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

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 • 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.

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.

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:

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

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

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

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:

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.

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.

Case 4 59 year old woman presents with diffuse lower abdominal pain. • History: • Examination: • Investigations: • When to Refer, Where to Refer:

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.

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).