reproductive Flashcards
aetiology of torsion of testis
- Children/young adults – commonest in neonatal period and around puberty
- Undescended testis
clinical features of torsion of testis
- Sudden onset severe painful testis – triggered by activity e.g. playing sports
- Vomiting
- Abdo pain
- Testicular exam: Red, tender, firm, swollen testis
- Opposite testis may lie horizontally (Angell’s sign)
- Abnormal rotation so that epididymis is not in posterior position
- Elevated (retracted) testicle
- Bell clapper deformity: absence of fixation of the tesicle posteriorly to the tunica vaginalis
- Lack of cremasteric reflex: testicle will not contract if torsion is present
- Prehn’s sign – worse pain when elevation of the testicles
investigation for torsion of testis
doppler USS - only if in double, otherwise straight to surgery
urine dip to check not infeective
differentials to testis torsion
epididymitis - pain relieved when lifted
epididymo-orchitis hydrocele/varicocele - shine light testicular cancer inguinal hernia renal colic HSP acute appendicitis
management of torsion of testis?
immediate referal to surgery - 6 our windwo before ischaemia is irrevesible
- surgical scrotal exploration
- untwisting of the testicle and orchiplexy (fixing both testicles to preventing further episodes)
- orchiectomy if necrosis
aetiology of ectopic pregnancy
PIPPA
- previous ectopic
- intrauterine contraceptive device
- PID
- pelvic/tubal surgery
- assisted reproduction
clinical features of ectopic pregnancy
presents around 6-8 weeks
usually a history of amenorrhoea (for around 8 weeks)/known to be pregnany
lower abdo pain - constant, iliac fossa
lower abdominal /cervical/adnexal tenderness
PV bleeding
breast tenderness
urinary symptoms
rectal pressure/pain on deification
clinical features of a ruptured ectopic pregnancy
collpase/fainting diarrhoea vomiting pain in the shoulder - haemorrhagic blood irritates the diaphragm shock Cullen's sign
investigation for ectopic pregnancy
pregnancy test - +Ve
TV USS - establish the location of the pregnancy, the presence of adnexal massess or freee fluid
serum hCG at 0 and 48 hour
- a rise > 63% suggests intrauterine pregnancy
- a suboptimal rise is suspicious of an ectopic pregnancy
- decrease of > 50% = likely failing pregnancy
management of rupture of ectopic pregnancy
resuss A-E assessment
followed by salpingectomy
when will you use expectant management of ectopic pregnancy
- stable
- asymptomatic
- hCG < 1500 iU
• EP <3cm and no fetal cardiac activity on TV USS
• No haemoperitoneum on TV USS
• Fully understand symptoms and implications of EP.
• Language should not be a barrier to understanding or communicating the problem to a third party (e.g. ambulance).
• Live in close proximity to the hospital and have support at home.
• You deem the patient will not default on follow up.
• Requires serum hCG initially every 48 hours until repeated fall in level, then weekly until <15IU.
when will you use medical management of ectopic pregnancy
failed expectant management
Methotrexate is given IM as a single dose of 50mg/m2.
• Criteria:
• Follow up possible
• Unruptured
• Adnexal mass <35mm
• No visible heart beat
• No significant pain
• hCG level <1500 IU/l
• Confirmed absence of intrauterine pregnancy on USS
• hCG levels should be measured at 4 and 7 days and another dose of methotrexate given (up to 25% of cases) if the in hCG is <15% on days 4-7
• Sexual intercourse should be avoided during treatment and reliable contraception used for 3 months after as meth
otrexate is teratogenic.
when will you use surgical management of ectopic pregnancy
when medical management fails
laparoscopy salpingectomy if - hemodynamically unstable - unable to return for follow up - significant pain - adnexal mass > 35 mm - foetal heartbeat visible on USS - hcg level > 5000 give methotrexate post-surgery
what is another name for genital wart
condylomata acuminate
aetiology of genital warts
Human Papilloma virus - subtype 6 and 11
early onset sexual activity
inc number of sexual patner
lack of barrier contraception
how is genital wart transmitted?
most often via sexual contact
incubation period between 3 weeks and 8 months
clinical features of genital warts
appearance varies
- tiny flat patches on vulval skin
- small papiliform (cauliflower-like) wellings
- may affect the cervix
many asymptomatic
localized skin irritation
implications in pregnancy
- tend to grow rapidly
- usually regress after delivery
Ix for genital warts
clinical diagnosis
a biopsy might be taken to exclude neoplasia
differential for genital wart
syphilius
molluscum contagiosum
pearly penile papules
skin tags
management of genital warts
- can just leave it if pt wishes
- podophyllotoxin applied locally
- or trichloroacetic acid for non keratinized lesions
- or imiquimod (for both keratinized and non-keratinized warts)
- cryotherapy or excision or electrosurgery or laser treatment
partner notification is not necessary
what is molluscum contagiosum
Sexual transmission usually affecting young adults. Affects genitals, pubic region, lower abdomen, upper thighs, and/or buttocks
characteristic of molluscum contagiosum
Lesions are usually characteristic, presenting as smooth-surfaced, firm, dome-shaped papules with central umbilication
treatment of molluscum contagiosum
no treatment
investigation for molluscum contagiosum
clinical, on the basis of recognising the characteristic lesions
offer a routine STI screen