Gynaecology Flashcards
1
Q
What is Asherman’s syndrome?
A
A syndrome where adhesions form within the uterus following damage to the uterus
2
Q
Causes of asherman’s syndrome?
A
Pregnancy related dilation and curettage procedure
Uterine surgery
Severe pelvic infection
3
Q
Pathophysiology of ashermans syndrome
A
Endometrial curettage (scraping) can damage the basal layer of the endometrium
The damaged layer heals abnormally and can lead to adhesions forming between areas of the uterus
It can lead to the uterus being sealed shut
4
Q
Presentation of Asherman’s syndrome
A
Following dilation and curettage, uterine surgery, endometriosis
- secondary amenorrhoea
- dysmenorrhea
- lighter periods
Can also present as infertility
5
Q
Diagnosis of Asherman’s syndrome
A
Hysteroscopy is gold standard
Can also include hysterosalpinography and sonohysterography
6
Q
Management of Asherman’s syndrome
A
Hysteroscopy with dissection and treatment of adhesions
7
Q
What is atrophic vaginitis?
A
Dryness and atrophy of the vagina mucosa that is caused by lack of oestrogen after menopause
8
Q
Presentation of atrophic vaginitis
A
Itching
Dryness
Dyspareunia
Bleeding due to local infection
9
Q
Examination results of atrophic vaginitis
A
Pale mucosa
Thin skin
Reduced skin folds
Erythema and inflammation
Dryness
Sparse pubic hair
10
Q
Treatment of atrophic vaginitis
A
Vaginal lubricants
Topical oestrogen -cream, pessaries
11
Q
What is androgen insensitivity syndrome
A
A genetic condition where cells are unable to respond to androgens (testosterone) due to a lack of the androgen receptor
12
Q
Describe patient with androgen insensitivity syndrome
A
A genetic male (46XY) with female phenotype
13
Q
Genetics of androgen insensitivity syndrome
A
X linked recessive condition caused by mutation in the androgen receptor on the X chromosome
14
Q
Pathophysiology of androgen insensitivity syndrome
A
Lack of androgen receptors prevents the development of male phenotype
The extra androgens are converted into oestrogen which leads to the development of secondary female sexual characteristics
15
Q
Presentation of androgen insensitivity syndrome
A
- primary amenorrhoea
- lack of male facial hair, pubic hair and male muscle development
- infertility
- female external genitalia (wont have uterus, upper vagina, cervix, fallopian tube or ovaries as the testes produce anti-mullerian hormone which prevents development of female internal organs)
16
Q
Two examples of how androgen insensitivity syndrome might first present
A
Inguinal hernia in infants (containing the testes)
Primary amenorrhoea at puberty.
17
Q
Management of androgen insensitivity syndrome
A
Counselling
Bilateral orchidectomy
Oestrogen therapy
18
Q
What is lichen sclerosis
A
A chronic inflammatory skin condition that presents as ‘shiny’ patches of ‘porcelain-white’ skin
19
Q
Typical patient with lichen sclerosis
A
A woman aged 45 -60 with vulval itching and skin changes to the vulva
20
Q
What is an imperforate hymen
A
A hymen which prevents the flow of flood through the vagina- cuases primary amenorrhoea
May present as a blue and building membrane with mass protruding from behind the vagina
21
Q
How might the presentation of ovarian torsion an a rupture ovarian cyst present?
A
Both will have sudden severe pain
Ruptured cyst is more likely to have peritoneal signs like rebound tenderness and haemodynamic instability
22
Q
Most common type of vulval cancer
A
Squamous cell carcinoma
23
Q
What is the most common cause of post menopausal bleeding
A
Atrophic vaginitis (however consider endometrial cancer )
24
Q
What are the most common type of uterine fibroids?
A
Intramural - confined to the myometrial layer of the uterus
25
What antibiotics should be given to someone with pelvic inflammatory disease?
IM ceftriaxone
oral doxycycline
Oral metronidazole
26
After how long should someone be referred for infertility
After 12 months of trying
27
How does vulval cancer present
Vulval soreness, burning, pruritis and bleeding
28
What blood test result may be suggestive of PCOS
A high LH to FSH ratio
29
First line management of PCOS
Combined oral contraceptive pill
30
Which HPV is associated with cervical cancer?
