Gynaecology Flashcards
HORMONES
What is the main function of oestrogen
steroid sex hormone
Promotes secondary sexual characteristics
- Breast tissue development
- Growth of vulva/vagina/uterus
- Development of endometrium
HORMONES
What is the function of progesterone
Acts on tissues previously stimulated by oestrogen to:
- Thicken and maintain endometrium
- Thickens cervical mucus
- Increases body temp
- Spiral artery formation
- Decreases myometrial excitability
HORMONES
What structures produce progesterone
Not pregnant
- Corpus luteum after ovulation
pregnancy
Placenta - from 10 weeks
INCOTINENCE
Describe stress incontinence
Increase in abdominal pressure leads to urine leakage
due to urethral sphincter weakness
- post childbirth
- post prostatectomy
INCOTINENCE
Name 4 risk factors for stress incontinence
age obesity prolonged vaginal childbirth Hysterectomy pelvic trauma post-menopausal (oestrogen)
INCOTINENCE
What investigations are required for Stress incontinence
Pelvic exam - determine if there is loss of tone
Urinalysis - Exclude UTI
- MSU
- MC&S
Bladder diary
shows frequent voiding of small volumes
INCOTINENCE
What is the management of stress incontinence
1st line
- weight loss
- smoking cessation
- caffeine reduction
- 3m Keegle exercises
2nd line -
Pharmacological
- Duloxetine
3rd line
- Burch colposuspension
INCOTINENCE
What is urge incontinence
sudden urge to void due to detrusor instability
leads to frequent urination and nocturia
INCOTINENCE
Name 3 risk factors for urge incontinence
recurrent UTIs
High BMI
Age
Smoking
INCOTINENCE
What investigations are required for a suspected urge incontinence
1st line
- MSU / Urinalysis
2nd line
- Urodynamics
- Bladder diary
INCOTINENCE
What is the management of urge incontinence
1st line - lifestyle
- Bladder retraining
- weight loss
- caffeine reduction
- smoking cessation
2nd line - Pharmacological
- Oxybutynin
- Mirabegron
3rd line
- Botox
INCOTINENCE
What is Mirabegron
Beta 3 agonist used if concerned about Anti-Ach effects of incontinence management in frail elderly patients
INCOTINENCE
Name 4 neurological causes on inconteincen
DM
Autonomic neuropathy - decreases detrusor excitability
Parkinson’s
Dementia
MS
Prostatectomy
Hysterectomy
PROLAPSE
Name 4 preventative methods of reducing the risk of a prolapse
recognising obstructed labour
avoid long 2nd stage labour
pelvic floor exercises post birth
weight reduction
Tx of chronic cough
PROLAPSE
Name 4 risk factors for a prolapse
Multiple vaginal deliveries Instrumental deliveries prolonged deliveries advanced age post menopausal chronic constipation
PROLAPSE
Name 2 anterior wall prolapses
Cystocele - bladder
Urethrocele
PROLAPSE
What is a vaginal vault prolapse and what increases its risk
Prolapse of uterus / cervix / upper vagina
Hx of hysterectomy
PROLAPSE
Name 2 posterior wall prolapses
Rectocele
Enterocele - Pouch of Douglas
PROLAPSE
What is a cystocele
prolapse of anterior vaginal wall including bladder
PROLAPSE
What is a rectocele
Prolapse of lower posterior vagina involving anterior wall of rectum
associated with constipation and urinary retention
palpable lump in vagina
PROLAPSE
Name 4 causes of a prolapse
vaginal delivery
congenital factors
- Ehlers Danlos syndrome
Menopause
- Deterioration of collagenous connective tissue occurring following oestrogen withdrawal
Iatrogenic
- Hysterectomy
Cough
obesity
constipation
PROLAPSE
How does a prolapse present
Dragging sensation - worse at end of day or after prolonged standing
sensation of a lump
Stress incontinence
dyspareunia
PROLAPSE
What investigations are required for a suspected prolapse
Abdominal examination
bimanual pelvic exam
Sims speculum
- ask patient to cough
PROLAPSE
How is a prolapse managed
conservative
- weight reduction
- pelvic floor exercises
Medical
- Pessaries
surgical
- surgery
PROLAPSE
Describe a pessary
acts as artificial pelvic floor
changed every 6m
topical oestrogen provided
PROLAPSE
What are the adverse effects of a pessary
pain
urinary retention
infection
fall out
PUBERTY
What are the age ranges of puberty in males and females
F: 8 - 14
M: 9 - 15
PUBERTY
What is aromatase
enzyme found in adipose tissue that converts androgens into oestrogens
PUBERTY
What does FSH do during the early stages of puberty
Increase in oestrogen synthesis
oogenesis initiation in females
onset of sperm production in males
PUBERTY
What does LH do during the early stages of puberty
Increase in production of progesterone
increase in testosterone production
PUBERTY
How are the stages of puberty assessed
Tanner scale - based on secondary sexual characteristics
PUBERTY
Describe the 1st stage of puberty
Thelarche - breast bud development
occurs at around 9 - 10
PUBERTY
Describe the 2nd stage of puberty
Pubarche - pubic hair growth
hair becomes coarse and dark
PUBERTY
Describe the 3rd stage of puberty
Menarche
occurs 3yrs following thelarche
average age - 13
PUBERTY
What is precocious puberty
Appearance of secondary sexual characteristics before age of 8 or age of 9 in boys
PUBERTY
