Pathophysiologies gynae Flashcards
Aetiology/risk factors of Endometriosis
Often unknown, 25-35, rarely in men, 1st degree relatives
Most common symptom endometriosis
Pelvic pain, worsening few days before menstruation easing after
Other symptoms of endometriosis
Infertility, pain in back, upper leg, feeling of bloating/fullness, aliamentry symptoms such as blood in stools/pain on defecation, dysuria
Most common areas of endometriosis
around ovaries, Pouch of douglas
Less common areas of endometriosis
around bowel/bladder, sites of operation scars, very rarely brain/lungs
what is an endometrioma?
cyst formed from endometriosis, often ‘chocolate cyst’
mechanisms adhesions can cause pain
pressure on nerve or ischamia of associated organ
What is adenomyosis?
endometriosis within muscle of uterus
Gold standard test for dx endometrisosis
exploratory laproscopy of pelvis
Why would you take a biopsy in a pelvic laproscopy?
Endometriosis might not always be visible but biopsy will confirm, will confirm absence of tumours causing similar symptoms (eg; ovarian)
What might be the findings of a laproscopy in a pt with endometriosis
Many appearances, clear/red/powder burn lesions
Other conditions associated with endometrial Ca
Breast/colon Ca, gallbladder disease, Hgh bp, PCOS, Diabetes, obesity
Risk factors associated with endometrial Ca
HRT without progesterone, obesity, diabetes, young menarche (below 12), late menopause (above 50), 0 gravida, endometrial polyps, tamoxifen, infreq periods
Symptoms Endometrial Ca
Abnormal vaginal bleed (between periods, after menopause, heavy/frequent after 40, lower abdo pain, vaginal discharge after menopause
Signs of excessive vaginal bleedig
soaking sanitary products every hour consequtively, doubling up sanitary products, symptoms of anaemia, passing clots
normal menstrual bleeding should last how long and what quantity
3-4 days, 30-80ml
causes dysmenorrhea
fibroids,endometriosis, PID, ovarian cyst/tumour, IUD
causes of bleeding between periods
fibroids, cervial/uterine Ca/polyps, PID, IUD, ectopic pregnancy/miscarriage, recent start contraceptive pill, hypo thyroid, anticoagulants
How can thyroid disorders affect menstrual flow?
Hypothyroidism, longer, heavier periods, earlier onset of menarche, hyper, opposite
What happens during the menstrual phase of cycle and how long does it last?
days 0-4, shedding of menstrual lining
What happens during the follicular stage of the cycle when does it occur?
Days 4-13/14, follicular maturation, endometrial thickening
What happens during the luteal/secretory stage of the cycle and when does it occur
development of corpus luteum causing increased progesterone levels preparing uterus for implantation
normal menstrual cycle lasts…
21-35 days
Menstrual cycle is longest
pre-puberty and post menopause
LH surge precedes ovulation by approx
24-36 hours
LH stimulates …. and FSH stimulates …. Current theory suggests that…
LH stimulates Theca cells and FSH stimulates Granulosa cells, current theory is that LH stimulates production of androgens from cholesterol and FSH stimulates conversion of these to oestrogens (E2 and oestradiol)
which phase of the menstrual cycle is the most fixed?
luteal, usually at 14 days, can be less/more but usually remains constant through a woman’s life