16 and 18
31
Which HPV are associated with genital warts
6 and 11
32
First line investigation for uterine fibroids
Transvaginal USS
33
What method of contraception can be used for up to 5 days after unprotected sex and can provide long term protection
Copper IUD
34
What medication can cause hyperprolactinaemia
Risperidone
35
What part of the vulva is most commonly affected by vulval cancer
Labia Majorca
36
Who does cervical cancer typically present?
Women of reproductive age- 25 to 29
37
Most common cause of cervical cancer
HPV type 16 and 18
38
How does HPV cause cervical cancer
IT produces 2 proteins which inhibit 2 tumour suppressor genes
E6 inhibits p53, E7 inhibits pRb
39
Risk factors for cervical cancer aside from HPV
Smoking, HIV, combined oral contraceptive use for >5 years, increased number of full term pregnancies, family history, exposure to diethylstilbesterol in utero
40
Presentation of cervical cancer
Unusual vaginal bleeding- intermenstrual, post sex, post menopausal
Dyspareunia
Vaginal discharge
41
Most common types of cervical cancer
Most= squamous cell carcinoma
Other- adenocarcinoma
42
How is cervical cancer diagnosed
If symptoms- speculum examination - if abnormal changes then colposcopy
If colposcopy positive then biopsy
May also be picked up on smear test- if smear positive- colposcopy
43
Describe colposcopy
A speculum is inserted and a colposcope (magnifying) is used to examine cells.
Dyes may be added: iodine (normal cells=brown), acetic acid (cancer cells = white)
44
What grading system is used for colposcopy
Cervical intraepithelial neoplasia (CIN) grading system
45
What does a CIN I suggest
Mild dysplasia covering one third of the thickness of the epithelial layer
Likely will resolve
46
What does CIN II suggest
Moderate dysplasia covering 2/3 of the thickness of the epithelial layer- will likely become cancerous
47
What does CIN III suggest
Severe dysplasia covering entire thickness
Carcinoma in situ
48
How is cervical cancer screened for?
Smear test
49
What 2 things does the smear test look for?
Presence of HPV
Abnormal cell changes - dyskaryosis
If HPV is negative it won’t test cells
50
How often is HPV screening done?
If 25-49 = every 3 years
If 50-64= every 5 years
51
How often should women with HIV have smear tests ?
Yearly
52
Should pregnant women have smear tests?
No- should wait until 3 months postpartum
53
If HPV is positive but cytology is negative what should happen
Re-smear in 12 months
54
If smear test is positive what test should be done
Colposcopy
55
If colposcopy is positive for cancer what test should be done?
Biopsy
56
What grading system is used for cervical cancer biopsy
FIGO
57
Stage 1 FIGO cervical cancer
Confined to the cervix
58
Stage 2 FIGO staging cervical cancer
Invades the uterus or upper 2/3 of the vagina
59
Stage 3 FIGO staging cervical cancer
Invades the pelvic wall or the lower 2/3 of the vagina
60
Stage 4 FIGO staging
Invades the bladder, rectum or beyond the pelvis
61
Treatment of CIN or early stage cervical cancer (1A)
Large loop excision of the transformation zone (LLETZ)
Cone biopsy
62
Treatment of stage 1B to 2A cervical cancer
Radical hysterectomy, local lymph node excision, chemo and radiotherapy
63
Treatment of stage 2B to 4A cervical cancer
Chemo and radio
64
Treatment of stage 4B cervical cancer
Combination surgery (potentially pelvic exenteration - removal of most/all pelvic organs)
Radiotherapy and chemo
Palliative care
65
What chemotherapy drug may be used in cervical cancer
Bevarizumab (avastin) - targets vascular endothelial growth factor
66
What are Nabothian cysts and how do they present
They are cysts on the cervix that occur when the squamous cell epithelium of the cervix slightly covers the columnar epithelium- means the mucous secreted by the columnar epithelium gets trapped
Present as yellow/amber mucous
67
What is Chandelier sign
Cervical motion tenderness
68
Management of ectopic pregnancy if not in significant pain, not ruptured and no visible heartbeat
Methotrexate
69
Management of ectopic pregnancy if ruptured, severe pain, haemodynamic instability or visible heartbeat
Surgery -salpingectomy or salpingotomy
70
If a mother has the BRCA 1 gene what is the likelihood of her children and siblings having the gene?
50%
71
What is the snow plant sign on uss of the breast
Rupture of an implant
72
What is adenomyosis?
