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PELVIC MASS AND PAIN Flashcards

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1
Q

What is chronic pelvic pain?

A

Any pain in the lower abdomen or pelvis that lasts more than 6 months

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2
Q

In what proportion of chronic pelvic pain cases is a laparoscopy done and found no obvious cause?

A

In 1/3rd of cases

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3
Q

How common is chronic pelvic pain?

A

Common
Affects 1 in 6 women

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4
Q

Causes of chronic pelvic pain?

A

Endometriosis
PID
Interstitial cystitis - bladder inflammation
Ovarian cyst
Womb or ovarian cancer
Adenomyosis
Uterine fibroids
Adhesions
Pelvic venous congestion
Trapped or damaged nerves in pelvic area
Pelvic organ prolapse
MSK pain
IBS
Depression
Traumatic experiences e.g. sexual or physical abuse

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5
Q

Acute causes of pelvic pain in women?

A

UTI
Pelvic inflammatory disease
Ovarian cyst rupture or torsion
Appendicitis
Peritonitis
Ectopic pregnancy
Miscarriage
Ovulation pain - mittelschmerz
Flare up of a chronic condition e.g. endometriosis
dysmenorrhea

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6
Q

What can cause pelvic adhesions?

A

Endometriosis
Previous surgery
Previous infection

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7
Q

Pelvic pain which varies markedly over the menstrual cycle is likely to be attributable to what?

A

A hormonal driven condition e.g. endometriosis

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8
Q

Investigating chronic pelvic pain?

A

Daily pain diary for 2-3 menstrual cycles to help identify any provoking factors or temporal associations
Abdominal and pelvic examination
Screen for infection if sexually active
TVUSS and MRI for adnexal masses, adenomyosis
Diagnostic laparoscopy is “gold standard” for diagnosing pelvic pain and can see endometriosis
CA125 if any Sx of ovarian cancer

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9
Q

What is mittelschmerz and when does it occur?

A

Transient pelvic pain in the middle of their cycle
Caused by ovulation!

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10
Q

How does ovarian torsion present?

A

Sudden onset unilateral lower abdominal pain
May coincide with exercise
N&V are common

On examination - unilateral tender adnexal mass

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11
Q

How might an ovarian cyst present?

A

Unilateral dull ache which may be intermittent or only occur during intercourse. Torsion or rupture may lead to severe abdominal pain
Large cysts may cause abdominal swelling or pressure effects on the bladder

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12
Q

What is ovarian torsion?

A

Partial or complete torsion of the ovary on its supporting ligaments that may, in turn, compromise the blood supply

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13
Q

What is an adnexal torsion?

A

When there is torsion of the ovary and the fallopian tube

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14
Q

Risk factors for ovarian torsion?

A

Having an ovarian cyst is the biggest RF!
Being of a reproductive age
Pregnancy
Ovarian hyperstimulation syndrome

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15
Q

Vaginal examination findings in ovarian torsion?

A

Adnexial tenderness

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16
Q

USS findings for ovarian torsion?

A

Free fluid or a whirlpool sign

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17
Q

Management and diagnosis of ovarian torsion?

A

Laparoscopy - fixation
If necrotic then oophorectomy

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18
Q

What should you do if a woman has cyclic pelvic pain?

A

Offer a therapeutic trial of hormonal treatment e.g. GnRH analogues for 3-6 months before a diagnostic laparoscopy
Appropriate analgesia

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19
Q

Link between pelvic pain and physical/sexual/emotional abuse?

A

There is a link to chronic pelvic pain syndrome

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20
Q

Dyspareunia causes?

A

Infections - thrush, STI
Menopausal atrophic vaginitis
Lack of sexual arousal
Vaginal dryness e.g. sjogren’s syndrome
Vaginismus
Genital irritation or allergy caused by spermicides, latex condoms, soaps etc
Bartholin’s cyst
Lichen sclerosus or lichen planus
FGM
Congenital vaginal abnormalities
Rape and sexual assault
PID
Endometriosis
Fibroids
IBS
Constipation
Bladder pain e.g. UTI or interstitial cystitis

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21
Q

Most common cause of pelvic pain?

A

Primary dysmenorrhea

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22
Q

What is acute pelvic pain in women of a reproductive age with a positive pregnancy test until proven otherwise?

A

Ectopic pregnancy

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23
Q

How common is dyspareunia?

Study These Flashcards
A

1 in 13 women in the UK - 7.5%

24
Q

What is the broad ligament?
What is it made up of?

