Week 204 - gynaecology1 Flashcards
Name this finding
Artero-venous fistula
Occurs in long - term dialysis.
what is this?
Basal Cell Carcinoma
What is this?
Butterfly Rash - Lupus Erthematosus
Which skin condition is this?
Eczema (Atopic dermatitis)
Which skin conditino is this?
Atopic Dermatitis (Eczema)
What does this image show?
Erythema Multiforme
what does this image show?
Erythema Multiforme
Say what you see
Erythema Nodosum
What is this condition?
Impetigo
what is this?
Malignant Melanoma
what is this?
Malignant melanoma
what is this?
Melanocytic naevus
what condition is this?
Placque soriasis
What do you see? What is this a clinical sign of?
Pretibial Myxoedema
Grave’s disease
what is this child infected with?
Ringworm
what pathology do you suspect?
ringworm
what condition is this? Does this happen quickly?
Shingles
Normaqlly, redness appears later, after asymptomatic period and subsequent pain period.
what does this image show?
Squamous cell carcinoma
What does this image show?
Thyroglossal cyst
What does this image show? Is this normal?
Cervical Ectropian - migratin of clumnar eipithelium outside of the OS - Normal
What does this image show? (Other than sheer horror)
HPV - Genital Warts
What does this image show? Is it normal?
NOT normal. Yeast Candida infection.
What is meant by the term “Lesser pelvis”?
The lesser pelvis (or “true pelvis”) is the space enclosed by the pelvic girdle and below the pelvic brim: between the pelvic inlet and the pelvic floor.
What is meant by the term greater pelvis?
The greater pelvis (or “false pelvis”) is the space enclosed by the pelvic girdle above and in front of the pelvic brim. It is bounded on either side by the ilium; in front it is incomplete, presenting a wide interval between the anterior borders of theilia, which is filled by the parietes of the abdomen; behind is a deep notch on either side between the ilium and the base of the sacrum.
Demonstrate the main palpable anatomical landmarks of the iliac, ischial and pubic bones in the
living, on bones and suitable radiographs.
Identify and describe the joints and ligaments of the pelvis.
Sacroiliac
hip
lubosacral
pubic symphysis
Tendons on image
What is the pelvic inlet?
The pelvic inlet or superior aperture of the pelvis is a planar surface which defines the boundary between the pelvic cavity and the abdominal cavity (or, according to some authors, between two parts of the pelvic cavity, called lesser pelvis and greater pelvis).
Its position and orientation relative to the skeleton of the pelvis is anatomically defined by its edge, the pelvic brim. The pelvic brim is an approximately apple-shaped line passing through the prominence of the sacrum, the arcuate andpectineal lines, and the upper margin of the pubic symphysis.
What are the component parts of the pelvic outlet?
Compare and contrast the female and male pelvis
Describe and identify the location of the perineal membrane and the perineal body
Describe the origins, courses and relations of the uterine and ovarian arteries.
Describe the paths and innervations of the pudendal nerves, and the sites that may be injected
for anaesthesia during childbirth.
through the vagina - medial and slightly inferior to ischial spine through vaginal wall - usually lidocaine.
Explain the functions of the greater vestibular glands (Bartholin’s glands )
Bartholin’s glands secrete mucus to provide vaginal lubrication. Bartholin’s glands secrete relatively minute amounts of fluid when a woman is sexually aroused.The minute droplets of fluid were once believed to be important for lubricating the vagina, but research from Masters and Johnson demonstrated that vaginal lubrication comes from deeper within the vagina. The fluid may slightly moisten the labial opening of the vagina, serving to make contact with this sensitive area more comfortable for the woman.
Identify the recto-uterine (pouch of Douglas) and the vesico-uterine pouch.
Rectouterine is pouch of douglas
Describe the lymphatic drainage of the pelvis.
