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Pathophysiology - Diseases > Diseases and Disorders of Female Reproductive System > Flashcards

Diseases and Disorders of Female Reproductive System Flashcards

1
Q

function of female reproductive system?

A

ova (eggs) and carries, nourishes, and gives birth
to a fetus

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2
Q

external organs of the female reproductive system?

A

External genitalia (vulva)
- the mons pubis ( fat pad that covers the symphysis pubis (the joint formed by the union of the two pubic bones)
- labia (split into labia majora (outer vaginal lips) enclose and protect other external reproductive organs. labia minora (inner vaginal
lips) protect the vaginal and urethral openings
- clitoris (tuft of erectile tissue whose function is sexual arousal and pleasure)
- urethral opening (small tubular structure that drains urine from the bladder)
- perineum (space between the rectal opening and the vaginal opening)
- greater vestibular glands (or Bartholin’s glands) lie on
either side of the vaginal entrance and produce a
lubricating secretion during sexual intercourse.

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3
Q

internal female reproductive tract

A
  • ovaries (two small almond-shaped structures located on each side of the uterus. The ovaries produce ova, estrogen, and progesteron)
  • fallopian tubes (4 in long, either side of uterus, transport ova from ovaries with fimbriae, site of fertilization of ovum)
  • uterus (hollow pear like ogran located btwn urinary bladder and rectum, mainly body, then cervix, has endometrium linning that is thickened by estrogen and progesterone)
  • Vagina (thin-walled muscular tube abt 6 in long from uterus to externa genitialia, passageway for childbirth, mestrual flow and receiving penis during sexual intercourse)
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4
Q

How many lobules do the breasts contain?

A

15-20 lobules

lobules r tiny, saclike acini that secrete milk during lactation (minute ducts drain the acini to form larger ducts as they travel to the nipple)

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5
Q

What is the areola?

A

pigmented area encircling the nipple

numerous sebaceous glands on surface of the areola to prevent dryness and carcking during breastfeeding

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6
Q

How is puberty triggered?

A

by rising levels of gonadotropin-releasing hormone (GnRH) which stimulate anterior pituary to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

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7
Q

What does FSH do + what happens after that?

A

stimulates the development of ovarian follicles which stimulates estrogen and progesterone production responsible for puberty changes (breast development, depositing fat beneath skin of the hips, thighs and buttocks and widening pelvis_

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8
Q

What does FSH do + what happens after that?

A

stimulates the development of ovarian follicles which stimulates estrogen and progesterone production responsible for puberty changes (breast development, depositing fat beneath skin of the hips, thighs and buttocks and widening pelvis)

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9
Q

When does puberty in females start?

A

9-10

first signs r breast development and growth in pubic and axillary region

menarche at age 12

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10
Q

What is the reproductive cycle?

A

28 days long, includes overian cycle and menstrual cycle

starts on first day of noticeable vaginal bleeding (menstruation) lasting 3-5 days

begins as low levels of estrogen and progesterone (this triggers hypothalamus to secrete GnRH which indices anterior pitauary gland to secrete FSH and LH)

FSH stimulates maturation of single ovarian fillicle that secrete estrogen and orgesterone = thickening of endometrium

in middle of cucle estrogen levels peak = LH surge = follicle rupture and release ovum (ovulation) after which empty follicle becomes corpus luteum which secretes lot sof progresterone which causes endometrium to thicken

if ovum is not fertilized corpus luteum degenerates = estrogen and progresteron levels fall = menustration

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11
Q

ovarian and menestrual cycle

A

FSH and LH produced by anterior pituary gland drives ovarian cycle

estrogen and progesterone secreted by ovaries drive menstrual cycle

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12
Q

Pelvic exam?

A

can detect certain cancers in early stages, infections and oterh reproductive diseases

examines external genitalia, visual exam of vagina and cervix through speculum and palpation of female internal organs by bimanual exam

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13
Q

What is Pap test?

A

a sample for papanicolaou test which tests for changes in cells of cervix

may look for CA 125 (protein tumor marker found in greater concentration in tumor cells) which can be used to diagnose endometrial and ovarian cancer

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14
Q

What is D&C?

A

dilation and curettage

dilation - cervix is widened

curettage - part of lining of iteirus is removed

used to diagnose endometrial cancer and treat menorrhagia

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14
Q

What is D&C?

A

dilation and curettage

dilation - cervix is widened

curettage - part of lining of iteirus is removed

used to diagnose endometrial cancer and treat menorrhagia

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15
Q

What can ultrasound diagnose?

A

visual exam of female reproductive system

can aid in diagnosing pelvic inflammatory disease (PID), benign breast condition, uterine fibroid tumor, some cancers, ectopic pregnancy, and mestrual disorders

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16
Q

What are all the -scopy for reproductive system?

A

laparoscopy - examine female reproductive organs

colposcopy - visualize cervix

hysteroscopy - uterine linign

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17
Q

Mammography?

A

xray examination of breast tissue

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18
Q

What is pelvic inflammatory disease (PID)?

A

infection of a women’s pelvis (tubes, ovaries, surrouding tissues r involved and can be selflimiting or, in cases of abscess formation, life threatening)

750,000 women experience episdoe of acute PID yrly

risk is highest for sexually active women under 25 and those of childbearing age

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19
Q

risk factors for PID r?

A

having multiple sex partners, having a
sexually transmitted infection (STI), and being
under age 25 and sexually active.

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20
Q

s/s of PID?

A

most common symptom is lower abd pain

others r fever, chills, malaise, backache, walking becomes painful, soft, tender pevic mass unusual vaginal discharge with foul odor, painful intercourse, painful urination, irregular mestrual bleeding

serious complication of some STIs

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21
Q

How to diagnose PID?

