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Phase 3a > Gynaecology flashcards > Flashcards

Gynaecology flashcards

1
Q

What is endometriosis?

A

Tissue from the endometrium on other organs in the body

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2
Q

What is the cause of endometriosis?

A

Not sure could be retrograde menstruation but not confirmed Sampson’s theory, Extraperitoneal spread embolidsation, Halban’s theory, Meyers theory from metaplasia

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3
Q

What are the symptoms of endometriosis?

A

Chronic pelvic pain usually cyclical also dysmenorhhoea subfertility, pain on passing stool. Endometrioma, pain (cyclical), Infertility, high risk of recurrence impact on fertility and life, deepdysparunia, young low parity

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4
Q

Why does endometriosis regress after the menopause?

A

It is oestrogen sensitive.

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5
Q

What is the gold standard investigation for Endometriosis?

A

Diagnostic laproscopy with biopsy,

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6
Q

What are principals of treatment for endometriosis?

A

Reduce the symptoms from the tissue. Either by removing it or by stopping it bleeding reducing the cyclisity or glandula atropy

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7
Q

What are the medical treatment options?

A

Can use Nsaids, the pill may help spor HnRH analogues to suppress the ovaries can only take for 6 months due to bone demineralisation, mirena

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8
Q

What are surgical treatment options for endometriosis?

A

Scisors laser of bipolar diathermy see and treat or disections of adhesions and remocal of endometrioma.

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9
Q

What is the normal orientation of the cervix?

A

Anteverted in80%

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10
Q

What is the main component of the uterus?

A

They myometrium a smoothmscle layer

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11
Q

What are the layers of and surrounding the uterus?

A

Endometrium is glandular epithelium then myometrium and serosa and then peritoneum.

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12
Q

What is the blood supply of the uterus?

A

The uterine artery which comes from the internal illia artery anastomoses at the superiolateral aspect of the uterus with the ovarian arteries

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13
Q

What blood vessels supply the uterus?

A

There are spiral and basal arterioles spiral are important in pregnancy for fomation of the placenta

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14
Q

What are fibroids?

A

They are leiomyomata benign tumours of the myometrium. They occur in 25% of women

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15
Q

What are the risk factors for fibroids?

A

Nulliparous afro-Carribbean or those who have taken COP and injectable progestrogens

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16
Q

Wha causes fibroid development?

A

Oestrogen and probably progesterone,

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17
Q

What happens to fibroids in pregnancy?

A

They may grow shrink or stay the same

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18
Q

What happens to fibroids in menopause?

A

They usually regress but can calcify

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19
Q

What are the symptoms of fibroids?

A

Usually asymptomatic, depends on site, some can have menorrhagia, pain dysmenorrhoea, can get urinary frequency or retentio and can reduce fertility

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20
Q

What are the effects of fibroids on pregnancy?

A

They can cause premature labour malpresentations transverse lie obstructed labour PPH. Can get red degerneration and cauase pain

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21
Q

What is red degeneration of fibroid/

A

When blood supl is reduced you get pain terine tenderness haemorrhage and necrosis

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22
Q

What are chances of fibroid malignant change?

A

0.1%

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23
Q

What are the best investigations for fibroids?

A

Ultrasound may need MRI to differntiate sometiems

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24
Q

What are the medical treat ment options for fibroids?

A

Tranexamic acid, NSAIDs progestogens not usualyl efffective though. GnRH agonists can be used but only temoirary,

25
Q

What are the surgical treatments for fibroids?

A

Hysteroscopic surgery t remove submucosal ones
Myomectomy open or laporoscopic
Radical hysterectomy can also be perfomred in sever cases. or uterine artery embolisation has 80% success rate

26
Q

What is adenomyosis?

A

Endometriosis interna in old terms, presence of endometrium and underlying stroma within myometrium is quite common usualy aroudn 40 years onle symptoms usually subside after menopause

27
Q

What is the symptoms of adenomyosis?

A

Painful regular bleeding and heavy menstruation.

28
Q

What is the treatment for adenomyosis?

A

Progesterone IUS, COCP may need hysorectomy it is probab oestrogen dependant

29
Q

What is endometrial cancer?