Lymphatics in the pelvis
Several groups of lymph nodes are located along the vessels in the pelvic region:
External iliac lymph nodes: Receive lymph from the inguinal lymph nodes, which are located along the femoral vein in the anterior thigh, and from pelvic organs
Internal iliac lymph nodes: Receive lymph from the pelvic organs, perineum, and gluteal region
Sacral lymph nodes: Receive lymph from the pelvic organs and drain into the internal or common iliac nodes
Common iliac lymph nodes: Receive lymph from the other pelvic nodes
Pararectal nodes: Lie in the connective tissue next to branches of the internal iliac lymphatic vessels
Superficial inguinal and deep inguinal nodes: Drain lymph from the inferolateral part of the trunk and perineum
Lumbar nodes: Associated with the aorta and inferior vena cava; receive lymph from the previously listed nodes
The lymph nodes of the pelvis are interconnected quite extensively, which means some of the nodes can be removed without disturbing lymphatic drainage. However, it also means cancerous cells can easily spread to any pelvic or abdominal organs.
Sterilisation
The clips have just fallen off - but they don’t cause any trouble.
what is this?
What is the imaging for a lost coil?
US and X ray
what do you want, if you’d like to use US to image pelvic region?
what can you see?
what can you see?
what can you see?
What is the pathology?
What is the pathology, and what is the imaging technique?
CT
What do each of these arrows point to?
What does this image show?
what is hyperemesis gravidarum?
Hyperemesis gravidarum (HG) is a complication of pregnancy characterized by intractable nausea, vomiting, anddehydration and is estimated to affect 0.5–2.0% of pregnant women.[1][2] Malnutrition and other serious complications, such as fluid or electrolyte imbalances, may result.
What is a molar pregnancy?
A molar pregnancy is an unsuccessful pregnancy where the placenta and foetus do not form properly and a baby does not develop.
Can you name 6 sites for ectopic pregnancy?
what are common problems of pregnancy?
Ectopic
MOlar
Bleeding
Abdo pain
Hyperemesis Gravidarum
Mrs Jones presents very anxiously to
accident and emergency with persistent
vaginal bleeding. She is at 7 weeks
pregnant, and you are called to see her.
What are your next steps and ivx’s?
General examination- Looks comfortable, stable
Abdominal examination – Normal
Speculum examination – Some blood in
the vagina, cervical os is closed
Bimanual examination – Bulky uterus, No
adnexal tenderness or cervical excitation
What investigations do you want ?
Full blood count Blood group and save
HCG ( Human chorionic gonadotrophin )
Ultrasound scan
what are the four ivx’s you carry out for distressed pregnant women with abdo pain complaint?
Full blood count
Blood group and cross match
HCG ( Human chorionic gonadotrophin )
Ultrasound scan
43 year old Afro Caribbean lady presents to GP
• P3
• Progressively heavier and longer menstrual cycles 10/30, no inter
menstrual or post coital bleeding
• Lethargic
• Abdominal examination reveals a firm mass arising from the pelvis
Diff. Diagnoses?
Fibroid uterus
• Ovarian cyst – benign or malignant
• Pregnancy
• Palpable bladder
• Hydrosalpinx
• Bowel adherent to uterus
• Appendix absess
What are fibroids?
- Benign tumours of myometrium
- Size varies – few mm to filling abdomen
- Formed from smooth muscle with fibrous elements
- 1 in 3 women >30
- More common as approach menopause
- More common in Afro-Caribbean women
Tamoxifen is a risk factor for?
Fibroid cysts
What are the names and locations of fibroids?
Symptoms of fibroids?
Asymptomatic – 50%
• Heavy menstrual bleeding
• Haematological disorders
• Dysmenorrhoea
• Pressure effects
• Infertility
• Pregnancy associated problems – red degeneration, preterm labour,
malpresentation, post partum haemorrhage
complications of fibroids?
Degeneration – hyaline change, calcification, red
• Torsion of pedunculated fibroid
• Infection with pyometra
• Malignancy Malignancy – leiomyosarcoma leiomyosarcoma – rare
Medical treatment of Fibroids?
Esmya
In which 3 ways does Esyma work?