A

physical exam, pelvic exam, STI testing, ultrasound, cervical cultures, WBC count

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22
Q

complication of PID?

A

infertility, ectopic pregnancy, abscess formation and chronic pelvic pain

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23
Q

how to treat PID?

A

antibiotics but cant reverse damage

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24
Q

How to prevent PID?

A

abstinence, monogamy, latex condoms, early diagnsoes and treatment of STIs

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25
Q

What is cervical cancer + most important risk factor?

A

malignat neoplasm that forms within tissue of cervix

most important risk factor is infection by human papillomavirus (HPV)

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26
Q

cervical cancer stats?

A

12340 cases r diagnosed and 4030 women will die from it in US

estimated 528,000 women were diagnosed
with cervical cancer and 266,000 died of cervical cancer worldwide in 2012

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27
Q

s/s of cervical cancer?

A

usually no sumptoms until cancer becomes invasive and grows into nearby tissue

abnormal vaginal bleedin (bleeding btwn menstrual periods, after itnercourse or after neopause),an unusual vaginal discharge (watery, bloody, or purulent vaginal discharge), pelvic pain, and pain during intercourse

pelvis or lower back pain

hematuria

dysuria

rectal bleeding

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28
Q

2/3 of all cerivcal cancers r caused by?

A

HPV 16 and HPV 18

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29
Q

How to diagnose cervical cancer?

A

pelvic exam, Pap test, HPV DNA test, colposcopy and cervical biopy as well as Imaging tests

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30
Q

What is the 5 yr survival rate for localized cervical cance and for all stages r?

A

91% for localized

70 for all stages

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31
Q

How to treat precancerous lesions?

A

cryosurgery (freezing)
cauterization (burning)
laser surgery

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32
Q

treatment for cervical cancer?

A

surgery (radical hysterectomy), radiation therapy, chemotherapy

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33
Q

What is endometrial cancer?

A

cancer that forms in the tissue lining the utuerus

Avg age of diagnosis is 60
(cumulative lfietime expsoreu to estrogen plays a role i nmay risk factors for endometrial cancer)
etiology is idiopathic

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34
Q

stats for endometrial cancer?

A

The ACS estimates that in
2013 there will be 49,560 new cases of cancer of the body of the uterus diagnosed in the
United States and about 8,190 women will die from uterine cancer.

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35
Q

endometrial cancer risk factors?

A

abnormal overgrowth of the endometrium (endometrial hyperplasia)
early puberty
late menopause e
estrogen-only hormone replacement therapy
never having given birth
family history of uterine cancer or Lynch syndrome,
obesity

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36
Q

s/s of endometrial cancer?

A

vaginal
bleeding after menopause, abnormal bleeding,
abnormal vaginal discharge, pelvic pain, and
pain during intercourse.

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37
Q

How to diagnose endometrial cancer?

A

med hisyory, pelvic exam, hysteroscopy and biulateral salpingo-oopherctomy , removal of endometrial tissue (D&C or endometrial biopsy), CBC and CA 125 blood test

imaging tests for staging-

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38
Q

How to treat endometrial cancer?

A

removing cancer via surgery, radiation therapy (vaginal brachytherapy) and chemo

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39
Q

The 5-year relative survival
rate for endometrial cancer is about ___%; if the
cancer is found at an early stage the 5-year
survival rate is over __%.

A

83

96

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40
Q

What are leiomyomas?

A

fibriod tumors r benign tumors of the smooth muscle of the uterus

most common tumor of female reproductive system (affects 2-40% of women 35+)

develop after 30 and skrink or disppear after menopause

only risk factor is age

etiology of urine fibroid tumor is idiopathic (growth is stimulated by estrogen and typically regress after menopause)

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41
Q

s/s of fibroid tumors?

A

depends on size and location of fibroid tumor

size vary from quarter of inch to size of canatolpe

most r asymptomatic

some symptoms r excessive vaginal bleeding, pevlic pressure, abd pain, abd enlargement, pain during intercourse, constipation, urianry frequency, abnormal bleeding

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42
Q

how to diagnose and treat fibroid tumors ?

A

diagnose - pelvic exam and ultraspound, biopsy

treat - severity of s/s and childbearing plans, watching if no s/s. oral contraceptivees may decrease bleeding caused by uterine fibroid tumors

may do uterine artery embolization to shrink fibroid tumors by cutting off their blood supply

foccused uuultarouns surgery destroys uterine fibroid tumors using high-frequency sound waves

endometrial ablation - destroys endometrium and reduced amt of bleeding during menustration

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43
Q

What is myomectomy?

A

surgical removal of uterine fibroid tumors

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44
Q

_______ of hysterectomies performed in the United States are due to uterine
fibroid tumors.

A

One-third

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45
Q

What is ovarian cancer?

A

malignant neoplasm in tissue of ovaries

Avg age of diagnosis is 63

etiology is idiopathic

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46
Q

ovarian cancer stats?

A

22,240 cases of ovarian
cancer will be diagnosed and 14,230 women will
die from ovarian cancer in the United States.

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47
Q

risk factors of ovarian cancer

A

age, nenver have given birth, personal or family history of ovarian, breast or colorectal cancer

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48
Q

s/s of ovarian cancer?

A

often asymptomatic until more advanced stages

bloating, pelvic or abd pain, trouble eating or feeling full quickly, constipation, ascites, persistent, vague, digestive disturbances, change in urianry urgerncy or frequencyften asy

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49
Q

About ___% of ovarian cancers
are found at an early stage

A

20

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50
Q

How todiagnose and treat ovarian cancer?

