Pediatric Gynecology Flashcards
T/F if someone has PID you should remove any foreign bodies including IUDs to prevent further infection
false. you do not need to remove an IUD
Most common foreign body injury
toilet paper
Straddle Injuries/Foreign Body
Most common foreign body: toilet paper
Presentation: malodorous discharge, bleeding,
Treatment: Most require no intervention, may use tylenol or ibuprofen.
Vaginal flushing
Examination may be done under anesthesia
Labial/Vulvar Ulcers
Definition: single or multiple shallow ulcers with raised and demarcated borders. Many have grey overlying exudate or adherent grey eschar. Typically on the medial aspect of the labia minora.
Known as “kissing ulcers: usually occurs post viral URTI with fever, takes 7-10 days to resolve.
treatment?
Treatment: ensure the patient can void prior to discharge, use Sitz baths, ice, pain control, pee in the tub, xylocaine jelly.
contributing factors to non-specific vulvovaginitis
Non-Specific Vulvovaginitis
Makes up 25-75% of all vulvovaginitis complaints
Contributing factors: lack of labial development, non estrogenized mucosa, more alkaline pH, poor hygiene, bubble baths, foreign bodies, clothing choice.
Symptoms: vaginal discharge, erythema, soreness, pruritis, dysuria, and bleeding. May be confused with urinary or bowel complaints.
options for heavy menstrual bleeding in young adults (12yo)
Very common. If in ER, ensure pt is stable (less than 1 pad
Baseline blood work should be done: CBC, INR/PTT, TSH, bHCG.
Consider bleeding disorder with frequent nose bleeds, easy bruising. NO need for vWD workup– may be falsely increased in the acute setting.
Treatment: tranexamic Acid. Option 1: high dose estrogen/progesterone IV, option 2: progesterone, Iron.
ovarian torsion symptoms:
__ abdominal pain, __ abdominal pain, __/__
Diagnosis: __ with and without color flow __
Treatment: __ is the preferred surgical approach for adnexal torsion
colicky abdominal pain, unilateral abdominal pain, nausea/vomiting
Diagnosis: ultrasound with and without color flow doppler
Treatment: laparoscopy is the preferred surgical approach for adnexal torsion
3 germ cell layers of teratomas
ecoderm, endoderm and mesoderm
Germ cell tumors: teratomas
Contain 3 germ cell layers – ectoderm, endoderm, mesoderm
Immature malignant teratomas: contains the three germ layers + immature neural or embryonal structures. → very uncommon, less than 1% of ovarian cancers.
Can occur at 1st and 2nd decades of life, very rare after menopause.
if a girl comes in with labial adhesions aka synechiae vulva, you should rule out ___ ___>
liche sclerosis.
treatment for labial adhesions
Symptoms: asymptomatic, pulling sensation, difficulty with urination, recurrent UTIs, recurrent vaginal infections
No treatment if: asymptomatic, involves only a small portion of labia, not affecting the urinary system.
Treatment: topical estrogen cream BID to midline fusion. DO NOT TEAR THE ADHESION
Side effects: minimal breast bud formation, possible vaginal bleeding.
Rarely: surgical intervention for anuria, unable to apply cream, treatment failure.
- Identify how a patient with an imperforate hymen presents, and how to manage her.
Septal Hymen; band in the middle– will still have period, but will have pain during intercourse or putting tampon in.
Imperforate hymen: little openings.
