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Women's Health > Gynaecology Summary > Flashcards

Gynaecology Summary Flashcards

1
Q

What is asked in a gynae history?

A
  • Vaginal bleeding
  • Menstrual hx: LMP, menopausal, pregnant, cycle, menorrhagia, age of menarche
  • Pain: abdo pain or dyspareunia
  • Vaginal discharge: colour, odour and amount
  • Sexual hx: last cervical smear, sexually active, partners, contraception/HRT
  • Obstetric history
  • Constitutional: fever, weight loss, tired, appetite
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2
Q

What are the investigations for PV bleeding?

A
  • Abdominal and pelvic examination - feel for pelvic masses
  • PV exam: confirm it is a PV bleed, look for pathology
  • Bloods: FBC, clotting, CA-125
  • Urine beta-HCG (pregnancy test)
  • STI screen - high vaginal and endocervical swabs
  • Cervical smear
  • Transvaginal USS - endometrial thickness
  • Urgent USS - ectopic
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3
Q

What are the differentials for post menopausal PV bleeding?

A
  • Endometrial Cancer – most important to rule out
  • Atrophic Vaginitis - most common
  • Endometrial Hyperplasia
  • Endometrial Polyp
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4
Q

What are the differentials for inter-menopausal PV bleeding?

A
  • Pregnant ?? Ectopic Pregnancy
  • Endometriosis
  • Pelvic Inflammatory disease
  • Ovarian cyst rupture
  • Uterine Fibroids
  • Breakthrough bleeding after starting contraceptives
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5
Q

What are differentials for post-coital PV bleeding?

A
  • Cervical Cancer
  • Cervical ectropion
  • Cervical polyp
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6
Q

What are the risk factors for endometrial cancer?

A
  • Elderly
  • Nulliparity
  • DM
  • Obesity
  • Menstrual irregularity (early menarche/late menopause
  • Oestrogen therapy (tamoxifen, oestrogen only HRT)
  • Hypertension
  • PCOS
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7
Q

What are the protective factors for endometrial cancer?

A
  • COCP
  • Mirena coil
  • Increased pregnancies
  • Smoking
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8
Q

What is the presentation of endometrial cancer?

A
  • Unusually heavy menstrual bleeding
  • Post coital bleeding
  • Intermenstrual bleeding
  • Abnormal vaginal discharge (unusual)
  • Haematuria
  • Anaemia
  • Pain is rare
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9
Q

What are the investigations for endometrial cancer?

A
  • TV USS
  • Pipelle biopsy @ outpatient clinic, less invasive than hysteroscopy
  • Hysteroscopy with endometrial biopsy
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10
Q

What is the management for endometrial cancer?

A
  • Total abdo hysterectopy w/bilateral sapingo-oopherectomy

- May need radio/chemotherapy

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11
Q

What symptoms should be referred for TVUS in women >55 yrs?

A
  • Unexplained vaginal discharge

- Visible haematuriaplus raised platelets, anaemia or elevated glucose levels

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12
Q

What is atrophic vaginitis?

A
  • Dryness+atrophyof vaginal mucosa due to low oestrogen, thinner, less elastic, more dry mucosa, inflammation prone
  • Changes in vaginal pHmicrobial flora, to localised infections.
  • Risk factor is menopause
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13
Q

What is the presentation of atrophic vaginitis?

A
  • Itching/dryness
  • Dyspareunia (discomfort or pain during sex)
  • Bleeding via localised inflammation
  • Urinary incontinence + recurrent UTIs
  • Examination: pale mucosa, thin skin, erythema / inflammation, dryness
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14
Q

What is the management of atrophic vaginitis?

A
  • Vaginal lubricants - help dryness

- Topical oestrogen creams

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15
Q

What is the risk factors for ectopic pregnancy?

A
  • Damage to tubes: PID, surgery
  • Previous ectopic
  • Endometriosis
  • IUCD
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16
Q

What is the presentation of an ectopic pregnancy?