A

diagnose -pelvic exam, CT, MRI scan or ultrasound, laparoscopy, laparotomy, biopsy, CA 125 blood test

test - surgery (bilateral saplingo-oophorectomy, hysterectomy) radiation therapy, chemo

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51
Q

If detected early ovarian cancer has a 5-year survival rate of approximately
___%. Unfortunately, 80% of ovarian cancers
are diagnosed at an advanced stage, when the
5-year survival rate is approximately ___%

A

90

30

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52
Q

What is breast cancer?

A

malignatnt tumor that forms in tissues, ducts or glands of breast (mostly in terminal ductal lobular unit (TDLU) of breast)

mostly in women but some men

avg age of diagnosis is 61

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53
Q

breast cancer stats

A

The ACS estimates that in
2013 approximately 232,340 cases of invasive
breast will be diagnosed and 39,620 women
will die from breast cancer in the United States.
An estimated 1.67 million women were diagnosed with breast cancer and 522,000 died of breast cancer worldwide in 2012.

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54
Q

risk factors for breast cancer/

A

age
never having given birth
having your first child after age 35
beginning menopause after age 55
genetic risk factors
prolonged exposure to and higher concentrations of endogenous estrogen increase the risk
being overweight or obese after menopause
lack of physical activity,
drinking alcohol
breast density
being Caucasian
family or personal history of breast cancer
ductal carcinoma in situ (DCIS), defined as malignant popoulation of cells that lack the capacity to invade through the basement membrane, is precursor lesion for breast cancer

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55
Q

s/s of breast cancer?

A

most common is lump or mass with irregular border within breast

swelling of all or part of breast, skin irritation or dimpling, breast or nipple pain, nipple retractoin, redness, scaliness or thickening of nipplie or breast skin and nipple discarhge other than breast milk, peau d’orange

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56
Q

Approximately _______% of breast cancer cases are
thought to be hereditary

A

5–10

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57
Q

Women who inherit
a BRCA1 or BRCA2 mutation have a __________%
chance of developing breast cancer by age 70.

A

50–85

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58
Q

Women who inherit
a BRCA1 or BRCA2 mutation have a __________%
chance of developing breast cancer by age 70.

A

50–85

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59
Q

Approximately ___% of breast cancer tumor cells have receptors for estrogen,

A

75

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60
Q

In approximately ____%
of breast cancers the tumor cells overexpress
HER2, the receptor for human epidermal growth
factor

A

20–25

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61
Q

what can overexpression of HER2 cause?

A

cells to divide more rapidly than normal cells bc human epidermal growth factor transmits signals directing growth

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62
Q

how to diagnose breast cancer?

A

self breast examination (monthly), clinical breast examination (CBE) (3 yrs if btwn 20-30, yrly if above 40)

mammography, ultrasound, biopsy, imaging tests (MRI)

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63
Q

how to treat breast cancer?

A

surgery, radiation, chemo, targeted drug therapy (block growt hand spread of cancer by interferring with specific molecules involved in tumor growth and progression)

hormone tharpy to bloc kestrogen receptors or inhibit estrogen production

trastuzumab is humainzed monoclonal antibody directed against c-erbB-2 and may be effective agaisnt tumors that over express this oncogene

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64
Q

What are the 3 types of benign breast conditions?

A

fibroadenomas
breast cysts -
fibrocystic breast changes -

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65
Q

what are fibroadenomas?

A

most common
10% of women
oftne feel smooth, firm, round, ruberry, easy to move and clear defined edges (swollen and tender bc hormoal changes)
hormonally responsive (growing in size during late phases of menstrual cycle or during pregnancy)

diagnsoed with breast exam, mammogram, ultrasound, MRI and fine needle bopsy

tretmeent - often stop grwoing or shirnk on owne, may remove wit hsurgaery, laser ablation or cryoablation

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66
Q

What are breast cysts?

A

fluid-filled sacs within breast tissue (feel like soft grape or water-filled balloon or may be firm)

s/s r smooth, easily movable round or oval breast lu,p with defined edges, breast pain or tenderness in aea of cyst (cyst may vary in size during menstrual cycle)

diagnosed with breast exam, mammogram, ultrasound, fine needle aspiration and biopsy

disappear after menopause

treat - oral contraceptives to reduce recurrence of breast cysts, fine needle aspirtion to drain fluid from breast aspiration, discontinuing hormone replacement

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67
Q

What are fibrocystic breast changes?

A

common benign breast condition (more than 1/2 of all women, mostly in women of child-bearing age)

includes fibrosis (more fibrous connective tissue) and breast cyst formation

s/s r breast swelling or thickening, lumps within breast that vary in size and texture, breast pain or tenderness (may change throughout menstrual cycle or during pregnancy)

diagnosed by breast exam, mammogram, ultrasound, fine needle aspiration and biopsy

treatment - no treatment needed, may wear supportive bra, over the counter pain relievers, reducing intake of caffeine and stimulants, oral contraceptives

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68
Q

What is amenorrhea?

A

absence of menstrual periods

known as primary amenorrhea if menstruation fails to begin by 16 (affects less than 1% of adolescent girls in US)

secondary amenorrhea is cessation of menstrual periods for 3-6 months or more (5-7% menstruating women in US)

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69
Q

risk factors + etiology for primary amenorrhea?

A

risk factors r eds, athletic training and family history of amenorrhea

etiology - chromosomal abnormalities, problems with hypothalamus, pituary disease, lack of reproductive organs or structural abn of vagina

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70
Q

etiology for secondary amenorrhea?

A

pregnancy
contraceptives
breastfeeding
stress
medication
chronic illness
hormone imbalance
low body weight
excessive exercise
thyroid disorders
pituitary tumor
uterine scarring
premature menopause

71
Q

how to diagnose amenorrhea?

