Dysmenorrhea Flashcards
Endometriosis, adenomyosis, PID (83 cards)
1
Q
Dysmenorrhea
A
Painful menstruation
2
Q
2 types of dysmenorrhea
A
- Primary
- Secondary
3
Q
Primary dysmenorrhea
A
Painful menstruation usually appearing in 1 year of menarche
4
Q
Primary dysmenorrhea occurs with
A
ovulatory cycles
5
Q
When does pain occur in primary dysmenorrhea
A
begins with onset of menstruation
6
Q
Type of pain in primary dysmenorrhea
A
spasmodic- type
7
Q
Cause of primary dysmenorrhea
A
Due to physiological release of Prostaglandin 2 (PGE2) which cause contraction and cause pain
8
Q
Mx of primary dysmenorrhea
A
usually self- limiting
* NSAIDs
* COCP- combined Oral Contraceptives
9
Q
Main component responsible for primary dysmenorrhea
A
Prostaglandin 2 (PGE 2)
10
Q
Secondary dysmenorrhea onset
A
3rd - 4th decade of life
11
Q
Secondary dysmenorrhea- type of pain
A
Congestive pain
12
Q
Associated Sx of Secondary dysmenorrhea
A
- Pelvic heaviness
- Back pain
13
Q
Secondary dysmenorrhea is associated with
A
- Cycle irregularity
- Heavy periods
- Dyspareunia
- Vaginal discharge
- IMB
- Post- coital bleeding and pain
14
Q
Causes of Secondary dysmenorrhea
A
- Endometriosis
- Adenomyosis
- Intra- uterine polyps
- Submucosal fibroids
- IUCD
- PID
- Congestive uterine abnormalities
- Cervical stenosis
- Ashermann Syndrome
- Uterine retroversion
15
Q
Endometriosis
Epidemiology
A
8%- 10% of women in reproductive years
16
Q
Endometriosis
Endometriosis
A
Presence of functioning endometrial tissue ( glands and stroma) at** sites outside the uterine cavity** which induces a chronic inflammatory reaction
17
Q
Endometriosis
Theories about the pathophysiology
A
- Retrograde menstruation
- Hematological or lymphatic spread
- Celomic hyperplasia
18
Q
T/F
- MCC of dysmenorrhea is PID
- Cause of endometriosis is unknown
- Secondary dysmenorrhea pain is spasmodic
- Dysmenorrhea is due to the release of PGE2
- Secondary dysmenorrhea is seen from 2nd to 4th decade of life
A
- F ( endometriosis)
- T
- F ( congestive- type)
- F (only primary )
- F (3-4th decades)
19
Q
Endometriosis
Sites
A
- Uterosacral ligament
- Ovaries
- Fallopian tube
- Rectovaginal septum
- Outer surface of uterus
- lining of the pelvic cavity
- Bladder
- Bowel
- Vagina
- Cervix
- Vulva
- Abdominal surgical scars
- Less common- arm, lung, thigh
20
Q
Endometriosis
Risk factors
A
- Age
- Increased peripheral body fat
- Greater exposure to menstruation
- Genetic predisposition
21
Q
Endometriosis
Why is greater exposure to menstruation a risk factor
A
due to short cycles, Long duration of flow, reduced parity
22
Q
Endometriosis
Sx
A
- Dysmenorrhea >6 months
- Chronic pelvic pain
- Deep dyspareunia
- Dyschezia
- Pain on micturition
- Pain on exercise
- Subfertility
- Non specific Sx- Fatigue, General malaise, sleep disturbances
- Cyclical rectal bleeding (hematochezia)
- Hematuria
23
Q
Endometriosis
Dysmenorrhea should be present for
A
> 6 months
24
Q
Endometriosis
- Most patients are asymptomatic
- Endomteriosis can be seen in vulva
- Celomic hypoplasia is a pathophysiological theory behind endometriosis
A
- T
- T
- F ( hyperplasia)
25
# Endometriosis
Ix
* Laparoscopy
* CA 125
* TVUSS
* MRI
26
# Endometriosis
Gold standard Dx test
Laparoscopy
27
# Endometriosis
Why is laparoscopy the gold standard test
for direct visualization and confirmation by biopsy when there is a doubt
28
# Endometriosis
Why is laparoscopy done
to exclude malignancy- malignant transformation of endometrioma
29
# Endometriosis
Endometrioma
a malignant tumor with chocolate coloured blood
30
# Endometriosis
Is endometrioma common
Rare 0.7%
31
# Endometriosis
CA125 uses
No evidence to say it is useful as a screening test but levels will be high in severe disease
32
# Endometriosis
CA 125 levels in severe endometriosis
raised
33
# Endometriosis
TVUSS uses
to detect ovarian endometrioma
34
# Endometriosis
MRI uses
to evaluate deep lesions involving the cul de sac ( rectouterine pouch)
35
# Endometriosis
Main methods of Mx
* Surgical
* Medical
* Combination of surgical and medical
36
# Endometriosis
Surgical Mx
* Laparoscopy
* Laparotomy
Adhesiolysis, Cystectomy
37
# Endometriosis
Medical Mx
* Non- hormonal
* Hormonal
* Different types of progestagens
38
# Endometriosis
Hormonal drugs
* COCP
* Anti- progetagens
* Gestrinone
* GnRH agonists
* Aromatase inhibitors
39
# Endometriosis
Danazole is not a treatment according to.....
