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Obs and Gynae Y4 > 8. Common Gynaecological Disorders > Flashcards

8. Common Gynaecological Disorders Flashcards

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1
Q

Menstrual blood loss

A

35-45mls per cycle

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2
Q

Prostaglandins controlling uterine vasoconstriction

A
  • PG F2a – causes vasoconstriction
  • PG E2 and Prostacyclin (PGI2) – causes vasodilatation
  • Prostacyclin (PGI2) – inhibits platelet aggregation
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3
Q

List 7 menstrual disorders

A
  • Amenorrhoea
  • Menorrhagia
  • Metrorrhagia
  • Intermenstrual bleeding
  • Polymenorrhoea
  • Oligo/Amenorrhoea
  • Dysmenorrhoea
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4
Q

Primary amenorrhoea

A

Temporary or permanent absence of menses due to dysfunction of hypothalamus /pituitary /ovaries /uterus/ vagina.

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5
Q

Puberty stages

A
  • Growth spurt
  • Axillary and pubic hair development
  • Apocrine sweat glands, breast development
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6
Q

1* Amenorrhoea and short statue

A

–> Turner syndrome or growth hormone deficiency

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7
Q

1* Amenorrhoea and Galactorrhoea

A

Hypothalamic or pituitary disease, or drug induced (metoclopramide)

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8
Q

1* Amenorrhoea and PCOS + hyper-androgenism (acne, hirsutism)

A

Adrenal tumour

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9
Q

Kallmann’s syndrome and amenorrhoea

A

Kallmann;s causes 1* amenorrhoea - absence of GnRH neurons. (associated with ansomnia and colour-blindness)

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10
Q

Kallmann’s Syndrome inheritance

A

Autosomal dominant or X-linked recessive

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11
Q

Anatomical abnormalities in primary amenorrhoea

A
  • Intact hymen
  • Transverse vaginal septum
  • Mullerian/vaginal agenesis
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12
Q

Tanner staging

A

Rates development of 2ndary sexual characteristics; Sexual Maturity Rating

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13
Q

Treatment for 1* Amenorrhoea in Primary Ovarian Insufficiency

A

Give HRT to prevent bone loss or premature coronary heart disease

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14
Q

Treatment for 1* amenorrhoea for pts to get pregnant

A

Exogenous GnRH or pulsatile GnRH

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15
Q

Secondary amenorrhoea

A

Absence of Menses for >6 moths in someone with previous regular periods

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16
Q

2* amenorrhoea and hypothalamic-pituitary involvement

A

Polyuria, polydipsia, fatigue, visual defects, headaches

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17
Q

2* amenorrhoea and oestrogen deficiency

A

hot flushes, vaginal dryness, poor sleep, decreased libido

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18
Q

Laboratory test for 2* amenorrhoea

A

hCG, FSH, TSH, Prolactin

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19
Q

How to manage low bone density in 2* amenorrhoea?

A

Oestrogen replacement

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20
Q

Menorrhagia

A

Ovulatory heavy menstrual bleeding

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21
Q

Investigations in menorrhagia

A

Pelvic USS, FBC, TFT, Clotting screen, endometrial biopsy (all women >45yo)