A

med history, pregnancy test, pelvic exam, blood test to check hormone levels and progestin challenge test ( given progestin to see if it trigger menstruation

72
Q

How to treat amenorrhea?

A

depends on cause, may include lifestyle changes related wt, physical activity or stress level

if related throid or pituary disorder than meds

73
Q

how to prevent amenorrhea?

A

maintaining a sensible exercise program
maintaining a healthy weight
eating a healthy diet
avoiding excessive
alcohol consumption
not smoking
finding healthy outlets for stress

74
Q

What is dysmenorrhea?

A

painful or difficult menses (affects 1/2+ women in US)

primary dysmenorrhea involves no physical abn and usually begins 6 months to a yr after menstruation (caused by Prostaglandins)

secondary dysmenorrhea involves underlying physical cause (endometriosis or uterine fibroid tumors)

75
Q

risk factors for dysmenorrhea?

A

being under 20
early-onset puberty
heavy bleeding during periods
irregular menstrual bleeding
never having given birth
family history of dysmenorrhea
smoking

76
Q

s/s of dysmenorrhea

A

cramping and dull to severe pelvic and lower back pain

77
Q

Etiology of secondary dysmenorrhea

A

PID
uterine fibroid tumors
endometriosis
cervical stenosis
pelvic infections
fibroids

78
Q

how to diagnose and treat dysmenorrhea

A

diagnose - pelvic exam, ultrasound, laparoscopy and hysteroscopy

treatment - antibiotics, oral contraceptive therapy to regulate and decrease menstrual flow, OTC pain relievers, NSAIDS, hormonal birth control, treat uterine fibroid tumors or endometriosis (laparoscope-guided fibroid diathermy and progesterone receptor antagonists for fibroids)

79
Q

how to prevent dysmenorrhea?

A

abstinence, monogamy,
use of latex condoms, and obtaining early diagnosis and treatment of STIs

80
Q

What is menorrhagia?

A

excessive or prolonged bleeding during menstruation

total blood looks over 80mL

affects 30% of all premenopausal women

risk factors r being adolescent girl who recently starts menstruating and being older woman approaching menopause

81
Q

s/s of menorrhagia?

A
  • soaking through one
    or more sanitary pads or tampons every hour for
    several consecutive hours,
  • needing to use double
    sanitary protection to control menstrual flow
  • needing to change sanitary protection during the night
  • bleeding for a week or longer, - passing large blood clots with menstrual flow
  • restricting daily activities due to heavy menstrual flow, and
    anemia
82
Q

etiolgy of menorrhagia?

A
  • hormonal imbalance
  • uterine fibroid tumors
  • lack of ovulation
  • cervical or endometrial polyps
  • use of a nonhormonal IUD
  • pregnancy complications
  • medications (anti-inflammatory and anticoagulants)
  • PID
  • thyroid disorders
  • endometriosis
  • liver or kidney disease
83
Q

How to diagnose menorrhagia?

A

pelvic exam, pap test, blood tests (anemia, thyroid, blood clotting), biopsy, and ultrasound

84
Q

how to treat menorrhagia?

A

iron supplements, OTC pain relivers, oral contraceptives to inhibit ovulation, progestin therapy to decrease menstrual flow and IUD that releases progesterone

surgical treatment - D&C, endometrial ablation, hysterectomy

85
Q

how to prevent menorrhagia?

A

not using a nonhormonal IUD
abstinence
monogamy
use of latex condoms
obtaining early diagnosis and treatment of STIs

86
Q

What is metrorrhagia?

A

bleeding between menstrual
periods or extreme irregularity of the menstrual
cycle.

risk factors r hormonal imbalance, PID, oral contraceptives, ovarian cysts, uterine fibroid tumors, endometrial cancer and endometriosis

87
Q

s/s of metrorrhagia?

A

bleeding between periods
irregular menstrual cycles
cramping abdominal pain with bleeding

88
Q

Etiology of metrorrhagia?

A

hormonal imbalance
uterine fibroid tumors
cervical or endometrial polyps
pregnancy complications
infection
endometriosis
miscarriage
ectopic pregnancy
cancer
IUD
thyroid disorders
diabetes
blood-clotting disorders

89
Q

how to diagnose metrorrhagia?

A

record of menstrual
cycle
physical examination
pelvic examination
blood tests (CBC, chemistry screen, and hormone levels), culture
Pap test
pregnancy test
ultrasound
biopsy

90
Q

how to treat metrorrhagia?

A

depends on etiology and may include treating underlying conditions

prevent by early diagnosis and treatment of infections and not using IUD

91
Q

What is premenstrual syndrome?

A

premenstrual dysphoric disorder (PMS)

group of symptoms that starts 1-2 wks before menstruation and cease with osnet of menses (85% of all women have at least 1 PMS symptom)

risk factors: age, family history of PMS, previous anxiety, depression or other mental health problems

92
Q

PMS s/s

A

breast swelling
tenderness
acne
bloating and weight gain headache or joint pain,
food cravings
irritability
mood swings
crying
spells
fatigue
trouble sleeping
anxiety
depression

93
Q

how to diagnose PMS?

A

based on med hisotry, s/s, when s/s ocurr, how much s/s interfere with daily life

94
Q

How to manage PMS?

A

• Avoid salt, caffeine, and alcohol.
• Exercise regularly.
•Eat a healthy diet.
•Get enough sleep.
• Take calcium and vitamin B6.
•Manage stress.
•Take pain relievers.
•Take oral contraceptives.

95
Q

What is premenstrual dysphoric disorder (PMDD)?

