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Clinical Conditions > 13. Reproductive INCOMPLETE got to 6.5 LUSUMA notes > Flashcards

13. Reproductive INCOMPLETE got to 6.5 LUSUMA notes Flashcards

1
Q

What is amenorrhoea?

A

Absence of periods for at least 6 months.

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2
Q

What is the difference between primary and secondary amenorrhoea?

A

Primary is never having a period by age 14 with absence of secondary sexual characteristics or by 16 with SSC, secondary is when established menstruation has ceased for three month in a woman with history of regular cyclic bleeding or nine months with irregular cyclic bleeding.

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3
Q

What is oligomenorrhoea?

A

Infrequent period occurring at intervals of 35 days to 6 months.

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4
Q

What is dysmenorrhoea?

A

Painful periods.

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5
Q

What is menorrhagia?

A

Heavy periods: excessive (>80ml) or prolonged (>7 days).

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6
Q

What is cryptomenorrhoea?

A

Periods occur but not visible due to obstruction in outflow tract.

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7
Q

What is dysfunctional uterine bleeding?

A

Abnormal bleeding, no obvious organic cause.

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8
Q

What are anovulatory cycles?

A

No ovulation/luteal phase, oligo/amenorrhoea +/- menorrhagia.

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9
Q

What are ovulatory cycles?

A

Normal menstrual cycles + dysmenorrhoea/mastalgia (sore breasts).

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10
Q

What is the pathophysiology behind hypothalamic/pituitary amenorrhoea?

A

Inadequate levels of FSH lead to inadequately stimulated ovaries, which then fail to produce enough oestrogen to stimulate endometrium of uterus.

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11
Q

What is a primary hypothalamic cause of amenorrhoea?

A

Kallmann syndrome - inability to produce GnRH.

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12
Q

What are some secondary hypothalamic causes of amenorrhoea?

A

Exercise amenorrhoea from physical exercise, stress amenorrhoea, eating disorders (weight drops below critical weight 47kg).

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13
Q

What are some secondary pituitary causes of amenorrhoea?

A

Sheehan syndrome (hypopituitarism), hyperprolactinaemia, haeocrhomastosis.

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14
Q

What is the pathophysiology behind gonadal/end-organ amenorrhoea?

A

Ovary does not respond to pituitary stimulation so oestrogen levels are low, lack of negative feedback from oestrogen causes elevated FSH levels.

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15
Q

What are some causes of primary gonadal/end-organ amenorrhoea?

A

Gonadal dysgenesis (e.g. Turner syndrome), androgen insensitivity syndrome, receptor abnormalities for FSH and LH, congenital adrenal hyperplasia.

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16
Q

What are some causes of secondary gonadal/end-organ amenorrhoea?

A

Pregnancy, anovulation, menopause, polycystic ovarian syndrome, drug-induced.

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17
Q

What are some primary outflow tract obstruction causes of amenorrhoea?

A

Uterine - Mullerian agenesis.

Vaginal - vaginal atresia, cryptomenorrhoea, imperforate hymen.

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18
Q

What is a secondary outflow tract obstruction cause of amenorrhoea?

A

Intrauterine adhesion (Asherman’s syndrome).

19
Q

How can amenorrhoea be managed?

A

Depends on cause, if insufficient in a hormone - hormone replacement, if due to lifestyle - modify factors.

20
Q

What is the pathophysiology behind dysfunctional uterine bleeding?

A

90% cases from no ovulation as corpus luteum doesn’t form to produce progesterone so oestrogen is made continuously -> overgrowth of uterine bleeding and subsequent bleeding.
10% from prolonged progesterone secretion with ovulation, low levels of oestrogen means irregular shedding of uterine lining and erratic bleeding.

21
Q

How is menorrhagia managed?

A

With progesterone.

22
Q

What are some of the common clinical problems of the ovary?

A

Ovarian cysts and tumours of the ovary.

23
Q

What is polycystic ovaries?

A

More than 10 cysts in ovary, associated with infertility.

24
Q

What cells of the ovaries have tumours most commonly?

A

Epithelial components or from germ cells.

25
Q

What is salpingitis?

A

Inflammation of the uterus tube caused by microorganisms causing fusions or adhesions of the mucosa and blocked lumen.

26
Q

How can salpingitis lead to trouble conceiving?

A

Fusions of adhesions of the mucosa of the uterine tube can block the lumen -> infertility. This could lead to ectopic pregnancy or implantation outside the uterus.

27
Q

What is endometriosis?

A

Ectopic endometrial tissue is dispersed to various sites along the peritoneal cavity and beyond.

28
Q

What are some of the complications of endometriosis?

A

Severe period pain (dysmenorrhoea), infertility.

29
Q

Where do most neoplasms form in endometrial carcinomas?

A

In the transformation zone - junction between columnar cells of endocervix and squamous cells of exocervix.

30
Q

What is the major symptoms of endometrial carcinoma?

A

Abnormal uterine bleeding.

31
Q

What are some of the clinical conditions affecting the greater vestibular glands (Bartholin glands)?

A

Bartholinitis (infection/inflammation), bartholin gland cyst (duct of gland is blocked -> cyst).

32
Q

What is vaginitis?

A

Inflammation of the vagina.

33
Q

What is vaginismus?

A

Condition making any vaginal penetration painful (e.g. tampon insertion, sexual intercourse) due to reflex of pubococcygeus muscle.

34
Q

What is ectopic implantation?

A

Implantation anywhere but the body of the uterus.

35
Q

What is the peritoneal cavity a risk of infection spread in females?

A

If is open via the ostium of the uterine tube.

36
Q

What is an episiotomy?

A

Cutting medio-lateral in labour to avoid perineal body rupture.

37
Q

How can the pelvic floor be damaged by stretching of nerves, muscles, and ligaments?

A

Stretch pudendal nerve -> neuropraxia and muscle weakness.
Stretch and damage of pelvic floor and perineal muscle -> muscle weakness.
Stretch/rupture of ligament supports of muscles -> ineffective muscle action.

38
Q

What are some risk factors for pelvic floor dysfunction?

A

Age, menopause (atrophy of tissue without oestrogen), obesity, chronic cough, intrinsic connective tissue laxity.

39
Q

Outline how pelvic floor dysfunction can be managed.

A

Pelvic floor muscle exercises, continence surgeries (tension-free vaginal tape), prolapse procedures.

40
Q

What are the pathogens causing the following sexually transmitted infections?
HPV, herpes, chlamydia, gonorrhoea, syphilis, trichomoniasis.

A 
HPV - human papillomavirus
Herpes - herpes simplex virus type I (oral) or II (genital)
Chlamydia - Chlamydia trachomatis
Gonorrhoea - Neisseria gonorrhoeae
Syphilis - Treponema pallidum
Trichomoniasis - trichomonas vaginalis
41
Q

What are the differential diagnoses for genital skin and mucous membrane lesions?

A

Genital ulcers, vesicles or bullae, genital papules, anogenital warts.

42
Q

What are the differential diagnoses for urethritis (discharge, dysuria, frequency)?

A

Gonococcal urethritis, chlamydial urethritis, non-specific urethritis, post-gonococcal urethritis, non-infectious urethritis.

43
Q

What are the differential diagnoses for vulvo-vaginitis and cervicitis?

A

Vulvo-vaginitis, cervicitis, bacterial vaginosis, Bartholinitis.

44
Q

What are the differential diagnoses for infection of the female pelvis?

A

Pregnancy-related, pelvic inflammatory disease.

Clinical Conditions (13 decks)

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