A

Cancer of the columnar endometrial gland cells usually usually after 60 years old.

30
Q

What are the risk factors for endometrial cancer?

A

Exogenous oestrogen without progesterone, obesity, PCOS, ovarian granlosa cell tumours, Tamoxifen

31
Q

What protects agaisnst endometrial cancer?

A

COCP and pregnancy

32
Q

What are the most common symptoms of endometrial cancer/

A

Post menopausal bleeding, Premenopausal ladies might have intermentrural bleedin or new onset menorrhagia.

33
Q

How is endometrial cancer staged?

A

1 lesion in uterus only a 1/2 b moore than 1/2
2 in cervix as well
3 invades through the uteruus 3A invades serosa or adnexae, 3B vaginal or parametrial involvement 3Ci pelvic nodes 3Cii para-aortic involvement
Stage 4 In bowel or bladder
4B distant mets

34
Q

What are investigations for Endometrial cancer?

A

Ultrasound then pipelle biopsy or hysteroscopy and biopsy MRI can be performed,

35
Q

What is the treatment of Endometrial cancer?

A

Hysterectomy and bilateral salpingo-oophrectomy maybe lymph node disection if indicated
Radiotheraoy for before surgery to shrink it or stop recurrance.

36
Q

What is the imporatant area of the cervix in terms of cancer?

A

The squamocolumnar junction

37
Q

Where is the lymphatic drainage of the cervix?

A

Into the external iliac nodes

38
Q

What is a cervical ectropian?

A

It is when the columnar epithelium f the endocervical is visible as a red area it is common in pregnanct or those taking the pill

39
Q

What are the symptoms of cervical ectropian?

A

Post coital bleeding, or vaginal discharge

40
Q

How care extropians treated?

A

Cryotherapy without ansasthetic but after smear etc,

41
Q

What is CIN?

A

Cervical intraepithelia neoplasia when you get abnormal cells in the cervix that are precancerous.

42
Q

What causes CIN?

A

HPV

43
Q

What are the most dangerous HPV strains/

A

16,18,31 and 33.

44
Q

How often are smears done?

A

Every 3 years from 25 up to50 then every 5 years

45
Q

When is cervical cancer most common?

A

25-49 two peaks at 30s and 80sq

46
Q

What are the symptoms of cervica cancer?

A

Postcoital bleeding, vagina discharge, if it invades other areas it can cause localised symptoms

47
Q

What is staging for cervical cancer?

A

Stage 1 just in cervix
Stage 2 invasion into vagina but not pelvic side wall
Stage 3 invasion of lower vagina or pelvic wall causing ureteric obstruction, invasion of bladder or rectal mucosa beyond the true pelvis

48
Q

What are the investigations for cervical cancer?

A

biopsy and examination under anasethiteic and CT scan or MRI

49
Q

What are treatments for stage one cervical cancer?

A

wide margin excision.

50
Q

What treatments are used for stage 2 cervical cancer?

A

radiotherapy and chemotheraooy or surgery.

51
Q

What is a threatented miscarriage?

A

Bleeding but the fetus is still alive and the os is closed

52
Q

What is inevitable miscarriage?

A

Bleeeding usually heavier the fetus can be alive but the os is open

53
Q

What is an incomplete miscarriage?

A

Some fetal tisse has passes and the os is usually open

54
Q

What is a complete miscarriage?

A

All the fetal tissue has passed and there is a reduction in bleeeding and the os is closed

55
Q

What is a septic miscarriage?

A

The contents of the uterus are causing endometritis and are infected the uterus is tender but fever isn’t always present, usually offensive discharge

56
Q

What is a missed miscarriage?

A

The fetus has not developed or died in uteros but not recognised until bleeding occurs or ultrasound is performed os is closed.

57
Q

What are the likely causes of miscarriae?

A

Chromosomal abnormalities but there are other recurrent causes that could be posible

58
Q

What are the symptoms of misscarriage?

A

Bleeding is often there and pain from contractions

59
Q

What is the treatment for incomplete miscarriage?

A

Either medical or surgical (evacuation of retained products of conception) or just wait as might pass

Phase 3a (9 decks)

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