Name 4 causes of precocious puberty
Iatrogenic - exposure to oestrogens
- creams
Pathologies increasing GnRH secretion
- Meningitis
- CNS tumour
- Hydrocephaly
- Ovarian tumour
- Adrenal tumour
PUBERTY
How is precocious puberty managed
GnRH agonists
- Arrest sexual development
PUBERTY
Name 4 genetic conditions leading to delayed puberty
Turners syndrome - 45X0
Klinefelter syndrome - 47XXY
Androgen insensitivity syndrome
Kallaman syndrome
PUBERTY
In males what do Leydig and Sertoli cells do
Leydig
- Testosterone synthesis
Sertoli
- Sperm production
OVARIAN TORSION
Name 2 causes of ovarian torsion
Ovarian mass > 5cm
Long infundibulopelvic ligaments - common in young girls before menarche
OVARIAN TORSION
How does ovarian torsion present
sudden onset unilateral pelvic pain
Pain radiates to loin, groin and back
Pain waxes and wains
N+V
Pain may improve after 24hrs - ovary dead
OVARIAN TORSION
How does ovarian torsion present on pelvic and vaginal examination
vaginal - adnexal tenderness
pelvic - palpable mass
OVARIAN TORSION
What investigations are required for suspected ovarian torsion
1st line - TVUS
- shows free fluid
- Whirlpool sign
- potential volvulus
2nd line - Doppler studies
- shows lack of blood flow
OVARIAN TORSION
What is the diagnostic investigation for ovarian torsion
Laparoscopic surgery
diagnostic and therapeutic
OVARIAN TORSION
How is ovarian torsion managed
Laparoscopic surgery
- Detorsion
- Oophorectomy
OVARIAN TORSION
Name 3 risk factors for ovarian torsion
ovarian mass
reproductive age
pregnancy
ovarian hyperstimulation syndrome
MITTELSCHMERZ
What is mittelschmerz
Periovulatory unilateral pain experienced by women
MITTELSCHMERZ
Name 4 features consistent with mittelschmerz
Mid cycle pain
- associated with ovulation
- occurs 14 days prior to ovulation
sharp onset pain
recurrent epsioes
settles over 24-48hrs
MITTELSCHMERZ
What investigations are required for mittelschmerz
USS - Shows free fluid
MITTELSCHMERZ
What is the management of mittelschmerz
conservative - Analgesia
- Paracetamol
- NSAIDs
CHRONIC PELVIC PAIN
Give a definition of chronic pelvic pain
Intermittent or constant pain in lower abdomen/pelvis for minimum 6m not occurring excessively with menstruation or intercourse
CHRONIC PELVIC PAIN
Name 4 gynaecological causes of chronic pelvic pain
dysmenorrhoea
endometriosis
adenomyosis
PID
Ovarian cyst
pelvic organ prolapse
pelvic congestion syndrome
fibroids
OVARIAN TUMOURS
What are the 4 main types of ovarian tumours
Surface derived - epithelial
(Most common)
germ cell
sex cord stromal
Metastases
OVARIAN CYSTS
What is a simple ovarian cyst
contains fluid only
OVARIAN CYSTS
Name 2 functional cysts
follicular cyst
corpus luteum cyst
OVARIAN CYSTS
What is a follicular cyst
functional cyst < 3cm
represents developing follicle in first 1/2 of of cycle
cyst fails to rupture and release egg
disappears after a few menstrual cycles
OVARIAN CYST
What is the appearance of a functional cyst on US
Thin wall appearance
no internal structures
OVARIAN CYST
What is protective against functional cysts
COCP - Prevent ovulation
OVARIAN TUMOURS
What is a corpus luteum cysts
functional cyst < 5 cm
occurs in luteal phase after corpus luteum fails to breakdown
seen in early pregnancy
OVARIAN TUMOURS
Name 3 pathological cysts
Endometrioma
PCO
Theca lutein cyst
OVARIAN TUMOURS
What is a theca lutein cyst
increased ovarian cysts due to increased hCG
Eg: Molar pregnancy
OVARIAN TUMOURS
What ovarian masses are common in premenopausal women
follicular / letein cysts
dermoid cysts
endometriomas
benign epithelial tumours
OVARIAN TUMOURS
Which ovarian masses are common in postmenopausal women
benign epithelial tumours
malignancies
OVARIAN TUMOURS
Name 5 benign ovarian tumours
serous cystadenoma
Mucinous cystadenoma
Brenner
dermoid cyst
fibroma
OVARIAN TUMOURS
What is a serous cystadenoma
Epithelial benign tumour
- Bilateral
- Have septations
- Cysts lined by ciliated cells
OVARIAN TUMOURS
Describe a mucinous cystadenoma
Epithelial benign tumour
- can grow to be very large
- Unilateral
- Lined by mucous secreting epithelium
OVARIAN TUMOURS
Describe a brenner tumour
epithelial beingn tumour
- unilateral
- solid grey / yellow appearance
- Coffee bean nuclei
- Contain Walthard cell rests
OVARIAN TUMOURS
Describe a dermoid cyst
Benign germ cell tumour
- Associated with premenopausal women
- Bilateral
- Large
- Asymptomatic
- Common in pregnancy
- Associated with torsion
- Contain complex cystic structures (teeth / hair)
OVARIAN TUMOURS
What does the histopathological analysis of a dermoid cyst show
Rokitansky’s protuberance
OVARIAN TUMOURS
What can rupture of a mucinous cystadenoma lead to
Pseudomyxoma peritonei
OVARIAN TUMOURS
Describe a fibroma tumour
Sex cord stromal tumour
- Presents with Meig’s syndrome
- pulling sensation in pelvis
- Typically occurs around menopause
OVARIAN TUMOURS
What is Meig’s syndrome
Triad:
- Ascites
- Ovarian mass
- R sided pleural effusion
OVARIAN TUMOURS
What are the indicators for malignancy in a cyst
Irregular boarders
ascites
septations