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Year 4k: Obs and Gynae > Gynaecological Presentations > Flashcards

Gynaecological Presentations Flashcards

1
Q

What is Heavy Menstrual Bleeding?

A
  • Losing 80ml or more in each period, havving period that last longer than 7 days or both.
  • Management shifted towards what the woman considers excessive and depends on whether a women needs contraception
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2
Q

What questions are asked to assess Heavy Menstrual Bleeding?

A
  1. Are you having to change your sanitary products every hour or 2?
  2. Are you passing blood clots larger than 2.5cm (about the size of a 10p coin)?
  3. Are you bleeding through to your clothes or bedding?
  4. The use of 2 types of sanitary product together (e.g., tampons and pads)
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3
Q

What are the investigations to assess heavy menstrual bleeding?

A
  • Full Blood Count should be performed in all women to assess for anaemia
  • Routine Transvaginal USS if symptoms suggest a structural or histological abnormality. Other indications include abnormal pelvic exam findings.
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4
Q

What is the long term management for Heavy Menstrual Bleeding?

A

If they do not require contraception

  • Either Mefenamic acid 500 mg tds (particularly if there is dysmenorrhoea as well) or Tranexamic acid 1 g tds. Both are started on the first day of the period
  • If no improvement, then try other drug whilst awaiting referral

If they require contraception, options include

  • 1st-line: Intrauterine system (Mirena)
  • Combined oral contraceptive pill
  • Long-acting progestogens
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5
Q

What is the Short term managment for Heavy Menstrual Bleeding?

A
  • Norethisterone 5 mg tds can be used as a short-term option to rapidly stop heavy menstrual bleeding.
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6
Q

What are some causes of Post-Coital Bleeding?

A
  • No identifiable pathology is found in around 50% of cases
  • Cervical ectropion is the most common identifiable causes, causing around 33% of cases. This is more common in women on the combined oral contraceptive pill
  • Cervicitis e.g. secondary to Chlamydia
  • Cervical cancer
  • Polyps
  • Trauma
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7
Q

What are causes of Acute Pelvic Pain?

A

Non pregnancy

  • Torsion of ovarian cyst
  • Degeneration of fibroid
  • Flare up of PID
  • Hamatocolpos
  • Hematometra/pyometra
  • Endometriosis

Pain in pregnancy

  • Ectopic
  • Torsion of ovarian cyst
  • Degeneration of fibroids
  • Flare up of PID

Other

  • Constipation, UTI diverticulitis, IBS, interstitial cystitis, sickle cell crisis, porphyria, acute appendicitis, cholecystitis, peptic ulcer, pancreatitis, intestinal obstruction, ruptured liver/spleen, GI cancer
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8
Q

What is Chronic Pelvic Pain?

A
  • Intermittent or constant pain in the low abdomen or pelvis lasting at least 6 months in duration.
  • Does not occur exclusively with menstruation or intercourse or pregnancy
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9
Q

What is the pathophysiology of Chronic Pelvic Pain?

A
  • Local factors at the site such as chemokines and TNF-alpha affect peripheral nerve.
  • Central nervous system response – persistent pain leads to changes within central nervous system which eventually magnify the original signal
  • Visceral hyperalgesia – alteration in visceral sensation and function due to the chronicity of the pain
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10
Q

What are causes of Chronic Pelvic Pain?

A
  • Endometriosis
  • Adhesions
  • Adenomyosis
  • IBS
  • MSK pain
  • Nerve entrapment
  • Social and psychological (Child abuse, depression, anxiety or somatization)
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11
Q

What are types of Adhesional pain?

A
  • Vascular adhesion: May be division of vascular adhesions
  • Residual ovary syndrome: Can be removed
  • Trapped ovary syndrome
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12
Q

What are criteria and management of IBS diagnosis?

A
  • Rome Criteria used for diagnosis
  • Management: Antispasmodics
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13
Q

What are clinical features and management of MSK pain?

A
  • Pathology: Joints in the pelvis. Damage to muscles in abdominal wall or pelvic floor. Pelvic organ prolapse would be a source of pain. There could be trigger points due to localised areas of deep tenderness
  • Management: Treated with analgesia, physiotherapy, nerve modulation and antidepressants
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14
Q

What are clinical features and management of Nerve Entrapmnet chronic pelvic pain?

A
  • Pathology: highly localised, sharp stabbing or aching pain exacerbated by particular movement and persisting beyond 5 weeks or occring after pain free interval
  • Managment: analgesia, physiotherapy, nerve modulation and antidepressants
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15
Q

What is the initial assessment for someone with Chronic Pelvic Pain?

A
  • History
  • Association – psychological, bladdr nad bowel symptoms and effect on movement and posture
  • Rule out red flag symptoms
  • Prospective pain diary for 2-3 months
  • Effect on quality of life and function
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16
Q

How is Chronic Pelvic examined?

A
  • Abdominal and pelvic examination including speculum and bimanual pelvic examination to feel focal tenderness, trigger points along abdominal wall and/or pelvic flood, enlargement or distortion or tethering or prolapse.
  • Sacroiliac joint and pubic symphysis should also be felt
17
Q

What are investigations for Chronic Pelvic Pain?

A
  • STI screening
  • Transvaginal Sonography (TVS)
  • MRI
  • Laparoscopy
18
Q

What is the defintion of Dysmenorrhoea?

A
  • Characterised by excessive pain during menstrual period.
  • Divided into primary and secondary dysmenorrhoea
19
Q

What are characteristics of Primary Dysmenorrhoea?

A
  • No underlying pelvic pathology.
  • Affect up to 50% of menstruating women and usually appear within 1-2 years of menarche.
  • Excessive endometrial prostaglandin production is thought to be partially responsible
20
Q

What are symptoms of Primary Dysmenorrhoea?

A
  • Pain typically starts just before or within a few hours of period starting. Suprapubic cramping pain may radiate to back or down the thigh
21
Q

What is the management for Primary Dysmenorrhoea?

A
  • Mefenamic Acid and Ibuprofen effective in 80% of women. Work by inhibiting prostaglandin production
  • COCP used second line
22
Q

What are characterisitcs of Secondary Dysmenorrhoea?

A
  • Typically develops many years after menarche and resulting of an underlying pathology.
  • Causes include Endometriosis, Adenomyosis, Pelvic inflammatory disease, Intrauterine Devices, Fibroids
23
Q

What are the symptoms and management of Secondary Dysmenorrhoea?

A
  • Symptoms
    • Pain usually starts 3-4 days before the onsets of the period
  • Management
    • Gynaecology investigation

Year 4k: Obs and Gynae (19 decks)

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