Gyny (causes, investigation & management) Flashcards
Menorrhagia - causes
Primary - DUB Secondary - Clotting problems (Factor V von lieden) - Structural (fibroids, polyp, ectropion) - Endometriosis - PID - Cancer - Hypothyroidism
Menorrhagia - Investigations
1) FBC 2) If indicated - TFTs 3) If indicated - Clotting screen 4) if indicated - TV USS 5) Cervical smear 6) Endometrial biopsy
Menorrhagia - management
1) Rule out 2* (otherwise treat) 2) IUS is first line 3) COCP OR Tranexamic/Mefanamic acid
Menstrual history
1) First day of last period 2) Duration of period -> length of bleeding/flow 3) Length & regularity 4) Abnormal bleeding - IMB/ICB 5) Menarche
Dysmenorrhooea - causes
1) endometriosis 2) adenomyosis 3) Fibroids 4) pelvic inflammatory disease 5) intrauterine devices*
Dysmenorrhoea - investigations
1) Pelvic ultrasound 2) Cervical smear 3) High vaginal swab
Dysmenorrhoea - management
1) NSAIDs - Ibuprofen/Menefamic acid 2) COCP 3) IUS
Amenorrhoea - Causes
1) Hypothalamic a) Kalmann syndrome - Primary b) Exercise, stress, eating - Secondary 2) Pituitary a) Sheehan syndrome b) Hyperprolactinaoma 3) Gonadal a) turner syndrome - primary b) CAH - primary c) PCOS - secondary d) Pregnancy - secondary e) Anovulation - secondary 4) Outflow tract a) Mullerian genesis b) Vaginal atresia
PCOS Path
Hyperinsulinaemia -> Raised LH -> Raised Oestrogen & Testosterone
PCOS Presenting
1) Outward -> Hirstuitism, alopecia, acne 2) Inward -> Oligoamenorrhoea/amenorrhoea/infertiltiy 3) Physical -> Polycystic ovaroes
PCOS Investigations
1) FSH, LH, Testosterone, TSH, Prolactin 2) OGTT
PCOS Management
1) Lifestyle -> Lose weight, exercise more 2) Menstrual -> COCP 3) Infertility -> Clomiphene
Ectopic Pregnancy Presenting
1) Abdominal/Pelvic pain (first symptom) 2) Amenorrhoea or missed period 3) Vaginal bleeding (brown) 4) Shoulder tip pain, breast tenderness, urinary symptoms
Ectopic Pregnancy Examination
1) Pelvic tenderness 2) Pallor/tachycardia 3) Cervical motion tenderness
Ectopic Pregnancy Investigations
1) Pregnancy Test 2) TV USS 3) Serial HCG (if surgery)
Ectopic Pregnancy Management
1) Methotrexate 2) Surgical (Salpingotomy) 3) Anti-D Prophylaxis
Ectopic Pregnancy criteria for Methotrexate
1) No sig pain 2) <35mm and no HB 3) No IUP 4) Serum HCG <1500
Ectopic Pregnancy criteria for surgery
1) Significant pain 2) >35mm 3) Fetal HB on scan 4) Serum HCG >5000
Methotrexate use in Ectopic - Actions
1) LFTs and serial HCGs 2) Warn pelvic pain 2-3 days afterwards 3) Warn do not get pregnant for 6-months
Chlamydia screening (3)
1) Anyone in GUM clinic 2) Sexually active <25 annually 3) Sexual partners
Chlamydia symptoms (In Chlamydia you get the D!)
Chlamydia 1) Discharge 2) Dysuria 3) Deep dyspareunia 4) Duff bleeding (IMB or PCB)
Chlamydia management
1) Partner notification 2) Screening for other STIs 3) Management 1g Azithromycin OR 75mg Doxcycline (7-days)
Gonorrhoea symptoms (In Gonnorrhoea you get the D!)
1) Discharge 2) Dysuria 3) Deep dyspareunia 4) Duff bleeding (IMB or PCB)
Diagnosis Chlamydia & Gonorrhoea
Women - VVS Men - First catch urine
Gonorrhoea management
1) Partner notification 2) Screening for other STIs 3) Management - Ceftriaxone 500mg IM - Azithromycin 1g orally
How do you differentiate gonorrhoea and chlamydia?
Gonorrhoea is a gram-‘ve intracellular diplococci on microscopy
Trichomoniaisis Vaginalis symptoms
- Itchy, sore vulva/vagina - dyspareunia - Frothy green fishy discharge
Diagnosis of TV
VVS
Management TV
Metronidazole
Bacterial vaginosis symptoms
White/grey foul smelling discharge