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Flashcards in Pelvic mass Deck (37)
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1
Q

non gynae causes for pelvic mass bowel

A

constipation - commonest
caecal cancer
appendix abscess
diverticular abscess

2
Q

non gynae causes for pelvic mass other

A

urinary retention, pelvic kidney

retroperitoneal tumour
lymphomas

3
Q

gynae causes for pelvic mass

A

uterine
tubal and para tubal
ovarian

4
Q

uterine causes for pelvic mass

A

pregnancy

fibroids - commonest

endometrial cancer - but usually presents early with PMB before mass

cervical cancer - late presentation with renal failure/bleeding/pain before mass is seen

5
Q

what are uterine fibroids
age
size

A

very common
leiomyosarcomas very rare
>40s
can be few cm to bigger and multiple

6
Q

types of fibroids

A
submucosal
suserous
intracavity
intramural
pedunculated
7
Q

presentation of fibroids

A

may be asymp/incidental finding
menhorrhagia
pelvic mass
pain/tenderness but this if pregnant or menopause
pressure symptoms - increased frequency and nocturia

8
Q

who are fibroids common in

A

afro carribean population

9
Q

investigations for suspected fibroids

A

Hb if heavy bleeding
USS - usually dx
MRI for more precise localisation

10
Q

treatment of fibroids

A

hysterectomy - if family complete
myomectomy
uterine artery embolisation
hysteroscopic resection

11
Q

tubal swellings

A

ectopic preg - usually ruptures before becoming a pelvic mass

hydrosalpinx - fluid blocking tube - often longstanding/incidental

pyosalpinx - pus blocking tube - acute/inflam

paratubal cysts - usually small and incidental - embryological remnants

12
Q

ovarian massess

A

tumours
functional cysts
endometriosis cysts

13
Q

what are functional cysts related to
size
rx
sx

A

follicular cysts/luteal cysts

rarely >5cm dm

usually resolve spontaneously

often asymp/incidental finding
may be menstrual disturbance
may bleed or rupture and cause pain

14
Q

what can endometriosis cause
what is assoc with
px

A

can cause blood filled cysts

severe dysmehnorrhagia, premenstrual pain, dyspareunia, sub fertility

tender mass with nodularity behind uterus

asympt till large choc cysts which may rupture

15
Q

ovarian tumours that rise form the surface epithelium

A
serous
mucinous
endometrioid
clear cell
brenner
16
Q

ovarian tumours that arise from germ cells

A

benign cystic teratoma (dermoid cyst) - commonest

malignant germ cell tumours - v v v rare

17
Q

ovarian tumours arising from stroma

A

granulosa cells - secrete oestrogens - percasious puberty
theca/lydig cells severe androgens - androgenisation
fibroma - meigs syndrome

18
Q

what can malignant germ cells produce

A

HCG or AFP

19
Q

types of dermoid cyst

A

totipotential
teeth, sebaceous materia, hair
thyroid tissue -> thyrotoxicosis

20
Q

granulosa cell tumours

A

oestrogen producing

precocious puberty, PMB

21
Q

thecal tumours

A

androgen producing

hirsutism -> virilisation

22
Q

fibromas

A

meigs syndrome with benign fibroma and pleural effusion and ascites

23
Q

secondary mets in ovary

A

breast
pancreas
stomach
GI primaries

24
Q

presentation of ovarian cancer

A

mass, swelling, pressure symptoms
early peritoneal spread - malignancy ascites with protein exudate
insidious symptoms
often referred

25
Q

referred ovarian cancer

A
heart burn/indigestion 
early satiety
weight loss/anorexia
bloating 
pressure symptoms (esp bladder)
change of bowel habit
SOB/pleural effusion 
leg oedema/DVT
26
Q

genetics and ovarian cancer

A

BRACA1/2

lynch syndrome

27
Q

risk factors for ovarian cancer

what protects

A

age
nulliparity
FH

OCP

28
Q

ix for ovarian cancer

A

hx and exam
CA 125, CEA markers
US - nature
CT - assessing spread

29
Q

CA125 raised when

when more useful

A
in 80% of cancers
endometriosis
peritonitis/infection 
preg
pancreatitis
ascites
other malignancies

for follow up rather than dx

30
Q

CEA raised when

primary function

A

moderately elevated in ovarian cancer esp in mucinous tumours

exclude mets from GI primary

31
Q

USS finding of ovarian cancer

A
complex mass with solid and cystic areas
multi loculated
thick separations
associated ascites
bilateral disease
32
Q

what is RMI

A

menopausal status x CA125 x USS score

33
Q

treatment of ovarian cyst/mass

A

removal or drainage if benign

removal of ovaries and uterus

34
Q

acute presentation of pelvic mass

A

cyst - rupture, haemorrhage, torsion and ischaemia

fibroid degeneration - red, compromised blood supply, seen in pregnancy or in peri menopause

35
Q

examination for pelvic mass

A
anaemia
cachexia
chest
breast
nodes
legs
abdo
speculum/bimanual
36
Q

describing the mass

A
size - cms or weeks gestation
consistency
surface 
tenderness
mobility
relation to uterus
pouch of douglas
37
Q

ix of pelvic mass

A
Hb
WCC/CRP if suspected inflam
Biochem esp serum albumin
tumour markers - CA125, CEA, HCG, AFP
CXR
USS
MRI for fibroids/uterine mass
CT - suspected ovarian cancer