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Gynaecology > Pelvic pathology > Flashcards

Pelvic pathology Flashcards

1
Q

What are the DDx of acute pelvic pain?

A

1) Preg
- Obs: labour, placenta abruptio, ligamentous pain
- Gyn: ruptured ectopic pregnancy, miscarriage / septic abortion, red degeneration of fiborid
2) Mass: ovarian cyst, pedunculated fibroid cx
3) Inf: PID, tubo-ovarian abscess
4) Others: appendicits, UTI/AROU

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2
Q

What are the DDx of chronic pelvic pain?

A

Gyne: PID, pelvic adhesion, post-operative pain, mass (endometriosis, adenomyosis, fibroid)
GI: IBS/IBD, diverticulitis, CRC
UG: chronic urethral syndrome, intestitial cystitis
Others: MSK, psycho

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3
Q

What are the DDx of central acute pelvic pain?

A

Uterus: fibroid, miscarriage, endometritis

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4
Q

What are the DDx of unilateral acute pelvic pain?

A

Ovary: cyst Cx
Tubal: ectopic pregnancy, tubo-ovarian abscess
RLQ: appendicitis

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5
Q

What are the DDx of sharp acute pelvic pain?

A

Ectopic pregnancy

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6
Q

What are the DDx of persistent acute pelvic pain?

A

Ectopic pregnancy
Ovarian cyst rupture
PID

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7
Q

What are the DDx of contractile acute pelvic pain?

A

Miscarriage

Protruding submucosal fibroid

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8
Q

What are the DDx of colicky acute pelvic pain?

A

Ovarian torsion

Colic (bowel, ureter)

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9
Q

What are the DDx of acute pelvic pain + PVB?

A

Pregnancy (miscarriage, ectopic)
Uterine / cervical (e.g. submucosal fibroid)
PID (IMB, post-coital B, breakthrough B)

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10
Q

What are the DDx of acute pelvic pain + fever?

A

Septic abortion
Acute PID
Appendicitis, UTI

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11
Q

What are the DDx of acute pelvic pain + hemodynamic compromise?

A

Ruptured cyst, ectopic pregnancy

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12
Q

What is uterine fibroid / leiomyoma?

A

Benign monoclonal tumors from sm cells & fibroblasts of myometrium

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13
Q

What is the prevalence of uterine fibroids?

A

MC gyne tumor
25% of women of reproductive age
Increases w/ age

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14
Q

What is the chance of malignant transformation of uterine fibroids?

A

Rare (<0.1%)

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15
Q

What affects the size of uterine fibroids?

A

Estrogen-dependent growth

  • Size increases w/ exogenous estrogen
  • Decreases w/ menopause
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16
Q

What are the types of fibroids?

A

Intramural (MC): menorrhagia, pressure symptoms
Submucosal: menorrhagia, dysmenorrhea, infertility -> 3 ESH subtypes
Subserosal: risk of torsion
Cervical (LC): menorrhagia, obst bladder

17
Q

What are the S/S of uterine fibroids?

A

Hx

1) Acute pain
2) Menses (menorrhagia, dysmenorrhea)
3) Pressure symptoms (abd discomfort, urinary freq/retention, constipation)
4) Subfertility
5) Pregnancy: red degen (acute localized uterine pain in 2nd/3rd trimester), miscarriage/preterm/malpresentation, PPH

PE

  • Abd: enlarged uterus (asm vs sym)
  • Bimanual: prolapsed submucosal fibroid
18
Q

How to Ix uterine fibroids?

A

USG pelvis: distinct mass w/ capsule
Hysteroscopy & saline infusion sonography: for submucosal fibroid
MRI

19
Q

How to Mx uterine fibroids?

A

x symp: expectant, medical (for menorrhagia)
Small fibroid <5cm: hysteroscopic myomectomy
Large fibroid >5cm OR sig symp: fertility wish (myomectomy), x fertility wish (hysterectomy), x fit for surg (UAE)

20
Q

What is endometriosis?

A

Endometrial tissue outside of uterine cavity

21
Q

What are the factors affecting the growth of endometriosis?

A

Increase: estrogen
Protective: pregnancy, lactation

22
Q

What is the prevalence of endometriosis?

A

10-20% of females

Increasing b/c fewer pregnancies and more late pregnancies

23
Q

What is the pathogenesis of endometriosis?

A

Sampson’s theory: retrograde flow of menstrual tissue through tube -> transported trans-abdominally

24
Q

What is the gross pathology of endometriosis?

A

Red: recent hemorrhage
Blue: hemosiderin
White: fibrotic tissue

25
Q

What are the S/S of endometriosis?

A

Dysmenorrhea, deep dyspareunia, chronic pain (lower back & iliac fossa)
Infertility: ovarian scarring, tuboperitoneal adhesion
Mass symptoms (endometrioma)
Others: cyclical hematuria/dysuria, PRB/pain, hemoptysis/hemopneumothorax

26
Q

How to Ix endometriosis?

A

Diagnostic laparoscopy

TVS for endometrioma: ovarian cyst, homogenous & low-level internal echoes, ground glass appearance, x papillary growth

27
Q

How to Mx endometriosis?

A

Mild: NSAID PRN
Med: first line (progestogens, COCP), 2nd line (GnRH agonist)
Surg (>3cm)
- Fertility preserving: endometrial ablation w/ diathermy +/- adhesiolysis
- x fertility preserving: hysterectomy +/- oophorectomy
- Laparoscopic ovarian cystectomy
- Post op hormonal therapy

28
Q

What is adenomyosis?

A

Ectopic endometrial tissue within endometrium -> reactive hypertrophy of surrounding sm
MC post wall of uterus

29
Q

What are the forms of adenomyosis?

A

Diffuse (MC)

Foci

30
Q

What is adenomyosis associated w/?

A

Gyn: fibroid, endometriosis, endometrial hyperplasia/polyps, adenocarcinoma
Obs: 2x risk of miscarriage, 30% reduction in live birth rate, 30% reduction in successful ART

31
Q

What are the S/S of adenomyosis?

A

Menorrhagia (x resp to hormonal therapy)
Secondary dysmenorrhea
Subfertility, TOP
PE: uniformly enlarged uterus

32
Q

How to Ix adenomyosis?

A

USG: globularly enlarged endometrium w/ cystic spaces

33
Q

How to Mx adenomyosis?

A

Med: mirena
Surg: standard (total hysterectomy +/- ovarian conservation), non-standard (adenomyomectomy)
UAE (high recurrence rate)

34
Q

What are follicular cysts?

A

After failed ovulation

35
Q

What are corpus luteal cysts?

A

After ovulation

Small w/ clear fluid

36
Q

What are theca luteal cysts?

A

Under excessive hCG stimulation e.g. OI, molar pregnancy

Formed within theca layer of cells surrounding oocytes

37
Q

What are dermoid cysts?

A 
aka mature teratoma (benign)
Very mobile -> torsion
Contains at least 2 germ layers
Contains skin tissue & clumps of long hair
USG: term-line echogenecity

Gynaecology (4 decks)

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