Obs + Gynae - Gynaecology Flashcards
Name a common cause of heavy menstrual bleeding
- Uterine fibroids
- Uterine polyps
- Adenomyosis
- Endometriosis
- Bleeding disorders (e.g. Von Willebrand disease)
- Endocrine disorders (diabetes and hypothyroidism)
- PCOS
- Pelvic inflammatory disease (infection)
- Contraceptives, particularly the copper coil
Name a pharmacological treatment and a surgical treatment for Fibroids
Pharmacological: LNG-IUS Mirena, NSAID, Antifibrinolytic (Tranexamic acid), CHC, GnRH agonist (Triptorelin), Progesterone receptor inhibitor (Mifepristone), Aromatase inhibitor (Letrozole), Ulipristal acetate
Surgical: Myomectomy, Laparoscopic resection, Endometrial ablation, Uterine artery embolisation, Hysterectomy
Benign tumours of myometrium (whorls of SMCs with collagen)
Uterine fibroids
Name a cause of abnormal bleeding during menstruation
Blood coagulation disorders (VW disease, ITP), Reproductive tract diseases (ectopic, malignancy, endometritis, fibroids, lesions), Hypothyroidism, Cirrhosis (ALSO rapid weight change, stress, medication)
Fibroids are what type of tumour, in what cell and where in the uterus?
Benign monoclonal tumour of smooth muscle cells of the uterine myometrium
Are most fibroids intramural, submucosal or subserosal?
Intramural
Name an investigation for Fibroids
FBC (Fe), Pelvic USS or TVUS, MRI, Endometrial sampling, Hysteroscopy, Pregnancy test may be indicated
Name a type of ovarian cyst
Functional cyst (Follicular cysts + Corpus lute cysts), Dermoid Cyst, Cystadenoma, Endometrioma
Name 2 common features for these causes of chronic pelvic pain: Endometriosis IBS Ovarian Cyst Urogenital prolapse
- Endometriosis - Chronic pelvic pain; Dysmenorrhoea; Deep dyspareunia; Subfertility
- IBS - abdominal pain, bloating and change in bowel habit (lethargy, nausea, backache and bladder symptoms may also be present)
- Ovarian Cyst - Unilateral dull ache which may be intermittent or only occur during intercourse (Dyspareunia); Torsion or rupture may lead to severe abdominal pain; Large cysts may cause abdominal swelling
- Urogenital prolapse - (older women) Sensation of pressure, heaviness, ‘bearing-down’; Urinary symptoms: incontinence, frequency, urgency
Name 2 common features for these causes of acute pelvic pain: Ectopic pregnancy UTI Appendicitis PID Ovarian torsion Miscarriage
- Ectopic pregnancy - amenorrhoea with lower abdominal pain and later develops vaginal bleeding (can see shoulder tip pain and cervical excitation)
- UTI - Dysuria and frequency are common but women may experience suprapubic burning secondary to cystitis, haematuria
- Appendicitis - Pain in the central abdomen before localising to the right iliac fossa; Anorexia common; Tachycardia; low-grade pyrexia; Rovsing’s sign
- PID - Pelvic pain, fever, deep dyspareunia, vaginal discharge, dysuria (menstrual irregularities and cervical excitation may occur)
- Ovarian torsion - sudden onset unilateral lower abdominal pain (Onset may coincide with exercise); N+V common; Unilateral, tender adnexal mass
- Miscarriage - Vaginal bleeding and crampy lower abdominal pain following a period of amenorrhoea
Name a treatment for polycystic ovarian syndrome
normalise weight/Tamoxifen (or Clomifene)/Metformin/Laparoscopic ovarian drilling
Name a treatment for tubal disease
tubal catheterisation/adhesiolysis/salpingostomy
Name:
a. ) the Gonadotrophin-releasing hormones and where they are produced
b. ) the Gonadotrophin hormones and where they are produced
c. ) the ovarian hormones that the Gonadotrophins control
a. ) LHRH and FSHRH from Hypothalamus
b. ) LH and FSH from anterior pituitary
c. ) Oestrogen and Progesterone
a. ) During the follicular phase, a rise in FSH stimulates development of several…, while a rise in LH mid-cycle triggers the release of the…
b. ) During the luteal phase, levels of … and … decrease, the ruptured … closes and forms a …, which produces …
a. ) several follicles (on the surface of the ovary); ovum (ovulation)
b. ) LH and FSH, follicle, corpus luteum, progesterone
Name a hormonal treatment for Dysmenorrhoea
Combined Hormonal Contraception (CHC), Oral progesterone-only contraception (Cerazette), Depo-medroxyprogesterone acetate (Depo-Provera®),Levonorgestrel-containing intrauterine system (LNG-IUS; Mirena®)
Name a surgical treatment of dysmenorrhoea
Laparoscopic uterine nerve ablation (LUNA) or Hysterectomy
What is the most often used pharmalogical treatment for pain due to dysmenorrhoea because of its low incidence of side effects?
Ibuprofen
What is the average menstrual blood loss and what would be considered excessive?
Average = 30-40ml; Excessive ≥80ml
What is the first-line pharmacological treatment of Menorrhagia?
LNG-IUS-Mirena (left in situ for 12 months)
Name a surgical treatment for Menorrhagia
Endometrial ablation, Uterine artery embolisation, Hysterectomy
Name 2 risk factors for developing Cervical cancer
Persistence of HPV infection, Heterosexual, Multiple sex partners, Smoking, Immunosuppression, COCP
Name a diagnostic investigation for cervical cancer
Colposcopy, Cone biopsy, CT/MRI/PET pelvis
How might cervical cancer be treated
Surgery (cervicectomy/hysterectomy), radiotherapy (external beam therapy and intracavity brachytherapy), chemotherapy (Cisplatin-based) (adjuvant, concurrent with radiation or palliative)
Most endometrial carcinomas are what type?
Adenocarcinomas