EISHRE GUIDELINES
40
# Endometriosis
Non- hormonal Drugs
* NSAIDs- mefenamic acid (Analgesic)
41
# Endometriosis
Progestagens used
* Medroxyprogesterone acetate
* Dienogest
* LNG- IUS
* Cyproterone acetate
* Norethisterone acetate
42
# Endometriosis
Medroxyprogesterone acetate is used as
oral or depot
43
# Adenomyosis
Adenomyosis
Presence of endometrium in the myometrium
44
# Adenomyosis
can involve the
whole muscle thickness down to the serosa
45
# Adenomyosis
Risk factors
* Parity
* Smoking
* Spontaneous miscarriage
* Endometriosis
* Menorrhagia
* Endometrial hyperplasia
* Infertility
* Preterm birth
* Surgical termination/ curettage in PG
46
# Adenomyosis
Ix
* TVS
* MRI
* FBC
47
# Adenomyosis
TVS or TAS
Trans vaginal is superior to trans abdominal USS in Dx
48
# Adenomyosis
Why is FBC done
assess the Hb
49
# Adenomyosis
Mx options
* Medical
* Surgical
50
# Adenomyosis
Medical Mx
* Non- hormonal
* Hormonal
51
# Adenomyosis
Non hormonal Therapy
Mefenamic Acid and tranaxemic acid - Sx relief
52
# Adenomyosis
Hormonal Rx
* Progestogen- LNG- IUS
* COCP- continuous combined Oral contraceptives
* GnRH analogues- reduce uterine volume
53
# Adenomyosis
Advantage of giving GnRH analogues
reduce the uterine volume
54
# Adenomyosis
Surgical Mx
* Localized excision of affected myometrium
* Reduction of the uterine blood flow by uterine artery embolization
* Hysterectomy
55
# Adenomyosis
Adenomyomectomy
Localized excision of affected myometrium
56
# Adenomyosis
Hysterectomy methods
* abdominal
* vaginal
* laparoscopic
57
# PID
Sites
* Upper genital tracts
* Fallopian tubes
* ovaries
58
# PID
Types of inflammation
* endometritis
* Salpingitis
* Tubo- ovarian abscess
* Pelvic peritonitis
59
# PID
Is PID unilateral or bilateral
Bilateral usually
60
MCC of preventable cause of infertility
Pelvic inflammatory disease
61
# PID
Sx
* Abdominal pain, pelvic pain and dyspareunia
* Mucopurulent vaginal discharge
* Fever
* HMB
62
# PID
Signs
* Pelvic tenderness
* Cervical excitation
* Tender adnexal mass
* Tubal damage
63
# PID
Cervical excitation
Pushing the cervix to one side with a finger causes stretching of the upper genital tract to the opposite side giving pain.
**IN PID PUSHING TO BOTH SIDES WILL CAUSE PAIN (B/L INVOLVEMENT)**
64
cervical excitation is used in
PID and ectopic PG
65
How to differentiate cervical excitation in ectopic PG and PID
* Ectopic PG- pain only on pushing to one side
* PID- pain on both sides
66
# PID
MCC of PID
STDs
67
# PID
STDs commonly causing PID
* Neisseria gonorrhea
* Chlamydia trachomatis
* anaerobes
68
# PID
Anaerobes
* H. influenzae
* Gardanella vaginalis
* Strep agalactaie
* Myco hominis
* Ureaplasma urealyticum
69
# PID
MO common in bacterial vaginosis
Ureaplasma urealyticum
70
# PID
Risk factors
* Adolescence
* Hx of STD
* Multiple sexual partners
* Insertion of IUCD
* Bacterial vaginosis
* Nonuse of barrier methods- OCP
71
# PID
Long- term complications
* Tubal factor infertility
* Ectopic PG
* Chronic pelvic pain
* Recurrent PID
72
# PID
Dx
* Hx
* Clinical examination
73
# PID
Definitive test for Dx PID
**No Definitive test**
74
# PID
Supportive tests
* WBC - raised
* CRP/ ESR- raised
* USS- adnexal mass, hydrosalphynx
* Laparoscopy
75
# PID
Gold standard test
Laparoscopy
76
# PID
Mx is done Out-patient or in- patient
Out- patient in mild to moderate PID cases
77
# PID
Indications for admitting and IV ABX
* Severe infection
* Adnexal mass suspicious abscess
* Generalized sepsis
* Inadequate response to oral Rx
78
# PID
The test that should be done in a woman who comes with acute abdominal pain suspecting of PID
urine PG test to **exclude ectopic PG**
78
# PID
Mx of severe PID
* IV fluids
* IV ABX
* Analgesics
79
# PID
When to start ABX
should be started** without waiting for culture report**
80
# PID
First line ABx
* Ceftriaxone - 500mg IM single
* Doxycycline oral 100mg BD for 14 days
* Metronidazole oral 400mg BD for 10 days
81
# PID
2nd line ABx
* Ofloxacin
* Cefixime
82
# PID
Surgical Mx
I&D of tubo- ovarian abscess Laparotomy
