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3a > WH: Ovarian Disorders > Flashcards

WH: Ovarian Disorders Flashcards

1
Q

What is PCOS ? characterised by what ? (5)

A

PCOS is a common condition causing metabolic and reproductive problems in women.
characterised by:
- multiple ovarian cysts
- infertility
- oligomenorrhea,
- hyperandrogenism
- insulin resistance.

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2
Q

What criteria is used for PCOS diagnosis ? describe it ? (3)

A

Rotterdam criteria triad (2/3)
- oligo/anovulation (irregular or absent menstrual periods)
- Hyperandrogenism (hirsutism/acne or on bloods)
- Polycystic ovaries on US (or increased ovarian size)

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3
Q

PCOS differential ?

A
  • hypothyroidism
  • hyerprolactinaemia
  • bushings disease
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4
Q

other PCOS presentation ? (5)

A

(oligo/amenohrrhea, infertility, obesity, hirsutism, acne, hair loss)

  • insulin resistance/diabetes
  • CVD
  • Raised cholesterol
  • sexual problems
  • acanthoses nigricans
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5
Q

describe the relationship between insulin and PCOS ?

A

insulin resistance => increase levels of insulin form pancreas => insulin promote release of androgens form ovaries + adrenal PLUS insulin surpasses SHBG form liver => hyperandorogenism
- insulin halts development of follicles in ovaries => annovulation

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6
Q

Hirsutism differential ? (5)

A
  • Medications (corticosteroids, testosterone, anabolic steroids)
  • ovarian + adrenal tumours
  • Cushings syndrome
  • Congenital adrenal hyperplasia
  • PCOS
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7
Q

PCOS investigations ?

A
  • Blood test (testosterone, SHBG, LH, FSH, prolactin, TSH)
  • US
  • diabetes screening (OGGT)
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8
Q

what would blood tests show in PCOS ? (5)

A
  • high LH: FSH ratio (remember)
  • raised LH
  • raised testosterone
  • raised insulin
  • raised oestrogen
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9
Q

what is the gold standard PCOS investigation ? what would it show ?

A

TVUS
- string of pearls appearance

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10
Q

What does PCS management involve (overview) ? (6)

A
  • weight loss
  • exercise
  • smoking cessation
  • managing infertiliyt
  • managing hirsutism
  • managing acne
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11
Q

How is PCOS infertility managed ? (3)

A
  • Weight loss (reduce insulin resistance)
  • Clomifene
  • IVF
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12
Q

How is PCOS hirsutism managed ? (3)

A
  • electrolysis
  • Laser hair removal
  • Finasteride
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13
Q

How is PCOS acne managed ? (2)

A
  • COCP
  • topical adcipalene
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14
Q

what cancer does PCOS increase the risk of ? explain this ?

A

endo cancer risk
- PCOS => anovvulation => no corpus luteum => low progesterone => continue oestrogen production + no regular menstruation => endo proliferation => endo hyperplasia = Endo cancer risk
- plus associated RF (obesity, diabetes)

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15
Q

What are ovarian cysts ?

A

fluid filled sac within the ovary
- generally small cysts should not raised concern unless symptomatic

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16
Q

Patient presents with string of pearls sign on US. What is this ?

A

multiple ovarian cysts
(if have annulation or hyperandrogegism => PCOS)

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17
Q

name some cyst types ? (5) most common ?

A
  • follicular cyst (most common)
  • corpus luteum cyst
  • serous cyst adenoma
  • endometrioma
  • teratoma
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18
Q

what is a follicular cysts ? how does it form ?

A

(non-neoplastic)
developing follicle fail to rupture + release egg => cyst persist => follicular cyst

19
Q

what is a corpus luteum cyst ?

A

(non-neoplastic)
corpus luteum filas to break down => fills with fluid = > corpus luteum cyst

20
Q

ovarian cyst RF ?

