Gynaecology 3a Flashcards

Question

Fibroids | Fibroids are benign smooth muscle tumours of the uterus ## Footnote 20% of white and around 50% of black women in the later reproductive years. - Rare in puberty, develop in response to oestrogen

Answer 1

* Mennorhagia - leading to IDA * Dysmenorrhoea * bloating * Urinary symptoms (w/ larger fibroids) * Subfertility * Polycythaemia 2ndry to autnomour production of erythropoietin | Transvaginal USS ## Footnote Management - Asymptomatic: regular monitoring - Mennorhagia: levonorgestrel intrauterine system, NSAID (mfenamic acid), Tranxamic acid, COCP, Oral progestogen - Fibroid removal/shrinkage: GnRH agonists (gives menopausal symptoms - used short-term) - Surgical: myomectomy performed - **preferred option in subfertility**

Answer 2

* In early pregnancy, growth of fibroids in response to **oestrogen** and can cause pelvic pain and pressure symptoms Fibroid Degeneration * When growth of fibroids outstrip blood supply, degeneration can occur. * low-grade fever, pain and vomiting. * Managed with analgesia and rest ## Footnote presence of pelvic pain, the history of menorrhagia, usually indicates pre-existing fibroids

Answer 3

Women - Amenorrhoea - Infertility - Galactorrhoea - osteoporosis Men - Impotence - loss of libido - Galactorrhoea Both - headaches - visual disturbances - hypopituitarism | MRI diagnosis ## Footnote Managment - dopamine agonists (e.g. cabergoline, bromocriptine) which inhibit the release of prolactin from the pituitary gland - surgery is performed for patients who cannot tolerate or fail to respond to medical therapy. A trans-sphenoidal approach is generally preferred unless there is a significant extra-pituitary extension

Answer 4

* Oligomenorrhoea (+) * Hisutism + acne and male-like pattern baldness (+) * PCOS on USS (+) * subfertility * Obesity * Recurrent miscarriage. **Complications** insulin resistance and diabetes; leads to pancreas releasing more insulin that promotes release of androgens from ovaries and adrenal glands, and suppresses sex hormone-binding globulin production from the liver – promotes | pelvic ultrasound: multiple cysts on the ovaries + Raised LH:FSH ratio ## Footnote (+) = Rotterdam Criteria Management - lifestyle changes, lose weight - : COC pill or cyclical oral progesterone can help regulate menstruation. LNG-IUS gives continuous endometrial protection.

Answer 5

Features * Usually the sudden onset of deep-seated colicky abdominal pain. * Associated with vomiting and distress * fever may be seen in a minority (possibly secondary to adnexal necrosis) * Vaginal examination may reveal adnexial tenderness | Ultasound: **Whirlpool** sign ## Footnote Laparoscopy is usually both diagnostic and therapeutic.

Answer 6

* Lower abdo pain * Fever * Deep dyspareunia * Dysuria * Vaginal discharge * rule out Ectopic Pregnancy * Vaginal swab and screen for chlamydia and gonorrhoea Complications * perihepatitis (Fitz-Hugh Curtis Syndrome) * occurs in around 10% of cases * it is characterised by right upper quadrant pain and may be confused with cholecystitis * infertility - the risk may be as high as 10-20% after a single episode * chronic pelvic pain * ectopic pregnancy ## Footnote Management * oral ofloxacin + oral metronidazole or intramuscular ceftriaxone + oral doxycycline + oral metronidazole * RCOG guidelines suggest that in mild cases of PID intrauterine contraceptive devices may be left in.

Answer 7

- very painful period - Associated with flushing and nausea. - Red flags: abnormal cervix, persistent PCB, IMB or pelvic mass | Swabs and USS perfomed ## Footnote Management * NSAIDs such as mefenamic acid and ibuprofen are effective in up to 80% of women. They work by inhibiting prostaglandin production * combined oral contraceptive pills are used second line * Clinical Knowledge Summaries recommend referring all patients with secondary dysmenorrhoea to gynaecology for investigation. * IUS mirena coil may help

Answer 8

* Objective definition is blood loss of greater than 80ml per period, in an otherwise normal menstrual cycle * NICE recommend full blood count, coagulation screen (if since menarche/family history), pelvic USS (if history suggests structural/histological abnormality), high vaginal and endocervical swabs, thyroid tests with suggestive history ## Footnote **Management** * Mirena (LNG IUS) - provided long-term use (12 months) is expected. Very effective – mean blood loss reduction of 95% after 1 year. * Transxaemic Acid - antifibrinolytic reduces blood loss by 50% * Norethisterone taken 15mg daily in cyclical pattern from day 6 to 26. * Gonadotrophin-releasing hormone (GnRH) agonists – act on pituitary to stop oestrogen production leading to amenorrhoea. Only used short term however due to osteoporosis risk. * Endometrial ablation – destroy endometrial lining to a depth that prevents regeneration