The presence of endometrial tissue within the myometrium (the muscular layer of the uterus)
73
Who is effected by adenomyosis?
Predominately multiparous women towards the end of their reproductive cycle
Occurs in 10% of women overall
74
Aetiology of adenomyosis
Not fully understood but thought to be hormone dependent as tends to resolve with menopause
75
Presentation of adenomyosis
Dysmenorrhea
Menorrhagia
Dyspareunia
Can also have infertility and pregnancy related complications
76
Adenomyosis on examination
Enlarged boggy uterus
77
First line investigation for adenomyosis
Transvaginal US
78
Medical treatment of adenomyosis
1st line- contraception- Mirena coil
If not wanted:
- tranexamic acid (heavy bleeding)
- Mefanemic acid (pain and bleeding)
- GnRH agonist (induced menopause like state)
79
Surgical treatment of adenomyosis
Uterine artery embolisation
Hysterectomy
80
Pregnancy related complications of adenomyosis
Infertility, miscarriage, preterm birth , premature rupture of membranes
81
What is another name for uterine fibroids
Leiomyomas
82
Pathophysiology of uterine fibroids
They arise from the myometrium of the uterus- benign smooth muscle tumours
83
Three types of endometrial fibroids
Intramural (most common), submucosal, subserosal
84
Describe a intramural uterine fibroid
Confined to the myometrium of the uterus
85
Describe Submucosal fibroids
Arise from underneath the endometrium and protrude into the uterine cavity
86
Describe subserosal fibroids
Protrude and distort the serosal (outer) layer for the uterus, Can be pedunculated
87
Presentation of uterine fibroids
- pressure symptoms and abdominal distention
- heavy menstrual bleeding (menorrhagia)
- subfertility
- acute pelvic pain (can occur in pregnancy due to red cell degeneration were the rapidly growing fibroid undergoes necrosis
- urinary or bowel symptoms
- deep Dyspareunia
88
How are uterine fibroids diagnosed?
Transvaginal US
89
Treatment of a fibroid <3cm
Conservative
- Mirena coil
- Tranexamic acid
- Mefenamic acid
- progesterone contraceptives
90
Treatment of fibroids >3 cm
Preoperative GnRH (zolidex) to reduce size of fibroid
Surgery: myomectomy (if wanting to preserve fertility), uterine artery embolisation, hystectomy, endometrial ablation (balloon thermal ablation)
91
Complications of uterine fibroids
Iron deficiency anaemia
Compression of pelvic organs (recurrent UTIs, incontinence)
Subfertility
Red degeneration of the fibroid
Torsion of a pedunculated fibroid
92
Explain Red degeneration of a fibroid
Occurs during pregnancy as oestrogen sensitive
As the fibroid grows it can outstrip the blood supply and undergo red degeneration
93
How does red degeneration of a fibroid present
Low grade fever, pain and vomiting
94
RF for endometrial cancer
Obesity (increased adipose tissue which contains more aromitase)
T2DM
Nulliparity
Late menopause
Early menarche
Oestrogen only HRT- unopposed oestrogen
Ovarian tumours
Tamoxifen
Lynch syndrome
PCOS
95
Protective factors against endometrial cancer
Mirena coil
Combined oral contraceptive
Smoking
96
What is the most common type of endometrial cancer
Adenocarcinoma
97
How does endometrial cancer present
Post menopausal bleeding
Uterine mass
Abnormal menstruation in pre menopause (heavy bleeding, intermenstrual bleeding)
Abdominal pain - not common
Weight loss
98
How is endometrial cancer diagnosed
1st line- Transvaginal USS
Gold- Hysteroscopy and biopsy
99
Management of endometrial cancer
Total abdominal hysterectomy and bilateral salpingo-oophorectomy
100
What treatment may be used in frail old women who cannot have surgery for endometrial cancer
Progesterone therapy
101
Gold standard investigation of endometriosis
Laparoscopic visualisation
102
Who can the copper coil not be given to as emergency contraceptions?
Those with a suspected STI or PID
103
Treatment of stress incontinence after pelvic floor exercises
Duloxetine
104
What surgery should be used for ectopic pregnancy if the other fallopian tube is damaged?
Salpingotomy
105
Most common side effect of the progesterone only pill
Irregular bleeding
106
What drug is typically used to treat infertility in PCOS
Clomifene
107
How does the copper uterine devise work?