A

severe PMS that affects 3-8% of women

Risk factors r family history of PMS or PMDD, personal or family history of depression, post-partum depression, mood disroder, sexual or phyisca abuse and chronic stress

96
Q

How to diagnoe PMDD?

A

complete medical history, phyiscal exam, pelvic exam and psychiatric evalv.

treated with PMS treatemtns and sometimes antidepressants

97
Q

What is endometriosis?

A

condition in which endometrial tissue from uterus becomes embedded outside of uterus

during menstruation tissue may be pushed through fallopian tubes or carried by blood or lymph and is embed on ovaries, outer suraces of uterus, bowels or other abd organs and so it responds to ovarian hormones as endometrium does so cyclic swelling, inflammation, bleeding and scarrring r side effects

98
Q

Stats for edometriosis

A

s. Endometriosis affects 8.5 million women
in North America and 176 million women worldwide.

99
Q

risk factors for endometriosis?

A

age,
family history
never having given birth
menstrual history (short, heavy, or long periods).

100
Q

s/s of endometriosis?

A

pelvic pain is main, otehrs r diarrhea or constripation, abd bloating, menorrhagia, metrorrhagia, paimful intercourse, painful defecation, infertility, and fatigue

30-40% of women with endometiosis r infertile

101
Q

how to diagnose and treat endometriosis?

A

diagnose - durign pelvic exam physician may be able to detect tender areas, nodules, or even thickened scar, laparoscopy

treat - OTC pain relievers, hormone tharpy to decrease estrogen to slow or halt prolif of endometrial tissue, hormonal contraception, IUDs, subdermal progestin-releasing impants, aromatase inhibitors, and surgery (in sever ecases total hysterectomy with bilateral salpingo-oophorectomy)

102
Q

What is an ectopic pregnacy?

A

pregnancy in which fertilized ovum implamants in tissue other than uterus (most common sute is fallopian tubes)

caused by a conditon that causes the ovum to be blocked or slowed down in the fallopain tube from the uterus

most cases r result of scarring caused by a past infection i nthe fallopian tubes, surgery of the fallopian tubes or a previous ectopic pregancy

1-2% of pregnancies in US r ectopic

103
Q

s/s of ectopic pregnancy?

A

difficult to diagnsoe bc s/s mirror early pregnancy

one side lower abd pain, vaginal bleeding, positive pregnangcy test

if area of abn pregnancy ruptures then severe, sharp and sudden pain in lower abd area, feeling fait or actually fainting, pain to shoulder area, internal bleeding (shock)

104
Q

risk factors of ectopic pregancy?

A

risk factors - PID, previous ectopic pregnancy, infertility and infertility treatments, cigarette smoking, structural abn of uterus or fallopian tubes

105
Q

Up to ___% of women who have ectopic pregnancies have PID.

A

50

106
Q

how to diagnose and treat ectopic pregnancy?

A

diagnose - based on s/s, pelvic exam, ultrasound and positive pregancy test

treat - cant be continued to term so must be terminated

if rupture will occur than woman may be given a drug that targets rapidly dividing fetal cells and allows the body to reabsorb the pregancy (methotrexate)

if rupture than laparotomy to stop blood loss and terminate pregnancy

107
Q

how to prevent ectopic pregancy?

A

not preventable if not in fallopian tube

Prevention of an ectopic pregnancy in the fallopian tube includes abstinence, monogamy, use
of latex condoms, and early diagnosis and treatment of STIs.

108
Q

What is a spontaneous abortion?

A

aka miscarriage, loss of fetus before 20th week of pregnancy

risk factors r maternal age and previous miscarriage

15-20% of known pregnancy r miscarriages and occur btwn 7-12 wks

classified intomissed (no tissue), incomplete (some tissue) or complete (all tissue)

109
Q

It is estimated that up to
___% of all fertilized ova die and are spontaneously aborted, usually before the woman knows
she is pregnant

A

50

110
Q

s/s for spontaneous abortion?

A

low back pain, abd pain that is dull, sharp or cramping
vaginal bleeding, rapod pulse, low bp, blood in vagina
tissue or clotlike material discharged from vagina

111
Q

About ___% of pregnant women have some vaginal bleeding during the first 3 months of pregnancy; approximately half of these women have
a miscarriage

A

20

112
Q

Causes of miscarriages?

A

most common cause is genetic abnormalty of fetus

infection, physical problems in mother, hormonal factors, immune responses or serious systemic disease in mother like diabetes or thyroid disease

113
Q

how to diagnose and treat spontaneous abortion?

A

diagnose - pelvic exam, ultrasoun, pregnancy test

treatment - if all pregnancy tissue doesnt exit women’s body than womenmay be given, D&C, injection of drug that stops embryonic cells from dividing and mutliply or surgery

114
Q

What is preeclampsia?

A

high bp and excess protein in urine after 20 weeks in woman who had normal bp

occurs in 6-10% of all pregancies in US (most common 1st time pregnancies, pregnat teens, women over 40)

115
Q

What are the risk factors for preeclampsia?

A

history of high blood pressure
before pregnancy
previous history of preeclampsia
obesity prior to pregnancy, carrying more than one baby,
history of diabetes, kidney disease, lupus, scleroderma, and rheumatoid arthritis

116
Q

What is difference between mild preeclampsia and severe preeeclampsia?

A

mild - high bp and presence of protein in urine

severe - headaches, blurred vision, inabilty to tolerate bright light, upper abd pain, nuase, vomiting, dizziness. decrease urine outpit. sudden weight gain

117
Q

How to diagnose and treat preeclampsia?

