WK 1- Gynaecological Conditions (incomplete)

Question 1

What is Pelvic Inflammatory Disease?

Answer 1

Pelvic Inflammatory Disease [PID] is an infection & inflammation of organs affecting the female reproductive system (eg. uterus, vagina & fallopian tubes)

Question 2

What are some key signs & symptoms of Pelvic Inflammatory Disease?

Answer 2

Signs & Symptoms of PID-
- Fever
- Sepsis Signs
- Lower abdo pain
- Pain on mobilising

Question 3

Pelvic Inflammatory Disease can cause a lot of scar tissue to develop. What are some IMPLICATIONS/complications of this?

Answer 3

1. Pelvic adhesions- Scar tissue binds adjacent organs
2. Infertility- Scarring of fallopian tubes can block pathway of egg
3. Ectopic Pregnancy- Scar tissue can prevent a fertilised egg from moving into the uterus. Instead, it can begin to grow in the fallopian tube

Question 4

Which gynaecological condition can cause Tubo-ovarian Abscesses?

Answer 4

Pelvic Inflammatory Disease can cause Tubo-ovarian Abscesses (an infectious mass filled with pus)

Question 5

Describe the Pathophysiology of Pelvic Inflammatory Disease

Answer 5

Pelvic Inflammatory Disease:
1- Infection in genital tract [eg. secondary to STDs like Chlamydia & Gonorrhoea]
2- Causes cervical inflammation

Question 6

What is Endometritis?

Answer 6

Endometritis= the inflammation of the endometrium (inner lining of the uterus)

Question 7

Endometritis can be classified as either ‘Acute’ or ‘Chronic’. How are differentiated?

Answer 7

1. Acute Endometritis= Characterised by infiltration of micro-abscesses & neutrophils in the endometrial tissue
2. Chronic Endometritis= Characterised by the presence of plasma cells in the endometrial stroma (soft tissue)

Question 8

What are the most common organisms which cause Chronic Endometritis?

Answer 8

Chronic Endometritis is often caused by:
1. Chlamydia
2. Gonorrhoea
3. Streptococcus
4. Various viruses

Question 9

What are the key Signs & Symptoms of Acute Endometritis?

Answer 9

Acute Endometritis=
1. Fever [secondary to infection]
2. Purulent vaginal discharge [thick, puss filled discharge secondary to infection]
3. Excessive menstruation following

Question 10

How is Acute Endometritis treated?

Answer 10

Acute Endometritis is treated with Antibiotics

Question 11

What are 3 risk factors which can increase likelihood of developing Endometritis?

Answer 11

Risk Factors for Endometritis=
1. Post Caesarean section
2. Prolonged rupture of membranes/ long labour
3. Multiple vaginal examinations

Question 12

What is the pathophysiology of Endometritis?

Answer 12

Endometritis=
1. Risk factors (caesarean, prolonged rupture of membranes/long labour, multiple vaginal examinations)
2. Causes an infection within the endometrium
3. Infection leads to inflammation of the endometrium

Question 13

What is Endometriosis?

Answer 13

Endometriosis= condition when ectopic endometrial tissue exists outside the uterine cavity

Question 14

What is the difference between Endometriosis and Endometritis?

Answer 14

1. Endometriosis= a diseased condition where endometrial tissues grows outside the uterus
2. Endometritis= inflammation of the endometrium following an infection
   [Hint- ‘itis’= inflammation secondary to infection, ‘osis’= diseased condition]

Question 15

Using the theory of menstrual regurgitation/retrograde menstruation, explain the Pathophysiology of Endometriosis

Answer 15

Endometriosis Pathophysiology=
1. Menstrual blood containing endometrial cells is regurgitated/flows backwards through fallopian tubes
2. Cells enter peritoneal cavity rather than out of the body
3. Endometrial tissue implants & grows outside uterus [growths called ‘ectopic endometrial implants’. ectopic= defined as occurring in abnormal positions]
4. Endometrial implants grow as small cystic lesions/structures
5. During menstruation, ectopic endometrial tissue/cysts undergo same process of clinical breakdown & bleeding as endometrial tissue within uterus
6. Breakdown causes release of cytokines & prostaglandins, signalling inflammatory response
7. Adhesions (scar tissue) form and connect reproductive organs to other organs (eg. ovaries to pelvic wall or bladder)

Question 16

What is the Clinical Presentation of Endometriosis?

Answer 16

Endometriosis=
1. Chronic pelvic pain [secondary to adhesion’s/scar tissue]
2. Dyspareunia (painful sex) [secondary to adhesions/scar tissue]
3. Dysmenorrhoea (menstrual pain which impacts functioning) [secondary to adhesions/scar tissue]
4. Spotting before period [secondary to the ectopic tissue undergoing same process of clinical breakdown as uterine tissue]

Question 17

Where is the most common area for Endometrial implants to develop in? [as a result of having Endometriosis]

Answer 17

Endometrial implants can commonly develop in:
a) Ovaries
b) Utero-sacral and round ligaments
c) Fallopian tubes
d) Peritoneal surfaces (& other surfaces)

Question 18

What are the implications/complications of Endometriosis?