A
  • Pain, usually 1st sx, constant, may be unilateral
  • PV bleeding
  • Recent amenorrhoea (6-8wks typically)
  • Dizziness / fainting / syncope
  • Peritoneal bleeding may indicate shoulder tip pain or dysuria
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17
Q

What is endometriosis?

A
  • Ectopic endometrial tissue outside the uterus, may be due to retrograde menstruation.
  • Tissue sheds + bleed (as in menstruation) which leads to irritation + inflammation
  • Thus, it responds to hormones in same way
  • Can develop adhesions – scar tissue that binds organs together
  • Reduced fertility
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18
Q

What is the presentation of endometriosis?

A
  • Cyclical abdominal or pelvic pain
  • Deep dyspareunia
  • Dysmenorrhoea
  • Infertility
  • Cyclical bleeding from other sites, such as haematuria
  • Urinary Sx
  • Bowel Sx
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19
Q

What are the investigations for endometriosis?

A
  • Endometrial tissue on speculum exam
  • Fixed cervix on bimanual
  • Tenderness in vagina, cervix and adnexa
  • Pelvic USS
  • Laproscopy – gold standard
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20
Q

What is the management of endometriosis?

A
  • Analgesia - NSAIDs
  • Hormonal Tx including; COCP or Progestogens
  • Surgery – Laproscopic to remove adhesions
  • Hysterectomy
21
Q

What is the presentation of PID?

A
  • Non-Cyclical abdo/pelvic pain
  • Abnormal vaginal discharge
  • Fever
  • Infertility
  • Maybe dysuria, potential for ectopics
  • Infertility
22
Q

What are the investigations for PID?

A
  • Cervical excitation
  • Ovarian/fallopian tenderness and adnexa
  • High Vaginal swab
  • Pregnancy test – rule out ectopics
  • Chalmydia/gonorrhea screen
23
Q

What is the management of PID?

A
  • Antibiotics – IM ceftriaxone or 14 day oral doxy/metro

- Consider IUD removal

24
Q

What is the presentation of fibroids?

A
  • Menorrhagia
  • Prolonged menstruation, > 7 days
  • Abdo pain, worse in menstruation
  • Bloating
  • Urinary/bowel Sx via pelvic pressure/fullness
  • Deep dyspareunia
  • Reduced fertility
25
Q

What are the investigations for fibroids?

A
  • Palpable pelvic mass
  • Enlarged firm non tender uterus
  • Transvaginal USS
26
Q

What is the management of fibroids?

A
  • Manage the menorrhagia w/ IUS, NSAIDs, transexamic acid, COCP
  • Shrink fibroids w/ GnRH agonists or myomectomy
27
Q

What are the differentials for menorrhagia/dysmenorrhoea?

A
  • Dysfunctional uterine bleeding
  • Anovulatory cycles - usually in the extremes of a woman’s reproductive life
  • Uterine fibroids
  • Hypothyroidism
  • Intrauterine devices
  • PID
  • Bleeding disorders e.g. VW disease
  • Endometriosis
28
Q

What is stress incontinence?

A
  • Leakage of urine on coughing/straining/sneezing/laughing
  • Cause: damage to pelvic floor
  • RFs: previous childbirth, multiple pregnancies, surgery, perineal tears, atrophic vaginitis
29
Q

What is the management of stress incontinence?

A
  • Reduce caffeine/no fluids before bed
  • PELVIC FLOOR EXERCISES
  • Duloxetine
30
Q

What is urge incontinence?

A
  • No reason for incontinence (i.e not coughing and straining)
  • Cause: detrusor overactivity (overactive bladder)
  • RFs: DM, MS, Parkinson’s, infection, constipation/stool impaction, BPH (men)
31
Q

What is the management for urge incontinence?

A
  • Reduce caffeine/no fluids before bed
  • Bladder Retraining – 6 week training course to increase intervals
  • Antimuscarinics – Oxybutynin/tolterodine (mirabegron (b3 agonist) in elderly)
32
Q

What are the investigations for incontinence?