A

diagnose - based on incrased bp and urine protein levels

treat - if close enough to term then bb will be delivered

if not close to term then rest, frequent monitoring of bp and urine, reduced salt intake and increased water intake

severe preeclampsia may be treated with bp med

118
Q

What is gestational diabetes mellitus?

A

diabetes mellitus associated with pregnancy

2-10% of pregancies

increased metablic demands duing pregnancy require higher insulin level but certain normal maternal physiological changes like increased levels of estrogen and progesterone (intered with insulin action) during pregnancy can reult in insuffucient insulin levels which can lead to diabetes

placenta inactivates insulin, but normal pregnancy-induced elevates stress hromones (cortisol, epinephrine and glucagon) raise blood glucose

in most preg women insulin rises with blood glucose by in some it doesnt

only s/s is rarely excessive thirst or increased urination

119
Q

What r the risk factors for gestational diabetes mellitus?

A

family history of type 2 diabetes
age
previous diagnosis of gestation diabetes or prediabetes
being obese

120
Q

how to diagnose and treat gestational diabetes?

A

diagnose - glucose tolerance test

treatment - regular blod glucose monitoring, dietary control or regular blood glucose levels, wt control, exercise and possibly insulin therapy

121
Q

What can untreated gestational diabetes caused?

A

put fetus at risk of premature delivery, respiratory distress syndrome, excessive birth wt, hypoglycemia, jaundice, increased risk for type 2 diabetes

122
Q

how to prevent gestational diabetes?

A

eating healthy diet
maintinaing healthy wt
not gaining too much wt during pregnancy
engagin in exercise on regular basis

123
Q

What happens in older female?

A

pubic hair thins and grays
external reproductive genitalia acquire a wrinkled and sagging appearance due to decrease in elasticity

shrinking of internal reproductive organs, decrease in vaginal secretions and elasticity, decrease in breast tissue volume, pH of vaginal secretions become more alkaline making older women more susceptible to vaginal infections

124
Q

What is menopause?

A

cessation of menstrual periods (not disease, but physical change related to aging)

45-55 yrs of age

as women age increased FSH = more follicles whichcauses fluctuation in menstrual cycle hormones (= s/s of perimenopause) until ovaries stop producing viable eggs, produce less estrogen and progesterone = cessaton of ovulation and menstruation

125
Q

s/s of menopause?

A

hot flashes, night sweats, trouble sleeping, modd swings, trouble focusing, hair loss or thinning, facial hair growth and vaginal dryness, depression, poor memory, anxiety, sleep disorders, loss of interest in sex

126
Q

diagnose and treat menopause?

A

diagnose - s/s, elevated FSH, and low estrogen

treat - hormone therpay, local estrogen products, treat bone loss w/ biphosphonates, weight-bearing exercise and dietary calcium or calcium supplementations w/ adequate vitamin D3

127
Q

What is uterine prolapse?

A

falling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal

risk factors - age, 1+ vaginal births, and giving birth to a large baby

caused by trauma to the fascia, muscle, and pelvic ligaments during pregnancy and delivery or atrophy of the pelvic floor muscles with age (ligaments and muscles become so overstretched that they can no longer hold the uterus in place)

128
Q

s/s of uterine prolapse?

A

feelings of heaviness in pelvic area, urinary difficulties, and a feeling like you are sitting on a smalll ball

129
Q

how to diagnose and treat uterine prolapse?

A

diagnose - pelvic exam, ultrasound and MRI

treat - strengthening the pelvic floor muscles (Kegel exercise), inserting a pessary (removable device placed in the vagina designed to support areas of pelvic organ proplasye) or surgery

130
Q

What is cystocele?

A

downward displacement of the urianry bladder into the vagina

risk factors - age, 1+ vaginal births and having hysterectomy

131
Q

s/s cystocele?

A

pelvic pressure, urinary urgency and frequency and incontinence

132
Q

what is the etiology of cystocele?

A

trauma to the fascia, muscle and pelvic ligaments during pregnancy and delivery or atrophy of the pelvic floor muscles with age

133
Q

how to diagnose and treat cystocele?

A

diagnose - made by pelvic exam

treat - kegel exercises, vaginal pessary or surgery

134
Q

What is rectocele?

A

bulging of the front wall of the rectum into vagina

risk factors - include aging, 1+ vaginal births and obesity

135
Q

s/s and etiology rectocele?

A

s/s: discomfort, constipation, and fecal incontinence, back pain, pelvic pressure

etiology: trauma to the fascia, muscle and pelvic ligaments during pregnancy and delivery, or atrophy of the pelvic floor muscles with age

136
Q

how to diagnose and treat rectocele?

A

diagnose - pelvic exam, MRI, xray

treat - kegel exercises, vaginal pessary and surgery

137
Q

What are ovarian cysts?

A
  • fluid-filled, semisolid or solid masses that originate on or within the ovary, follicles that occur during normal menstrual cycle r often called cysts but became actual cysts when they are outside the physiologic norm in size or appearance
138
Q

s/s of ovarian cysts?

A
  • most go unnoticed
  • urainry retention when large cyst presses on areas near bladder
  • cyst produce hormones that can affect body functions associated w/ those hormoses
  • larger cysts can undergo undergoe torsion or twisting that can cause pain, N&V
139
Q

types of ovarian cysts/

A
  1. physiologic cysts (normal funcitoning of ovary)
  2. neoplastic cysts (benign or malignant)
140
Q

diagnose and treat of ovarian cysts?

A

diagnose - pelvic mass during pelvic or rectal exam, ultrasonography, MRI or CT, laparoscopy

treat - benign phsiologic cysts r common and dont need treatment, large cyysts sometiems can be drained during laparoscopy

141
Q

What is miteelschmerz?

