Gynaecology Flashcards
(29 cards)
What week is hyperemesis gravidum?
begins between 4–7th weeks, peaks between 9–16th weeks, and resolves by 16–20 weeks of pregnancy. NOTE IF ONSET STARTS AFTER 11 WEEKS THEN CONSIDER ALTERNATIVE CAUSE OF SYMPTOMS.
What is the PUQE-24 scoring system?
Pregnancy Unique Quantification of Emesis (PUQE) 24 is a scoring system of nausea and vomiting in 24 hours. It is out of 15
mild <= 6; moderate 7–12; severe 13–15.
What is hyperemesis gravidarum?
The term is used to describe the most severe spectrum of symptoms. It is a diagnosis of exclusion much like CFS, IBS and Behcets.
It is characterised by the TRIAD of
- Prolonged persistent and severe N+V
- Weight loss ≥5% of pre-pregnancy body weight
- Dehydration and electrolyte imbalance
What are the causes of N+V in pregnancy?
- physiological morning sickness
- high HcG
- UTI
- multiple pregnancy
- Trophoblastic disease
which antiemetic is associated with cleft palate if given in the first trimester
ondansetron
which antiemetic cannot be given for >5 days?
metaclopramide
What are the first line antiemetics for hyperemesis gravidarum?
Antihistamines- CYCLIZINE. PROMETHAZINE. PROCHLORPEZAMINE 2ND LINE as ondansetron and metaclopramide have more side effects and risks associated with them.
Why give antacids and alignates for hyperemesis gravidarum?
Gaviscon (antacid)
CKS recommends using acid-suppressing drugs only as a last resort in severe cases in primary care as there is no evidence that they are safe
omeprazole and famitidine
what is domperidone?
A dopamine receptor antagonist antiemetic
it should NOT BE USED FOR >7 DAYS BECAUSE THE RISK OF CARDIAC SIDE EFFECTS
How is cervical cancer staged? How many stages are there and what do they mean?
using the FIGO system
1 A1 A2 B1 B2 B3 - Confined to cervix (varying size depending on the subdivision)
2 A1 A2 B - Spread from the cervix to the upper vagina, the uterus or parametrium (connective tissue around the uterus but NOT the pelvic walls (muscles or affecting the ureters)
3 A B C - Spread from the cervix to the lower vagina or to the pelvic walls. C- lymph nodes may also be involved. Cancer is any size.
4 A B - Spread to the bowel/bladder (A) or distant organs (B)
What treatment is offered for stage 1 cervical cancer
1A Surgery - radical trachelectomy or hysterectomy
1B Chemo and radio
What treatment is offered for stage 2 and 3 cervical cancer
combined chemoradiotherapy
what treatment is offered for stage 4 cervical cancer?
4A - combined chemoradiotherapy
4B - palliative ie IVC filter, pain relief, stents/nephrostomy.
How are high grade dysplasia treated?
CN1- Yearly survellance for 10 years
CN2- treated at colposcopy with LLETZ
CN3- treated at colposcopy with LLETZ
What are the first signs of cervical cancer?
Starts with increased discharge that becomes smelly
what are the symptoms of cervical cancer
- Vaginal discomfort
- DYSPARENURIA
- Cervical friability and ulcerations on examination
- If it spreads/later stage =
- Back pain
- Urinary retention
- Constipation
- Leg oedema
- Hydronephrosis
- Blood in urine
what histology are the MAJORITY OF CERVICAL CANCERS?
SQUAMOUS
- Adenocarcinomas 5-20%
- Squamous cell 80-95%
What mm thickness is suspicious of endometrial cancer?
> 4mm in post menopausal lady
what are the risk factors for type 1 endometrial cancer?
type 1 is the most common - it is adenocarcinoma, oestrogen sensitive. type 2 is oestrogen insensitive.
risk factors include
- unopposed oestrogen (i.e. without progesterone)
- anything that stops the endometrial wall from shedding i.e., PCOS
- anything that increases the cycles of endometrial shedding i.e., nulliparity, early menarche or late menopause
- family history
- Older age >35 years
- Obesity
- BRCA or conditions like Lynch
- HRT
- Nulliparity
- Tamoxifen
what is the cause of an enlarged tender but NOT TENSE uterus with no PV bleed
adenomyosis
a tense uterus or a mass may indicate fibroids
but an enlarged and soft/flaccid uterus is a sign of endometrial tissue invasion into the muscle –> flaccidity
It resolves in menopause
What are the three types of fibroids? and how do they present?
Subserosal
Intramural
submucousal
- bleeding
- pain
- mass
treatment is focused on stopping bleeding, stopping pain and reducing the mass (GnRH agonsits) (reduce secretion of hormones but are used short term as not to increase risk of osteoporosis)
What are the two types of physiological ovarian cysts? what is the management and what are the complications?
follicular
corpus luteum
Self resolving, no management needed.
Complications are haemorrhagic corpus luteum where when it degenerates it fills with blood –> scarring or rupture into the peritoneum.
what are the main pathological ovarian cysts/tumours?
either classified by disease i.e., endometrioma which is a ruptured follicular cyst that has opened up the ovary allowing for endometrium to enter and grow alongside it.
Or classified by origin:
- endometrial
- germ
- sex cord stromal
what are the most common ovarian cancers?
endometrial
- mucinous or serous
- found in >20
