Reproductive/Gynaecological Emergencies

Question 1

What is Epididiymitis?

Answer 1

Inflmmation of the epididymis, most commonly caused by bacteria

Question 2

Reconition of epididymis

Answer 2

Pain and swelling of one teste,
fever
Affected teste will hang over
Occurs over several days

Question 3

What is Orchitis?

Answer 3

Inflammation of one or both of the testes caused by bacterial infection

Question 4

Orchitis recongonition?

Answer 4

Sevre pain, 
Visable swelling of groin lymph nodes on affected site
Fever
Blood in sperm (hamatospermia)
Blood in urine (hematuria)

Question 5

What is Testicular Torsion?

Answer 5

Occurs when spermatic cord is twisted, cutting off the testical’s blood supply can result in loss of teste

Question 6

testicular torsion recognition

Answer 6

Sevre testicular pain, nausea/vommitting, mild fever and redness of area

Question 7

What is varicoele

Answer 7

Abnormal enlargement of connective tissue of the scrotum can result in infertility

Question 8

What is Haematocele?

Answer 8

collection of blood in the tunica vaginalis (the lining of the scrotum)

Question 9

recognition of haematocele and variocele

Answer 9

soft lumps around testes, redness, pain and tenderness

Question 10

What is hydrocele?

Answer 10

Accumlation of serous fluid around a teste caused by a issue with production or drainage of fluid
causes swelling

Question 11

what is spermatocele

Answer 11

A abnormal cyst that devops in the epididymis

Question 12

What is Priaprism

Answer 12

An errection in the absecnce of stimulation or after stimulation has ended
very painful
requires urgent treatment

Question 13

Common infection sites of in the female reproductive system include

Answer 13

uterus, ovaries and fallopian tubes, but because of the open-ended structure of female reproductive sustem the infection can easily spread to surrounding organs

Question 14

What is a ruptured ovarian cyst?

Answer 14

Fluid filled sac on the surface of an ovary, their sizes alter at diffrent stages of the menstrual cycle. Intact cysts are asymtomatic, when ruptured it can result in massive haemorrhage and significant abdo pain

Question 15

Recognition of Ruptured Ovarian Cyst

Answer 15

Abdo pain can be a sign of cyst expansion, torsion (twisting) can lead to ischemia and acute rupture
Unilateral lower abdo pain
Inflammation that can lead to sepsis
Intraperitoneal haemorrhage

Question 16

What is an ectopic Pregnancy

Answer 16

Pregnancy that develops outside the uterus (mostly in fallopian tubes). Clinical signs appear 6-8 weeks after last normal menstural period. If it continues to grow growing egg is placing pressure and strecthing the fallopian tubes and surrounding organs. Will result in rupture of tubes

Question 17

Risk factors for ectopic pregnancy include:

Answer 17

Hx of STDs and Pelvic Inflammatory DIsease
IUCD (intra-uterine contraceptive device)
Maternal age over 40
IVF

Question 18

Recognition of Ectopic Pregnancy

Answer 18

First Trimester bleeding, abdo pain and amenorrhoea (absence or missed menstural period)
Lower abdo pain and cramping that can spread to lower back, pelvis and shoulder tip
vaginal spotting
Dizziness/fainting
Diarrohea and pain on defaction

Question 19

If an ectopic pregancy ruptures what will it lead to

Answer 19

Internal haemorrhage, hypovolemic shock, sepsis, death

As well as infertility

Question 20

What is cystits

Answer 20

UTI or bladder infection

Question 21

Difference between simple cystis and kidney infection

Answer 21

Simple cystis - Lower urinary tract

Kidney Infection - upper urinary tract

Question 22

Recogniton of Cystits

Answer 22

Painful urination (stinging/burning), frequent urge to urinate, fever, flank pain, lower abdo pain, Purulent urine, cloudy urine and haematuria

Question 23

What is Pelvic Inflammatory Diease

Answer 23

Infection of the upper female genital tract (uterus, fallopian tubes, ovaries and surrounding structures), commonly caused by STI bacteria or bacterial infections

Question 24

How does Pelvic Inflammatory infection begin?

Answer 24

Generally begins as an infection that travels from the geneital tract to the cervix which leads to inflammation

Question 25

Symtoms of Pelivic Inflammatory Disease

Answer 25

mucoprulent cervical discharge (mucous/puss) Intermenstrual or post-intercourse bleeding Pain in intercourse (dyspareunia) Low grade fever, abdo pain, vaginal discharge, pain on walking (PID shuffle), generalised signs of sepsis.

Question 26

Consequences of PID

Answer 26

``` Scarring/rigidity of the reproductive tract (greater risks of complications of infertiliaty and pregnancy) Pelvic Adhesions/scar tissue Chronic Pain Ovarain Abscess Infertility Ectopic Pregnancy ```

Question 27

What is Endometritis

Answer 27

Uterus lining inflammed from infection can be acute or chronic

Question 28

Acute vs Chronic Endometritis

Answer 28

Acute Endometritis is characterised by infection, high fever and purulent discharge symtoms reslove after 2 weeks Chronic Endometritis is characterised by plasma cells in Stroma (connective tissue) well perfused by blood - ideal for bacteria growth Common bacteria includes STI's

Question 29

What is Endometriosis?

Answer 29

The growth of endometrial tissue on outside of uterus occurs as small fragments of tissue are "regurgitated" during menstration through the fallopian tubes into the peritoneal cavity. These endomertial tissue implant on surfaces and grow small cystic structures

Question 30

Where does endometriosis usually devlop?

Answer 30

The outside of the ovaries, utero-sacral ligaments (outside ovaries) fallopian tubes and peritonieal surfaces

Question 31

Endometriosis symtoms

Answer 31

chronic pelvic pain Dyspareunia (pain w/ sex) Dsymaenorrhoea (pain during menstration)

Question 32

Endometriosis Complications

Answer 32

adhesions/scar tissue form which dont stretch and can cause pain Compression and infiltration of pelvic nerves

Question 33

Endometriosis treatment

Answer 33

analgesia, NSAIDS, hormonal therapy oral contraceptives, progesterone or gonadotropine-releasing-hormone (GRH)

Question 34

Miscarriage Defination:

Answer 34

An interuption of pregnancy before the 24th week either spontaneous or induced. Most commonly caused in the first 12 weeks following contraception

Question 35

Contributing factors towards Miscarriages

Answer 35

``` Genatic abnormalaties Hormonal abnormalaties Maternal Factors Uterine abnormalaties Incompetence of the cervix (Cervix fails to protect the fetus) ```

Question 36

Classification of Miscarriages | There are 6 but only two are relevant to the pre-hospital setting

Answer 36

Threatend Miscarriage -> where the body is showing signs of miscarriage such as vaginal bleeding, lower abdo pain, may continue or reslove Incomplete Miscarriage: This is where the threatned miscarriage continues further and results in a loss of the fetus. Signs inlcude increased bleeding and pain.

Question 37

Incomplete Miscarriage complications

Answer 37

The cervix dilates and products of contraception or parts of the placenta may be passed or retained by the cervix. Retained products/placenta must be removed surgically as they are a major source of infection

Question 38

Miscarriage Treatment includes

Answer 38

Supporitive measures, pain nausea and hypovolemic managements try and estimate blood loss and collect expelled tissue

Question 39

Stilbirth Defination

Answer 39

Death of the fetus in-utero or at least 20 weeks of completed gestation that shows no-signs of life after birth

Question 40

Risk factors of still birth

Answer 40

``` Smoking Diabetes High BP Obese Previous Still Birth Over 35 years being over 41 weeks pregant hx of reproductive issues Reduced baby movements ```