What family history to ask for ovarian cancer?
- BRCA1/BRCA2
- HNPCC
What are the signs of the spread of tumour?
Mnemonic: BALLO
B -> Bowel obstruction
A -> Ascites
L -> Lymph node (Para-aortic)
L -> Liver capsule
O -> Omental caking
What are the red flags for ovarian tumour?
- IBS
- Prolapse
- New onset of urinary incontinence
- Paraneoplastic syndrome (Dermatomyositis)
- Loss of appetite
What are the investigations of ovarian tumour?
- Tumour markers
1. CA-125
2. AFP
3. CA 19-9
4. CEA - B-HCG -> Choriocarcinoma, dysgerminoma
- LDH -> dysgerminoma
- Inhibin -> Granulosa
- USS Abdo/Pelvis -> Look for papillary projections
What staging is used for ovarian tumour?
FIGO staging
What are the management plan for ovarian tumour?
- Exploratory staging laparotomy
- Peritoneal washing, TAHBSO, infracolic omentectomy, lymph node biopsy
- Primary pelvic clearance and tumour debulking - Metastasis: Surgical debulking and chemotherapy
- E.g: PACLITAXEL, CARBOPLATIN - Biological
E.g: BEVACIZUMAB, OLAPARIB (poly ADP-ribose polymerase inhibitors)
What is the pre-menopausal management for ovarian cyst/tumour?
Conservative management
- <5cm (small) and simple: rescan in 12 weeks
- 5 - 10cm/increase size/symptomatic: Diagnostic laparoscopy/laparotomy
What is the pre-menopausal management for ovarian cyst/tumour?
Refer
- Low RMI/small/simple: rescan every 4 months
- Intermediate RMI: laparotomy oophorectomy (stage if malignant)
- High: full staging laparotomy
What are the complications of ovarian cyst/tumour?
- Rupture
- Torsion
- Hemorrhage
Define pre-existing hypertension in pregnancy
- Hypertension history before pregnancy or BP>140/90
- Period of gestation <20 weeks
What are the risk factors of pre-existing hypertension?
- Renal disease
- Increase age
- DM
- BP >160/110 (<20w)
What are the investigations done to manage pre-existing hypertension in pregnant ladies?
- Exclude secondary hypertension
- Prevent pre-eclampsia (Aspirin from 12w)
1. Increase antenatal appointments with regular BP monitoring
2. Proteinuria: urine dipstick, PCR, 24h urine protein
3. Uric acid levels
4. Doppler US -> uterine artery - Foetal: serial growth scan -> growth restriction
State the management for pre-existing hypertension in pregnant ladies
- Medical
- 1st: LABETOLOL (Side effect: Neonatal hypoglycemia)
- 2nd: NIFEDIPINE
- 3rd: METHYLDOPA (Contraindicated in depression) - Only Oxytocin in labour, ergometrine -> Increase in BP
- Avoid ACEI, ARB & diuretics (teratogenic)
Why is ACEI, ARB and diuretics avoided in the treatment of pre-existing hypertension for pregnant lady?
- Teratogenic
- Decrease in placental perfusion
- Furosemide crosses placenta (use in pulmonary oedema)
- Atenolol is contraindicated (It causes IUGR)
What are the maternal complications of pre-existing hypertension in pregnant ladies?
Mnemonic: HIPP
- Heart failure
- Intracerebral hemorrhage
- Placental abortion
- Pre-eclampsia
What is the management for PIH?
Mild: 140-149/90-99
- Treat conservatively
- Regular BP monitoring and check for protein
Moderate: 150-159/100-109
- Treat
- Monitor 2X
- Start medication -> Continue drugs for 6 week to <130/80
- FBC, U&E, LFT
Severe: 160/110
- Admit and treat
- Monitor BP 4X a day, check for proteinuria
- FBC, U&E, LFT
