More Gynae Flashcards
Endometriosis risk factors
Early menarche Late menopause Nulliparity Caucasian Low BMI Smoking FH Autoimmune disease
Presentation of endometriosis
Dysmenorrhea Chronic pelvic pain Menorrhagia Deep dysparaeunia Can get haematuria or haematochezia Cyclical - bloating, nausea and LUTS Infertility/subfertility
Findings on exam for endometriosis
Bimanual - fixed, retroverted uterus, uterine or ovarian enlargement, for ideal or uterine tenderness
Diagnosis of endometriosis and findings
Laparoscopy
Active: powder burn deposits, chocolate cysts, red flame lesions
Inactive: scarring
Management of endometriosis
Medical = suppress ovulation
- COCP
- continuous progestogen therapy
- GnRH analogues +/- HRT add back therapy
- mefanemic acid or tranexamic acid
Surgery
- laparoscopic good for fertility : diathermy, laser, complete resection of endometrium leaving other repro organs before
- TAH + BSO if family complete
Common pt group for adenomyosis
Multiparous women towards the end of reproductive years
Parts of reproductive tract affected in PID
Upper repro tract - uterus, Fallopian tubes and ovaries
Common organisms causing PID
STI - Chlamydia trachomatis, neisseria gonorrhoea
Non STI - Gardnerella sp, mycoplasma genitalium
Risk factors for PID
Young age <25 Hx if multiple partners No use of barrier contraception New sexual partner TOP/Miscarriage IUD insertion Uterine interventions
Presentation of PID
Lower abdo pain Purulent discharge Dyspareunia Abnormal uterine bleeding Dysmenorrhea Fever, rigours, night sweats
Exam signs of PID
Pyrexia B/L Abdo tenderness Bimanual: uterine/adnexal tenderness Speculum: discharge, cervicitis (contact bleeding) RUQ tenderness - Fitz Hugh Curtis
Complications of PID
Pelvic abscess (tubo-ovarian)
Subfertility from adhesions
Peritonitis
Fitz Hugh Curtis
Investigations forPID
Diagnosis of exclusion
Endocervical/vaginal swabs
Urine dipstick
Pregnancy test
Microscopy of discharge
Transvag USS or laparoscopy if severe or diagnostic uncertainty
History for infertility man and woman
Both
- how often they’re trying
- diet, lifestyle
- stress
- smoking, alcohol
- drug Hx
- STIs
- chemo or RT
- emotional distress
Woman
- prev pregnancy and obs history
- gynae Hx and surgical Hx
- folic acid
- menstruation Hx
Male
- prev pregnancy
- erectile dysfunction
- ejaculatory failure
- surgical Hx
Exam for infertility
Woman
- general for thyroid
- Breast for galactorrhoea
- vaginal exam, speculum and bimanual
Man
- Dont examine unless relevant Hx
- testicular exam for descent, swellings, size
- scrotum for varicocele
- prostate for chronic infection
