Pelvic Pain and benign gynaecology Flashcards
Marsupialisation is used to treat which condition?
bartholin’s cyst
acute infection
Define fibroids
benign tumours of myometrium= oestrogen dependent tumour
List two sites of fibroids
sub-mucosal
intramural
sub-serosal
What happens to fibroids during pregnancy and menopause?
grows during pregnancy
shrinks after menopause
What is red degeneration?
miscarriage due to fibroids
What are the symptoms of fibroids?
heavy menstrual bleeding
abdo swelling
pressure symptoms
pain- torsion
How to diagnose fibroids?
confirm by USS
MRI to plan management
What is the management of fibroids?
medical
- HMB
- GnRH prior to surgery
surgical- hysterectomy, myomectomy
uterine artery embolisation
Name two benign conditions of the uterus
polyps
fibroids
Name two benign conditions of the vulva
bartholin cyst
lichen sclerosis
genital herpes
Name two benign fallopian tube conditions
hydrosalpinx
pelvic inflammatory disease
What are the causes of pelvic inflammatory disease?
chlamydia
e.coli
anaerobes
What are the risks of blockage in fallopian tubes?
infertility
ectopic pregnancy
chronic pelvic pain
Symptoms of pelvic inflammatory disease?
malaise
pain during sex
lower abdo pain (bilateral)
variable discharge
List three signs of PID?
pyrexia
tachy
distension and tenderness
RUQ
rebound and guarding
What is Fits-Hugh-curtis syndrome?
peri hepatic inflammation from PID
What are the investigations for PID?
pregnancy test
FBC +CRP
MSU- exclude UTI
STI swabs
Laparoscopy
What is the management of PID?
empircal antibiotics broad spectrum (don’t wait for swab)
pain relief
Which abx used for pelvic inflammatory disease?
ceftriazone 500 mg IM stat then doxy + metronidazole
Define hydrosalpinx
Hydrosalpinx is the condition in which the end portion of a woman’s fallopian tube becomes fluid-filled and swollen, which can cause infertility.
How are cysts diagnosed?
USS or CT or MRI
Ca125 and other markers- CEA, aFP, hCG
What is the management of ovarian cyst?
conservative
remove if >6cm and/or symptomatic
ovarian cystectomy or oopherectomy
laparoscopic if possible
List three types of ovarian cysts
functional cyst
dermoid cyst
epithelial cyst
endometriotic cyst
What is dermoid cyst also known as?
benign cystic teratoma
What are the tumour markers to assess for in ovarian cyst?
Ca125, AFP, HE4
Which accidents are associated with cysts?
torsion
rupture
Investigations for cysts
pregnancy test
MSU
vaginal swabs
FBC +CRP
Ca125
TV USS
laparoscopy
What are the three types of endometriosis?
superficial peritoneal lesions
deep infiltrating lesions
ovarian cysts (endometriomas)
What is the treament of lichen sclerosis?
dermovate= potent steroid
Which virus causes genital herpes?
HSV-2
What is the management of genital herpes?
aciclovir 5-10 days
increase fluid intake
vaseiline or lidocaine for painful micturation
salt water to prevent infection and promote healing
What are the symptoms of endometriosis?
dysmenorrhoea
dyspareunia
pelvic pain
subfertility
How is endometriosis diagnosed?
transvaginal USS
How to manage endometriosis?
conservative
NSAIDs
Progesterone
OCP
Surgical
IVF
Define nulliparous
“Nulliparous” is a fancy medical word used to describe a woman who hasn’t given birth to a child.
What is a complication of herpes that affects the vulva?
post-herpetic neuralgia= hypersensitivity of vulval nerve fibres
Treatment= tricyclic antidepressants
What is the management of chronic pelvic pain syndrome?
antispasmodics IBS
NSAIDs MSK
specialist referral
MDT- chronic pain services, pschology, physio, pscyhosexual therapy, self help groups
30 year old female patient presents with acute lower abdominal pain. What are the gynaecological differentials?
cyst accident
pelvic inflammatory disease
ectopic pregnancy
35 year old female patient with chronic lower abdo pain. What are your differentials?
endometriosis
chronic pelvic pain syndrome CPP
What are the ligaments of the uterus?
broad (peritoneum)
ovarian
uterine ligaments
