Gynaecology Flashcards
Follicle cyst
follicle cysts form when the follicle doesn’t break open to release the egg each month - this causes the follicle to continue growing into a cyst
No symptoms - go away in 1-3 months
Corpus luteum cysts
once the follicle breaks open and releases the egg the empty follicle sac shrinks into a mass of cels called corpus luteum
corpus luteum makes hormones to prepare for the next egg of the menstrual cycle
corpus luteum cysts form if the sac doenst shrink
instead the sac reveals itself after the egg is released, and then fluid builds up inside
most corpus luteum cysts go away after a few weeks
they can grow to 4 inches wiede
they may bleed or twist the ovary and cause pain
Most common cause of ovarian cysts
- Hormonal problems
- Endometriosis
- Pregnancy
- Severe pelvic infections
Signs and symptoms of ovarian cysts
pressure, bloating, swelling or pain in the lower abdomen on the side of the cyst, pain may be sharp or dull and may come and go
if a cyst ruptures: it can cause sudden severe pain
if a cyst causes twisting of an ovary you may have pain along with nausea and vomiting
less common symptoms: pelvic pain, dull ache in lower back and things, problems emptying the bladder or bowel completely, pain during sex, unexplained weight gain, pin during your period, unusual vaginal bleeding, breast tenderness, needing to urinate more often
Eitiologies to exclude in the diagnosis of PCOS
congenital adrenal hyperplasia, androgen secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinaemia
Rotterdam Diagnostic criteria for PCOS
Two of the following three criteria are required:
oligo/anovulation
hyperandrogenism
clinical (hirsutism or less commonly male pattern alopecia) or
biochemical (raised FAI or free testosterone)
polycystic ovaries on ultrasound
First line treatment for PCOS
A lifestyle program that addresses a healthy diet with caloric restriction, behaviour change support and exercise to aid in weight loss and prevention of future weight gain
Medical management of infertility in PCOS
Clomiphene citrate
also metformin
Criteria for PID diagnosis
One of
adnexal tenderness, uterine tenderness, or cervical motion tenderness
bartholin’s glands
re 2 pea sized compound racemose glands located slightly posterior to the left and right of the opening of the vagina.
they secrete mucous to lubricate the vagina and are homologous to bulbourethral glands in males
located in the superficial perineal pouch
What levels are raised in PCOS?
Raised Free Androgen Index
Raised DHEAS
(Hyperandrogenemia)
Most common pelvic configuration
Gynecoid
Shape of an anthropoid pelvis
Heart shaped with a wider AP diameter than transverse
Android pelvis shape
Narrower and taller than the Gynecoid
What is the major blood supply to the pelvic organs
Internal iliac artery
Blood supply to the cervix
Cervical branch of the uterine artery
Stress Incontinence
Involuntary loss of urine with increased intra abdominal pressure (coughing, laughing, sneezing, walking, running)
Urge Incontinence
Urine loss associated with an abrupt sudden urge to void
Neurological causes of urge incontinence
Multiple Sclerosis
Herniated Disc
Diabetes Mellitus
Risk Factors for stress incontinence in women
pelvic prolapse pelvic surgery childbirth hypoestrogenic state (post menopause) age smoking neurological/ pulmonary disease
Treatment for stress Incontinence
TVT - Tension free vaginal tape
Treatment for urge incontinence
behaviour modification
Kegel exercises
Medications - anticholinergics; ocybutynin
prolapse
herniation due to failure of muscular and connective tissue supports of
pelvic floor
uterus and cervix
avulsion of which ligament is most likely to cause an anterior compartment prolapse
arcus tendineus fascia pelvis (ATFP)
Which 3 muscles make up the levator ani?
Pubococcygeus
Puborectalis
Iliococcygeus
which nerve innervates the levator ani?
Pudendal nerve
where does the pudendal nerve run in relation to the ischial spine
beneath and lateral to
What does a stage 4 prolapse indicate
complete eversion of the genital tract
everything is out
Risk Factors for prolapse
Obesity lifestyle occupational medical conditions: respiratory, menopause iatrogenic factors age parity
4 main things prolapse affects
Bladder
Bowel
Sex
Psyche
main causes of prolapse
direct trauma
pelvic neuropathy
most common presenting symptom of vaginal prolapse?
Pelvic heaviness
Structural causes of vaginal prolapse
Pudenal neuropahty
avulsion of the pubococcygeus muscle
tearing of the arcus tendineus fascia pelvis
elongation of the uterosacral ligament
in women with prolapse of the posterior vaginal compartmnet which symptom is pathognomic
digitation
In a woman with stage IV vaginal prolapse requiring surgery, which one of the following is most appropriate regarding medical management of warfarin taken for controlled AF
Aim for INR of 1
a deficient perineal body is most likely associated with
a wide genital hiatus
Dysfunctional Uterine Bleeding
excessive, heavy, prolonged or frequent bleeding that is not due to pregnancy or any recognisable pelvic or systemic disease
Name 3 drugs that interfere with the OCP
Phenytoin, Rifampicin and carbamazepine
What mediates the increased risk of thromboembolic disease with OCPs
oestrogen stimulates production of clotting factors: VII and X and decreases levels of antithrombin III
What is breakthrough bleeding due to on OCP
Atrophic endometrium
- increase oestrogen dose
what is the OCP metabolised by
cytochrome P450
Drugs including anticonvulsants, antibiotics and some antriretrovirals all induce liver enzymes and result in faster metabolism
Treatment for candida
single dose of fluconazole
Lymphogranuloma venereum
caused by chronic infection with Chlamydia trachomatis
Granuloma Inguinale
Donovonosis