Decreases sperm motility and survival
108
After how many days is the IUD effective
Immediately
109
After how many days is the IUS effective
7 days
110
What is an IUD made of and how does it prevent pregnancy
IUDS are copper coils
They prevent pregnancy by decreasing sperm motility and survival
111
How quickly do IUDs work?
Immediately
112
SE of IUDs
Heavy menstrual bleeding
113
Explain what an IUS is and how it works
Levonorgesterol intrauterine system
Works by preventing endometrial proliferation and causes cervical mucous thickening
114
How quickly ones the IUS work?
After 7 days
115
What is placental invasion through the perimetrium called?
Placenta percreta
116
What ovarian pathology is associated with Rokitansky’s protuberance
A teratoma (germ cell tumour- dermoid cyst)
117
5 criteria for expectant management of a ectopic pregnancy
1- unruptured embryo
2- <35mm
3- no heartbeat
4- asymptomatic
5- B-hCG less than 1,000 and declining
118
At what age is premature ovarian failure
Before the age of 40
119
What is the treatment of stress incontinence in those who do not respond to pelvic floor exercsie
duloxetine
120
stage 1 ovarian cancer
confined to the ovary
121
stage 2 ovarian cancer
outside ovary but within the pelvis
122
stage 3 ovarian cancer
outside ovary but within the abdomen
123
stage 4 ovarian cancer
distant metastases beyond the pelvis and abdomen
124
What condition is associated with a symmetrically enlarged boggy uterus
adenomyosis
125
what endocrine marker is typically used in the diagnosis of PCOS
low sex hormone binding globulin concentration
126
If there is evidence of infection in an incomplete miscarriage what management should be used
vacuum aspiration
127
What is the mechanism of oxybutynin
anti-muscarinic
128
what is the most common side effect of the progesterone only pill
irregular vaginal bleeding
129
How often is the depo injection given?
every 12 weeks
130
What treatment for thrush should be used in pregnant women?
clomitrazole pessary (oral fluconazole is contraindicated)
131
Where is the first place that ovarian cancer typically metastasies to ?
the para-aortic lymph nodes
132
For how long after amenorrhoea does a women under 50 require contraception?
2 years
133
For how long after amenorrhoea does a women over 50 need contraception
1 year
134
What is Fitz-Hugh-Curtis syndrome
perihepatitis usually caused by pelvic inflammatory disease.
135
HOw does Fitz-Hugh-Curtis syndrome present
right upper quadrant pain that worsens with inspiration and coughing
May have evidence of underlying PID- pain, fever, history of chlamydia etc
136
most common cause of post-coital bleeding in post menopausal women
vaginal atrophy
137
what blood test should be done in women with recurrent vaginal candidiasis
HbA1c
138
How is mild PMS managed
lifestyle advice:
- exercise
- sleep
- small, balanced, frequent meals high in complex carbohydrates
139
Management of moderatePMS
new generation COCP
140
management of severe PMS
SSRIs - either taken continuously or during the luteal phase
141
If someone takes the combined oral contraceptive pill what should they do in terms of surgery?
stop 4 weeks before major elective surgery - a progesterone only pill could be used instead
142
What is pelvic inflammatory disease?
infection and inflammation of the female pelvic organs including the uterus, fallopian tubes, ovaries and surrounding peritoneum
143
RF od pelvic inflammatory disease
not using protection, multiple sexual partners, younger age, existing STIs, IUD
144
What are some STI causes of PID
chlamydia (most common), c
gonorrhoea
mycoplasma
145
What are some non-STI causes of PID
gardenella
haemophilus influenzae
e.coli
146
How does PID present
lower abdominal pain
fever
deep dyspareunia
dysuria
menstrual irregularities
vaginal discharge
cervical excitation
147
How is PID diagnosed?
pregnancy test to exclude ectopic
High vaginal swab- look for pus cells
NAAT for chlamydia and gonorrhoea
148
How is pelvic inflammatory disease treated?
IM ceftriaxone + 14 days cause of oral doxycycline and oral metronidazole
149
What bacteria does ceftriaxone cover in PID treatment>
gonorrhoea
150
What bacteria does doxycycline cover in PID
chlamydia
151
What bacteria does metronidazole cover in PID
gardenerella
152
What complication can PID cause affecting the liver?
