Pelvic masses 2 Flashcards
What is hydrosalpinx and what causes it ?
- A hydrosalpinx is a distally blocked fallopian tube filled with serous or clear fluid. The blocked tube may become substantially distended giving the tube a characteristic sausage-like or retort-like shape. The condition is often bilateral and the affected tubes may reach several centimeters in diameter. The blocked tubes cause infertility.
- Often caused by PID
When tubes filled with pus = pyosalpinx (more seen in the acute phase of PID)
What are the symptoms of hydrosalpinx ?
- Some patients have lower often recurring abdominal pain or pelvic pain, while others may be asymptomatic.
- As tubal function is impeded, infertility is a common symptom. Patients who are not trying to get pregnant and have no pain, may go undetected.
- vaginal discharge dyspareunia
- cervical excitation
- menorrhagia
- dysmenorrhoea
- ectopic pregnancy
Functional cysts are a potential pelvic mass cause but do they often cause pelvic masses ?
- No they dont usually grow over 5cm
- •Usually resolve spontaneously
- •Often asymptomatic/incidental finding.
- •Expectant management appropriate.
- •May be menstrual disturbance
- May bleed or rupture and cause pain
Define what endometriosis is
A common condition characterised by the growth of ectopic endometrial tissue outside of the uterine cavity.
Who is commonly affected by endometriosis ?
- Occurs in 5-10% of women of reproductive age
- Commonly diagnosed in a women in her 30s
What are the common sites endometriosis occurs ?
Usually found within the peritoneal cavity and pelvic organs - Commonly on uterosacral ligaments ==> adenxal mass or tenderness on PV exam may suggest endometriosis
What can endometriosis cause on the ovaries ?
Blood filled cysts (chocolate cysts)
What are the signs/symptoms of endometriosis ?
- Typically associated with severe dysmenhorrhoea - often starting days before menstruation
- Chronic pelvic pain
- Dyspareunia (painful intercourse)
- Often associated with subfertility
- Menhorragia
- Typically tender mass with ‘nodularity’ and tenderness behind uterus.
- Occasionally asymptomatic until large chocolate cyst, which may rupture.
- Period-related/cyclical gastrointestinal symptoms - painful bowel movements or rectal bleeding
- Period-related/cyclical urinary symptoms, in particular, blood in the urine or dysuria
How is endometriosis diagnosed ?
- 1st line = laproscopy
Note - there is little role for investigation in primary care (e.g. ultrasound)- if the symptoms are significant the patient should be referred for a definitive diagnosis
What is the typical appearance of endometriosis seen on laproscopy ?
Looks like ‘match-stick’, ‘powder burns’ or ‘gunshot’ lesions
What is the treatment of asymptomatic endometriosis ?
Do nothing incidental finding
What is the treatment of symptomatic endometriosis with severe pain ?
- 1st line = NSAID’s (ibuprofen, naproxen or mefenamic acid) +/- paracetamol
- 2nd line = if analgesia helpful then hormonal treatments should be trialed - 1st line - COCP, 2nd line progestogens e.g. medroxyprogesterone acetate
Review effectivness of trial after 3-6months
What is the treatment of symptomatic endometriosis with infertility ?
1st line = surgery to excise the endometrial lesions will improve fertility
May need assited conception treatment
What points should you cover in the history of someone presenting with a pelvic mass ?
- Speed of onset/duration of all symptoms
- Mass/swelling/bloatedness
- Pressure symptoms (bladder/bowel)
- Pain (with periods/between periods/dyspareunia)
- Menstrual history (heaviness, cycle, unscheduled)
- Cervical smear history
- Parity and fertility problems.
- Family history.
- Previous gynaecological and surgical history.
- Ovarian cancer symptoms
What examminations should you carry out for pelvic masses after history ?
Abdominal
Speculum and bimanual pelvic
