Week 1 Flashcards
Indications for endometrial sampling
- abnormal uterine bleeding
- investigation for infertility
- spontaneous and therapeutic abortion
- assessment of response to hormonal therapy
- endometrial ablation
- work up prior to hysterectomy for benign indications
- incidental finding of thickened endometrium on scan
- endometrial cancer screening in high risk patients
menorrhagia
prolonged and increased menstrual flow
metrorrhagia
regular intermenstrual bleeding
polymenorrhoea
menses occurring at < 21 day interval
polymenorrhagia
increased bleeding and frequent cycle
menometrorrhagia
prolonged menses and intermenstrual bleeding
amenorrhoea
absence of menstruation > 6 months
Oligomenorrhoea
Menses at intervals of > 35 days
microorganisms that can cause endometritis
Neisseria
Chlamydia
TB
CMV
Actinomyces
HSV
endometrial polyps presentation
usually asymptomatic but may present with bleeding or discharge
when do endometrial polyps often occur
around and after menopause
are endometrial polyps benign
almost always yes, but endometrial carcinoma can present as a polyp
what is molar pregnancy?
A form of gestational trophoblastic disease which grows as a mass.
characterised by swollen chorionic villi.
Categorized as partial moles or complete moles
It happens when the fertilisation of the egg by the sperm goes wrong.
complete mole
a single or two sperm combining with an egg which has lost its DNA (the sperm then reduplicates forming a “complete” 46 chromosome set.
Only paternal DNA is present in a complete mole.
is maternal or paternal DNA present in a complete mole
paternal
Partial mole
egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid).
Partial moles have both maternal and paternal DNA
which has higher risk of developing into choriocarcinoma - complete or partial mole?
complete
Adenomyosis
occurs when the tissue that normally lines the uterus (endometrial tissue) grows into the muscular wall of the uterus
Endometrial glands and stroma within the myometrium
Causes menorrhagia/dysmenorrhoea
Leiomyoma
Benign tumour of smooth muscle, may be found in locations other than the uterus
what scan is most clinically useful for assessing the endometrium and ovaries?
transvaginal ultrasound
is follicular cyst a neoplasm?
no it’s a physiological cyst
complications of endometriosis
- pain
- cyst formation (usually in ovary)
- adhesions
- infertility
- ectopic pregnancy
- malignancy (endometrioid carcinoma)
why is infertility a complication of endometriosis?
inflammation and scarring you get in the tube due to the endometriosis
what are chocolate cysts a sign of
endometriosis
where are chocolate cysts most commonly found?
ovary
is cystic tumour usually malignant or benign?
benign
is a very solid tumour usually malignant or benign?
benign
classification of ovarian tumours
- Epithelial
- Germ cell
- Sex‐cord/stromal
- Metastatic
- Miscellaneous
which of the ovarian tumours is most likely to be malignant?
epithelial
epithelial ovarian tumours
- Serous
- Mucinous
- Endometrioid
- Clear cell
- Brenner
- Undifferentiated carcinoma
borderline epithelial ovarian tumours
- cytological abnormalities, proliferative
- no stroma invasion
commonest epithelial malignancy of the ovary
serous carcinoma
precursor lesion of high grade serous carcinoma
serous tubal intraepithelial carcinoma (STIC)
are 95% of serous carcinomas high grade or low grade?
high grade
what distinguishes malignant from benign or borderline epithelial ovarian tumour?
stromal invasion
Endometrioid and Clear Cell carcinoma of the ovary are associated with _______ syndrome
lynch
which epithelial ovarian cancers are associated with lynch syndrome?
endometrioid and clear cell carcinoma
prognosis of endometrioid carcinoma of the ovary
most are low grade and early stage so good
what is primary diagnosis of serous carcinoma often made on
ascitic fluid - e.g. epithelium which shouldn’t be there
benign serous neoplasia
thin walled cysts filled with straw coloured fluid
brenner tumour is a tumour of what type of epithelium?
transitional
Are brenner tumours usually malignant or benign
benign
most common germ cell tumour of ovary
mature cystic teratoma
if fat is seen on scan in ovary, what might be there?
teratoma
granulosa cell tumour may produce oestrogen, true or false
true
commonest cancers that metastasise to ovary
Stomach
Colon
Breast
Pancreas
what is salpingitis
inflammation of the fallopian tubes, caused by bacterial infection
ectopic pregnancy commonest site
fallopian tube
when should you consider ectopic pregnancy?
any female of reproductive age with amenorrhoea and acute hypotension or an acute abdomen
main pathological groups of ovary
Cysts
Endometriosis
Tumours
how long do follicular cysts usually take to resolve?
a few months
what is endometriosis?
Endometrial glands and stroma outside the uterine body
endometriosis sites
– Ovary (‘chocolate’ cyst)
– Pouch of Douglas
– Peritoneal surfaces, including uterus
– Cervix, vulva, vagina
– Bladder, bowel etc
how can cervicitis lead to infertility?
simultaneous silent fallopian tube damage
neoplastic pathology of cervix
- Cervical Intraepithelial Neoplasia (CIN)
- Cervical cancer (squamous carcinoma, adenocarcinoma, other rare tumours)
risk factors for CIN/cervical cancer
- persistence of high risk HPV viruses, mostly type 16 and 18. Many sexual partners
- vulnerability of SC Junction in early reproductive life
age at first intercourse
long term use of oral contraception
non-use of barrier contraception - smoking 3x risk
- immunosuppression
genital warts - what types of HPV
6 and 11
Can Cervical Intraepithelial Neoplasia (CIN) be detected by cervical screening?
yes
what is the most common cervical cancer?
