Intermenstrual bleeding, Post-coital bleeding, Dyspareunia Flashcards
(21 cards)
Post-coital bleeding First intercourse a year ago Stable partner Periods normal and regular Taking COC Cervix appears red on examination Most likely diagnosis?
Ectropian
columnar cells around the OS of there cervix
more transparent - can see underlying blood vessels
more fragile - bleeding
What are the main causes of post-menopausal bleeding?
endometrial carcinoma (early post-menopausal bleeding often sole presenting feature) atrophic vaginitis
Risk factors for endometrial carcinoma?
obesity
late menopause
nulliparity
hypertension
What is the first line investigation for endometrial cancer and what is this followed by?
transvaginal ultrasound - assess endometrial thickness
followed by endometrial biopsy
What are the two biggest risk factors for vaginal prolapse?
childbirth
age
What changes in micturition are caused by a cystocoele?
increased frequency
increased urgency
feeling of incomplete emptying of the bladder
How does vaginal prolapse usually present?
feeling of fullness, dragging sensation in the vagina
Superficial dyspareunia
Post Menopausal
most likely diagnosis?
atrophic vaginitis – inflammation of the vagina due to atrophic changes (because of decreased Oestrogen)
What is a threatened miscarriage?
A threatened miscarriage is characterised by vaginal blood loss but an external cervical os that remains closed, and the fetus is well. The majority of women with a threatened miscarriage do not go on to miscarry.
What are the different stages of miscarriage?
- threatened
- inevitable
- incomplete
- complete
There is vaginal bleeding, with cramping abdominal pain. There cervical OS is open. No products of conception have passed yet.
What stage of miscarriage is this?
inevitable
US shows empty uterine cavity. The cervical OS is closed, products of conception have passed.
Why stage of miscarriage?
complete
What is an in complete miscarriage?
currently happening heavy and increased vaginal bleeding intense lower abdominal pain cervical OS open passage of some products of conception products of conception in the canal
What is a missed miscarriage?
nonviable intrauterine pregnancy remained in the uterus - fetus has not spontaneously aborted
What are the five points to check in pregnancy?
Dating
Location
Multiple pregnancy
Molar pregnancy
Nonviable pregnancy
- gestation sac >25mm with no yolk sac or embryo
- no cardiac activity (5.5-6weeks)
Differential diagnoses of early pregnancy bleeding?
Miscarriage Ectopic pregnancy Molar Pregnancy Implantation bleed Genital tract trauma Cervical pathology - ectropion, polyp, malignancy
Important management of every miscarriage?
Haemodynamically stable
Rule out ectopic
Check rhesus status - if Rh- give anti-D
A 33 year old woman has been referred to the gynaecologist by her GP with a history of post coital bleeding. There have been 3 episodes over the last 4 weeks. There are no other symptoms on systematic questioning. There is no history of previous illness
She lives with her partner of three months and 3 children, aged between 3 and 16. She smokes 15-20 cigarettes per day, drinks only occasionally. She had regular smear examinations until 3 years ago up until the birth of her last child.
In the family history her mother died of cancer at the age of 51. Her father is alive and well.
On examination she appears well. There are no abnormal findings in the chest or abdomen and no pelvic masses. She is slightly tender on pelvic examination and there is a small amount of blood on the examining glove. Bimanual examination of the uterus was difficult but the uterus feels diffusely enlarged
Speculum examination was difficult. The uterus was anteverted and anteflexed and the cervix could not be well seen with the axis directed to the posterior fornix.
What is the most likely diagnosis and why?
Cervical Carcinoma with local spread
Patient sexually active at a young age - HPV infection more likely
May have family history if cervical cancer
missed 3 years of screening
post-coital bleeding
cervical distortion - local invasion
A clinical diagnosis of cervical cancer with local invasion has been made. What imaging investigation would you request initially and why?
Pelvic MRI
to determine local and lymph node spread
demonstrate size of cervical tumour, evidence outside the cevix into the uterus vagina and parametric and to the side wall.
demonstrate complications such as lymph node involvement and ureteric obstruction
CT will not clearly separately identify uterus and cervix and will not therefore accurately locally stage.
What is Barrett’s Oesophagus?
The oesophagus is lined by stratified squamous epithelium.
Barrett’s oesophagus is a metaplastic condition where this epithelium is replaced by columnar epithelium, which lines the stomach and intestines.
It is a pre-malignant condition, and is commonly seen in people who have had long term gastro-oesophageal reflux disease.
What is metaplasia?
An abnormal change in the nature of a tissue, from one type of tissue (e.g. stratified squamous epithelium) to another (e.g. columnar epithelium)
