Paediatric and Adult Gynaecology Flashcards
Definition of the Gillick Competence
Child < 16 years can give/withhold consent if the doctor feels that they are fully understanding of what is involved in an intervention
Definition of Fraser Competence
A doctor can prescribe contraception/give contraceptive advise to a girl <16 y/o if
- mature enough to understand advise and the implications of treatment
- girl likely to begin or continue to have sex with or without treatment
- doctor try to get her to inform parents or allow him to inform them
- girls health would summer without treatment/advise
- in the girls best interests to give treatment/advise
When to investigate primary amenorrhoea
Normal secondary sexual characteristics - investigate at age 16
Absent secondary sexual characteristics - investigate at age 14
Investigations prior to referral for amenorrhoea
FSH, LF, PRL, TSH, testosterone, oestrogen
Pelvic USG
Progesterone withdrawal bleed (pregnancy, not enough oestrogen)
Cyclical abdominal pain
Puberty induction treatment
Gradual build up of oestrogen (until stopped growing so breast shape is not altered)
Then add progesterone once the max height potential is reached
Secondary amenorrhoea definition
Had periods before and now they have stopped
Causes of secondary amenorrhoea
Weight gain (obstructed uterus)
PCOS
Pregnancy
Fluctuating LH/oestrogens
Menorrhagia definition
Heavy periods
Possible treatments of menorrhagia
POP Tranexamic acid Medenamic acid COC Mirena (usually when cant take pills)
Length of treatment in a patient for menorrhagia
A year or so then come off it as it will have settled down
Presentation of accidents to cysts
Subacute history
Usually tender to one side of the pelvis or behind
Uterus may feel a mass
Vulvovaginitis causes
Foreign body (e.g. toys)
Playing with genitals
Sexual abuse
Urinary incontinence
Age that you would get vulvovaginitis
2-7 years old
Labial agglutination definition
Adhesion of labia minora in midline (usually)
Presentation of labial agglutination
Vulvovaginitis
Retention of urine
Retention of vaginal secretions
UTI
Treatment of labial agglutination
Improve hygiene may all be thats needed
treatment indicated if chronic vulvovaginitis or difficulty urinating
lubrication of labia with a bland ointment
topical oestrogen
surgical separation (rarely necessary)
Vaginal discharge is common in
Infants up to 2 weeks after birth resulting from maternal oestrogen
Prepubertal girls who experience increasing oestrogen produced by maturing ovaries
Episiotomy definition
Surgically planned incision on the perineum and posterior vaginal wall during the second stage of labour
Purposes of episiotomy
Help normal vaginal birth
Help prevent tears towards the back passage
Angles of episiotomy
Midline towards anus
Mediolateral
Caesarean section definition
Delivery of the foetus through an incision in the abdominal and uterine walls
Reasons for a hysterectomy
Fibroids
Malignancy
Heavy bleeding
Endometriosis
The 3 approaches to hysterectomy
Open laparotomy
Laparoscopy
Transvaginal
Endometritis vs Endometriosis
Endometritis = inflammation of endometrium Endometriosis = a medical condition
Most common causes for Pelvic inflammatory Disease
Chlamydia
Gonorrhoea
Mycoplasma Genitalium
Risk factors for pelvic inflammatory disease
If have more than 1 sexual partner Have a new sexual partner Have a history of STIs Have had PID in the past under 25 y/o Started having sex at a young age
Definition of vulvovaginitis
Inflammation of the vulva and the vagina
Presentation of PID
Pelvic pain Fever Deep dyspareunia Vaginal discharge Dysuria Menstrual irregularities Cervical excitation on examination
Presentation of ovarian torsion
Sudden onset lower unilateral abdominal pain
Nausea and vomiting
On examination
- unilateral, tender adnexal mass
What may the onset of ovarian torsion coincide with?
Exercise
Presentation of an ovarian cyst
Intermittent pain Iliac fossa pain Pain worse during intercourse Urinary frequency Feeling bloated
Causes of vaginal discharge
Common - physiological - candida - trichmonas vaginalis - bacterial vaginosis Less common - gonnorhoea - chlamydia - ectropion - foreign body - cervical cancer
Key features of candida
Cottage cheese discharge
Vulvitis
Itch
Associated with pain during sex
Key features of trichomoniasis vaginalis
Offensive, yellow/green, frothy discharge
Vulvovaginitis
Strawberry cervix
Key features of bacterial vaginosis
Offensive, thin white/grey “fishy discharge”
How many women with bartholins abscess are pyrexial?
1 in 5
Presentation of bartholins abscess
Worsening perineal pain Severe pain May have fever Mass Erythmatous skin overlying mass
Treatment of bartholins abscess
Marsupialisation procedure
What are bartholins glands?
Pair of glands located at entrance to the vagina
How does the uterus feel, fibroids vs adenomyosis?
Fibroids - bulky uterus
Adenomyosis - boggy uterus with subendometrial linear striations
