Flashcards in Gynae 2 Deck (88)
What is PID
infection of the upper genital tract. Infection spreads upwards from the endocervix causing one or more of:
What causes PID
Chlamydia trachomatis (14–35% of cases)
Neisseria gonorrhoeae (2–3% of cases)
Organisms in normal vaginal flora (such as anaerobes, Gardnerella vaginalis, Haemophilus influenzae, enteric Gram-negative rods, and Streptococcus agalactiae) have also been implicated.
What are some risk factors for PID
Factors related to sexual behaviour, such as:
Early age of first coitus.
Multiple sexual partners.
New partner within least 3 months
History of STI in the woman or her partner.
Recent instrumentation of the uterus or interruption of the cervical barrier, such as due to:
Insertion of an intrauterine device
IVF and intrauterine insemination.
What are the symptoms of PID
Lower abdominal pain
menorrhagia, dysmenorrhoea or IMB
Dysuria (painful urination)
Abnormal vaginal discharge (especially if purulent or with an unpleasant odour)
fever and N+V if severe
What are the signs of PID on examination
Lower abdominal tenderness (usually bilateral).
cervical motion tenderness,
or uterine tenderness
Abnormal cervical or vaginal mucopurulent discharge
What investigations should be considered in PID
Pregnancy test, urine dip
FBC, CRP, ESR, GIV, syphilis
Endocervical swabs - gonorrhea and chlamydia,
high vaginal swab - trichomonas vaginalis and bacterial vaginosis
How is PID managed
immediate start of 14-day course of broad spectrum antibiotics - Ceftriaxone 500 mg IM, oral doxycycline 100 mg BD and oral metronidazole 400 mg BD for 14 days.
avoid sexual intercourse until the antibiotic course is complete and partner(s) are treated.
All sexual partners from the last 6 months should be tested and treated to prevent recurrence and spread of infection.
How should a woman with diagnosed PID be followed up?
R/V in 72 hours
should be clinical improvement. if not, consider admission or review the diagnosis.
Check the antibiotic sensitivities from swab result and adjust antibiotics treatment if necessary.
Continue treatment even if swabs are negative.
R/V in 2-4 weeks to check:
compliance with, and response to, treatment.
Confirm that sexual contacts have been screened and treated.
Discuss the potential sequelae of PID
Ensure repeat pregnancy test, if clinically indicated
What are the long term complications of PID
Chronic pelvic pain.
Fitz-Hugh Curtis syndrome
What is an ovarian cyst
fluid filled sac within the ovary
What is the difference between a simple and complex ovarian cyst
simple - fluid only
complex - not simple! may contain blood, solids, septation or vascularity
Name some non-neoplastic types of ovarian cysts
Name some benign neoplastic types of ovarian cysts
benign cystic teratoma - germ cells
benign mature teratoma - germ cells
What are the risk factors for ovarian cyst formation
What are the symptoms of ovarian cysts
dull ache or pain in lower abdomen
pressure effects - frequency
if torsion - severe pain
if rupture - pain, peritonitis, shock
What investigations should be done in ovarian cysts
pregnancy test, urine dip
FBC CA125 AFP BhCG
FNA and cytology of cyst
When should ca125 not be done for an ovarian cyst
for premenopausal women who have a simple cyst on ultrasonography
When should AFP and betahCG be done for an ovarian cysts
if it is a germ cell tumour and the woman is under 40
What is the RMI in relation to ovarian problems
risk of malignancy index
How is the RMI calculated
ultrasound score x menopausal score x CA 125 level in U/mL.
The ultrasound score is the number of the following findings on scan: multilocular cyst, solid areas, bilateral lesions, ascites, intra-abdominal metastases. (0 = no abnormalities, 1 = one abnormality, 3 = two or more)
menopausal score is where 1 = premenopausal and 3 = postmenopausal).
How are ovarian cysts managed
expectant - if simple <50mm. repeat TV US in 6 weeks - if persistent then monitor with ultrasound and CA125 3-6 monthly and calculate RMI.
surgery - if persistent and 5-10cm, symptomatic or complex
How is the RMI used in management of ovarian cysts
in postmenopausal women:
Low RMI (less than 25): follow up for 1 year with ultrasound and CA125 if less than 5cm.
Moderate RMI (25-250): bilateral oophorectomy and if malignancy found then staging is required (with completion surgery of hysterectomy, omentectomy +/- lymphadenectomy).
High RMI (over 250): referral for staging laparotomy
State the different kinds of ovarian cancer
epithelial - 90%
sex cord stromal
What are the risk factors for ovarian cancer
infertility, clomifene, nulliparity, early menarche, late menopause, HRT
history of breast, ovarian or bowel cancer
What are the symptoms of ovarin cancer
abdo distention or bloating
any new IBS if >50Y
fatigue, weight loss, anorexia, depression
pain - late sign
breathlessness - pleural effusion
What investigations should be done in suspected ovarian cancer
ca125, AFP, beta hCG
TV USS/ abdo US
What can cause a raised ca-125
torsion, rupture or haemorrhage of ovarian cyst
What are the management options for ovarian cancer
chemo - cisplatin
What is chronic pelvic pain
Intermittent or constant pain in the lower abdomen or pelvis in women.
Lasting for at least six months.
Not occurring exclusively with menstruation or sexual intercourse.
Not being associated with pregnancy.