**Fibroid **
Acts by blocking the progesterone receptors, inhibiting cell proliferation and stimulating apoptosis, thereby reducing fibroid size
**• Pituitary **
Selectively blocks progesterone activity reducing luteinising hormone (LH) and follicle stimulating hormone (FSH) secretion, whilst maintaining mid
Inhibits ovulation contributing to the induction of amenorrhoea
• Endometrium
Direct effect which rapidly reduces uterine bleeding
What do GnRH agonists do to Fibroids?
GnRH agonists – shrink fibroid and decrease vascularity, risk of menopausal symptoms and osteoporosis
Surgical options for fibroids?
Myomectomy – hysteroscopic, laparosopic
• Complications – blood loss, damage to other organs, infection, recurrence
• Hysterectomy considered if family complete
• Uterine artery embolization
• Catheterise femoral artery, angiography performed and artery
• Fibroid becomes avascular and shrinks
• Day case with sedation
• 40-75% reduction in volume, 62-95% symptom improvement
• Complications – infection, pain, small risk of premature ovarian failure, small
risk bowel necrosis if subserosal fibroids adherent to bowel
Uterine artery embolisation brings about a ___ reduction in volume and ____ symptom improvement in fibroid cases.
40-75% reduction in volume, 62-95% symptom improvement
56 year old post menopausal lady
• Admitted to A & E with sudden onset left iliac fossa pain
• Nauseous/vomiting
• Guarding and rebound on left side
• Palpable mass on PV examination
Diff. diagnoses>?
Ovarian cyst torsion – benign or malignant
• Diverticular disease/abscess
• Pelvic collection
• Palpable bladder
• Large bowel obstruction
• Small bowel obstruction
What are the ovarian cyst tumour markers?
9, α-fetoprotein, β-HCG, androgens
– CA-125, CEA, CA-19-
Types of ovarian cyst?
Physiological – follicular or luteal
• Endometriomas
• Polycystic ovaries
• Germ cell tumour – dermoid (mature
teratoma
• Epithelial tumours – cystadenomas
tumours
• Sex cord stromal tumours – granulosa
tumours, fibromas, Sertoli-Leydig tumours
Complications of cysts?
- Pain
- Pressure effects
- Torsion
- Rupture
- Haemorrhage
- Malignancy
- Hormone secretion
What is the risk of malignancy index (RMI)?
RMI = U x M x CA-125
• U = Ultrasound features
• 1 point for each of the following characteristics
• Multiolocular cysts, solid areas, metastases, ascites and bilateral
• Score 0 if US score 0
• Score 1 if US score 1
• Score 3 if US score 2-5
• M = Menopausal status
• 1 if pre-menopausal
• 3 if postmenopausal
what is this?
A Normal Ovary
What is this?
A simple ovarian cyst
what do thes images show?
Polycystic Ovary
what do these images show (obvious in US)
Septated cyst
what does this image show?
A torted cyst
the very front of a sperm is called?
The acrosome
Subfertility is defined as?
Involuntary failure to conceive
What are the pathologies of subfertility?
Ovulation disorder up to 25%
Sperm dysfunction up to 30%
Tubal disease up to 20%
Endometriosis up to10%
Coital failure, cervical mucus disorders, uterine
abnormalities up to10%
Unexplained: failure to conceive within 2 years in the
absence of pathology occurs in __% of subfertility cases.
25
Polycystic ovarian syndrome
Rotterdam consensus criteria (2003) are what?
Presence of 2 of the following 3 criteria and to
exclude other causes
– Hyperandrogenism (clinical or biochemical or both)
Oligo-ovulation or anovulation
Polycystic ovaries on scan – 12 or more follicles
measuring 2-9mm on each side
Name 3 Estrogen antagonists
Clomifene Citrate,
Tamoxifen
Can you name the tubal diseases (semineferous)
Infective
Chlamydia trachomatis
Neisseria gonorrhoea
Inflammatory
Endometriosis
Traumatic/post surgical
Sterilisation
IVF success rate?
10-40%
What are the symptoms of Ovarian hyperstimulation syndrome?
Massive ovarian cysts
Ascites
Pleural and pericardial effusions
Hypovolaemia & thrombosis
Recent IVF or sim procedure.