Fitzz-Hugh-Curtis syndrome
153
How does Fitz-Hugh-Curtis syndrome present?
right upper quadrant pain and right shoulder tip pain
154
pathophysiology of Fitz-Hugh-Curtis syndrome
Inflammation and infection of the liver capsule leading to adhesions between the liver and the peritoneum
155
Can IUDs be left in in PID?
yes if mild
156
What criteria is used to diagnose PCOS
Rotterdam criteria
157
What are the components of the rotterdam criteria?
anovulation- oligo/amenorrhoea
Polycystic kidneys on USS- volume of more than 10cm or 12 cysts
Raised androgens- hirtuism and acne (or biochemical raised testosterone)
158
What may bloods show in PCOS
raised testosterone
raised LH (presents as raised LH:FSH ratio)
raised insulin
normal oestrogen
159
How is infertility in PCOS treated?
normalise weight- can use orlistat (lipase inhibitor)
induce ovulation (clomifene)
Metformin
gonadotrophins
160
What skin change may patients with PCOS present?
aconthosis nigrcans - thick roughened skin around the axilla and elbows
161
what is lichen sclerosis
a chronic inflammatory condition that usually effects the genitalia of elderly females
162
how does lichen sclerosis present
porcelain white plaques
itching
superficial dyspareunia
163
what is koebner phenomenon
when signs and symptoms are wose when friction is applied to it (occurs in lichen sclerosis)
164
How is lichen sclerosis diagnosed?
usually examination but may do biopsy if uncertainty
165
treatment of lichen sclerosis
topical potent steroids (dermovate) - used once a day for 4 weeks then gradually reduced (alternate days then twice weekly)
emollients should also be used
166
what is a complication of lichen sclerosis
squamous cell carcinoma
167
what is endometriosis
a condition caused by ectopic endometrial tissue outside ofthe uterus
168
how common is endometriosis
affects around 10% of women of reproductive age
169
how does endometriosis present?
chronic pelvic pain
secondary dysmenorrhoea
deep dyspareunia
subfertility
non gynae symptoms -urinary symptoms, dyschezia (painful bowel movements)
170
how does endometriosis present on examination
reduced organ motility, tender nodularity in the posterior fornix and visible vaginal endometriotic lesions
171
gold standard investigation of endometriosis
laparoscopy
172
first line management of endometriosis
analgesia- NSAIDSn paracetamol
173
treatment of endometriosis if analgesia doesnt work
combined oral contraceptive pill or progesterone only pill (stops ovulation and reduced endometrial thickening
174
Treatment of endometriosis if analgesia and hormonal methods do not work
GnRH analogues (induce pseudo menopause)
surgery- laparoscopic excision and ablation of endometriosis, hysterectomy if not wanting to conceive)
175
How does ovarian torsion present
- sudden onset severe unilateral pelvic pain
- nausea and vomiting
- pain can come and go if the ovary twists and untwists
- localised tenderness
176
what does vaginal examination of ovarian torsion show
adnexial tenderness
177
how is ovarian torsion diagnosed
transvaginal USS- whirlpool stool
178
treatment of ovarian torsion
urgent detorsion and fixation- laparoscopic surgery
179
complications of ovarian torsion
loss of function of the ovary -increased infertility
if nectrotic ovary is left then can cause an abscess and infection
180
RF of ovarian torsion
ovarian mass (usually >5cm)
pregnancy
reproductive age
ovarian hyperstimulation syndrome
181
differentials of ovarian torsion
appendicitis, ectopic pregnancy, rupture of an ovarian cyst
182
RF for ovarian cancer
increasing age (peak at 60)
BRCA 1 and BRCA 2
increased number of ovulations (early menarche, late menopause, no pregnany)
obesity
smoking
clomifene use
183
protective factors for ovarian cancer
combined oral contraceptive
breastfeeding
pregnancy
184
What are the most common type of ovarian cancers
serous carcinomas
185
Where does ovarian cancer commonly spread
intraperitoneal structure and organs
the liver
para-aortic lymph nodes
lung
186
How does ovarian cancer present
vague symptoms
bloating
early satiety
pelvic pain
urinary symptoms
diarrhoea
ascities
187
If ovarian cancer causes hip and groin pain which nerve has been compressed
obturator nerve
188
Differentials for ovarian cancer
fibroids
ovarian cysts
IBS
constipation
other female cancers
189
Tumour marker for ovarian cancer
CA125
190
what other conditions cause a rise in CA125
endometriosis
menstruation
benign ovarian cysts
adenomyosis
pelvic infection
liver disease
pregnancy
191
what value of CA125 is raised
above 35
192
What index is used to estimate the risk of an ovarian mass being malignant
risk of malignancy index
193
what components make up the risk of malignancy index
CA125 level
menopausal status
USS findings
194
RF of vulval cancer
advanced age (>75)
immunosuppression
HPV
lichen sclerosis
195
What is the most common type of vulval cancer
squamous cell carcinoma
196
What are premalignant conditions that may precede vulval cancer called?
