Pathophysiologies gynae

Question 1

Aetiology/risk factors of Endometriosis

Answer 1

Often unknown, 25-35, rarely in men, 1st degree relatives

Question 2

Most common symptom endometriosis

Answer 2

Pelvic pain, worsening few days before menstruation easing after

Question 3

Other symptoms of endometriosis

Answer 3

Infertility, pain in back, upper leg, feeling of bloating/fullness, aliamentry symptoms such as blood in stools/pain on defecation, dysuria

Question 4

Most common areas of endometriosis

Answer 4

around ovaries, Pouch of douglas

Question 5

Less common areas of endometriosis

Answer 5

around bowel/bladder, sites of operation scars, very rarely brain/lungs

Question 6

what is an endometrioma?

Answer 6

cyst formed from endometriosis, often ‘chocolate cyst’

Question 7

mechanisms adhesions can cause pain

Answer 7

pressure on nerve or ischamia of associated organ

Question 8

What is adenomyosis?

Answer 8

endometriosis within muscle of uterus

Question 9

Gold standard test for dx endometrisosis

Answer 9

exploratory laproscopy of pelvis

Question 10

Why would you take a biopsy in a pelvic laproscopy?

Answer 10

Endometriosis might not always be visible but biopsy will confirm, will confirm absence of tumours causing similar symptoms (eg; ovarian)

Question 11

What might be the findings of a laproscopy in a pt with endometriosis

Answer 11

Many appearances, clear/red/powder burn lesions

Question 12

Other conditions associated with endometrial Ca

Answer 12

Breast/colon Ca, gallbladder disease, Hgh bp, PCOS, Diabetes, obesity

Question 13

Risk factors associated with endometrial Ca

Answer 13

HRT without progesterone, obesity, diabetes, young menarche (below 12), late menopause (above 50), 0 gravida, endometrial polyps, tamoxifen, infreq periods

Question 14

Symptoms Endometrial Ca

Answer 14

Abnormal vaginal bleed (between periods, after menopause, heavy/frequent after 40, lower abdo pain, vaginal discharge after menopause

Question 15

Signs of excessive vaginal bleedig

Answer 15

soaking sanitary products every hour consequtively, doubling up sanitary products, symptoms of anaemia, passing clots

Question 16

normal menstrual bleeding should last how long and what quantity

Answer 16

3-4 days, 30-80ml

Question 17

causes dysmenorrhea

Answer 17

fibroids,endometriosis, PID, ovarian cyst/tumour, IUD

Question 18

causes of bleeding between periods

Answer 18

fibroids, cervial/uterine Ca/polyps, PID, IUD, ectopic pregnancy/miscarriage, recent start contraceptive pill, hypo thyroid, anticoagulants

Question 19

How can thyroid disorders affect menstrual flow?

Answer 19

Hypothyroidism, longer, heavier periods, earlier onset of menarche, hyper, opposite

Question 20

What happens during the menstrual phase of cycle and how long does it last?

Answer 20

days 0-4, shedding of menstrual lining

Question 21

What happens during the follicular stage of the cycle when does it occur?

Answer 21

Days 4-13/14, follicular maturation, endometrial thickening

Question 22

What happens during the luteal/secretory stage of the cycle and when does it occur

Answer 22

development of corpus luteum causing increased progesterone levels preparing uterus for implantation

Question 23

normal menstrual cycle lasts…

Answer 23

21-35 days

Question 24

Menstrual cycle is longest

Answer 24

pre-puberty and post menopause

Question 25

LH surge precedes ovulation by approx

Answer 25

24-36 hours

Question 26

LH stimulates …. and FSH stimulates …. Current theory suggests that…

Answer 26

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)

Question 27

which phase of the menstrual cycle is the most fixed?

Answer 27

luteal, usually at 14 days, can be less/more but usually remains constant through a woman’s life