Gynaecology Flashcards
what is a normal endometrial thickness in a post menopausal woman
4-5mm
> 8 mm in a premenopausal weomn is abnormal
What is Sheehan syndrome
post-partum pituitary necrosis
significant post-partum bleeding, hypovolemia, and shock
Presents (weeks- years post partum with)
- difficulty with breastfeeding or cannot produce milk at all (agalactorrhea)
- Irregular menses or amennhorrea
- fatigue, weakness, hair loss, constipation, weight gain
- hyponatremia, hypoglycemia, anaemia
- Low cortisol/TSH/GH/LH/FSH/ACTH/prolactin
Which ethnic group is ovarian cancer highest in?
most commmon type of ovarian cancers
Pacific islanders
Epithelial cell cancers make up 90% of cases
other types are malignant germ cell and stromal
Risk fators for ovarian cancer
Ovulation (therefore early menses, late menopause, COCP protective)
Genetics: BRCA1/BRCA2, lynch
Pasifica ethnicity
obesity
Etoh
smoking
prolonged MHT
PCOS
PID
endometriosis
how does CA-125 guide management
<35 - consider ddx
35-200:
- if pre-menopausal repeat in 6 weeks
- if post menopausal for USS
>200: USS +/- gynae referral
Menstruation can raise CA 125 levels; avoid testing during this time
In pre-menopausal females, also measure hcg and AFP (can be elevated in germ cell tumours)
First line hormonal treatment for endometriosis (along with analgesia)
Progestins are first line- provera, noriday, jadelle, mirena. Ideally at a high enough dose to prevent ovulation
COCP if POP not working or CI, an off label use w little benefit
Other options include
-gonadotropin-releasing hormone (GnRH) analogues (e.g. goserelin, leuprorelin, buserelin) however these have lots of side effects
- androgenic medicines (e.g. danazol)
Fertility and endometriosis
Extent of disease burden does not perfectly correlate to fertility
however, surgery to ablate or excise endometriomas, adhesions and scar tissue is the most common treatment for women with endometriosis who wish to conceive.
Flushing with lipiodol (an oil soluble contrast medium) has been shown to increase the rate of pregnancy, and may be considered in the setting of a specialist fertility clinic.
What % of women re-develop symptoms post endometrial surgical resection
20–40% of women re-develop symptoms within five years of surgery, although rates vary by subtype.
Hormonal treatment, e.g.mirea following surgery can reduce the risk of recurrence
Risk factors for endometrial cancer
Largely linked to excessive exposure to endogenous or exogenous oestrogen unopposed by progesterone
-age (≥ 55 years)
-obesity
- familial cancer syndromes
- tamoxifen
- oestrogen only HRT
HPV vaccine - who is eligible, when do we give it, what strains does it protect against
Anyone aged 9-26yrs
ideally give at 9yrs
2x dose: 0 and 5 months
Protects against 6, 11 (warts), 16, 18 (cancerous) and 5 additional cancerous strains
if given when older will need 3x doses
Common pathogens associated with an uncomplicated UTI
E.coli 70+ %
Staphylococcus saprophyticus
Proteus spp
Klebsiella spp
Enterococcus spp.
Complicated UTIs are also more commonly caused by E. coli, however, the range of possible causative species is much broader than for uncomplicated infections
Implication of nitrites and leus on urine dipstick
Nitrite status – sterile urine generally should not contain detectable traces of nitrite. Enterobacteriaceae bacteria (most UTIs) metabolise nitrates to nitrites.
Leukocyte esterase is an enzyme produced by white blood cells. If the test is positive, it may indicate that white blood cells have been generated by the body in response to infection, and that they are present in the urine (pyuria).
A positive result for either + LUTS is sufficient for diagnosis, however negative urine dipstick results may not reliably exclude the possibility of a UTI e.g. some UTIs caused by bacterial species that are unable to produce nitrites
Haematuria is commonly associated with a UTI but not urethritis
should you request an MSU for an uncomplicated UTI
No
only request if complicated (recurrent, known abnormalities, suspected pyleo, immunosuppressed, diabetes, renal calculi etc)
should we prescribe ural
Ural is no longer routinely recommended during the acute treatment of UTIs as it raises the urinary pH, which in turn reduces the effectiveness of some antibiotics, e.g. nitrofurantoin.
Use NSAIDs instead
Common pathogens causing urethritis
(most cases are associated with a sexually transmitted infection (STI) but not all)
- Chlamydia trachomatis ** most common**
- Gonococcal: Neisseria gonorrhoeae (2nd most common)
- Mycoplasma genitalium (often recurrent)
- Trichomonas vaginalis, herpes simplex virus (HSV), adenovirus, enteric bacteria (insertive anal sex) and pharyngeal organisms (oral sex)