vulval intraepithelial neoplasia (VIN)
197
What two types of VIN are there
high grade squamous intraepithelial lesions- associated with HPV, 35-50
differentiated VIN - associated with lichen sclerosis , 50-60
198
What treatment options can be used in VIN
watch and wait
wide local excision
imiquimod cream - topical immune response modifier
laser ablation
199
How does vulval cancer present?
vulval lump
ulceration
bleeding
pain
itching
lymphadenopathy
200
what part of the vulva is most commonly affected by vuvlal cancer
the labia majora
201
How is vulval cancer diagnosed?
biopsy under 2 week wait
sentinel node biopsy
CT scan
202
How is vulval cancer treated
wide local excision, groin lymph node dissection, chemo and radiotherapy
203
what is a prolactinoma
a benign pituitary adenoma which secretes excess prolactin hormone
204
presentation of a prolactinoma in women
amenorrhoea
infertility
galactorrhoea
osteoporosis
symptoms of mass- headache, bitemporal hemianopia, symptoms of hypopituitarism
205
How does a prolactinoma present in men
impotence
loss of libido
galactorrhea
symptoms of mass
206
How are prolactinomas diagnosed?
MRI
207
What is the treatment of prolactinomas
dopamine agonists- cabergoline. bromocriptine
surgery
208
what causes continuous urinary dribbling incontinence after birth
vesicovaginal fistula
209
What is menopause
permanent cessation of menstruation at the end of the reproductive life due to loss of ovarian follicular activity
210
what is the average age of menopause?
51
211
hormonal changes associated with menopause
oestrogen and progesterone levels are low due a lack of ovarian follicular function
LH and FSH are high
212
presentation of menopause
oligomenorrhoea/ amenorrhoea
night sweats
weight gain
hot flushes
joint pain
vaginal dryness and atrophy
emotional liability and low mood
loss of libido
213
When would you investigate menopause with bloods
if a woman is under 40 or if a woman is 40-45 with menopausal symptoms
214
long term complications of menopause
increased osteoporosis risk
increased risk of ischaemic heart disease
215
contraindications to HRT
current or past breast cancer
any estrogen sensitive cancer
undiagnosed vaginal bleeding
untreated endometrial hyperplasia
215
3 categories of menopause treatment
lifestyle modifications
hormonal treatments
non hormonal treatments.
216
Two types of HRT.
combined (oestrogen and progesterone) - used if uterus is present
unnopposed oestrogen if hysterectomy
217
218
by what two methods can HRT be given
orally or through skin (transdermal patch, gel)
219
what non-hormonal methods can be used to treat vasomotor menopause symptoms
fluoxetine, citalopram or velafaxine
220
what can be used to treat loss of libido in menopause
testosterone
221
what is the most common type of vaginal cancer
squamous cell carcinoma
15% are adenocarcinomas
222
RF for vaginal cancer
previous hysterectomy, previous HPV , increasing age, HIV and AIDS
223
where does squamous cell vaginal cancer spread to
spreads superficially within the vagina and can invade the paravaginal tissues
can also spread to the lungs nad lvier
224
where do vaginal adenocarcinomas spread to
pulmonary metastases and supraclavicular and pelvic node involvement
225
how does vaginal cancer present?
