Obstetrics and Gynaecology Flashcards
(29 cards)
What is candidiasis?
A fungal infection due to any type of Candida (type of yeast)
Also known as thrush
What is the aetiology of candidiasis?
Candida normally lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems. Candida can cause infections if it grows out of control or if it enters deep into the body (bloodstream or internal organs)
Although mucosal disease is common, invasive disease is not, and the primary reason is that Candida species in general are unable to enter intact epithelium
What are the risk factors for candidiasis infections?
Immunosuppressive agents e.g. systemic corticoid steroid use
Current or recent past use of brand spectrum antibiotics
Malabsorption/ malnutrition
HIV infection
Poor oral hygiene (oral candidiasis)
Endocrine disturbances (DM, pregnancy, hypoadrenalism) - reduce effectiveness of immune system
What are the presenting symptoms of candidiasis infections?
Oral: -creamy white/ yellow plaques adherent to oral mucosa -Cracks/ ulcers around the mouth -spotty red areas on the buccal mucosa -burning oral pain -loss of taste -pain while eating or swallowing Vaginal: -vaginal itching or soreness -pain during sexual intercourse -pain/ discomfort when urinating -abnormal vaginal discharge
What are the risk factors for vaginal candidiasis?
Pregnancy Use of hormonal contraceptives Diabetics Immunosuppressed/compromised Past or recent use of broad spectrum antibiotics
What are the signs of a candidiasis infection on physical examination?
Rash
Erythema
Visible plaques/ulcers
What are the appropriate investigations for a candidiasis infection?
Superficial smear of the lesion for microscopy: test for candida
Biopsy
Blood culture
FBC: WCC elevated indicates infection
What is an epidural?
An anaesthetic injected into the epidural space surrounding the fluid-filled sac (the dura) around the spinal cord. It partially numbs the abdomen and legs and is most commonly used during childbirth.
What are the indications for an epidural?
Provide analgesia:
- intraoperative
- postoperative
- peripartum (labour analgesia, Caesarean section)
- end-of-life settings
Can be used as the primary anaesthetic for surgeries from the mediastinum to the lower extremities
What are the possible complications of an epidural?
Drug related: -anaphylaxis due to allergy due to anaesthetic Procedure related: -back pain -pneumocephalus (presence of air/gas in the cranial cavity) Potentially life-threatening: Subdural injection of LAs Total or high spinal, infectious or aseptic meningitis Cardiac arrest Spinal epidural abscess Epidural hematoma formation Permanent neurologic injury
What is mastitis?
Inflammation of the breast with or without infection
What are breast abscesses?
A breast abscess is a localised area of infection with a walled-off collection of pus
It may or may not be associated with mastitis (as a complication)
What are the two types of mastitis with infection?
Lactational
Non-lactational
What is the aetiology for mastitis/ breast abscesses?
Infectious mastitis and breast abscesses are usually caused by bacteria colonising the skin. Cases due to Staphylococcus aureus are by far the most common.
Non-infectious mastitis may result from underlying duct ectasia and infrequently foreign material (e.g. nipple piercing, breast implant)
What is the epidemiology for mastitis/breast abscesses?
The global prevalence of mastitis in lactating women is approximately 1% to 10% but may be higher.
Breast abscess develops in 3% to 11% of women with mastitis
What are the presenting symptoms for mastitis/breast abscesses?
Fever
Decreased milk outflow (if lactational)
Breast warmth/ tenderness/ swelling/ redness (erythema)
Flu like symptoms- malaise and myalgia
What are the signs of mastitis/breast abscesses on physical examination?
Breast erythema
UNCOMMON: Breast mass, fistula, nipple inversion/retraction, nipple discharge, lymphadenopathy, extra-mammary lesions
What are the appropriate investigations for mastitis/breast abscesses?
1st line:
-Breast ultrasound-hypoechoic lesion (abscess), may be well circumscribed, irregular, or ill defined
-Diagnostic needle aspiration- purulent fluid indicates a breast abscess
-CMS of nipple discharge or needle aspirate- indicate infection/malignancy
(CMS- cytology, microscopy and sensitivity)
Others: pregnancy test, mammogram, blood culture
What is the management for mastitis/breast abscesses?
The goal of treatment for mastitis is to provide prompt and appropriate management to prevent complications such as a breast abscess. Lactational: -Effective milk removal -Antibiotic therapy -Warm compresses -Symptomatic relief
Non-lactational:
- Antimicrobial therapy (observational period)
- Supportive measures should include analgesia, if necessary.
- For granulomatous mastitis (idiopathic granulomatous inflammation)- glucocorticosteroids
What are the complications of mastitis/breast abscesses?
Breast abscesses (less than 10% of patients with mastitis)
Cessation of breastfeeding (most patients can continue to breastfeed)
Sepsis
Scarring (recurrent infections)
Functional mastectomy (breast that is unable to effectively lactate as a complication of prior tissue destruction from infection or treatment)
What is the prognosis for mastitis/breast abscesses?
When treated promptly and appropriately, most breast infections, including abscess, will resolve without serious complications.
Resolution of mastitis after 2-3 days of appropriate antibiotic therapy is expected among most patients.
Lactational abscesses tend to be easier to treat than non-lactational abscesses- these are multi-factorial and have a greater risk of becoming chronic
What is polycystic ovary syndrome (PCOS)?
A syndrome characterised by:
-oligomenorrhoea/amenorrhoea
-hyper-androgenism (clinical symptoms or biochemical)
Usually associated with: obesity, insulin resistance and an increased risk of developing type 2 diabetes
What is the aetiology of PCOS?
Environmental factors:
related to diet and development of obesity
Genetic determinants:
genes regulating gonadotrophin, insulin and androgen synthesis, secretion and action, weight and energy regulation
What are the risk factors for PCOS?
FHx of PCOS
Premature adrenarche
Weaker risk factors: obesity, low birth weight