Answer 9

* Behavioural changes include ‘tension’, irritability, aggression, depression, and loss of control. Mood swings In addition, a sensation of bloating, minor gastrointestinal upset and breast pain can occur * **Minor Symptoms**: advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates * **Moderate**: new gen COCP (yasmin - drospirenone 3mg) * **severe**: SSRI during luteal phase (days 15-28)

Answer 10

Primary amenorrhoea * gonadal dysgenesis (e.g. Turner's syndrome) - the most common causes * testicular feminisation * congenital malformations of the genital tract * functional hypothalamic amenorrhoea (e.g. secondary to anorexia) * congenital adrenal hyperplasia * imperforate hymen (most common in the ones who have regular cycle - corrected via surgery) Secondary * hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise) * polycystic ovarian syndrome (PCOS) * hyperprolactinaemia * premature ovarian failure * thyrotoxicosis * Sheehan's syndrome * Asherman's syndrome (intrauterine adhesions) | Excl pregnancy. Low level gonadotroph= hypothalmic cause. raised=turners ## Footnote Management * primary amenorrhoea: investigate and treat any underlying cause with primary ovarian insufficiency due to gonadal dysgenesis (e.g. Turner's syndrome) are likely to benefit from hormone replacement therapy (e.g. to prevent osteoporosis etC)# * secondary amenorrhoea exclude pregnancy, lactation, and menopause (in women 40 years of age or older) treat the underlying cause

Answer 11

**Mild** Abdominal pain Abdominal bloating **Moderate** As for mild Nausea and vomiting Ultrasound evidence of ascites **Severe** As for moderate Clinical evidence of ascites Oliguria Haematocrit > 45% Hypoproteinaemia **Critical** As for severe Thromboembolism Acute respiratory distress syndrome Anuria Tense ascites | Early: within 7d of the hCG injection Late: OHSS presents from 10d+ ## Footnote management - Oral fluids - Monitoring urine output - LMWH - Ascitic fluid removal - IV colloids (human albumin solution)

Answer 12

- Ulcers or blistering lesions in genital area - Neuropathic pain (tingling, burning, shooting) - Flu-like symptoms - Dysuria - Inguinal lymphadenopathy | Aciclovir is used to treat (+lidocaine) ## Footnote Post-herpetic neuropathy can lead to long term neuropathic pain after the infection. Recurrence one of the main complications. Neonatal herpes is a serious infection with mortality of around 30%. Most often acquired at delivery of the mother has an active infection in the third trimester, especially in the last 6 weeks. Caesarean often indicated in these mothers.

Answer 13

**vaginal atrophy** the most common cause of postmenopausal bleeding the thinning, drying, and inflammation of the walls of the vagina due to a reduction in oestrogen following the menopause can result in vaginal bleeding **HRT (hormone replacement therapy)** periods or spotting can continue in some women taking HRT for many months with no pathological cause, or endometrial hyperplasia due to long-term oestrogen therapy may occur, which can also cause bleeding **endometrial hyperplasia** an abnormal thickening of the endometrium and a precursor for endometrial carcinoma risk factors include obesity, unopposed oestrogen use, tamoxifen use, polycystic ovary syndrome and diabetes **endometrial cancer** although 10% of patients with postmenopausal bleeding have endometrial cancer, up to 90% of patients with endometrial cancer present with postmenopausal bleeding, meaning it must be ruled out urgently **cervical cancer** it is important to obtain a full record of prior cervical screening programme attendance **ovarian cancer** can present with postmenopausal bleeding, especially oestrogen-secreting (theca cell) tumours **vaginal cancer** uncommon but can present with postmenopausal bleeding **other uncommon causes include** trauma vulval cancer bleeding disorders ## Footnote **vaginal atrophy:** Topical oestrogens and lifestyle changes such as lubrication can help reduce the symptoms of vaginal atrophy, HRT can also be used if a bleed is due to the type of HRT that the patient is on, different HRT preparations can be used to try to reduce this in the case of **endometrial hyperplasia**, usually dilatation and curettage is performed to remove the excess endometrial tissue

Gynaecology 3a Flashcards

(37 cards)