Study These Flashcards
A

A flat sheet of peritoneum associated with the uterus and ovaries
Made up of mesometrium, mesovarium and mesosalpinx

25
What is the ovarian ligament connected to?
Connects the ovary to the side of the uterus It lies within the broad ligament
26
What is the function of the suspensory ligament of the ovary?
It extendards outwards from the ovary to the lateral abdo and wall Contains the ovarian vessels and nerves
27
Function of the round ligament?
Originates at the uterine horns and attaches to the labia majora, passing through the inguinal canal Supports and anchors the uterus (This often causes pelvic pain during pregnancy)
28
Ligaments of the pelvis?
Iliolumbar ligament Sacrospinous ligament Sacrotuberous ligament
29
What is pelvic venous congestion syndrome?
When varicose veins develop around the ovaries Causes chronic pelvic pain unrelated to menstruation or pregnancy
30
What is vaginismus?
The body’s automatic reaction to the fear of vaginal penetration Involuntary muscle spasms in the vagina when something enters it
31
Possible treatments for vaginismus?
Psychosexual therapy Relaxation techniques Pelvic floor exercises Sensation focus Vaginal trainers
32
What can cause vaginismus?
fearing that your vagina is too small a bad first sexual experience an unpleasant medical examination believing sex is shameful or wrong a painful medical condition, like thrush
33
Features of sexual abuse in a child?
pregnancy sexually transmitted infections, recurrent UTIs sexually precocious behaviour anal fissure, bruising reflex anal dilatation enuresis and encopresis behavioural problems, self-harm recurrent symptoms e.g. headaches, abdominal pain
34
What is lichen simplex? Whats its characterised by? What causes it?
A chronic itchy skin disorder Characterised by well demarcated, erythematous patches and plaques of thick, leathery skin Caused by the chronic ‘itch-scratch’ cycle-> repetitive excoriation and scratching
35
What is lichen sclerosus? Where does it usually affect? Who normally gets it?
An inflammatory condition that usually affects the genitalia More common in elderly females
36
How does lichen sclerosus present?
White patches that may scar Prominent itch May result in dyspareunia or dysuria
37
Management and follow up of lichen sclerosus?
Topical steroids and emollients Follow up due to increased risk of vulval cancer. If there is clinical suspicion of VIN or cancer then biopsy
38
What is lichen planus? How does it present?
A skin disorder of unknown aetiology, likely immune-mediated Itchy, papular rash common on palms, soles, genitalia and flexor surfaces of arms. Rash is often polygonal in shape with white-lines on the surface (wickhams striae) Koebner phenomenon may be seen Oral involvement in 50% - white-lace pattern on buccal mucosa Thinning of nail plate and longitudinal ridging
39
Management of lichen planus?
Potent topical steroids Benzydamine mouthwash or spray for oral lichen planus
40
What is Bartholin’s cyst?
When the ducts become blocked and the Bartholin’s glands expand to form a cyst Sometimes linked to STIs or other bacterial infections
41
Who do Bartholin’s cyst most typically affect?
Sexually active women aged 20-30
42
Why are Bartholin’s cyst unlikely in children and after menopause?
Bartholin’s glands dont usually start functioning until puberty They also commonly shrink after menopause
43
Types of benign ovarian cysts?
Physiological cysts Benign germ cell tumours Benign epithelial tumours Benign sex cord stromal tumours
44
What should you do with any complex ovarian cyst?
Biopsy to exclude malignancy
45
Name of benign germ cell tumour?
Dermoid cyst - aka mature cystic teratomas!
46
What is the most common benign ovarian tumour in a woman under the age of 30?
Dermoid cysts (mature cystic teratoma)
47
most common benign epithelial ovarian tumours?
Serous cystadenoma Mutinous cystadenoma Less common - brenner tumour
48
2 types of physiological ovarian cysts?
Follicular cyst Corpus luteum cyst
49
benign sex cord stromal oavrian tumour
Fibroma - most common Sertoli-leydig tumour
50
What is the most common type of ovarian cyst?
Follicular cysts
51
What causes follicular cysts? Prognosis?
Non-rupture of the dominant follicule, or failure of atresia in a non-dominant follicle Commonly regress after several menstrual cycles
52
What is a corpus luteum cyst? Is it more or less likely to present with intraperitoneal bleeding than follicular cysts?
If the corpus luteum doesnt break down as usual then it can fill with blood or fluid and form a cyst More likely!
53
What is an endometrioma?
Aka a chocolate cyst Present in those with endometriosis There is bleeding into the cyst resulting in that appearance
54
Outline features of the ovarian cysts in PCOS?
When the ovaries contain more than 12 antral follicles or an ovarian volume greater than 10ml Classic ‘ring of pearls’ sign if seen on USS
55
What are theca lutein cysts?
Rare, benign lesions responsible for gross cystic enlargement of ovaries during pregnancy They result as a consequence of markedly raised hCG e.g. in a molar pregnancy They regret upon resolution of the raised hCG

GYNAECOLOGY (9 decks)

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