Chapter 23 Gynecology Flashcards
Study of female reproductive system with disease and routine physical care
Gynecology
What structures make up the female reproductive structures?
Female genitalia
Uterus
Vagina
Cervix
Fallopian tubes
Ovaries
Mammary glands
What releases eggs and controls reproductive hormones?
Ovaries
How does a released egg make it to the uterus?
Fallopian tube
Pear shape organ the embryo implants in and grows
Uterus
What is the upper convex portion of the uterus called?
Fundus
What layers does the uterine wall consist of?
Myometrium: muscle layer
Endometrium: nutrient rich inner layer that is shed during menstruation
Where does a fertilized egg implant?
In the endometrium
What is the neck of the uterus called?
The cervix
What does the cervix attach to?
The vagina
What does the lower part of the uterus, cervix and vagina, make up?
The birth canal
What is the tissue between the vaginal opening and anus?
Perineum
What is the hair covered fat pad overlying the symphysis pubis called?
Mons Pubis
What are the rounded fold of external adipose tissue called?
Labia majora
What is the thinner, pink/red folds that extend anteriorly to surrounding the clitoris called?
Labia minors
Where is the urethra found? AKA urethral meatus
Between the clitoris and vaginal opening
What protects the vaginal opening prior to first intercourse?
Hymen
What is it called when the hymen completely covers the vaginal opening? Will sometimes block the flow of blood during the first menses, resulting in low back pain and severe constipation
Imperforate hymen
Can cause endometriosis
What are other terms for menstruation?
Menses, period, menstrual cycle
What is the discharge of blood, epithelial cells, mucus, and tissue from the uterine lining called?
Menstruation
What is the first onset of menses called?
Menarch
What is it called when a female stops ovarian function a menstrual cycle?
Menopause and/or female climacteric
What are the 2 phases of the menstrual cycle called?
Ovarian cycle and uterine cycle
What cycle do the follicular phase and luteal phase make up?
Ovarian Cycle
How many days does the follicular phase last?
Day 1-13
How many days does the luteal phase last?
Days 14-28
What cycle do the proliferative phase and secretory phase make up?
Uterine Cycle
How many days does the proliferative phase last?
Days 5-14
How many days does the secretory phase last?
Days 15-28
What is it called when an ovarian follicle releases and egg?
Ovulation
When does ovulation occur?
Typically 14 days after start of LMP
What happens of the ovum is not fertilized?
Menstruation occurrs
What happens if the ovum is fertilized?
It implants in the endometrium and you get a baby
How long does menstruation last and how much blood do you loose?
4-6days w/ approximately 25-65ml
What is it called when a woman has abdominal pain, cramping, etc. during a period?
Mitterschmerz; result of rupture of ovarian follicle
How long does mitterlschmertz last?
A few minutes to 48hrs.
What are the signs and symptoms of mitterlschmertz?
Sharp cramp in pain in lower abd, localized pain to one side beginning mid cycle w/ hx of similar pain from previous periods. Pain can also switch sides from month to month
What is the absence or cessation of menses?
Amenorrhea
What is the most common cause of Amenorrhea?
Pregnancy
What else can cause Amenorrhea?
Woman looses body fat, emotional problems, stress, participation in high intensity sports, young females w/ anorexia d/t malnutrition and emotional state
Common elements of Gynecological History Taking
vaginal bleeding: amount? Any tissue passed?
ABD pain? OPQRST
Vaginal discharge: color, amount, odor, itching?
Pregnant?
Sexually activate? On birth control?
LMP?
Previous pregnancies? Gravidity, parity
Pregnancy complications?
Previous c section or other abd surgeries?
Other PMhx, meds, allergies
Current or previous STD
What is Cullen sign?
Ecchymosis, or bruising, at the umbilicus, indicates internal bleeding
Can be a sign of ruptured fallopian tube from ectopic pregnancy
What is grey turner sign?
Ecchymosis, or bruising, at the flanks; indicates internal bleeding
Can be a sign of ruptured fallopian tube from ectopic pregnancy
What is the primary management of gynecological emergencies?
Mitigating life threats, compassionate supportive care while maintaining pt’s modesty
What do you do for all pt’s?
Assess o2 and provide oxygen therapy as needed, obtain vital signs, and monitor, consider IV access, fluid therapy as needed and pain management if protocol allows
PROTECT PT’S MODESTY \
How do you control external bleeding of female genitals, which may be profuse?
Simple external pressure over area of trauma is usually sufficient enroute to control bleeding
How do you control internal vaginal bleeding?
Manage the same way you would any other hemorrhage, IV o2 monitor treat for shock, transport to hospital w/ obgyn services
DO NOT PACK THE VAGINA. HAS LITTLE TO NO BENEFIT
What is an infection of a woman’s reproductive organs?
Pelvis Inflammatory Disease (PID)
What is the most common cause of PID?
STD like chlamydia of gonorrhea
What group do you expect to find PID in?
25yrs or younger and sexually active
What causes PID?
