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O&G > gynae - Bleeding > Flashcards

gynae - Bleeding Flashcards

1
Q

what is a follicular cyst - physiological

A
  • commonest type of ovarian cyst
  • non-rupture of the dominant follicle or failure of atresia in a non-dominant follicle
  • regress after several menstrual cycles
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2
Q

what is a Corpus luteum cyst

A
  • In absence of pregnancy corpus luteum usually breaks down
  • If not, the corpus luteum may fill with blood or fluid and form a corpus luteal cyst
  • presents with intraperitoneal bleeding
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3
Q

what is a dermoid cyst

A
  • Lined with epithelial tissue and hence may contain skin appendages, hair and teeth
  • most common benign ovarian tumour
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4
Q

Serous cystadenoma

A

the most common benign epithelial tumour which bears a resemblance to the most common type of ovarian cancer (serous carcinoma)
bilateral in around 20%

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5
Q

Mucinous cystadenoma

A
  • benign epithelial tumour
  • typically large and may become massive
  • pseudomyxoma peritonei if rupture
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6
Q

Risk factors for endometrial cancer

A 
obesity
nulliparity
early menarche
late menopause
unopposed oestrogen
diabetes mellitus
tamoxifen
polycystic ovarian syndrome
hereditary non-polyposis colorectal carcinoma
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7
Q

Common features of endometrial cancer

A

post menopausal bleeding
change in bleeding pre-menopausally
uterine mass/fixed uterus

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8
Q

Investigation for post menopausal bleeding

A 
Pelvic USS
endometrial biopsy
hysteroscopy
Smear
FBC: anaemia
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9
Q

Differentials for post-menopausal bleeding

A

Endometrial hyperplasia
endometrial polyp
endometriosis
cervical cancer

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10
Q

Management endometrial cancer

A
  • hysterectomy

- +/- vaginal brachytherapy

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11
Q

what might you see in a transvaginal USS in endometrial cancer

A
  • thickened endometrium

- <4mm is a good negative predictive factor value

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12
Q

In which part of the fallopian tube is an ectopic pregnancy most likely to RUPTURE

A

isthmus

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13
Q

where is an ectopic pregnancy most likely to occur

A
  • 97% tubual - ampulla

- 3% ovaries, cervix or peritoneum

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14
Q

What is endometriosis

A

The endometrium is tissue that lines the inside of the uterine cavity. In endometriosis, this type of tissue is found outside the womb in the pelvic and tummy area

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15
Q

Symptoms of endometriosis

A
  • menorrhagia - cyclically
  • Deep, chronic pelvic pain
  • dyspareunia
  • sub-fertility
  • fixed retroverted uterus
  • depression is common
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16
Q

Investigations of endometriosis

A
  • transvaginal USS

- gold standard is laparoscopy

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17
Q

Differentials for endometriosis

A
  • PID
  • IBS
  • Ovarian cyst/cancer
  • interstitial cystitis
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18
Q

Management of endometriosis if contraception is required

A
  • Mirena coil
  • COCP
  • NSAIDs
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19
Q

Management of endometriosis if no contraception is required

A
  • clomifene: controlled ovarian hyperstimulation
  • therapeutic laparoscopy
  • Mefanamic/tranexamic acid
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20
Q

Surgical management of endometriosis

A
  • can only do surgical options when family has been completed
  • adhesiolysis
  • bilateral oophorectomy + Hysterectomy
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21
Q

Causes of Mennorrhagia

A
  • endometriosis
  • PCOS
  • Fibroids (leiomyotoma)
  • Miscarraige
  • salpingitis/endometritis - PID
  • Dysfunctional uterine bleeding
  • bleeding disorder
  • anticoagulation treatment
  • hypothyroidism
  • IUD
  • (malignancies)
22
Q

Causes of dysmenorrhoea

A
  • primary dysmenorrhoea
  • PID
  • endometriosis
  • adenomyosis
  • Fibroids/polyps
  • Ovarian cyst with haemorrhage
  • ovarian torsion
  • IUD
23
Q

What are uterine fibroids - patient

A

A non cancerous overgrowth of smooth muscle cells in the womb that vary in size

24
Q

What are the associations with fibroids

A
  • more common in Afro-Caribbean women

* rare before puberty, develop in response to oestrogen, don’t tend to progress following menopause

25
Q

What are the key featurse of fibroids

A
  • may be asymptomatic
  • menorrhagia
  • lower abdominal pain: cramping pains, often during menstruation
  • bloating
  • urinary symptoms, e.g. frequency, may occur with larger fibroids
  • subfertility
26
Q

How ar fibroids diagnosed

A

trans-vaginal ultrasounds

27
Q

What is the most common type of fibroid

A

intra-mural: grow within the muscle tissue of the womb

28
Q

What are the problems with fibroids in pregnancy

A
  • Increased risk of implantation probolems
  • pain or discomfort if they grow too large for it’s blood supply/it twists
  • increased need for c section
  • Breech/footling lay
  • preterm delivery
29
Q

What causes fibroids

A

we aren’t entirely sure, however we do know that their growth is affected by hormones so tend to swell during periods of high hormones such as pregnancy.

