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Gynae > Pelvic Problems > Flashcards

Pelvic Problems Flashcards

1
Q

When does Ovarian Cyst torsion commonly occur?

A

Younger patients
Post-menopausal patients
Puerperium

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2
Q

What are some symptoms of Ovarian Cyst Torsion?

A 
Unilateral Lumbar/Abdominal Pain
Duration >8h
Vomiting
NO Uterine Bleeding
Pyrexia
Tachycardia
Guarding 
Cervical Excitation
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3
Q

How is Ovarian Cyst Torsion diagnosed?

A

Pelvic USS

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4
Q

How should confirmed Ovarian Cyst Torsion be managed?

A

Laparoscopic detorsion +/- Oophorectomy

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5
Q

What are some potential complications of Ovarian Cyst Torsion?

A

Loss of function of the affected Ovary
Infection
Abscess
Perforation - Peritonitis and Adhesions

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6
Q

What happens to Fibroids during pregnancy that leads to their degeneration?

A

Fibroids grow rapidly exceeding their usual blood supply, leading to ischaemic and associated pain

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7
Q

Why is degeneration of Fibroids common during pregnancy?

A

Hormonal Stimulation found during pregnancy encourages excessive growth of the Fibroids

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8
Q

How does degeneration of Fibroids present?

A

Constant Dull Pain that responds to Opioids
Palpable mass
Raised inflammatory markers

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9
Q

What is the mainstay of management for Degenerated Fibroids?

A

Conservative

Surgical if ? Fibroid Torsion

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10
Q

What is Pelvic Inflammatory Disease?

A

Ascending infection from the endocervix commonly found in 15-24y

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11
Q

Which organisms are usually responsible for PID?

A

Chlamydia

Gonorrhoea

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12
Q

What are risk factors for developing PID?

A 
No use of Barrier Contraception
Previous PID
Early age of first intercourse
Multiple partners
DM
Immunocomprimise
Endometriosis
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13
Q

What are some symptoms suggestive of PID?

A 
Asymptomatic
Lower abdominal pain
Pyrexia
Vaginal discharge 
Dyspareunia
Intramenstrual and Post-Coital Bleeding
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14
Q

Which investigations would be appropriate for suspected PID?

A 
Pregnancy test
Bloods
MSU
Triple Swabs
USS
XR if ?Bowel Involvement
Diagnostic Laparoscopy
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15
Q

How should Mild-Moderate PID be managed?

A

Outpatient:
500mg IM Ceftriaxone Stat
Doxycycline 100 mg and Metronidazole 400mg BD PO for 14 days

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16
Q

How should Severe/Septic PID be managed?

A

Inpatient
IV Ceftriaxone 2g daily and Doxycycline 100mg BD IV
2W oral Doxycycline 100mg and Metronidazole 400mg BD PO

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17
Q

What is Endometriosis?

A

Endometrial glands are located outside the Uterus which respond to hormones giving Cyclical changes and pain

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18
Q

What is Adenomyosis?

A

Endometrial tissue is found within the myometrium. Presents with Pelvic Pain and Heavy Menstrual Bleeding

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19
Q

What are some symptoms of Endometriosis?

A 
Dysmenorrhoea
Dyspaerunia
Dyschezia
Dysuria
HMB, IMB, PCB
Persistent lower abdominal pain
Epistaxis
Rectal Bleeding
20
Q

What are some signs suggestive of Endometriosis?

A

Fixed retroverted uterus

Forniceal/Uterine tenderness

21
Q

How should suspected Endometriosis be investigated?

A

Pelvic USS

Diagnostic Laparoscopy - Gold standard

22
Q

What medical management options are available for confirmed Endometriosis?

A

Hormonal Therapy - COCP, GnRH, HRT

Tranexamic Acid

23
Q

What surgical management options are available for confirmed Endometriosis?

A

Hysterectomy

Diathermy +/- Laser

24
Q

Which criteria are used to assess for IBS?

A

Rome III Criteria

25
Q

What are the Rome III Criteria?

A

Continuous/Recurrent abdominal pain 3 days a month for 3m
Onset more than 6m ago
Improvement in symptoms after defecation
Associated with a change in form and frequency of stool

26
Q

What occurs in a Vaginal Prolapse?

A

Descent of some of the pelvic organs into the Vagina

27
Q

How are different Vaginal Prolapses defined?

A

Anterior - Urethrocoele and Cystocoele
Central - Cervix/Uterus
Posterior - Rectocoele and Enterocoele

28
Q

What are some risk factors for a Vaginal Prolapse?

A 
Childbirth
Menopause
Congenital
Suprapubic Surgery
Genetic
29
Q

What are some symptoms of a Vaginal Prolapse?

A 
Dragging feeling
"Something coming down"
Urinary Sx and Incontinence
Bleeding/Discharge
Bowel Sx
30
Q

What are some signs of a Vaginal Prolapse?

A

Atrophic Vulval Changes

Urinary leakage

31
Q

What are the three Primary management options for a Vaginal Prolapse?

A

Conservative
Vaginal Pessary
Surgery

32
Q

What is the conservative management option for a Vaginal Prolapse?

A

Pelvic Floor Exercises

33
Q

Which surgical options are available for management of a Vaginal Prolapse?

A

Anterior Vaginal Wall Repair
Vaginal Hysterectomy
Posterior Vaginal Wall Repair

34
Q

What is Urinary Incontinence?

A

Involuntary loss of urine

35
Q

What are the different types of Urinary Incontinence?

A

Stress Urinary Incontinence
Overactive Bladder
Urinary Retention with Overflow
Fistula

36
Q

What is Stress Urinary Incontinence?

A

Leakage of urine associated with a rise in intra-abdominal pressure

37
Q

What are some risk factors for Stress Urinary Incontinence?

A 
Pregnancy
Prolapse
Menopause
Collagen disorders
Obesity
38
Q

What causes an Overactive Bladder?

A

Detrusor overactivity which can be:
Idiopathic
Neurogenic
Psychogenic

39
Q

What causes a Fistula leading to incontinence?

A

Surgery

40
Q

What are some symptoms of incontinence?

A 
Frequency
Urgency
Nocturia
Voiding Sx
Prolapse Sx
41
Q

Which investigations are appropriate for a patient presenting with incontinence?

A 
Examination - Abdominal and Pelvic
Urinalysis - ?UTI
Bladder Diary
Post-Void USS - ?Residual Volumes
Urodynamics study
42
Q

Which lifestyle interventions can help to improve the symptoms of incontinence?

A 
Regulate fluid intake
Reduce alcohol and caffeine intake
Weight loss
Smoking cessation
Avoid carbonated drinks
Bladder retraining
Physiotherapy if Pelvic Floor cause
43
Q

Which medications can be used to manage Overactive Bladder?

A

Antimuscarinics - Oxybutinin

44
Q

Which medication can be used for Stress Urinary Incontinence?

A

Duloxetine

45
Q

Which surgical management options are available for incontinence?

A

Tension-Free Vaginal Tape for SUI

Botulinum Injections for OAB

Gynae (2 decks)

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