Pelvic Problems Flashcards
When does Ovarian Cyst torsion commonly occur?
Younger patients
Post-menopausal patients
Puerperium
What are some symptoms of Ovarian Cyst Torsion?
Unilateral Lumbar/Abdominal Pain Duration >8h Vomiting NO Uterine Bleeding Pyrexia Tachycardia Guarding Cervical Excitation
How is Ovarian Cyst Torsion diagnosed?
Pelvic USS
How should confirmed Ovarian Cyst Torsion be managed?
Laparoscopic detorsion +/- Oophorectomy
What are some potential complications of Ovarian Cyst Torsion?
Loss of function of the affected Ovary
Infection
Abscess
Perforation - Peritonitis and Adhesions
What happens to Fibroids during pregnancy that leads to their degeneration?
Fibroids grow rapidly exceeding their usual blood supply, leading to ischaemic and associated pain
Why is degeneration of Fibroids common during pregnancy?
Hormonal Stimulation found during pregnancy encourages excessive growth of the Fibroids
How does degeneration of Fibroids present?
Constant Dull Pain that responds to Opioids
Palpable mass
Raised inflammatory markers
What is the mainstay of management for Degenerated Fibroids?
Conservative
Surgical if ? Fibroid Torsion
What is Pelvic Inflammatory Disease?
Ascending infection from the endocervix commonly found in 15-24y
Which organisms are usually responsible for PID?
Chlamydia
Gonorrhoea
What are risk factors for developing PID?
No use of Barrier Contraception Previous PID Early age of first intercourse Multiple partners DM Immunocomprimise Endometriosis
What are some symptoms suggestive of PID?
Asymptomatic Lower abdominal pain Pyrexia Vaginal discharge Dyspareunia Intramenstrual and Post-Coital Bleeding
Which investigations would be appropriate for suspected PID?
Pregnancy test Bloods MSU Triple Swabs USS XR if ?Bowel Involvement Diagnostic Laparoscopy
How should Mild-Moderate PID be managed?
Outpatient:
500mg IM Ceftriaxone Stat
Doxycycline 100 mg and Metronidazole 400mg BD PO for 14 days
How should Severe/Septic PID be managed?
Inpatient
IV Ceftriaxone 2g daily and Doxycycline 100mg BD IV
2W oral Doxycycline 100mg and Metronidazole 400mg BD PO
What is Endometriosis?
Endometrial glands are located outside the Uterus which respond to hormones giving Cyclical changes and pain
What is Adenomyosis?
Endometrial tissue is found within the myometrium. Presents with Pelvic Pain and Heavy Menstrual Bleeding
What are some symptoms of Endometriosis?
Dysmenorrhoea Dyspaerunia Dyschezia Dysuria HMB, IMB, PCB Persistent lower abdominal pain Epistaxis Rectal Bleeding
What are some signs suggestive of Endometriosis?
Fixed retroverted uterus
Forniceal/Uterine tenderness
How should suspected Endometriosis be investigated?
Pelvic USS
Diagnostic Laparoscopy - Gold standard
What medical management options are available for confirmed Endometriosis?
Hormonal Therapy - COCP, GnRH, HRT
Tranexamic Acid
What surgical management options are available for confirmed Endometriosis?
Hysterectomy
Diathermy +/- Laser
Which criteria are used to assess for IBS?
Rome III Criteria
What are the Rome III Criteria?
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
What occurs in a Vaginal Prolapse?
Descent of some of the pelvic organs into the Vagina
How are different Vaginal Prolapses defined?
Anterior - Urethrocoele and Cystocoele
Central - Cervix/Uterus
Posterior - Rectocoele and Enterocoele
What are some risk factors for a Vaginal Prolapse?
Childbirth Menopause Congenital Suprapubic Surgery Genetic
What are some symptoms of a Vaginal Prolapse?
Dragging feeling "Something coming down" Urinary Sx and Incontinence Bleeding/Discharge Bowel Sx
What are some signs of a Vaginal Prolapse?
Atrophic Vulval Changes
Urinary leakage
What are the three Primary management options for a Vaginal Prolapse?
Conservative
Vaginal Pessary
Surgery
What is the conservative management option for a Vaginal Prolapse?
Pelvic Floor Exercises
Which surgical options are available for management of a Vaginal Prolapse?
Anterior Vaginal Wall Repair
Vaginal Hysterectomy
Posterior Vaginal Wall Repair
What is Urinary Incontinence?
Involuntary loss of urine
What are the different types of Urinary Incontinence?
Stress Urinary Incontinence
Overactive Bladder
Urinary Retention with Overflow
Fistula
What is Stress Urinary Incontinence?
Leakage of urine associated with a rise in intra-abdominal pressure
What are some risk factors for Stress Urinary Incontinence?
Pregnancy Prolapse Menopause Collagen disorders Obesity
What causes an Overactive Bladder?
Detrusor overactivity which can be:
Idiopathic
Neurogenic
Psychogenic
What causes a Fistula leading to incontinence?
Surgery
What are some symptoms of incontinence?
Frequency Urgency Nocturia Voiding Sx Prolapse Sx
Which investigations are appropriate for a patient presenting with incontinence?
Examination - Abdominal and Pelvic Urinalysis - ?UTI Bladder Diary Post-Void USS - ?Residual Volumes Urodynamics study
Which lifestyle interventions can help to improve the symptoms of incontinence?
Regulate fluid intake Reduce alcohol and caffeine intake Weight loss Smoking cessation Avoid carbonated drinks Bladder retraining Physiotherapy if Pelvic Floor cause
Which medications can be used to manage Overactive Bladder?
Antimuscarinics - Oxybutinin
Which medication can be used for Stress Urinary Incontinence?
Duloxetine
Which surgical management options are available for incontinence?
Tension-Free Vaginal Tape for SUI
Botulinum Injections for OAB