invasive squamous carcinoma
cervical invasive squamous carcinoma develops from pre-existing ___
CIN
what is figo staging used for?
gynae cancers, including cervical
symptoms of cervical invasive carcinoma
usually none at microinvasive and early invasive stages
abnormal bleeding
pelvic pain
haematuria/urinary infections
ureteric obstruction/renal failure
What is Cervical Glandular Intraepithelial Neoplasia (CGIN) a preinvasive of/precursor to?
endocervical adenocarcinoma
causes of miscarriage
- embryonic abnormality: chromosomal
- immune cause e.g. antiphospholipid syndrome
- infections
- stress
- iatrogenic
- “associations” - smoking, cocaine, alcohol misuse
- uncontrolled diabetes
- cervical incompetence and shortened cervix
NICE guidelines for threatened miscarriage
vaginal micronised Progesterone 400 mg b.d. till 16 weeks if viable intrauterine pregnancy is noted on scan and they have vaginal bleeding and have previously had a miscarriage
ectopic pregnancy presentation
pain>bleeding
dizziness/collapse
shoulder tip pain
SOB
diarrhoea rarely
miscarriage presentation
bleeding>pain
cramping
what is molar pregnancy?
gestational trophoblastic disease
outcome of a non-viable fertilised egg
pathology of molar pregnancy
overgrowth of placental tissue with chorionic villi swollen with fluid rich in hCG; giving picture of “grape like clusters”.
types of molar pregnancy
Complete and Partial
molar pregnancy USS
“ snow storm appearance” +/- fetus, theca lutein cysts.
molar pregnancy presentation
- Hyperemesis, hyperthyroidism, early onset pre-ecclampsia
- Varied bleeding and occasional history of passage of “grapelike tissue”
- Fundus > dates on abdominal palpation.
- Rare cases: shortness of breath (due to embolisation to lungs) or seizures (metastasis to brain)
mainstay treatment for molar pregnancy
surgery (uterine evacuation)
timing of implantation bleeding
about 10 days post ovulation
does pregnancy usually continue if implantation bleeding
yes
chorionic haematoma
a collection of blood between the chorion (the outer membrane surrounding the embryo) and the uterine wall
cervical causes of bleeding in early pregnancy
Ectopy/ectropion.
Infections: Chlamydia, Gonococcus or bacterial.
Polyp.
Malignancy
treatment for bacterial vaginosis in pregnancy
Metronidazole 400mg twice daily for 7 days
Avoid alcohol during medication
Option of vaginal gel
treatment of chlamydia in pregnancy
Erythromycin, Amoxicillin
Test of Cure 3 week later
Liaise with Sexual health, include partner tracing
Confidentiality issue
predominant symptom in ectopic pregnancy
pain
Hyperemesis Gravidarum (HG)
a more severe form of morning sickness
Hyperemesis Gravidarum (HG) consequences
Dehydration, ketosis, electrolyte and nutritional disbalance
Weight loss, altered liver function ( up to 50%)
Signs of malnutrition
Emotional instability, anxiety. Severe cases can cause mental health issues e.g. depression.
PUQE score - what is it used for
vomiting in pregnancy
which women are given anti-D in pregnancy?
rhesus negative women
manual vacuum aspiration
used to perform an abortion or to remove products of conception from the uterus
<10 weeks
medical management of pregnancy of unknown location
methotrexate
what size of cyst makes ovarian torsion more likely?
> 5cm
what percentage of adnexal torsions occur in children?
25%
management of ovarian torsion
surgical emergency
- resuscitation
- laparoscopy
- laparotomy
- detorsion
- cystectomy
- oophorectomy
cyst rupture management
- conservative if small amount of fluid
- resuscitation
- laparoscopy
- lavage
- stop bleeding
- if bleeding is very bad remove ovary (very rare)
pelvic inflammatory disease causative organisms
chlamydia
gonorrhoea
gardenella
anaerobes
pelvic inflammatory disease management
14 days metronidazole and doxycycline
acute bleeding - menstrual
anovulatory
fibroids
anticoagulant
von willebrand’s disease
acute bleeding - non menstrual
miscarriage
cervical cancer
endometrial cancer
vaginal trauma
what type of drug is tranexamic acid?
anti-fibrinolytic
(controls bleeding, e.g. heavy periods)
acute bleeding management
- resuscitation
- tranexamic acid
- mefenamic acid
- norethisterone
- IUS
- COCP
- GnRH analogues (don’t release LH and FSH so go into temporary menopause)
Bartholin’s abscess management
- conservative if not too bad and not causing bad pain
- antibiotics
- incision and drainage
- word catheter
- marsupialization (larger incision for recurrent and stuff)
procidentia
a severe form of pelvic organ prolapse (POP) that includes herniation of the anterior, posterior, and apical vaginal compartments through the vaginal introitus
endometrial polyps
overgrowths of endometrial glands
protrude into the uterine cavity
what age endometrial polyps
reproductive age and postmenopausal
types of endometrial polyps
pedunculated
sessile
risk factors for endometrial polyps
tamoxifen use (tamoxifen used in breast cancer)
excess endogenous oestrogen - raised BMI
where do fibroids (uterine leiomyoma) develop?
myometrium
types of fibroid (uterine leiomyoma)
sub mucosal
intramural
subserosal
broad ligament
cervical
pedunculated fibroid
fibroid medical treatment
non hormonal methods, hormonal
fibroid interventional radiology treatment
uterine artery embolisation
when is anti-D given in abortion?
if woman is rhesus negative and abortion is after 10 weeks
(but if surgical abortion give before 10 weeks too)
how does copper coil work
The copper alters the cervical mucus, which makes it more difficult for sperm to reach an egg and survive.
IUD prevents implantation
