Ch. 4 Flashcards
Absence menstrual flow clin sign various disorders
Eval: absence both menarche and secondary characteristics by age 13; absence menses by 15 yrs; absence menstruation with 5 yrs breast development; 6 month+ cessation after secondary amenorrhea
Associated with weight and nutritional status
Sign of a diseasxe
Can be result of pregnancy, anatomic abnormalities,
Hypogonadtropic amenorrhea
Amenorrhea
Prob in central hypothalamic-pit axis
Pit lesion or genetic inability produce LSH/FH
Often results from suppression as result of stress or sudden and severe weight loss
Loss of Ca can occur with this
Assessment: thorough H&P; specific components depend on age, prengnacy test, diagnostic tests, endocrine levels checked, CT scan
Hypogonadtropic amenorrhea
Pain during or shortly after menstruation most common prob
Common in smokers and obese pts
Associated with early menarche, nulliparity, lack of exercise
Primary Dysmenorrhea
Secondary Dysmenorrhea
Dysmenorrhea
Condition associated with ovulatory cycles
Biocmeical basis and arises with release prostaglandins with menses
During luteal phase and subsequent menstrual flow prostaglandin released increasing amplitude and frequency contractions and causing vasospasm of uterine arterioles - resulting in ischemia and lower abdominal cramps
Response: backache, weakness, sweats, anorexia, nausea, vomiting, diarrhea, dizziness, headache, syncope, poor concentration
Onset menstruation and last 12-72 hrs
Appears 6-12 months after menarche (ovulation establish)
Estrogen and progesterone necessary - experienced with ovulatory cycles
Primary Dysmenorrhea
Menstrual pain that develops later than primary - typ after 25 yrs
Associated with pelvic patho
Have underlying symptom to suggest underlying cause
Dull lower-abdominal aching radiating to thigh and back
Bloating or pelvic fullness
Careful pelvic exam, US, D&C, biopsy, laparoscopy
Treatment to remove underlying cause
Secondary Dysmenorrhea
Premenstrual dysphoric disorder (PMDD) - more severe variant - irritability, dysphoria, mood lability, anxiety, fatigue, appetite changes, sense feeling overwhelmed, mood distrubances
PMS - complex and poorly understood - 1+ large number physical and psychological symptom beginning in luteal phase of cycle then symptom-free period; symp:fluid retention, behavioral/emotional changes, cravings, headache, fatigue, backache; ovarian func required for this
Diagnosis PMDD
Premenstrual syndrome
5+ affective and phys symp present before menses and begin improve follicular phase
1 symp marked affective lability, irritability or anger, depressed mood or feelings hopelessness or self-deprecating thoughts, or anxiety
1+ following with total 5: decreased interest usual activities, subj difficulty concentrating, letharge, change in appetite, hypersomnia/insomnia, feeling overwhelmed, breast tenderness, muscle pain, bloating, weight gain
Symp interfere with work or relationships
Symp not caused by another condition/disorder
Woman and HCP confirm symp occurring and evidence through daily rating
Symptom not caused by effects substance/treatment
Diagnosis PMDD
Presence and growth endometrial tissue outside uterus
Contains uterine glands and stroma (CT) and responds to cyclic hormone stimulation in same way uterine endometrium does but often out of phase with it; grows during proliferative and secretory cycle; during or immediately after menstruation - tissue bleeds resulting in subsequent fibrosis and adhesions on adj organs
Symp: pelvic pain, dysmenorrhea, painful intercourse/dyspareunia, chronic noncyclic pelvic pain, pelvic heaviness, pain radiating into thighs, report bowel symptom: diarrhea, pain with defecation, constipation; abnormal bleeding and pain during exercise
Endometriosis
Changes in amt, duration, interval, regularity menstrual bleeding
Infrequent (oligomenorrhea)
Scanty at norm intervals (hypomenorrhea)
Excessive (menorrhagia)
Occurs between periods (metorrhagia)
Alterations in cyclic bleeding
30 organisms that cause infections/infectious disease syndromes primary through intimate contact
Causative organisms: wide spectrum
Direct cause of tremendous human suffering and heavy demands on healthcare sys
Common among young people
⅕ infected with STIs each year; untreated and rates underreported
If untreated - cause long-term consequences
Prevention
STIs
Preventing infection most effective way to prevent adverse consequences
Prompt diagnosis and treatment prevent comps and transmission to others
Identification of risk prevention cousneling
Be motivated understand how serious risk infection is
Ways: abstinence, monogamous relationship
Reduction number of partners, low-risk sex, avoid exchange body fluids, vaccines
Examine partner
Education on influence on drugs and alcohol
Prevention
Chlamydia
Gonorrhea
Syphilis
Pelvic inflammatory disease
Bacterial STIs
Most frequent
Asymptomatic and highly destructive
Increased risk ectopic pregnancy and tubal factor infertility
Causes inflammation on cervix - causes ulcartions increasing risk getting HIV infection
<25 yrs most common
Risky behaviors
Screening and diagnosis
Chlamydia
Obtaining info regarding risk factors
Symptoms - spotting, postcoital bleeding, mucoid or purulent cervical discharge, dysuria
Lab diagnosis - culture, DNA probe, ezyme immunoassay, nucleic acid amplification tests of urine specimens or from endocervix/vagina
Screening and diagnosis - Chlamydia
Oldest communicable disease
Drug-resistant more common
Aerobic, gram-negative
Sexual contact transmission - genital to genital
Teenagers and young adults more common engaging in multiple partners
Asymptomatic - if symptoms: greenish-yellow purulent endocervical discharge or experience menstrual irregularities; pain - pelvic or lower abdominal pain or menses that last longer or more painful than normal
Perinatal comps can occur
Screening and diagnosis
Gonorrhea
