L19. Gynaecology Flashcards
How is a Pap smear/ smear test done
Uses speculum to look for maturing epithelium between current squamocolumnar junction and the original squamous epithelium where cytobroom samples the cells- looking for precancerous change -CIN
Done from 25- 69 years, 1 year afterward then every 3 years. Moving to cytological HPV screening
What are the major LARCs, benefits and drawbacks
Subdermal contraceptive implant- eg. Jadelle
- cost effective, :<1% failure, not relying on patient compliance. However sometimes difficult to get out 1/3 have nuisance bleeding
Mirena IUS: HT- inhibits sperm from reaching egg, thickens cervical mucus to prevent entry, thins uterine lining, prevents ovulation in some women - 80% reduction in bleeding.
Copper IUCD- good for those can’t HT - bcancer, anti epileptic med- but increases bleeding a little bit
What is cervical cancer caused by, how long does it take to progress and what type of cancer is picked up by cervical smear
HPV virus triggers progressive cellular changes over 10 years- usually in the transformation zone.
Pap smear picks up squamous cell carcinoma
What are the 3 types of gynaecological examination
- Abdominal palpation- pelvic masses
- Speculum examination: -visualise cervix, swabs/STI screen, smear if indicated.
- Bimanual examination: uterine size, mobility & tenderness, adnexal masses.
What are 3 ways that heavy periods can be treated for someone wanting to get pregnant vs not wanting to
Wanting pregnancy:
1. Tranexamic acid: binds to plasminogen, blocking the interaction with fibrin to prevent dissolution of fibrin clot.
Not pregnancy:
- Endometrial ablation: burns the endometrium to prevent thickening- day case procedure.
- Abdominal/Vaginal / Laparoscopic hysterectomy: Removes the uterus and tubes (avoid ovarian cancer) from the pedicles. Ovaries are needed before 64 years for oestrogen. Major operation, but high satisfaction rate.
What is definition of menopause what is the treatment
Menopause = 1 year from LMP.
Symptom control with 1. lifestyle measures to reduce hot sweats/CVS/prevent osteoporosis: weight loss if obese, weight bearing aerobic exercise, reduce caffeine/alcohol, stop smoking.
2. Non hormonal treatment: antidepressants: SSRI/gabapentin, CBT
3. Hormone treatment- if no contraindications- use lowest dose for shortest duration- There is increased risk of stroke, DVT and gall bladder disease- combined o and p and breast cancer & dementia if oestrogen only.
What is the pathology of endometriosis
It is deposits of glandular tissue on the peritoneum. ovaries, tubes, bladder, bowel or rectovaginal septum which cause chronic inflammation, scar tissue and smooth muscle infiltration. the inflammation is promoted by hormonal cycles.
What are the symptoms of endometriosis- dys= pain
This can cause variable pelvic pain- unrelated to severity of cyst. Dysmenorrhoea, dyspareunia, dyschezia, dysuria, midcycle/ovulatory, chronic pelvic pain, delayed conception
It is only diagnosed on laparoscopy with biopsies
How is endometriosis managed
NSAID and hormonal suppression reduces inflammation.
Surgery aims to excise deposits of endometriosis however not always possible due to location, often repeated with increasing complexity. Hysterectomy is not curative.
How does ovarian cancer present and what is the treatment
Non specific symptoms so high index of suspicion required. 20-25% of women have genetic with BRCA genes account for 10-15%. If eligible they can have annual screening with serum tumour marker Ca125 as Most cases have elevated Ca125 levels and pelvic USS.
Otherwise most present with stage 3 disease.
Treatment: combination chemotherapy and interval debulking surgery.
After family genetic survey is complete- prophylactic removal of both ovaries and tubes is offered.
