Pelvic masses 2 Flashcards

1
Q

What is hydrosalpinx and what causes it ?

A
  • 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)

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2
Q

What are the symptoms of hydrosalpinx ?

A
  • 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
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3
Q

Functional cysts are a potential pelvic mass cause but do they often cause pelvic masses ?

A
  • 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
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4
Q

Define what endometriosis is

A

A common condition characterised by the growth of ectopic endometrial tissue outside of the uterine cavity.

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5
Q

Who is commonly affected by endometriosis ?

A
  • Occurs in 5-10% of women of reproductive age
  • Commonly diagnosed in a women in her 30s
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6
Q

What are the common sites endometriosis occurs ?

A

Usually found within the peritoneal cavity and pelvic organs - Commonly on uterosacral ligaments ==> adenxal mass or tenderness on PV exam may suggest endometriosis

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7
Q

What can endometriosis cause on the ovaries ?

A

Blood filled cysts (chocolate cysts)

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8
Q

What are the signs/symptoms of endometriosis ?

A
  • 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
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9
Q

How is endometriosis diagnosed ?

A
  • 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

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10
Q

What is the typical appearance of endometriosis seen on laproscopy ?

A

Looks like ‘match-stick’, ‘powder burns’ or ‘gunshot’ lesions

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11
Q

What is the treatment of asymptomatic endometriosis ?

A

Do nothing incidental finding

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12
Q

What is the treatment of symptomatic endometriosis with severe pain ?

A
  • 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

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13
Q

What is the treatment of symptomatic endometriosis with infertility ?

A

1st line = surgery to excise the endometrial lesions will improve fertility

May need assited conception treatment

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14
Q

What points should you cover in the history of someone presenting with a pelvic mass ?

A
  • 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
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15
Q

What examminations should you carry out for pelvic masses after history ?

A

Abdominal

Speculum and bimanual pelvic

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16
Q

After examminations for pelvic masses what should you move onto ?

A

Investigations depending on the type of pathology you think it occuring these all might be useful exmminations:

  • Hb
  • WCC/CRP if suspect inflammatory mass
  • Biochemistry esp serum albumin
  • Tumour markers (CA125, CEA, HCG,AFP)
  • (CXR)
  • Ultrasound TA/TV
  • +/- MRI (for fibroids/uterine mass)
  • +/-CT (for suspected ovarian Ca)
  • +/- CT/US guided tissue biopsy.