O+G Flashcards
What is candidiasis?
A fungal infection due to any type of Candida (type of yeast)
Summarise the epidemiology of candidiasis
75% of women have at least 1 at some point (vaginal)
Almost half have at least 2
5% have more than 3 infections in single year
Explain the aetiology of candidiasis
Candida - type of yeast
Candida albicans = most common
What are the presenting symptoms of candidiasis?
Genital itching Genital burning White "cottage cheese-like" discharge Redness of skin Burning with urination Pain during sex
What are the signs O/E of candidiasis?
Thick white discharge Erythema Vaginal fissuring Oedema Satellite lesions (sores)
How is candidiasis investigated?
Vaginal wet mount microscopy
Microbial culture
Antigen tests
What are the risk factors for candidiasis?
Immunosuppression HIV/AIDS DM Corticosteroids ABx Pregnancy
What is an epidural?
Medical route of administration in which a drug such as epidural analgesia and anaesthesia or contrast agent is injected into the epidural space around the spinal cord
What are the indications for an epidural?
- For analgesia alone e.g. childbirth
- Adjunct to GA to reduce opioid requirement e.g. gynae/ortho/general/vascular surgery
- Alone as surgical anaesthesia e.g. C section
- Post-op analgesia
- Back pain - analgesics + steroids
- Chronic pain/symptom palliation in terminal care
What are the possible complications of an epidural?
- Failure to achieve full analgesia/anaesthesia
- Accidental dural puncture with headache
- Delayed onset of/shorter duration of breastfeeding
- Bloody tap (punctured epidural veins)
- Catheter placed into a vein –> seizures, cardiac arrest
- Catheter placed in subarachnoid space –> high/total spinal block
- Epidural abscess/haematoma
- Paraplegia
- Arachnoiditis
- Death
What is mastitis?
Inflammation of the breast with or without infection
What age group does breast infection most commonly affect?
Women aged 15-45 years
Especially those who are lactating
What is the most frequent pathogen isolated from breast infection?
Staphylococcus aureus
Summarise the epidemiology of mastitis and breast abscess
15-45 years
What are the risk factors for mastitis and breast abscess?
Female > 30 Poor breastfeeding technique Lactation Milk stasis Nipple injury Previous mastitis Prolonged mastitis --> breast abscess Shaving/plucking areola hair Anatomical breast defect, mammoplasty, or scar Breast cancer Nipple piercing Implants Skin infection Staph aureus carrier Immunosuppression
What are the presenting symptoms of mastitis and breast abscess?
Flu-like symptoms, malaise, myalgia Fever Sharp, shooting breast pain Decreased milk outflow Breast warmth, firmness, swelling, erythema
What are the signs O/E of mastitis and breast abscess?
Fever
Breast warmth, firmness, swelling, erythema
How are mastitis and breast abscess investigated?
- US - hypoechoic lesion (abscess); may be well circumscribed, macrolobulated, irregular, or ill defined w possible septae
- Needle aspiration drainage - purulent fluid = breast abscess
- Cytology of nipple discharge/FNA sample - infection
- Milk, aspirate, discharge or biopsy tissue MC&S - positive culture = infection
- Histopathological examination of biopsy tissue - infection, granulomatous inflammation
- Pregnancy tes if in adolescent
How is mastitis managed?
Mild = effective milk removal + paracetamol/ibuprofen
Severe = ADD ABx - flucloxacillin/dicloxacillin/cloxacillin or cefalexin/clindamycin
MRSA confirmed by culture/prevalent locally = non-beta-lactam ABx - clindamycin/trimethoprim/sulfamethoxazole/vancomycin or doxycycline instead
What are the possible complications of mastitis and breast abscess?
Cessation of breastfeeding Abscess (complicating mastitis) Sepsis Scarring Functional mastectomy - breast unable to lactate Breast hypoplasia Necrotising fasciitis Extra-mammary skin infection Fistula
What is a breast abscess?
A localised area of infection with a walled-off collection of pus
How is a breast abscess managed?
- FNA w LA w/wo US guidance to drain abscess
- IV/oral ABx:
a) MRSA excluded = activity vs methicillin-sensitive staphylococci - dicloxacillin/cefalexin
b) MRSA +ve = non-B-lactam - clindamycin/trimethoprim/sulfamethoxazole - Paracetamol/ibuprofen
What is polycystic ovary syndrome?
PCOS includes symptoms of hyper-androgenism, presence of hyper-androgenaemia, oligo-/anovulation, and polycystic ovarian morphology on ultrasound
Summarise the epidemiology of polycystic ovary syndrome
Affects 6-8% of women of reproductive age
Symptoms generally start at time of puberty
Accounts for 80-90% of cases of hyper-androgenism in women
Explain the aetiology of polycystic ovary syndrome
Unknown
Primary defect is unclear
?Defect in hypothalamic-pituitary axis - increased amplitude and frequency of LH pulses
Inherited as common complex disorder: multiple genes w mild/moderate effects on overall disease risk involved
What are the signs O/E of polycystic ovary syndrome?
Hirsutism
Acne
Overweight/obese
Hypertension
How is polycystic ovary syndrome investigated?
- Serum total and free testosterone - elevated
- Serum DHEAS - elevated
- Serum 17-hydroxyprogesterone - normal (>24 nanomol/L = adrenal hyperplasia)
- Serum prolactin - normal (elevated –> prolactinoma)
- Serum TSH - normal
- Oral glucose tolerance test - fasting glucose 5.6-6.9 mmol/L; 2 hour glucose 7.8-11.0
- Fasting lipid panel - elevated total cholesterol, LDL, triglycerides + low HDL
What are the different types of mastitis?
Mastitis with infection may be lactational (puerperal) or non-lactational (eg duct ectasia)
Non-infectious mastitis includes idiopathic granulomatous inflammation and other inflammatory conditions, eg foreign body reaction