30
Q

When do fibroids normally begin to shrink

A

after menopause

31
Q

Management of fibroids

A
  1. observation
  2. medication to improve symptoms or shrink fibroid
  3. surgery
32
Q

What medications improve the symptoms of fibroids

A
  • Tranexamic acid
  • NSAIDs
  • COCP
  • IUS - mirena coil
33
Q

What medications shrink fibroids

A

gonadotrophin-releasing hormone (GnRH) analogue: decreases oestrogen levels i the body

34
Q

What is the downside of GnRH analogues

A

Essential put you through the menopause so can experience hot flushes, mood changes, osteoporosis etc.
NB. given for a maximum of 6 months

35
Q

Surgical management of fibroids

A
  • hysterectomy
  • myomectomy
  • uterine artery embolism
  • myolysis - shrinkage of fibroid e.g. endometrial abltion
36
Q

What red degeneration

A
  • haemorrhage infarct of the fibroid.
  • Often occurs during pregnancy
  • Presents with abdominal pain, low grade fever and often vomiting.
  • Management is conservative.
37
Q

Differential diagnoses for inter-menstrual bleeding

A

Cervical ectropion / polyp / cancer
Sexually transmitted infection
Endometrial polyp / cancer
Iatrogenic contraception related bleed

38
Q

Differential diagnoses for post-coital bleeding

A 
Often no cause is found
Cervical ectropion
Cervical inflammation secondary to infection (e.g. Chlamydia)
Cervical cancer
Atrophic vaginitis
Polyps
Other cancers (e.g. vaginal or endometrial)
Trauma
39
Q

what investigations should you complete in woman with menorrhagia

A
  • Pelvic exam

- Transvaginal pelvic US

40
Q

Indications for transvaginal pelvic US in woman with menorrhagia

A

Abnormal pelvic examination
Postcoital bleeding
Intermenstrual bleeding
Other abnormal pelvic symptoms (i.e. pelvic pain)

41
Q

What is the management of menorrhagia in woman who do not want contraception

A 
Tranexamic acid when no associated pain (antifibrinolytic – reduces bleeding)
Mefanamic acid (NSAID – reduces bleeding and pain)
42
Q

What is the management of menorrhagia in woman who do want contraception

A
  • Mirena coil
  • Combined pill
  • Progesterone pills (e.g. norethisterone)
  • Long acting progesterone (e.g. depo injection)
  • endometrial ablation and hysterectomy.
43
Q

What are the complications of Fibroids

A
  • Complications in pregnancy relating to the space they occupy (e.g. premature labour, blocking vaginal delivery, miscarriages).
  • Infertility
  • Heavy bleeding (leading to anaemia)
  • Constipation
  • Urinary outflow obstruction / urinary tract infections
  • Red degeneration AKA corneous degeneration
44
Q

What is a cervical ectropion

A
  • Columnar epithelium of the endocervix is displayed on the ectocervix and is visible on speculum
  • caused by increased oestrogen levels
  • can cause discharge or post-coital bleeding.
45
Q

How is a cervical ectropion managed

A

Treatment in symptomatic cases is with silver nitrate or diathermy.

46
Q

What is the transformation zone

A

the border between the columnar epithelium of the endocervix (the canal) and the stratified squamous epithelium of the ectocervix (the area visible on speculum examination).

47
Q

What is Ashermans syndrome

A
  • adhesions (sometimes called synechiae) form within the uterus
  • Excessive scraping of the endometrium can damage the bottom layer of the endometrium.
  • This then heals abnormally creating scar tissue connections between areas that are not normally connected (for example one side of the uterus to the other).
48
Q

What is the result of Asherman;s Syndrome

A
  • menstruation abnormalities (amenorrhea, dysmenorrhea)
  • infertility
  • recurrent miscarriages.
49
Q

How do you diagnose Asherman’s Syndrome

A
  • Sonohysterography (pelvic ultrasound after the uterus is filled with fluid)
  • Hysteroscopy is the gold standard investigation.
50
Q

How do you treat Asherman’s Syndromw

A

Adhesions can also be dissected during hysteroscopy.

51
Q

What is the presentation of ovarian cysts

A
  • Mostly asymptomatic, often found incidentally
  • Pelvic pain
  • Bloating
  • Fullness in the abdomen
  • Very large cysts (such as Mucinous Cystadenomas) can be felt as a pelvic mass.
52
Q

What are the complications of ovarian cysts

A

Torsion
Haemorrhage cyst – bleeding into the cyst causing increased pain
Rupture – bleeding into the peritoneum

O&G (13 decks)

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