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CP2 OBGYN > Gynae P2 > Flashcards

Gynae P2 Flashcards

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1
Q

Def Endometriosis

A

Progressive and benign oestrogen dependent diseases defined by presence of endometrial glands and stroma outside the uterine cavity

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2
Q

Prevalence endometriosis

A

10% pop

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3
Q

What % of infertile F have endometriosis

A

40%

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4
Q

What are the 3 types of endometriosis externa

A

Superficial endometriosis
Ovarian endometriosis
DIE

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5
Q

What is the most common type of external endometriosis

A

Superficial endometriosis

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6
Q

What is endometriosis interna

A

Adenomyosis

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7
Q

What is the pain in endometriosis dependent on?

A

infiltration

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8
Q

What are the 2 main theories about how endometriosis comes about

A

Sampson endometrial reflux theory

Coeliac metaplasia theory

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9
Q

What is the Sampson endometrial reflux theory?

A

Blood from menses doesn’t all leave vagina and –> pelvic cavity
Shed endometrium attaches to surface of abdominal structures
After invasion, ectopic endometrium needs to recruit adjacent vascularisation (angiogenesis)

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10
Q

What is the coeliac metaplassia theory?

A

1 type of adult cell turns into another type of adult cells

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11
Q

What is the 3rd endometriosis theory

A

Halban lymphohaemotagenous theory

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12
Q

Where are the most common sites of endometriosis?

A

Ovaries

Uterosacral ligaments

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13
Q

Sx endometriosis

A 
Cyclical pain 
\+ 
Deep dyspaerunia 
Chronic pelvic pain 
Dysmenorrhoea 
Infertility 
Abdominal bloating 
Chronic fatigue
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14
Q

GIT Sx endometriosis (6)

A 
Dyschezia 
Haematochezia 
diarrhoea 
cyclical rectal bleed 
Constipation 
Cramping (mimics ibs)
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15
Q

Urinary tract Sx endometriosis (5)

A 
Frequency 
Dysuria 
Haematuria 
Ureteric obstruction 
Hydronephrosis
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16
Q

Endometriosis and fertility (4)

A

Blocks tubes
Tubes become > fixed + rigid, lacking persitalsis
Scar tissue
Dyspaeruniea

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17
Q

Diagnosis endometriosis (5)

A 
Hx 
Physical exam - tender nodules post fornix, uterus fixed, retroverted 
Pelvic USS 
MRI
Diagnostic lapro + biopsy
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18
Q

DDx endometriosis (5)

A 
PID
Pelvic pain syndrome 
Submucus fibroids 
Ovarian accident 
Adhesions
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19
Q

Aims of Mx endomtriosis

A

Alleviate pain

Stop progression disease/development complications

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20
Q

Mx endometriosis - med

A 
analgesia 
OCP / mirena 
Progrestogens 
Danzol? 
GnRH analogues
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21
Q

Why do progestogens work for endometriosis Mx

A

Induces state of pseudopregancy –> endometrium regresses

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22
Q

SE Danzol Tx

A

Oily skin
Acne
Deepening voice
W gain

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23
Q

How effective is Danzol for endometriosis Tx?

A

90% pain free

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24
Q

Surgical Mx endometriosis

A 
Ablation 
Excision 
Surgical resection 
Adhesiolysis 
Nodulectomy 
TAH + BSO (if don't want kids)
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25
What is adenomyosis
Presence of endometrial glands and stroma within the myometrium
26
Sx adenomyosis (3)
Parous middle aged F w/ menorrhagia Dysmenorrhoea Dyspareurnia
27
O/E adenomyosis
Uterus tender + bulky
28
What is a key sign someone may have adenomyosis?
Failed ablation
29
USS findings adenomyosis
``` Diffuse uterine enlargement Thickened posterior wall Eccentric endometrial cavity Irreg cystic spaces Disruption homogenous pattern in myometrium ```
30
Tx adenomyosis
Hysterectomy
31
What % of western pop suffer from menorrhagia
9-15%
32
Extracephalic causes of menorrhagia (4)
Liver disease Thyroid disease Dx Bleeding comditions (vwD)
33
Pelvic causes of menorrhagia (4)
Fibroids Polyps Adenomyosis DUB
34
What is the most common cause of menorrhagia
DUB - dysfunctional uterine bleeding (75%)
35
What is a polyp
Discrete growth on endometrium
36
Tx of polyp
Hysteroscope
37
Tx of DUB
Mirena coil COC POP
38
How is menorrhagia diagnosed? (3)
Subjective assessment Pictorial blood loss assessment charts Objective assessment
39
Ix menorrhagia (4)
FBC Pelvic USS EM biopsy Hysteroscopy
40
Non-hormonal Mx menorrhagia
Transenamic acid | NSAIDS e.g. mefanamic acid/ibuprofen
41
Surgical Mx menorrhagia
Ablation | Hysterectomy
42
Risks of ablation Mx menorrhagia (5)
``` 20% failure rate Uterine perforation Fl overload Haemorrhage Infection ```
43
What is anovulatory DUB
Pt has heavy periods but doesn't ovulate
44
Causes of anovulatory DUB
PCOS Thyroid dysfunction Adolescents Perimenopausal F
45
Def fibroids
Benign uterine tumours of the myometrium
46
What % of F have fibroids
70%
47
What age are typically affected by fibroids
30-40 y/o
48
What are fibroids dependent on?
Oestrogen and progesterone
49
Sx fibroids (8)
``` Heavy + prolonged bleeding Menstrual and lower abdominal pain + bloating Pain on intercourse Pelvic pain Lower back pain Constipation Polyuria Chronic vaginal discharge ```
50
RF fibroids
``` Obesity Black Nulliparity PCOS HTN ```
51
What classification is now used for fibroids
Wamstekers
52
Ix fibroids
``` Hx Exam Laparo USS MRI/CT? ```
53
Indications for Tx fibroids (3)
Symptomatic Rapidly enlarging If thought to be causing infertility
54
Medical Mx fibroids
GnRH
55
Surgical Mx fibroids
Hysterectomy Myomectomy (if still want babies) Emobilization
56
Fibroids + pregnancy - what can go wrong (11)
``` IUGR Placenta accreta Obstruction Foetal malabsorption Placenta praevia PPH Miscarriage Pre-term labour Red degeneration Labour dystocia Uterine atony post partum ```
57
PS red degeneration
Severe localised pain | + pointing finger sign
58
Causes of endometritis
STI Post op complications Foreign tissue IUD
59
Features of endometritis (3)
Tender uterus Pelvic/systemic infection Accumulation of pus
60
Mx endometritis
ABX | ERPC
61
Cause of intrauterine polyps
Increased oestrogen
62
Features of intrauterine polyps
Asymptomatic Menorrhagia IMB Prolapse of cervix
63
Mx of intrauterine polyps
USS, hysteroscopy + resect
64
What is haematometra
Menstrual blood accumulates in the uterus due to outflow obstruction
65
Cause of uterine shape abnormalities
Failure of 2 mullerian ducts to fuse c9 w gesation

CP2 OBGYN (21 decks)

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