Answer 18

Implications/complications of Endometriosis=
1. Compression & infiltration of pelvic nerves [secondary to scar tissue/adhesions applying pressure on nerves]
2. Pelvic adhesions [secondary to scar tissue binding adjacent organs]
3. Infertility [secondary to adhesions, altered immune functioning, inflammation, distorted pelvic anatomy, scarred fallopian tubes, hormonal changes]

Question 19

What are the Pharmacological treatment options for Endometriosis?

Answer 19

Pharmacological Treatment of Endometriosis=
1. NSAIDs
2. Hormonal therapy containing Progesterone (oral contraceptive)
3. Gonadotropin-releasing hormone (GnRH)

Question 20

What are the Surgical treatment options for Endometriosis?

Answer 20

Surgical Treatment of Endometriosis=
1. Laparoscopic Ablation/Excision
2. Hysterectomy

Question 21

What is an Ovarian Cyst?

Answer 21

Ovarian Cyst= fluid filled sac on the surface of an ovary. They are asymptomatic when intact

Question 22

What is the Pathophysiology of a Ruptured Ovarian Cyst?

Answer 22

Ruptured Ovarian Cyst=
1. Ovarian cyst develops within the ovaries & fills with fluid
2. Tissue bursts an ovarian cyst ruptures
3. Ovarian cyst wall opens up, exposing fluid & sometimes blood within to the abdominal cavity
4. Leakage of cystic content into peritoneum can cause Peritonitis & sepsis

Question 23

What is the Clinical Presentation of a Ruptured Ovarian Cyst?

Answer 23

Ruptured Ovarian Cyst=
- Localised unilateral lower abdo pain
- Fever & other signs of infection

Question 24

What are the Implications/complications of a Ruptured Ovarian Cyst?

Answer 24

Ruptured Ovarian Cyst can result in-
1. Peritonitis (inflammation of peritoneum) secondary to cystic contents leaking into the peritoneal cavity
2. Sepsis- secondary to peritonitis
3. Intraperitoneal Haemorrhage- if a haemorrhagic cyst ruptures

Question 25

What is an Ectopic Pregnancy?

Answer 25

Ectopic Pregnancy= when a fertilised egg implants & grows outside the uterus

Question 26

95% of Ectopic Pregnancies occur where?

Answer 26

95% of Ectopic Pregnancies occur in the fallopian tube

Question 27

Although 95% of Ectopic Pregnancies occur in the fallopian tube, where are 3 other places Ectopic Pregnancies can occur (although rare)?

Answer 27

Ectopic Pregnancies can occur in-
- An Ovary
- Abdominal Cavity
- Cervix
However, most commonly they occur in the fallopian tube

Question 28

Clinical signs of Ectopic Pregnancies generally appear __ to __ weeks after last normal menstrual period?

Answer 28

Clinical signs of Ectopic Pregnancies generally appear SIX (6) to EIGHT (8) weeks after last normal menstrual period

Question 29

What is the Pathophysiology of an Ectopic Pregnancy?

Answer 29

Ectopic Pregnancy-
1. Egg is fertilised in the fallopian tube by the sperm
2. Instead of travelling down to the uterus & implanting there, the egg implants elsewhere (eg. fallopian tube 95% of the time, but can be in cervix, ovary, peritoneal cavity)
3. Foetal tissue begins to grow in the fallopian tube
4. Fallopian tube stretches abnormally as growth occurs
5. If rupture occurs, internal haemorrhage can occur

Question 30

Which type of pregnancy complication accounts for 10% of all pregnancy maternal deaths?

Answer 30

Ectopic Pregnancies account for 10% of all pregnancy maternal deaths

Question 31

What are some risk factors for Ectopic Pregnancies?

Answer 31

RISK FACTORS FOR ECTOPIC PREGNANCIES-
1. Previous ectopic pregnancies
2. History of STDs & Pelvic Inflammatory Disease
3. IUCD in situ
4. Use of emergency contraception
5. Cigarette smoking
6. Maternal age >40yrs
7. IVF (fertilisation of egg by sperm outside the body)

Question 32

What is the ‘Triad of Symptoms’ which usually occurs in Ectopic Pregnancies?

Answer 32

TRIAD OF SYMPTOMS [ECTOPIC PREGNANCIES]-
1. First trimester bleeding
2. Abdo Pain
3. Amenorrhoea (absence/missed menstruation)

Question 33

What is the clinical presentation of Ectopic Pregnancies OTHER than the ‘Triad of Symptoms’ [bleeding, abdo pain, amenorrhoea]?

Answer 33

ECTOPIC PREGNANCIES-
- Unilateral pain which radiates to lower back, pelvis, shoulder
- Shoulder tip pain
- Diarrhoea or pain on defecation

Question 34

What are the potential Implications/Complications of RUPTURED Ectopic Pregnancies?

Answer 34

Implications/Complications of Ruptured Ectopic Pregnancies-
1. Internal Haemorrhage
2. Hypovolaemic Shock
3. Sepsis
4. Death