Workshop Presented by: Hilary Liddell Case 1 18 year old female - - PowerPoint PPT Presentation

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Workshop Presented by: Hilary Liddell Case 1 18 year old female - - PowerPoint PPT Presentation

May 15, 2023 107 likes •260 views

Workshop Presented by: Hilary Liddell Case 1 18 year old female presents with acute RIF pain, associated nausea and abdominal bloating History: Examination: Investigations: When to Refer, Where to Refer: Case 1 Teaching Points

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SLIDE 1

Workshop

Presented by: Hilary Liddell

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Case 1

18 year old female presents with acute RIF pain, associated nausea and abdominal bloating

  • History:
  • Examination:
  • Investigations:
  • When to Refer, Where to Refer:
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Case 1 Teaching Points

  • Acute pain in young women is likely to be

gynaecological.

  • History may not be typically menstrually

related.

  • A small ovarian cyst / follicle can be

associated with acute pain.

  • Functional Ovarian cysts can be

associated with endometriosis.

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Case 1 Teaching Points (cont’d)

  • Functional Ovarian cysts are more

common on the POP and Mirena.

  • Surgical Laparoscopy may not detect

gynaecological pathology.

  • Don’t forget:

–PID –Ectopic –Torsion.

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Case 2

23 year old woman complaining of pain with intercourse. On O/C and getting frequent breakthrough bleeding. Long history of irritable bowel disease.

  • History:
  • Examination:
  • Investigations:
  • When to Refer, Where to Refer:
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Case 2 Teaching Points

  • Ultrasound does not detect peritoneal

endometriosis – Adenomyosis (50%) – Endometriomas (if large)

  • Endometriosis can present with:

– Deep Dyspareunia – Bowel symptoms – Menorrhagia – Intermenstrual bleeding

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Case 2 Teaching Points (cont’d)

  • Examine the uterus and the Pouch of

Douglas

  • Degree of Pain and Degree of

Endometriosis don’t correlate

  • Place for conservative management in

teenagers

  • Laparoscopy should be done by special

interest gynaecologist

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Case 2 Teaching Points (cont’d)

  • PCOS does not cause pain
  • Management after Laparoscopy can be

challenging – Running pill together – Mirena – Exercise – Diet – Bowel function – Avoid overuse of pain killers

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Case 3

42 year old woman with heavy painful periods. Chronic low back pain and right hip pain. BMI 35

  • History:
  • Examination:
  • Investigations:
  • When to Refer, Where to Refer:
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Case 3 Teaching Points

  • Adenomyosis is under diagnosed.
  • The uterus is a cause of ongoing pain in

women with endometriosis.

  • Counselling women for the Mirena.
  • Fibroids can cause pain.
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Case 3 Teaching Points (cont’d

  • Endometrial cells on a smear in a

symptomatic premenopausal woman should do ultrasound and endometrial sampling.

  • Endometriosis / Adenomyosis can present

as chronic low back pain and / or hip pain.

  • Women’s main fear regarding

Hysterectomy is how it will affect their hormones.

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Case 4

59 year old woman presents with diffuse lower abdominal pain.

  • History:
  • Examination:
  • Investigations:
  • When to Refer, Where to Refer:
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Case 4 Teaching Points

  • Ovarian cancer presents late.
  • 60% of women with ovarian cancer

present with pain +/- postmenopausal bleeding.

  • Complex cysts in postmenopausal women

are suspicious of malignancy regardless of size.

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Case 4 Teaching Points (cont’d)

  • There is an association between

endometriosis and ovarian cancer.

  • Ca 125 is the tumour marker for ovarian

cancer (and endometriosis).