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REPRO > Pelvic Mass > Flashcards

Pelvic Mass Flashcards

1
Q

When is shifting dullness useful?

A
  • with minimal fluid

500ml

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2
Q

Situations when CA125 is elevated?

A
  • endometriosis
  • pleural effusion
  • uterine fibroids
  • ovarian cancer
  • pancreatitis
  • ASCITES of any cause; liver cirrhosis
  • PID
  • peritonitis
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3
Q

When is CA125 produced?

A
  • the mesothelial cell on the ovarian surface/ pleural surface/ peritoneum are stimulate
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4
Q

What demographic gr. is predisposed to functional cysts?

A
  • pre-menopausal women
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5
Q

SYmptoms of endometriosis ?

A
  • period-related GI symptoms (painful BOWEL movements)
  • period-related urinary symptoms (BLOOD in urine)
  • severe DYSMENORHEA
  • PMENSTRUAL pain
  • dyspareunia and pain AFTER sex

– infertility a.w with one of the above

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6
Q

What is a dermoid cyst?

A
  • d.t totipotent cells= can differentiate into any cells

can have thyrotocxicosis /teeth/

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7
Q

How to manage ovarian benign tumors?

A
  • do not treat unless there are symptoms
  • how to preserve fertility
    MEDICAL: GnRH analogues, OCP
    SURGERY: laparotomy/ laparoscopic
    cystecomty
    oopherectomy —BCRCA (uni-/b.l)
    pelvic clearance
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8
Q

Symptoms of torsion?

Sign seen on transvaginal ultrasound with Doppler flow?

A
  • 20-40 y.o pt with ACUTE abdomen and relevant hx
  • SYNCOPAL attacks
  • N.V
  • lack of blood flow to the ovary
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9
Q

First line management of raised CA125?

A

USS

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10
Q

What are appendicile tumors a.w?

A
  • ovarian tumors
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11
Q

Recent stroke should be a deterrent for operations? True?

A

YES

- HIGH morbidity for post-op in those with RECENT CVA

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12
Q

Teenager with LARGE ovarian mass? Likely to be _________

A
  • germ cell tumors

teenager with LARGE malignant mass- REMOVE IT

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13
Q

Common ovarian tumors in post-menopausal women?

A
  • serosal tumors

High-grade

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14
Q

How to manage ovarian cancer in young women?

A
  • FERTILITY SPARING for young women (unilateral salpingoopherectomy +/- chemo)
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15
Q

What is important in early disease?

A
  • conduct a thorough explorative laporotomy (have a feel of the lnear by organs)
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16
Q

What is borderline ovarian tumors?

A
  • less aggressive
    can spread
    -less invasive (10-20 years)
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17
Q

BOWEL causes of pelvic masses

A
  • constipation
  • caecal carcinoma
  • appendix abscess
  • diverticular abscess
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18
Q

Urological causes of pelvic mass?

A
  • urinary retention

- benign/ malignant growth in bladder

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19
Q

What blood tests should be done for pelvic masses?

A
  • FBC
  • U&Es
  • LFTs
  • RFTs
  • CA125
  • LDH
  • AFP
  • HCG
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20
Q

What is RMI?

A
  • aka Risk of Malignancy Index
  • score is given based on:
    1. menopausal status
    2. Ultrasound ovarian features
    3. actual Ca125
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21
Q

What does it mean to have an RMI of > 200 ?

A
  • 3 out of 4 pts WILL have OC
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22
Q

If RMI is between 30-200?

A

0.2% chance

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23
Q

What FURTHER INVESTIGATIONS can be performed after an USS is done for a pelvic mass?

A
  • CT
  • MRI
  • Hysteroscopy
  • Diagnostic laparoscopy
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24
Q

What does the CT scan pick up on?

A
  • useful for retroperitoneal structures (LYMPH nodes)

- useful as a BIRD’S eye view of ALL organs in the pelvis and abdomen

25
Q

When is the MRI used?

A
  • for FINER details of SOFT tissue masses

can identify components of cyst, endometrioma, PCOS, extent of cancer invasion

26
Q

Name a germ cell tumor.

A

benign cystic teratoma

dermoid cyst

27
Q

Name benign ovarian tumors arising from the STROMA.

A

FIBROMA

beware of MEIG’s Syndrome

28
Q

What cells are part of the stroma and how may that affect the hormones released?

A
  • Granulosa cell= secretes Estrogen

- Theca/ leydig cells= secrete androgens

29
Q

Name primary benign ovarian tumors arising from the surface epithelium.