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22
Q

Medical therapies for Menorrhagia

A

NSAIDs, Haemostatics, Hormones, IUS

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23
Q

Menorrhagia and NSAIDs drugs

A

Mefenamic acid, Indomethacin, Ibuprofen, Naproxen

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24
Q

Menorrhagia and NSAIDs

A
  • Taken only during menstruation
  • 50% reduction in menstruation volume loss
  • Improves dysmenorrhoea and dyspareunia
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25
Menorrhagia and haemostatics drugs
- Antifibronolytics (tranexamic acid - cyclokapron) | - Capillary wall stabiliser (ethamsylate - dicynene)
26
Antifibrinolytics for menorrhagia
- Taken only during menstruation - >50% reduction in mestruation volume loss - Superior to NSAIDs controlling the loss, but not the pain
27
Capillary wall stabiliser for menorrhagia
- Taken only during menstruation - No contraindications - 20-30% blood loss reduction
28
Menorrhagia and hormones
- Oral contraceptives (cycle regulation, reduction of loss and dysmenorrhoea) - HRT (cycle regulation only) - Synthetic progestagens (cycle regulation, loss reduction)
29
Menorrhagia and hormones HPO axis regulation
- Danazol (reduces flow, lots of side effects and expensive) - Gestrinone (similar to danazol) - GnRH analogues (induce menopause, lots of side effects and expensive)
30
IUS for Menorrhagia
Levonorgesterol
31
Surgical therapy for menorrhagia
Hysteroscopy, Hysterectomy, Endometrial destruction
32
Menorrhagia and hysteroscopy
- Endometrial resection (TCRE) | - Endometrial ablation (ELA, RFA)
33
Endometrial resection
TCRE - transcervical resection of the endometrium
34
Endometrial ablation
ELA - endometrial laser ablation | RFA - radiofrequency ablation
35
Hysterectomy
TAH - total abdominal hysterectomy VH - vaginal hysterectomy LAVH - laparoscopy assisted vaginal hysterectomy
36
Endometrial destruction
- No risk of menopause induction | - Intra and post operative complications
37
Indication for therapy in menorrhagia
Women <40 yo, Regular cycles and no IMB, no risk factors for malignancy, clinically normal pelvis
38
Metrorrhagia definition
An-ovulatory Heavy Menstrual Bleeding
39
Intermenstrual bleeding differential diagnosis
ovulatory dysfunction, neoplasia, uterine structural pathology, disorders of haemostasis
40
Disorders that cause Abnormal Uterine Bleeding
- Bleeding disorders, Endocrine disorders, Coeliac disease, Anticoagulant use, hyperprolactinemia
41
AUB: PALM - COEIN
Polyp, Adenomyosis, Leiomyoma, Malignancy/Hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not classified
42
Fibroids treatment:
- conservative management - uterine artery embolisation - MRI-guided ultrasound coagulation - Myomectomy (surgical removal of fibroids) - Hysterectomy
43
Fibroid treatment
- Uterine artery embolization - Ultrasound coagulation - Myomectomy (surgical removal of fibroids) - Hysterectomy
44
Vaginal epithelium
Non-keratinized, stratified squamous; rich in glycogen.
45
Doderlein Lactobacilli
Convert glucose (from glycogen from sloughed cells) into lactate to provide acidic environment (pH 4.0-4.5)
46
The role of acidic pH in the vagina
- Maintain vaginal flora | - Inhibit growth of pathogens
47
Non-specific vulvovaginal symptoms:
- Change in volume, colour, or odour of vaginal discharge - Pruritis - Burning and irritation - Erythema - Dyspareunia - Spotting - Dysuria
48
Symptoms of bacterial vaginosis (BV)
Malodorous, thin grey discharge, symptoms during and just after period
49
Symptoms of vaginal candidiasis
Scant thick white, odourless discharge
50
Symptoms of trichomoniasis
Purulent, malodorous discharge + burning, pruritis, dysuria, dyspareunia, symptoms during and just after period
51
Pruritis characteristics
Diffuse infection and allergy; chronic -> malignancy or neoplasia
52
Burning and irritation – diseases:
- Candida vulvo-vaginitis | - Vulvodynia
53
Candida vulvo-vaginitis:
Inflammation, pruritis and soreness (premenstruation symptoms)
54
Vulvodynia:
Non-infectious disorder
55
Erosive vulvo-vaginitis
Multifocal rounded macular erythematous lesions (burises/spotter rash-like), purulent discharge and tenderness
56
BV discharge
Fishy-smelling, grey thin, homogenous discharge
57
Trichomoniasis discharge
Greenish-yellow purulent discharge
58
Candidiasis discharge:
Thick white, adherent, ‘cottage cheese like’ discharge
59
What do chocolate cysts suggest?
Endometrioma
60
Endometriosis treatment
- Continuous COCP or POP - Mirena IUS - GnRH agonists - Surgery (ablation and pelvic clearance)
61
Differential diagnosis in Pelvic Inflammatory Disease
- Ectopic pregnancy - Acute appendicitis - Endometriosis - Ovarian torsion - Ovarian cyst rupture - UTI
62
Symptoms of PID
- Lower abdominal pain - Dyspareunia - Abnormal vaginal bleeding - Dysmenorrhoea - Abnormal discharge - Fever, positive test for gonorrhoea, chlamydia, or M genitalium
63
Outpatient treatment for PID
IM ceftriaxone 1000mg (Single dose), Doxycycline PO BD 100mg (14 days), Metronidazole PO BD 400mg (14 days)
64
Inpatient treatment for PID
- IV continued for 24h post improvement and switched to oral - IV ceftriaxone 2g daily - IV doxycycline 100mg BD NEXT: - Doxycycline PO BD 100mg (14 days) - Metronidazole PO BD 400mg (14 days)
65
Chronic PID treatment
- Abx - Anaelgesia - Adhesiolysis - Hysterectomy and bilateral salpingectomy
66
Ovarian cysts blood tests:
- FBC - CA125 - Lactate dehydrogenase - A-FP and hCG
67
RMI (Risk of Malignancy Index)
U x M x CA-125 U – ultrasound (1 for: multilocular cysts, solid areas, metastases, ascites, bilateral lesions) M – menopausal status (1 – premenopause, 3 – postmenopause) Serum CA125 – IU (0-1000s)
68
Ovarian cyst management
<5cm no treatment 5-7cm yearly USS >7cm MRI/surgical intervention (laparoscopic cystectomy but no aspiration!)
69
Bartholin glands (greater vestibular glands)
Secretes mucus and lubricates vulva and vagina (Bartholin ducts drain here – if blocked - vulvar mass)
70
Bartholin cyst
If Bartholin duct is obstructed, mucus accumulates -> dilatation of duct -> obstruction causes a cyst
71
Bartholin abscess
Obstructed duct becomes infected and forms an abscess
72
Fluid from Bartholins mass:
Cyst: clear or white fluid Abscess: yellow or green
73
Bartholin abscess/cyst management
Abx, word’s catheter, marsupialisation

Obs and Gynae Y4 (22 decks)

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