Uterus and Ovarian Disorders Flashcards
define benign ovarian cysts/tumours
formation of benign cysts around the ovaries and fallopian tubes
describe benign epithelial neoplastic cysts (serou cystadenoma)
cysts that develop papillary growths to point where they can appear solid
common in women 40-50yrs
describe benign epithelial neoplastic cysts (mucinous cystadenoma)
large ovarian cysts/tumours
filled with mucinous material
common in women 20-40yrs
describe benign neoplastic cystic tumour of germ cells
cysts arising from primitive germ cells that contain well-differentiated tissues
common in young women
risk factors of ovarian cyst formation
obesity
early menarche
infertility
tamoxifen therapy
clinical features of ovarian cysts
dull ache/pain in lower abdomen + back
dyspareunia
swollen abdomen with palpable mass
increases urinary frequency
investigations of ovarian cysts
urine pregnancy test
bloods (FBC, U+Es)
transvaginal or transabdominal US
management of ovarian cysts <50mm
no follow up as self-resolving
management of ovarian cysts 50-70mm
yearly US follow up
management of ovarian cysts >70mm
further MRI or surgical intervention (e.g. cystectomy)
clinical features of ovarian cyst rupture
acute unilateral pain brought on by exercise or sexual intercourse
fainting
nausea and vomiting
investigations of ovarian cyst rupture
serum or urine β-hCG
transabdominal or transvaginal US
diagnostic laparoscopy
define polycystic ovarian syndrome (PCOS)
a heterogeneous disorder causing metabolic and reproductive problems in women characterised by:
polycystic ovarian morphololgy
ovulation disorders
hyperandrogenism
describe the Rotterdam criteria for PCOS
PCOS diagnosed based on the presentation of at least 2/3 main features of:
oligoovulation or anovulation
hyperandrogenism
polycystic ovaries on US
risk factors of PCOS
FH of PCOS
obesity
smoking
diabetes
clinical features of PCOS
hirsutism sub-fertility mood changes/depression fatigue weight changes + issues losing weight male pattern baldness + thinning hair high testosterone levels acne low sex drive oligoovulation or anovulation
blood investigations of PCOS
FBC
U+Es
TFTs
serum LH, FSH, E2, oestrogen, prolactin, testosterone and SHBG
fasting glucose or oral glucose tolerance
imaging investigation of PCOS
transabdominal or transvaginal US
conservative management of PCOS
weight loss and exercise control
education about risks to health
medical management of PCOS (not planning pregnancy)
co-cyprindrol
combined oral contraceptive pill
metformin
medical management of PCOS (planning pregnancy)
clomiphene
metformin
gonadotrophins
surgical management of PCOS (if other treatment fails)
ovarian drilling
define pelvic inflammatory disease (PID)
spreading of an infection from the vagina to the cervix and upper genital tract
primary causes of PID
chlamydia
gonorrhoea
mycoplasma genitalium
risk factors of PID
young age
multiple sexual partners
history of STI
interruption of cervical barrier
clinical features of PID
bilateral abdominal pain
abnormal vaginal or cervical discharge
abnormal vaginal bleed
deep dyspareunia
signs of PID
adnexal tenderness
cervical motion tenderness on bimanual examination
fever
investigations of PID
pregnancy test high vaginal swab bloods (FBC, ESR, CRP + serum HIV + syphilis) transabdominal US MRI or CT pelvis
management of PID
analgesia empirical antibiotics (e.g. ofloxacin and metronidazole)
describe Fitz-Hugh-Curtis Syndrome
presentation of RUQ pain in those with PID due to secondary inflammation of liver capsule
investigations of Fitz-Hugh-Curtis syndrome
abdominal US
diagnostic laparoscopy