lump in the vagina
ulcers and skim changes
vaginal bleeding and itching
vaginal discharge
226
investigations for vaginal cancer
examination
colposcopy
CT scan
227
Management of vaginal cancer
surgery and radiotherapy in early stage
pelvic exenteration may play a role- particularly in recurrence after radiation
228
what is cystocele
a defect in the anterior vaginal wall which causes the bladder to prolapse backwards into the vagina
229
What is rectocele
a defect in the posterior vaginal wall which allows the rectum to prolapse forwards into the vagina
230
causes of rectocele
constipation- faecal loading
231
What is a vaginal vault prolapse
occurs in women who have had a hysterectomy - the top of the vagina descends into the vagina
232
RF for pelvic organ prolapse
multiple vaginal deliveries
prolonged and traumatic deliveries
advanced age
post menopause
obesity
chronic respiratory disease causing coughing
chronic constipation causing straining
233
presentation of pelvic organ prolapse
a sensation of something coming down into the vagina
a dragging heavy sensation in the pelvis
urinary symptoms- incontinence, urgency, frequency, weak stream)
bowel symptoms- constipation, incontinence, urgency
Sexual dysfunction- pain, altered sensation, reduced enjoyment
234
What examination is done to examine pelvic organ prolapse
a sim's speculum (U shaped)- held on the anterior wall to look at rectocele, held on the posterior wall to look at cystocele
235
conservative management of pelvic organ prolapse
physiotherapy- pelvic organ, weight loss, lifestyle changes (reduced caffeine), vaginal oestrogen cream
236
management of prolapse in someone not suitable for surgery
vaginal pessary- ring is most common, shelf, cube, donut
237
surgical management of anterior prolapse
anterior colporrhaphy
238
surgical management of posterior prolapse
posterior colporrhaphy
239
how soon after LLETZ is a smear done
6 months
240
what is the most common type of ovarian cancer?
epithelial cell tumour
241
what is the most common type of ovarian cancer in young
germ cell tumours
242
What is a type of sex cord stromal tumour that spreads to the ovary from the GI tract
Krukenberg tumour
243
what tumour markers may be better used in ovarian cancer in young women?
AFP and B-HCG
244
what value of CA125 is elevated
above 35
245
what other conditions may cause a raised CA125?
pregnancy
PID
endometriosis
adenomyosis
menstruation
benign cysts
liver disease
246
What % of women are diagnosed with ovarian cancer after it has spread?
70%
247
248
If the nexplanon implant causes irregular light bleeding when first inserted, what can be given to treat ?
A 3 month course of the combined oral contraceptive pill
249
what is a molar pregnancy?
a type of tumour that grows like a pregnancy in the uterus
250
what types of molar pregnancies are there?
complete and incomplete
251
explain what a complete molar pregnancy is
when two sperm cells fertilise an ovum containing no genetic material - the cells divide and grow however there will be no fetal material
252
explain what a partial molar pregnancy is?
occurs when two sperm fertilise a normal ovum containing some genetic material - the new cells contain three sets of chromosomes and will have some fetal material
253
what type of disorders do hydatidiform moles belong to ?
gestational trophoblastic disorders - along with choriocarcinomas
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how do hydatidiform moles present?
- very severe morning sickness
- vaginal bleeding
- large uterus
- abnormally high hCG
- thyrotoxicosis
-hypetension
- pelvic pain
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How is a molar pregnancy diagnoses
USS- shows a snowstorm appearance
bloods show large hCG, low TSH, high T3 and T4
diagnosis is confirmed with histological examination of the placenta.
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1st line treatment of molar pregnancy
suction evacuation
patients should be given contraception for a year after to prevent pregnancy.
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What structures do the internal female genital organs develop from?
the mullerian or paramesonephric ducts
these use to make the upper vagina, cervix, uterus and fallopian tubes
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what are come congenital abnormalities in the development of the female genital organs?
bicornuate uterus
imperforate hymen
transverse vaginal septae
vaginal hypoplasia and agenesis
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what are the two phases of the menstrual cycle?
the follicular (days 0-14) and the luteal phase (final 14 days)
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What happens in the follicular phase of the menstrual cycle?
- FSH causes the development of follicles
- The granulosa cells on the follicles grow and start secreting more oestrogen
- The oestrogen has negative feedback on the pituitary and decreases LH and FSH.
- the oestrogen also causes the cervical mucus to become more permeable
- one follicle develops into the dominant follicle
- an LH surge causes the dominant follicle to release the ovary in ovulation
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What happens in the luteal phase of the menstrual cycle?
- the dominant follicle that release the ovum becomes the corpus luteum
- the corpus luteum secretes high amounts of progesterone to maintain the endometrial lining and make the cervical mucus thick so that it is no longer penetrable
- if no fetilisation occurs the corpus luteum will break down and stop producing oestrogen and progesterone
- this causes the endometrium to break down and menstruation to occur
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