A
  • serous
  • mucinous
  • endometroid
  • brenner
  • clear cell
30
Q

What is Meig’s Syndrome?

A
  • involves a benign ovarian fibroma a.w ASCITES +/- pleural effusion
31
Q

What is MEIG $ often confused with?

A
  • a benign ovarian fibroma may be confused with stage 4 Ovarian Cancer
32
Q

What is the prognosis of functional cysts?

A
  • <5cm
  • incidental finding
  • resolves spontaneously
33
Q

What are functional cysts a.w?

A

ovulation!

34
Q

Name 2 functional cysts.

A
  • follicular cysts

- luteal cysts

35
Q

What may functional cysts cause?

A
  • menstrual dist
    urbance
  • may BLEED/ rupture and cause PAIN
36
Q

How to manage functional cysts?

A
  1. Watchful waiting

2. surgery (if potentially cancerous/large/persistent)

37
Q

What are the signs of endometriotic cysts?

A
  1. severe dysmenorrhea
  2. premenstrual pain
  3. Dyspareunia
    - —occasionally asymptomatic, until its a LARGE chocolate cyst and it ruptures
38
Q

What are the clinical findings of the endometriotic cysts?

A

subfertility

  • tender mass with NODULARITY and tenderness behind the uterus
  • “boggy uterus”
39
Q

What maybe seen in a dermoid cyst?

A
  • teeth, sebacious material, hair, thyroid tissue
40
Q

Which surgeries may be performed?

A
  • ovarian cystectomy
  • unilateral/B.L oopherectomy
  • pelvic clearance
41
Q

When may surgeries be performed?

A
  • in acute presentation

- –torsion/rupture/ Hemorrhage

42
Q

Describe the ways in whcih ovarian cancer may present as.

A
  • heartburn
  • early SATIETY
  • wgt LOSS
  • BLOATING
  • pressure symptoms (freq. and urgency)
  • SOB/ pleural eff.
  • leg edema (DVT)
43
Q

Where ovarian Ca said to spread to?

A
  • early transperitoneal spread
  • deposits on MULTIPLE peritoneal surfaces
  • —OMENTAL infiltration
  • —> MALIGNANT ascites with protein exudates
44
Q

How is one dx with ovarian cancer?

A
  • non-gynaecologically

- —d.t insidious path

45
Q

How to manage germ cell tumors?

A
  • Fertility sparing, unilateral salpingoopherectomy +/- chemotherapy
46
Q

What is the aim of surgery?

A
  • total macroscopic DEBULKING of tumor

v. impotant for prognosis

47
Q

What is meant by staging via midline incisions in ovarian cancer?

A

—-done through MIDLINE incisions (allows palpation of ALL peritoneal surface)

48
Q

What is the AIM of staging via midline incision?

A
  • to exclude disease involving the LIVER, spleen, peritoneum, retroperitoneal nodes, appendix, diaphragm
49
Q

Define cytoreduction.

A
  • to remove AS many cancerous cells as possible

- –optimal cytoreduction: when there is no VISIBLE disease left behind

50
Q

What is given PRIOR to the sugrical procedure?

A
  • NEOADJUVANT chemotherapy (to shrink the cancer)
51
Q

What is supraradical surgery for ovarian cancer?

A
  • removal of supracolic omentum, peritoneal ablation, removal of the SPLEEN +/- large/ small bowel resection
52
Q

Name sources IIary ovarian tumors.

A
  • BREAST, STOMACH, PANCREAS, GI primaries
53
Q

What is a kruckenbrug tumor?

A
  • metastasis from the STOMACH

- —-characteristic SIGNET ring on histology

54
Q

What are borderline ovarian tumors?

A
  • less aggressive
  • can spread transcoelomic
  • —-risk of recurrence (5-10% in the long run)
55
Q

Most common symptom of fibroids?

A
  • Abnormal Uterine Bleeding

- —presents with PRESSURE symptoms

56
Q

Which group of people are leiomyomas seen in?

A
  • ladies >40y.o

- –very COMMON

57
Q

What pressure symptoms may be seen with Fibroids?

A
  • dyspareunia
  • pelvic pain
  • constipation
  • urinary symptoms
58
Q

What surgical rx can be done for fibroids?

A
  • laproscopic/ laparotomy
  • myomectomy
  • subtotal hysterectomy
  • total hysterectomy
59
Q

What medical interventions for fibroids?

A
  • GnRh analogues
  • Mirena
  • Progestins

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