A
  • unilateral pain occuring in region of an ovary during ovulation
142
Q

What is vaginitis?

A
  • inflammation and/or infection of vaginal tissue
  • s/s r irritating and painful, vaginal dischargem local itching, burning, odor (whitem gray, green), fever
  • most common cause is fungal infection, Trichomonas (protozoan), cervical infection in chlamydia or gonorrhea,avsence of estrogen in postmenopausal women
143
Q

diagnose and treatment of vaginitis?

A

diagnose - medical history, pelvis exam, swabs the vagina to analyze for bacteria and fungus, pH, Gardenerlla infection causes strong “fishy” odor

treat 0 antifungal, antibacterial, hormone theray,

144
Q

What is toxic shock syndrome?

A
  • acute, systemic infection with Staphylococcus aureus or streptococcal toxic-like syndrome
  • cause is thought to be increase in S. aureus colonization on superabsorbant tampons
145
Q

diagnose and treat TSS?

A

diagnose - clinical evaluation and lab tests

treat - replacement of fluids, antibiotics

146
Q

s/s of TSS?

A
  • s/s r high fever, headache, sore throat, rash, hypotension and shcok, GI symptoms, diarrhea, neuromuscular distrubance, abn kidney function, elevation of liver enzyme levels
147
Q

Name for premalignant lesion for cervical cancer?

A

0 cervical intraepithelial neopoasia(CIN)

148
Q

What is vaginal cancer?

A
  • priamry cancer of the vagina is rare (mostly metastasis)
  • most primary tumors r squamous cell carcinomas but can also be melanoma or adenocarcinoma
149
Q

s/s of vaginal cancer?

A
  • vaginal beeding (postcoital or postmenopausal bleeding)
  • malodorous or watery vaginal discharge
  • urianry symptoms such as dysuria or frequency
  • constipation
  • melena
  • vaginal mass
  • mass presents as mass, plaque or ulcer on vaginal wall
150
Q

etiology of vaginal cancer?

A
  • HPV infection (HPB 16 and 18 particulay)
  • gynecologic malignancy
  • advanced age
  • multiple lifetime sexual parterns
  • early age at first intercourse
  • cig smoking
  • veagginal intraepithelial neoplaisa VAIN)
  • for squamous cell carcinoma average age at diagnosis is 60, adenocarcinomas usually occur in women younger than 20 and r linked with synthetic hormone diethylstilbestrol
151
Q

diagnose and treat vaginal cancer?

A

0diagnose - is difficult bc malignant lesion may be small and missed on gynecologic exam, Pap smear may rerveal malignatn cells of vagina, colposcopic exam, direct biopsy of lesion, cervical biopsy,

treat - hysterectomy, upper vaginectomy, bilateral pelvic lymphadenectomy and radiation therapy

152
Q

What is labial or vulvar cancer?

A
  • any condition that can affect skin n other parts of body can affect vulva (greater than 90% of vulvar malignancies r squamous cell carcinomas)
  • most pt have nodule or ulcer usually on labia majora, pruritus, vulvar bleeding, discharge, dysuria, enlarged lymph nodes in groin
  • most in postmenopausal women (65 y/o is avg), cig, HPV (16 and 33), HIV, multiple sexual partners, prior history of cervical cancer, northern European ancestory, Vulvar intraepitheli
153
Q

diagnose and reat labial/ vulvar cancer

A

diagnose - biopsy, colposcopy, physical exam for regional lymph nodes, PET, CT, Pap smear

treat 0 surgical removal of growth and surrounding skin or removal of all or part of vulva (vulvectomy), inguinofemoral lymphadenoectomy, radiation, chemo

154
Q

diagnose and reat labial/ vulvar cancer

A

diagnose - biopsy, colposcopy, physical exam for regional lymph nodes, PET, CT, Pap smear

treat 0 surgical removal of growth and surrounding skin or removal of all or part of vulva (vulvectomy), inguinofemoral lymphadenoectomy, radiation, chemo

155
Q

What is morning sickness?

A
  • N&V associated with pregnacy
  • affects 80% of pregant women
  • symptoms may being before first missed menses but normally resolve by 12 to 16 weeks of pregnancy
  • only 1% of pregnant women will have persistent morning sickness beyond 20th week of pregnancy
  • if severe enough to cause excessive wt. loss or metabolic imbalance then called hyperemesis gravidarum (HG)
  • thought to be caused vby hyman chorionic gonadotropin and estrogen
156
Q

s/s of morning sickness?

A
  • symptoms of nausea and vomitting during day
  • nausea is short-lived and occurs in waves or pt may feel nauseated for hurs
  • if dehydrated urine can look dark, ketones may be present on urine testing, if vomiting is severe enough then blood tests may show evdience of metabolic and electrolyte abnormalites
  • rapid pulse
  • poor skin turgor
  • decreased urine output
  • constipation
  • dehydration
157
Q

diagnose and treat morning sickness?

A

diagnose - symptoms and positive prengancy test results

treat - hydration, rest, eating small amts of food, avoiding certain food, smell, environemntal triggers, ginger, hyponsis, wristbands vitamin B6 and B12 can help reduce severity,

158
Q

What is hyperemesis gravidarum?

A
  • more severe morning sickness that doesnt respond to OTC remedies and requires prescription meds and even hospitalization
  • associated w/ wt loss greater than 10% and associated metabolic distrubances and dehydration
  • elevated estrogen adn hCG levels r thought o be cause as well as emotions
159
Q

s/s of hyperemesis gravidarum?

