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Gyn NonCancer Disord
Noncancerous gynecologic Disorders
| Question | Answer |
|---|---|
| ___ dz is pruritis, burning, irritation, or abnormal growth | Vulvar Disease. Common in women of all ages. Maintain high index of suspicion in peri-and postmenopausal women due to higher risk of malignancy |
| Common vulvar dermatoses | lichen sclerosis, lichen simplex chronicus, lichen planus, psoriasis |
| thin, white "onion skin" or "cigarette paper" is a finding commonly seen in | lichen sclerosis. Disfigurement,stenosis of vaginal introitus. Biopsy, refer! Risk of squamous cell cancer 4-6%. THINNING |
| Tx of Lichen sclerosis | potent topical steroids. |
| "an itch that rashes" | Lichen simplex chronicus. Vicious cycle of itch, scratch, itch. Often trigger unknown. Progressive vulvar pruritus and burning. THICKENED, white, unilaterla/localized. Biopsy! |
| Tx of lichen simplex chronicus | Medium potentcy steroids. Hydroxyzine (best antihistamine for itching) and SSRIs |
| Violaceous, flat topped papules (erosive type), white patches, ulcerations, may have oral, vaginal lesions. Chronic burning and itching autoimmune suggests | lichen planus. Biopsy, refer. Topical steroids, douches, suppositories. Vaginal cream if atrophic. Beware adhesions, introital stenosis |
| Other vulvar dermatoses | psoriasis, epidermal inclusion cysts, bartholin's duct cyst and abscess, nevi (melanoma!) |
| Endocervical Polyps | biopsy. fairly common. |
| Signs and Sx of Endocervical Polyps | postcoital bleeding, intermenstrual bleeding. Malignancy <1% |
| Leiomyomas (fibroids) | Benign Uterine Neoplasm |
| Most common presenting symptom | Fibroids. Very often asymptomatic. Progressive increase in pelvic pressure, fullness. Pelvic pain. Acute pain associated with "red degeneration" or torsion of pedunculated myoma |
| Fibroids | irregular, enlarged uterus. If large enough, palpable abdominally. Size referred to in gestational weeks pregnancy size |
| At 20 weeks, the uterus is at the | belly button |
| Fibroid diagnosis | Usually by U/S. CT, MRI expensive and not that much extra help in most cases. If calcified, may show up on X-ray. Endometrial Biopsy not helpful. Hysteroscopy may be helpful for submucous. Laparoscopy to visualize occasionally necessary |
| Fibroid Tx | Most patients don't require tx. Myomectomy. Hysterectomy only if symptomatic: extreme pain and intractable bleeding. Fibroids will usually involute with menopause. Menopause mimics treatments (GnRH). MRI guided focused US |
| Fibroids have a blood supply and therefore may be treated with | uterine artery embolization. |
| ____ may occur with fibroids and pregnancy. Rapidly outgrow blood supply and die off | red degeneration |
| Functional Ovarian Cysts | not really neoplasms, but exaggeration of normal process. Follicular, Corpus luteum cysts. Theca lutein cysts associated with abnormal pregnancy, not common. Functional ovarian Cysts must be differentiated from malignancy. |
| Progression of Function Ovarian Cysts | usually spontaneously regress, very common. Also called "physiologicc ovarian cysts". May rupture and cause acute pelvic pain. Refer to US |
| Sx that are probably benign | Mobile, Cystic, unilateral, smooth, <10cm, minimal septations |
| Sx that are possibly malignant | Fixed, solid, bilateral, nodular, >10cm, solid, multiple septations >3mm, bilateral, ascites, doppler blood flow (?) |
| Warning of large functional ovarian cysts | Risk of torsion. Pelvic rest (no sex or putting anything inside), limited exercise |
| Tx: for functional ovarian cysts | Symptomatic |
| Where are teratomas often found? | often high in the pelvis. They are mobile, nontender, asymptomatic, unilateral cystic adnexal masses. Dermoid derivatives in cyst: cartilage, bone, teeth |
| PCOS associated symptoms | Oligo/amenorrhea, often obesity, infertility, hirsutism, acanthosis nigricans, acne, insulin resistance (and progression to diabetes). MAKE SURE TO ASK IF THEY HAVE HAIR THAT THEY REMOVE |
| Pathophysiology with PCOS | Functional disorder, complex genetic trait, related to type 2Dm, hyperandrogenism, insulin resistance, increased LH |
| PCOS Tx | oral contraceptives, medroxyprogesterone for withdrawal bleed if contraception not needed, spirinolactone for hirsutism, Yasmin (spirinolactinoid estrogen), Weight loss, metformin |
| Complications of PCOS | Type 2 DM, HTN, Hyperlipidemia, CV disease, Infertility, recurrent SAB, Depression |
| Causes of vulvar pain | infection, neoplasm, neurologic disease, inflammation |
| Discomfort in the absence of specific cause | Vulvodynia (provoked or unprovoked). Localized Vulvodynia: 1)introital pain (entry dyspareunia), 2) erythema or inflammation of vestibule, 3) Vestibular tenderness |
| Approach to the patient with Vulvar pain | Complete medical, surgical and sexual hx. PE: map area of pain. Management: bland hygeinen, emotional support, treat any underlying conditions, dietary changes, TCAs, SSRIs, Gabapentin, lidocaine, biofeedback, surgery |
| Chronic Pelvic Pain | Pelvic pain that persists more than 6 months. Not just cyclic |
| Approach to the patient with pelvic pain | Hx: medical, surgical, sexual. PE, Careful description and mapping of pain. CBC, UA, HCG, GC/chlamydia, Imaging: US, Laparoscopy |
| Treatment for Chronic Pelvic Pain | Refer, tx etiology if identified, NSAIDs?, OCs?, Depo-Provera? Mirena IUD |
Created by:
ltm12