Inflammatory & Infective Disorders Flashcards
Pelvic pain is described as being chronic when it has been present for how long?
More than 6 months
What are the two most common causes of chronic pelvic pain?
Endometriosis and PID
What is endometriosis?
The presence of endometrial glands and stroma outside the uterine cavity
What is the most widely accepted theory behind the occurrence of endometriosis?
Retrograde menstruation
Describe the relationship between endometriosis and genetics?
Women are 5 times more likely to have endometriosis if their mother also had the condition
The prevalence of endometriosis is lower in women using what medication?
Hormonal contraceptives
What are the three main clinical features of endometriosis?
Cyclical pelvic pain, deep dyspareunia and subfertility
When does the pelvic pain of endometriosis usually begin in relation to the menstrual cycle?
A few days before the onset of bleeding
What is the typical examination finding of severe endometriosis?
A fixed, retroverted uterus
What is the relationship between the severity of symptoms of endometriosis and the extent of disease?
These do not correlate well
What are some non-gynaecological symptoms of endometriosis?
Fatigue, depression, bowel and urinary symptoms
What are some bowel symptoms that may occur in endometriosis?
Pain on defaecation, diarrhoea
What are some urinary symptoms that may occur in endometriosis?
Dysuria, haematuria, urgency
The presence of blood filled ‘chocolate’ ovarian cysts on ultrasound is suggestive of what diagnosis?
Endometriosis
Endometriosis increases the risk of developing which malignancy?
Epithelial ovarian cancer (particularly endometrioid, clear cell and low grade serous)
What is the gold standard diagnostic investigation for endometriosis?
Laparoscopy
What effect does pregnancy have on endometriosis?
It usually makes the condition better
What symptomatic management is offered first line to women with endometriosis?
NSAIDs and/or paracetamol
What is the aim of medical management for endometriosis?
To suppress ovulation and induce amenorrhoea
What are some options of medical management that can be used in endometriosis to suppress ovulation and induce amenorrhoea?
COCP, POP, contraceptive implants, injections or IUS
If hormonal contraceptives are not successful in the management of endometriosis, what is the next line medical management and what is the effect of this?
GnRH analogues and HRT - stimulate the menopausal state but without the symptoms
What is done if medical management fails in the treatment of endometriosis, or the woman is wishing to become pregnant in the near future?
Surgical management (ablate/excise endometrial deposits, remove cysts, divide adhesions)
Intractable symptoms of endometriosis may warrant what surgical procedure?
Hysterectomy
When do symptoms of endometriosis usually resolve and why?
After the menopause as there are lower levels of circulating oestrogens
What organism is the most common cause of PID?
Chlamydia trachomatis
The risk of PID can be reduced how?
Barrier contraceptives
What are some risk factors for the development of PID?
Aged < 25, multiple sexual partners, unprotected sex, recent insertion of Cu-IUD
What types of abnormal menstrual bleeding may be seen in those with PID?
Inter-menstral and post-coital bleeding
What are some features that may be seen on examination of someone with PID?
Cervical excitation, adnexal tenderness and swelling
What blood tests are useful in the investigation of suspected PID?
WCC and CRP
How should chlamydia and gonorrhoea be screened for in women with suspected PID?
NAATs from high vaginal and endocervical swabs
What imaging investigations can be used in individuals with suspected PID?
Trans-vaginal US, MRI
In those with PID, there may be free fluid where?
The rectouterine pouch
What is Fitz-Hugh-Curtis syndrome, and what infection is most likely to cause it?
Peri-hepatic adhesions, caused by chlamydia
How does Fitz-Hugh-Curtis syndrome present?
RUQ pain
How long are antibiotics given for in the treatment of PID?
14 days
What is the standard outpatient antibiotic treatment for PID?
Ofloxacin and metronidazole PO (bd)
What is the outpatient antibiotic treatment for PID in those aged < 18 years or who are at high risk of gonorrhoea?
PO metronidazole and PO doxycycline (bd) and a single dose of IM ceftriaxone
What antibiotics are used in the inpatient treatment of PID?
IV ceftriaxone and metronidazole and PO doxycycline
Do patients with mild PID need to have their Cu-IUD removed (if present)?
No
When may surgery be necessary in the treatment of PID?
To drain pelvic abscesses that do not respond to antibiotics
What are some long-term consequences of PID?
Chronic pelvic pain, adhesions, ectopic pregnancy, infertility
Who are vulval skin disorders typically seen in?
Post-menopausal women
What type of condition is lichen sclerosus?
Autoimmune
What is the risk associated with the majority of vulval skin conditions?
Risk of progression to vulval cancer
What vulval skin disorder is this describing: whitened skin in a figure of eight distribution, and loss of vulval architecture?
Lichen sclerosus
What are some risk factors for vulval intra-epithelial neoplasia?
High risk HPV infection, immunosuppression and smoking
What vulval skin disorder is this describing: white, red or pigmented nodules that may co-exist with an invasive vulval carcinoma?
Vulval intra-epithelial neoplasia
What vulval skin disorder is this describing: red plaques with white ‘cake icing’ effect?
Extra-mammary Paget’s disease
Extra-mammary Paget’s disease may be associated with which malignancies?
Breast, colon or GU tract
What vulval skin disorder is this describing: reddened vulval skin in a ‘nappy distribution’?
Chronic vulval dermatitis
What are the most common symptoms of vulval skin disorders?
Itching and irritation
An extremely painful, hot, swollen, red labium is suggestive of what diagnosis?
Bartholin’s cyst abscess
If cases of vulval skin disorders do not respond to treatment or are ambiguous, what investigation is necessary?
Vulval biopsy
What can be used to relieve symptoms in cases of lichen planus, lichen sclerosus and vulval intra-epithelial neoplasia?
Topical corticosteroids
When is surgical excision considered in women with vulval skin disorders?
If symptoms are unbearable or if there is suspicion of cancer
How are patients with lichen sclerosus, lichen planus and vulval intra-epithelial neoplasia followed up?
Annual review to exclude malignancy
Where does Mittelschmerz cause pain?
RIF
What is the imaging investigation of choice for adenomyosis?
Pelvic MRI
