Gynaecology Flashcards
what are the levels of LH+FSH and gonadotropins (oes+test) in hypogonadotropic hypogonadism?
low LH + FSH
low oestrogen + testosterone
causes of hypogonadotropic hypogonadism
abnormal functioning of hypothalamus or pituitary gland
eg hypopituitarism, damage, chronic conditions, kallman syndrome, prolactinoma
what is kallman syndrome?
genetic condition
causes hypogonadotropic hypogonadism
failure to start puberty
absent sense of smell
what are LH+FSH and gonadotropin levels in hypergonadotropic hypogonadism?
high FSH + LH
low gonadotropin levels
what is hypergonadotropic hypogonadism caused by?
damage to gonads eg torsion, cancer, mumps congenital absence of ovaries turners syndrome AIS CAH
what is congenital adrenal hyperplasia? what enzyme is deficient? what is inheritance pattern?
deficiency of 21-hydroxylase enzyme
AR inheritance
symptoms of congenital adrenal hyperplasia?
tall for age facial hair primary amenorrhoea deep voice early puberty
assessment of primary amenorrhoea
FBC, ferritin - anaemia UE - CKD anti TTG, anti EMA LH, FSH - hypo/hypergonadotropic hypogonadism TFT ILGF-1 - GH deficiency prolactin - hyperprolactinaemia testosterone - PCOS, AIS, CAH genetics - turners syndrome
management of primary amenorrhoea
depends on cause > weight gain, CBT > treat endocrine condition > pulsatile GnRH, COCP in HH > COCP in PCOS
what is androgen insensitivity syndrome? what is inheritance pattern? what are patients genetically? XX or XY?
cells can’t respond to androgens as there are no androgen receptor. extra androgens –> oestrogen
X linked recessive
XY
AIS features?
external female genitalia and breasts testes in inguinal canal / abdomen infertile primary amenorrhoea inguinal hernia
AIS hormone results - LH, FSH, testosterone, oestrogen
LH increased
FSH increased / normal
testosterone increased
oestrogen increased
management of AIS
bilateral orchidectomy (avoid testicular tumours)
oestrogen therapy
vaginal surgery
support and counselling
levels of testosterone in CAH + AIS?
increased testosterone
CAH pathophysiology?
no 21-hydroxylase enzyme
this enzyme converts progesterone into ald+cortisol.
extra progesterone –> testosterone
result = high test, low cortisol + aldosterone
CAH presentation
virilised genitalia (ambiguous) enlarged vlitoris primary amenorrhoea tall for age, deep voice, early puberty HYPERPIGMENTATION!!!!!(increased acth)
CAH treatment? key features?
hyperpigmentation
cortisol replacement - hydrocortisone
aldosterone replacement - fludrocortisone
corrective surgery
when to investigate secondary amenorrhoea?
if normally regular = 3-6 months
if irregular = 6-12 months
causes of primary amenorrhoea
kallman syndrome turners syndrome damage to pituitary - surgery, radiation hypopituitarism damage to gonads - surgery, mumps, torsion
causes of secondary amenorrhoea?
pregnancy menopause and premature ovarian failure contraception PCOS sheehan syndrome hypo/hyperthyroidism pituitary - tumours, failure excessive exercise, low body weight
investigations in secondary amenorrhoea
beta HCG LH, FSH prolactin TSH testosterone
management of secondary amenorrhoea
hormone replacement
if PCOS - medroxyprogesterone for 14d
what causes urge incontinence
overactive detrusor muscle
what causes stress incontinence
weak pelvic floor muscles
causes of overflow incontinence
chronic urinary retention due to obstruction of urine outflow
anticholinergic medication
fibroids
pelvic tumours
neurological conditions - MS, diabetic nephropathy
common in men
3 risk factors for urinary incontinence
older age post menopausal increased BMI previous vaginal deliveries pelvic organ prolapse pelvic floor surgery neuro conditions eg MS
assessment of incontinence
medical history
risk factors - caffeine, alcohol, meds, BMI
severity
examinations
examinations to do for incontinence
assess pelvic tone - ask to squeeze finger
look for prolapse, masses
investigations in incontinence
bladder diary vaginal examination urine dipstick!!!!! post void residual bladder volume urodynamic testing
management of stress incontinence
pelvic floor muscle training
surgery options - TVT
management of urge incontinence
- bladder retaining
- anticholinergic medication - solifenacin, oxybutynin
- mirabegron (alternative to anticholinergics. watch BP!!!)
SE of anticholinergic medication
dry mouth and eyes, urinary retention, constipation, blurry vision
cognitive decline !! in elderly
what is adenomyosis?
endometrial tissue in the myometrium
presentation of adenomyosis
painful periods
secondary dysmenorrhoea
dyspareunia
enlarged, tender uterus
diagnosis of adenomyosis
transvaginal USS
management of adenomyosis
does woman want contraception?
a) no = tranexamic / mefenamic acid
b) yes = mirena coil, COCP
what is ashermans syndrome?
adhesions form in the uterus after it is damaged
eg after DIC, RPOC, myomectomy, endometritis
presentation of ashermans syndrome
secondary amenorrhoea
light periods
dysmenorrhoea
infertility
diagnosis of ashermans syndrome
hysteroscopy (gold)
where is bartholins gland?
pair of glands either side of the posterior part of the vaginal Introits
normally pea sized and not palpable
help vaginal lubrication
where does bartholins cyst occur?
in the duct of bartholins gland
posterior aspect of the vaginal Introitus
5 + 7 o’clock
treatment of bartholin cyst
good hygiene
warm compress
analgesia
biopsy if malignancy needs excluded
treatment of bartholin abscess
antibiotics
swab! to check sensitivities
may need surgery
- marsupialisation
what is cervical ectropion?
columnar epithelium of endocervix extends out to ectocervix
risk factors for cervical ectropion?
high oestrogen levels
young women, COCP, pregnancy
presentation of vaginal ectropion
asymptomatic PV discharge PV bleeding dyspareunia post coital bleeding