A

more frequent ovulation => increase surface epithelial irritation => increase risk of developing malignant
- nulliparity, early monarch, late menopause, smoking, obesity

(common in reproductive years)

21
Q

ovarian cyst presentation ? (3)

A
  • mostly asymptomattic (found incidentally on pelvic US)
  • vague symptoms: pelvic pain, bloating, flyness in abdo, palpable pelvic mass
  • acute pelvic pain (ovarian torsion, haemorrhage, rupture of cysts)
22
Q

What investigations would you do for an ovarian cyst ? do work out what ?

A

need to establish of behind or malignant
- blood tests: lactate dehydrogenase, alpha fetoprotein
- risk of malignancy index
- Ca125

23
Q

what is in the risk of malignancy index for ovarian cancer ? (3)

A
  • menopausal status
  • US finding
  • Ca125 level
24
Q

ovarian cyst managment ? premenopausal woman with simple ovarian cyst on US (<5cm) ?

A

no further investigations

25
Q

what would indicate possible ovarian cancer in a cyst presentation ? (2)

A

complex cyst
raised Ca125

26
Q

clmplicaitons of ovarian cyst ?

A
  • torsion
  • haemorrgae
  • rupture
  • megs syndrome
27
Q

Older woman presents with pleural effusion + ovarian mass. what is this ?

A

Meig’s syndrome
- ovarian fibroma
- pleural effusion
- ascites

28
Q

What is the most common cell type in ovarian cancer ? where ?

A

malignant transformation of the epithelium covering the ovarian capsule + distal Fallopian tube

29
Q

ovarian cancer RF ? (6) describe the logic

A
  • factors that increase no. ovulations: early onset periods, late menopause, nulliparity
  • age (60)
  • BRCA1/2 genes (FHx)
  • Obesity
  • Smoking
  • Clomifene (infertility Tx)
30
Q

name some protective factors for ovarian cancer ? (3)

A

(decrease ovulations)
- OCP
- more pregnancies
- breastfeeding

31
Q

Ovarian cancer présentation ?

A

vague/non-specific + GI related (often presents late) (65 ish yrs)
- adobo blating, early satiety, loss of appetite
- weight loss
- ascites
- abdo or pelvic mass

32
Q

when would you have a 2 week wait for ovarian cancer ? (presentation)

A

2 week wait: (urgent referal to specialist)
- ascites
- pelvic/abdo mass
- US scan shows abnormal lump (/possible ovarian mass)

(suspect a women >50 with new onset IBS symtpoms)

33
Q

ovarian cancer Ix ?

A
  • Ca125 blood tes
  • Pelvic US
34
Q

what could raised Ca125 indicate ? (6)

A
  • Ovarian Cancer
  • endometriosis
  • fibroids
  • adenomyosis
  • Pelvic infection
  • pregnancy
35
Q

what is RMI ? and would are the 3 things ?which cancer ?

A

risk of malignancy index (ovarian cancer)
- menopausal status
- US finding
- Ca125 level

36
Q

ovarian cancer managment ?

A

surgery + chemo
(MDT approach)

37
Q

What is ovarian torsion?

A

Where the ovary twists in relation to surround connective tissue, fallopian tube + blood supply ?

38
Q

what is the adenexa ?

A
  • fallopian tube
  • connective tissue
  • blood supply
39
Q

ovarian torsion presentation ?

A
  • sudden onset, severe unilateral pelvic pain (constant, gets worse, or intermittent (if untwists/twists)
40
Q

what might be seen OE in ovarian torsion ?

A

localised tenderness
- possible palpable mass

41
Q

ovarian torsion Ix ? diagnostic ?

A
  • pelvic US (TV or abdo): whirlpool sin
  • definitive: laparoscopic surgery
42
Q

ovarian torsion Mx ?

A

emergency admission + surgery (de-torsion or oophorectomy)

43
Q

ovarian torsion complications ?

A
  • loss of function of ocary
  • necrotic ovary => abcsess => sepsis
  • Rupture => peritonitis => intraabdominal adhesions

3a (43 decks)

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