A
  • Bladder diaries > 3 days
  • Vaginal exam – exclude prolapse
  • Urine dip/culture
  • Urodynamic Studies
33
Q

What are the risk factors for cervical cancer?

A
  • Smoking
  • HIV
  • COCP
  • Many sexual partners
  • Low socioeconomic background
  • High parity
34
Q

What are the features of cervical cancer?

A
  • Abnormal vaginal bleeding (can be PMB, IMB or post-coital)
  • Discharge
  • Usually detected on screening
35
Q

What are the symptoms of PCOS?

A
  • Androgens -> hirtuism, acne
  • Periods: oligo/amenorrhoea
  • Subfertility/infertility
  • Obesity
  • Acanthosis nigricans (insulin)
36
Q

What are the investigations for PCOS?

A
  • Normogonadoptrophic normogonadism
  • High LH: FSH ratio (3:1)
  • US shows ovarian cysts
37
Q

What is the management for PCOS?

A
  • General - weight loss; COCP (decreases androgen effects + if not wanting baby); Levon-IUS if severely obese
  • Hirtiuism/acne- COCP or co-cyprindiol (anti-andronergic), topicaleflornithine; finasteride, flutamide,spironolactone
  • Infertility – metformin if obese, otherwise clomephine
38
Q

What is premature ovarian failure?

A
  • Hypergonadotropic hydpogonadism - high LH/FSH
  • Causes: idiopathic, excessive exercise, radiation, low BMI, marijuana, chemo/radiotherapy, chromosomal changes (e.g. Turner Syndrome), infections (mumps)
39
Q

What are the features of premature ovarian failure?

A
  • Menopausal symptoms before age of 40 – either via reduced follicles or dysfunctional follicles
  • Secondary amenorrhea
  • Night sweats
  • Libido
  • Weight gain
40
Q

What is the management for premature ovarian failure?

A
  • Replace hormones - HRT

- IVF

41
Q

What are the symptoms of ovarian cancer?

A
  • Constitutional PLUS abdo bloating/pain
  • Ascites
  • AUB
  • Early satiety
  • Pelvic pain/pressure
42
Q

What are the risk factors for ovarian cancer?

A
  • Smoking
  • Drinking
  • Early menarche
  • Late menopause
  • HNPCC (aka Lynch Syndrome)
  • BRCA1/2
  • Obesity
  • REDUCES RISK: COCP, multiparity
43
Q

What are the investigations for ovarian cancer?

A
  • CA-125 /AFP/b-hCG
  • TVUS (may be large, complex, multi-loculated cysts present, high suspicion for malignancy)
  • Diagnostic LAPAROTOMY
44
Q

What are the symptoms of ovarian torsion?

A
  • Acute, colicky abdo pain
  • N/V
  • Adnexal mass
  • Can get fever if adnexal necrosis via adnexal torsion
45
Q

What is the investigations for ovarian torsion?

A
  • USS (whirlwind presentation)

- Laparoscopy (also management)

46
Q

What are differentials for pelvic pain?

A
  • Ovarian torsion
  • Ectopic
  • Appendicitis
  • PID
  • Mittlschmerz - sharp mid cycle pain, settles after couple days, conservative management
47
Q

What are the symptoms of PMS?

A

Before periods, patients might get different emotional + physical symptoms:

  • Anxiety
  • Stress
  • Fatigue
  • Mood Swings
  • Bloating/ abdo pain
48
Q

What is the presentation of atrophic vaginitis?

A

Atrophic vaginitis often occurs in women who are post-menopausal women. It presents with vaginal dryness, dyspareunia and occasional spotting. On examination, the vagina may appear pale and dry.

49
Q

What is the treatment of atrophic vaginitis?

A

Treatment is with vaginal lubricants and moisturisers - if these do not help then topical oestrogen cream can be used.

Women's Health (19 decks)

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