Disease causing organism enter vagina usually through sexual activity. Migrates through cervix into uterine cavity. Can expand into fallopian tubes. Tubal walls get infected and swell. Fill with purulent fluid. Can develop peritonitis and pelvic abscesses
What happens if PID is left untreated?
Pt can become septic
Long term complications: infertility and increased risks of ectopic pregnancy
What are the symptoms of PID?
Diffuse lower quadrant abd pain that typically starts during or after menstruation
Pain can increase w/ walking or sexual activity
What does localized RUQ pain indicate?
Infection has spread to abdominal cavity
What are the symptoms of infection that has spread to abdominal cavity?
Vaginal discharge, fever, chills, pain, burning during urination
What are the most common risk factors of PID?
Untreated STD, douching, hx of previous PID
What else can PID be associated with?
Abortion, child birth, implantation of IUD, or any other procedure where contaminated instruments have been introduced into the vagina
What will a physical exam reveal if a pt has PID?
Can be scarce or include entire textbook of symptoms; peritoneal irritation (tenderness on palpation)
How do you treat PID?
Pre Hospital is primarily Supportive care: o2, IV, fluids as needed.
Definitive care includes: abx for 10-14 days
What is a bartholin abcess?
Abscess that forms inside the bartholin gland or duct that connect the barthoin glands to the outside vagina
What does the bartholin gland do?
Secrets lubrication during intercourse
How do you treat a bartholin abscess?
Pre Hospital: primarily supportive
Definitive: surgical I/D to drain abscess and remove cyst
What is vaginitis?
Inflammation of the vagina caused by infection
What are common symptoms of vaginitis?
Itching, irritation, discharge, odor, painful intercourse, lower abd pain
What foreign bodies can predispose a woman to vaginitis?
Retained tampons and condoms or any other device left in vagina for extended period of time
What is a vaginal yeast infection?
Infection typically cause by Candida albicans fungus
What keeps normal yeast from growing?
Acidic environment of vagina; if it becomes less acidic, yeast population can increase dramatically
What can alter acidity of vagina?
Oral contraceptives, menstruation, pregnancy, diabetes, some abx, deodorant, tampons, excessive use of vaginal sprays, douches
When else can promote growth of yeast?
Stress, lack of sleep, illness, poor diet, immunosuppressive disease like HIV,
What are the symptoms of vaginal yeast infection ?
Itching, burning, soreness in vagina, around vulva, vulvar swelling, thick white discharge, pain during sex, and burning w/ urination
What is vulvovaginitis?
Inflammation of external vulva
What are the symptoms of vulvovaginitis?
Redness, pain, swelling, discharge, burning, and itching
What can happen if vaginitis is left untreated?
Infertility, preterm birth, endometritis, PID, increase risk of STD
How do you treat vaginitis?
Pre Hospital: mostly supportive, ABCs, treat symptoms
Definitive: abx, vulvovaginitis can also include topical creams
What is cystitis?
Bladder infection, infection isolated to bladder
What causes cystitis?
Bacteria ascends from perineum through genital tract into urethral opening
What are the signs/symptoms of cystitis?
Suprapubic pain, cloud urine, urinary frequency, hematuria, dysuria,
What will happen if cystitis is left untreated?
Can lead to pyelonephritis (kidney infection), which is more serious. Pt’s will present with same symptoms as cystitis but also with fever, chills, vomiting
How do you treat cystitis/pyelonephritis?
Pre Hospital: supportive, abcs, treat symptoms, watch for shock, IV, EKG, O2 as needed, fluid, pain management and anti emetics
Definitive: abx
What is an ovarian cyst?
Fluid filled sac on ovary
Ovarian cysts can be ruptured or unruptured, solitary or multiple, unilateral or bilateral, generally asymptomatic, and disappear on their own
What happens when a cyst becomes large?
Pelvic discomfort, urinary retention, urinary frequency, or menstrual irregularities
When can an ovarian cyst rupture?
Spontaneously, mild abd injury, during sex, or exercise
What symptoms to you expect if a cyst has ruptured?
Sudden onset of moderate to severe lower abd pain that may radiate to back, may have vaginal bleeding, light headedness, signs of shock, hypotension, tachycardia. DEPENDS ON SEVERITY OF RUPTURE
What is an ovarian torsion?
Twisting of an ovary that cuts off blood supply, true medical emergency, can lead to permanent damage to ovary
When is an ovarian torsion more common?
In pt’s w/ hx of ovarian cyst
What are the signs/symptoms of ovarian torsion?
Acute onset moderate to severe unilateral lower abd pain, pain increases over a few hours, may be intermittent, may radiate to back, pelvis, thigh, affected side will be tender to palpation, may feel a mass
N/V are common but non specific findings
How do you treat ovarian torsion?
Prehospital:
How do you treat ovarian torsion?
Pre Hospital: quick recognition and rapid transport, supportive care, abc management, iv vitals, fluids as needed, o2 as needed
Definitive: generally needs surgical correction
What is endometritis?
Inflammation of endometrium
When is endometritis most common?
After childbirth, most common cause of infection
When is it most common?
After childbirth, most common cause of infection
What are the signs/symptoms of endometritis?
