hCG <1,500 ?

A

Medical management of miscarriage

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15
Q

> 35mm, ruptured?, pain, visible HB, HCG >5,000 ?

A

Surgical.

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16
Q

5 categories of miscarriages?

A
  1. Threatened
  2. Inevitable
  3. Incomplete
  4. Complete
  5. Missed
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17
Q

Bleeding less than menstruation, close cervical os, slight/no pain before 24 weeks (6-9)

A

Threatened

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18
Q

Missed (delayed) miscarriage

A

Light vaginal bleeding, pregnancy symptoms disappear, no pain, closed cervical os,

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19
Q

What’s an inevitable miscarriage

A

Heavy bleeding clots pain and open os

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20
Q

What’s an incomplete miscarriage e

A

Not all products expelled, pain, bleeding open os

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21
Q

Loss of internal labial margin, redness and soreness, scaling?

A

Lichen sclerosis

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22
Q

What’s adenomyosis

A

Endometrial tissue within myometrium

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23
Q

Describe the physiology of micturition

A

2 phases: 1. Storage 2. Voiding - uses pontine continence centre - spinal continence - hypogastric nerve - detrusor muscle relaxation and internal sphincter constriction for storage.

Uses pontine micturition centre - spine - pelvic nerves - contraction of detrusor muscle and relaxation of internal sphincter voluntary external sphincter depending on what you want

24
Q

What acts on the bladder to cause relaxation

A

Acetylcholine

25
Q

What can cause increase risk of voiding

A

Anticholinesterases
Diabetes
Caffeine
Alcohol

26
Q

What is receptive relaxation

A

Intra vesicle pressure is lower than the urethral pressure

27
Q

How long does the voiding phase last?

A

20-25ml/s fo men, 25-30ml/s for women

28
Q

how much urine do you need to void?

A

400ml

29
Q

What is urodynamics testing?

A

Pressure difference measurement between rectum and bladder.

30
Q

How is urodynamics testing conducted

A

Thin catheter in front and back passage

31
Q

When is urodynamic testing used?

A

Women with overflow incontinence or those where first line urge incontinence treatments aren’t working

32
Q

What’s measured on a urodynamic test?

A

Post voiding pressure
Leak point pressure (pressure needed to leak)
Flow rate
Custom entry (bladder contraction pressure)

33
Q

What is stress incontinence

A

Urine leakage due to weak pelvic floor muscles

34
Q

What 4 things can cause stress incontinence?

A
  1. Pregnancy
  2. Coughing
  3. Laughing
  4. Sneezing
35
Q

What is urge incontinence

A

Overactivity of the bladder muscle

36
Q

What causes urge incontinence

A
  1. Alcohol
  2. Caffeine
  3. Medications
    4, UTI
37
Q

What causes overflow incontinence

A
  1. Bladder stones
  2. Chronic urinary retention
  3. Anticholinergic medication
  4. Urodynamics neeed
38
Q

What is overflow incontinence?

A

Urine leakage due to bladder being overfilled

39
Q

When is pelvic floor exercises indicated?

A

Stress incontinence

40
Q

When is bladder retraining indicated?

A

Urge incontinence

41
Q

What is classed as heavy menstrual bleeding?

A

Blood loss of over 80ml

42
Q

What is normal blood loss for periods?

A

40ml

43
Q

3 criteria for menorrhagia

A

Changing pads every 1-2 hours
Bleeding more than 7 days
Large clots

44
Q

What causes menorrhagia (4 subcategories)

A
  1. Disorders (diabetic, hypothyroid, bleeding and connective tissue disorder)
  2. Medication (anticoagulation, contraception)
  3. Abnormalities (PCOS, fibroids, PID)
  4. Dysfunctional bleeding or extreme of reproductive age
45
Q

What subcategories are there for causes of heavy menstrual bleeding /

A
  1. Conditions
  2. Medications
  3. Problems/abnromlaities
  4. General issue/natural
46
Q

What is chronic pain defined as?

A

Pain that is usually continuous and dull that is suggested to affect mental health more that lasts longer than 6 moths

47
Q

What is acute pain defined as?

A

Sharp severe immediate pain that usually has sudden-short onset and is usually recent or new and less than 2 weeks/6months

48
Q

what is important in distinguishing pelvic pain? Describe steps taken (7)

A
  1. History/collateral history
  2. Sats
  3. Abdo and I manual pelvic exam
  4. STI screen (HVS, chlamydia/gonorhhoea)
  5. TVUS/MRI (endo/adenomyosis/fibroids)
  6. Diagnostic laparoscopy
  7. CA125 (cancer and endometriosis/fibroids)
49
Q

3 non GUM causes of pelvic pain

A

Appendicitis
IBS
IBD

50
Q

3 Basic screening modalities used in pelvic pain

A

TVUS, mri, ct sometimes and laparoscopy

51
Q

What is the clinical criteria needed to make an endometriosis diagnosis? (5+1)

A

Infertility and 1 more of these:
- chronic pain for more than 6 months
- period pain that affects ADLl
- period related GI problems (diarrhoea/vomiting/constipation)
- period related excessive bleeding/toilet pain etc
- deep pain during sex

52
Q

What investigative steps are taken for suspected endometriosis

A
  1. History
  2. Abdo and pelvic exam
  3. TVUS
  4. Laparoscopy
53
Q

What’s a tell tale sign of adenomyosis?

A

Enlarged, boggy uterus

54
Q

how would you investigate adenomyosis?

A

TVUS, MRI alternative

55
Q

How would you treat/manage adenomyosis?

A
  1. Symptomatic treatment such as TXA
  2. GnRH agonists
  3. Uterine artery emobolism
  4. Hysterectomy

Year 4 - Womens Health (10 decks)

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