Normal Gyn Symptoms Flashcards
discharge - c / I
can be normal (sex, puberty, the pill) // infection (STI/thrush) , CA , local cause (retained tampon, fistula)
I - do speculum exam
itch - c / DD / I
c - infection (bact/viral/fungal) atrophic vaginitis, eczema/lichen sclerosis, vulva CA
DD - always consider dermo condition
I - if unsure, biopsy and smear + test for DM
hyperemesis - C / I / T
uti/ketones
I - take hx and examine / MSSU / Bloods (TFT’s and U+E) / USS (multiple preg?)
T - fluids, anti-emetic, thromboproph, vit replacement, refer to dietician?
prolapse - ? / forms / severity scale
when weakness of supporting pelvic musc to allow pelvic organs to sag within vagina
takes form of:
CYSTocele (bladder comes through to upper ant wall of vag) –> freq and dysuria
URETHRocele ( lower an vag wall bulge) –> stress incont
RECTocele (rectum bulging through middle posterior wall) –> asymp, may need reduced before poo though
Uterine prolapse also occurs with severity = 1 - 3rd degree (3rd being procidentia)
CF / I / RF / T of uterine prolapse
CF - dragging sensation, freq up, stress incont, defecation issues
I - use a SIM’s speculum and ask pt to bear down
RF - childbirth is most common, menopausal atrophy, pelvic floor muscles weak
T - lose weight, stop smoking, stop straining
physiotherapy for pelvic floor + topical oestrogen cream
SURG - pesseries, repair or hysterectomy
incontinence - 2 main forms / c / I / T of each
split into urge and stress (normal bladder control is via external sphincter in urethra as well as pelvic floor muscles)
URGE
CF - need to go now!
c - preg/ pelvic mass/ prolapse/ uti/ diuretics
I - input/output chart to monitor
T - avoid any bladder stimulants + behavioural therapy (retraining) +/- anti-cholinergic meds
STRESS
CF - invol loss of urine during increased abdo pressure (sneeze, cough etc)
RF/c - parous women, prolapse
I - urodynamic study
T - pelvic floor exercises (PT) +/- duloxetine +/- SURG (colposuspecsion/ slings)
dysparenunia - ?/ CF/ DD / T
pain during sex, either described as superficial or deep
hx - pain // o/e = determine cause. ?discharge? Dry? post partum? narrow intra-oitus?
DD superfical - infection, decrease sexual stim, scar
DD Deep - endometriosis, pelvic sepsis, PID, cerv CA
T - fix cause if possible, otherwise topical creams
dysmenorhea - ? / c
pain during period
either normal or pathological (endometriosis, PID, fibroids)
Acute abdo
general pain causes
localised pain causes
PID, STI, UTI, endometriosis
ectopic/ CA/ STI/ abscess/ wound
ovarian CA - what kind/ C/RF / genetic testing criteria/ CF/ I /T / staging
80% cystadenoma
c - genetic (BRCA 1+2), nulliparity, unsuccessful IVF, +ve FHx, no use of OCP, increased age, HRT use
test for BRCA if FHx = 1 ov CA + 2 Breast CA // 2 ov CA
CF - often asymp (reason why so deadly) 4 NICE criteria pain, bloating, appetite, freq up (+ other CA CF’s)
I - pelvic US (solid mass) / CT scan (staging/mets) / Ca125 / biopsy
T - depends on tumor type : most common is surgical excision + chemo
staged 1-4 1-ovaries 2-capsule invaded but confinied 3-peritoneum 4-mets