Gynae Flashcards
Endocervical chlamydia swab
Turn 10-30 secs
White
Swabs prep
I will insert a small plastic tube into your vagina. I will then insert thin swabs into your vagina and the neck of your womb. It should no be painful and if it is too uncomfortable at any point just say so and I will stop.
In order to do this, I will need you to undress from the waist down. To bring your heels to your bottom and let your knees flop out to the side. Please cover yourself with the drape. There will be a nurse present throughout for your comfort and will act as a chaperone.
Would you like to empty your bladder?
LMP, spotting, last smear?
Explaining colposcopy
Mild dyskariosis = not cancer
Abnormal cells that have numerous causes
Similar set up to smear test. The doctor uses a microscope to have a closer look. They then use a dye which highlights abnormal cells. They may remove a small bit of tissue for further investigations.
If abnormal area seen may treat it then or organise another appt.
Use hot or cold therapy to get rid of abnormal cells.
Afterwards: spotting, no sex or tampons for 1 week
F/u appt 4-6 months
Swabs order
Smear
High cervical charcoal - BV, candida
Endocervical charcoal - gonorrhoea
Endocervical white - chlamydia
Cervical ectropian
Extension of endocervical epithelium to squamous epithelium
Pregancy, pill, puberty
Sx: asymptomatic, post-coital bleeding, inc discharge
At inc risk of HPV»_space; do smear
Hysteroscopy
Safe and effective way of finding out the cause of:
Post-menopausal bleeding
Heavy periods
Small camera is used to look inside womb. Small tools can be used to remove polyps or fibroids. Can be done under GA or LA. Day case surgery.
Complications: failure, bleeding, infection, blood clot
Most people can return to normal activities next day
Fibroid
Muscle layer of womb becomes overgrown
Due to unopposed oestrogen
Inc urinary frequency, dyspareunia, menorrhagia
Polyp
Overgrowth of lining of womb
Looks like a grape on a stalk
HRT counselling
Reduction in oestrogen 45-55 y/o Amennorhoea for 12 months Sx: Hot flushes Mood swings Vaginal dryness Sleep problems HOW BOTHERSOME ARE THESE SYMPTOMS? Introduction of oestrogen should improve these symptoms \+ red osteoporosis \+ prevent # - breast tenderness, inc appetite, weight gain - breast & endometrial Ca - DVT
Blood tests show inc FSH
With uterus: oestrogen & progesterone
Without uterus: oestrogen
Transdermal (weekly), oral (daily), pessary
Shortest period possible, no longer than 5 yrs, reduce slowly
CI: Breast Ca, active endometrial Ca, active VTE, active CVD
Other tx: SSRIs, complementary therapies, breast self exam, diet inc soy
Pre-menopausal: cyclical (bleeding)
Post-menopausal: continuous (avoid bleeding)
Endometriosis
Menorrhagia, dyspareunia, dysmenorrhea Extrauterine tissue Cyclical pain Comp: IMB, subfertility, endo Ca Mx: - Mirena - Tranexamic acid & Mefanamic acid - Surgical removal
PCOS
Raised LH
FH, hirsutism, weight gain, lighter/no periods, acne, mood
Ix: bloods, TVUSS
>12 cysts, oligomenorrhoea, hyperadrogenism
Mx:
- exercise & weight to minimise CV / DM risk factors
- Metformin
- COCP, mirena
Comp: Endo Ca, CVD & DM, pregnancy issues due to sub-fertility
Menorrhagia history
Ask: LMP, length of periods, regular? Tampons & pads together? Clots? FH: endometriosis, blood disorders SH: smoking, alcohol, drugs MH: blood thinners, contraception DDX: SOB,energy levels, STI, pregnant? Weight loss, night sweats
Mennorhagia differentials
Hypothyroidism 2' to contraception or blood thinners Bleeding disorder Endometrial Ca Ectopic pregnancy Fibroids PID
Right shoulder tip pain (acute station)
Ectopic pregnancy
Amenorrhoae possible causes
Cerebral - stress, starvation, anorexia, exercise
HPA axis - prolactinoma
Thyroid - hypo/hyperthyroidism
Adrenal - cushings, androgen secreting tumour
Ovary - PCOS, premature menopause
Vaginal - pregnancy