Fever, chills, vomiting, tachycardia, lower abd or pelvis pain, foul smelling discharge
What are the treatments for endometritis?
Pre Hospital: transport in position of comfort, IV, titrate to pt’s vitals,
Definitive: abx, severe infection and sepsis can occur if left untreated
What is endometriosis?
Presence of tissue outside uterus that resembles endometrium in structure and function
Where is endometriosis found?
On pelvis structures including ovaries, fallopian tubes, bowel, or rectum
What are the signs and symptoms of endometriosis?
Extreme pain is most common sign. Most women do not know they have endometriosis until they can not have children
Pain can be localized to lower back, pelvis, abd region. Often constant and deep. May be unilateral or bilateral. Described as sharp or dull. Heavy prolonged menstruation, escalating menstrual cramping, pain w/ sex, rectal pressure, fatigue, bleeding between periods,
How do you treat endometriosis?
Pre Hospital: pain management per protocol, transport in position of comfort, supportive care, use towels/dressing to absorb significant vaginal bleeding
What is uterine prolapse?
Protrusion of any part of the uterus outside the vagina
What are the risk factors? WHO commonly experiences uterine prolapse?
Risk factors: obesity, weakness pelvis floor d/t decreased estrogen, intra abd pressure related to pregnancy, difficult child birth including prolonged labor, multiple birth, large baby, or repeat pregnancies
What are the signs and symptoms of prolapsed uterus?
Usually seen i advanced stages: pelvis heaviness, fatigue, low back pain, symptoms worsen w/ prolonged standing and relieved when lying down
How do you treat uterine prolapse?
Pre hospital: supportive care, if vaginal tissue visibly prolapsed cover with moist sterile dressing
What is dysfunctional uterine bleeding?
Uterine bleeding that is abnormal in amount or frequency (more than every 21 days)
DX after r/o of other systemic conditions such as medication therapy or disease
Why does dysfunctional uterine bleeding occur?
Hormonal events responsible for menstruation are interrupted. Usually at beginning or end of woman’s’ reproductive years
What are the risk factors associated with dysfunctional uterine bleeding?
Extreme weight loss or gain, age greater than 40, high stress levels, PCOS, long term medication use, excessive exercise, anatomical abnormalities such as uterine fibroids
How do you treat uterine dysfunctional bleeding?
Pre Hospital: supportive care, abcs, IV, O2 as needed, monitor, position of comfort. Provide towels or dressing for excessive vaginal bleeding
Definitive: may require hormonal therapy or surgery
What is traumatic vaginal bleeding?
Bleeding common after vigorous voluntary sex
Should consider violent involuntary sex as well
What causes traumatic vaginal bleeding?
Posterior vaginal wall behind cervix is injured
What are the complications of traumatic vaginal bleeding?
Bleeding, organ rupture, hypovolemic shock
How do you treat these pt’s?
Pre Hospital: same as you would other hemorrhage shock, warm, oxygen, IV access, IV fluids as indicated, monitor vitals, rapid transport
What is an ectopic pregnancy?
Any pregnancy that develops outside uterus
What are the common sites?
Fallopian tube, abd cavity, ovary, cervix.
Fallopian tube most common
What happens to the fallopian tube?
Fertilized oocyte can cause tube to stretcher and eventually rupture, cause significant bleeding
LIFE THREATENING EMERGENCY
What are the signs of ectopic pregnancy?
Abdominal bleeding, delayed period, abnormal vaginal bleeding/spotting 6-8wks after last period
Signs of unruptured ectopic pregnancy?
ABD pain on one side that is dull, lower quadrant
Signs of ruptured ectopic pregnancy?
Changes to colicky pain then to sharp and stabbing, sudden excruciating pain felt through lower abd. Can have referred should pain as abd fills with blood
How do you treat a pt w/ ectopic pregnancy?
Pre Hospital: ABCs, oxygen as needed, make them NPO, placed them in left lateral recumbent position, IV w/ fluid therapy, anticipate vomiting, keep pt warm, cardiac monitor, transport pt to facility with surgical capabilities, monitor
Definitive: surgery to remove ruptured tube and stop bleeding if necessary
What is sexual assault?
Any non consensual sexual encounter even when victim lacks capacity to consent
How do you assess sexual assault pt?
Treat medical concerns first, Don’t push for information, allow female to assess female, support pt emotionally, be mindful that date rape drugs may have been used,
How do you manage sexual assault pt?
Encourage pt not to shower or “clean”, placed evidence items in paper bags, transport to facility with staff capable of performing rape kit (SANE nurse)
What are examples of date rape drugs?
Rohypnol, GHB, Ketamine, Klonopin, Xanax
How do you document sexual assault?
Be concise and only use facts. Place pt version of events in quotes, document facts
How to manage foreign bodies in vagina/rectum?
Most common gynecological emergency, do not attempt to remove, keep pt calm, protect their dignity, transport in position with knees flexed and legs together position
During 2nd & 3rd Trimester of pregnancy, what does moms BP/HR do?
BP drops (higher blood volume)
HR elevates