A
  • severe episodes of N&V
  • wt loss
    -dehydration
  • unable to keep eithe rfood or liquid in stomach
  • fluid and electrolyte imabalances can cause acid-base distruabances in fetus and mother
  • abn urine osmolatity, excretion of moderate or high level of ketones in urine
  • increase in number of RBCs
  • mild elevation in WBC and abn in other blood chemistires
  • abn liver enzymes and thyroid lab values
160
Q

diagnose and treat hyperemesis gravidarum?

A

diagnose - symptoms, wt loss, dehydration

treat - hospitalized for reversal of dehyrdation w/ IV fluids, infuision of salts for electrolyte imbalance, antiemetics

161
Q

What is premature labor?

A
  • contraction leading to cervical change occurring before 37 completed weeks of pregnancy
  • occur when pregnant women begin experiencing contractions that are generally regular and painful and that lead to changes in size of the cervical opening or length of cervix
  • most causes r maternal infection, uterine abnormalities, uterine fibroids, uterine bleeding, prior history of preterm birth, multifetal pergancy, advanced maternal age, gum disease, vaginal colonization with certain bacteria, lack of prenatal care, preterm cervical dilation, or effacement
162
Q

diagnose and treat premature labor?

A

diagnose - demonstrating cergbical change in presence of uterine contractions, test for fetal fibronectin, ultrasonography for cervical length

treat - no effective treatmnetn, can delay by 48 to 72 hours w/ terbutaline, indometahcin, calcium channel blockers, magnesium sulfate, intramuscular injection of steroids, for women with prior history of preterm birth use weekly intramuscular progesterone injections

163
Q

What is eclampsia?

A
  • occurence of a seizure in pt with preeclampsia
164
Q

s/s of preeclampisa

A
  • increased wt gain, usually noted as peripheral swelling or edema
  • elevation of bp to level greater than 140/90 mm Hg
  • over 300 mg of protein in urine over 24 hr period
  • persistent headache
  • visual distrurbances
  • epigastric pain
  • deep tendon reflexes may also be more exaggerated
  • clonus
  • grand mal seizure (can demonstrate usual postictal manifestation of confusion and disorientation)
164
Q

s/s of preeclampisa

A
  • increased wt gain, usually noted as peripheral swelling or edema
  • elevation of bp to level greater than 140/90 mm Hg
  • over 300 mg of protein in urine over 24 hr period
  • persistent headache
  • visual distrurbances
  • epigastric pain
  • deep tendon reflexes may also be more exaggerated
  • clonus
  • grand mal seizure (can demonstrate usual postictal manifestation of confusion and disorientation)
165
Q

What is abruptio placentae

A
  • premature detachment of a normally positioned placenta during pregnancy
  • causes hemorrhage, abd pain, fetal distress, fetal death, painful contraction, coagulopathy
  • etiology r hyperrtension, preeclampsia, truama, maternal vascular disease, infection, drug use (cocaine), multiple gestation
166
Q

diagnose and treat abruptio placentae

A

diagnose - risk factors, fetal heart rate pattern, mother’s symptoms, contraction pattern, presence of bleeding, most of the time diagnosis is only suspected

treat - in mild cases labor may continue w/ anticipated baginal delivery, operating oom, hospitalization w/ carefgul monitoring, replacement of blood and clotting

167
Q

What is placenta previa?

A
  • placenta covering opening to cerbic
  • in partial previa the majority of placenta is away from the opening (os) and in complete or central previa, the more central portion of the placenta covers the os
  • caused by low implantation of blastocyst in uterine cavity, prior cesarean delivery and previous childbirth increases risk of previa
168
Q

s/s of placenta previa?

A
  • painless, bright vaginal bleeding, usually in first or second trimsester
  • abd is soft and nontender
  • in cases of excessive bleeding, vital sigsn may indicate shock, with rapid and thready pulse and falling blood pressure
  • fetal heart rate may indicate that blood supply to fetus is compromised
169
Q

diagnose and treat placenta previa

A

diagnose - pelvic ultrasongoram showing placenta being implanted over cervical os, in complete placenta totally overlies os, in partial placenta is implanted low in iterus but doesnt entirely overlie the os, as cerbix begins to dilate, the vessels tear loose, placenta bleeds, no cerbical exam until ultrasonography

treat - go abt as normal, if bleeding go to evalvulation (more signifincatn = hospitalization, delivery is accomplished around 36th week, for massive hemorrhage immediate devliery by casarean

170
Q

What is hydatidiform mole?

A
  • abn proliferation of placental tissue that take on characteristic of a malignancy
  • placenta has a culster of grapes type of appearance on ultrasonography or diagnosis may be based on pathologic evalv after a miscariage or pregancy termination
  • cause is a genetic anomaly in fertilization (placemnta develops abn as a mass of clear grapelike vesicles)
171
Q

s/s of hydatidform mole?

A
  • normal symptoms just like any other pregant women
  • occasionaly there may be more nause and vomitigna nd more vaginal bleeding
  • uterus may feel larger than expected
  • in case of complete molar pregnacy no fetus develops and ultrasonography show empty or absent sac and abn apearing placenta, if incomplete mole w/ living fetus, feeling may be more difficult to detec
  • blood hCG level is greatly eleaed
172
Q

diagnose and treat hydatidiform mole

A

diagnose - clinical picture, absence of fetal heart tomes (FHTs) in complete mole, abnormally elevated hCG levels, appearance of placenta on ultrasonogram, microscopic exam of placenta by pathologist after delivery or pregnancy termination or miscarriage

treat - surgical intervention (D&C), observation for hemorrhage, chem to prevent further growth and spread of the tissue, hysterectomy if persistent trophoblastic, serial beta-hCG assessment until values fall below detecable wmt, avoid pregnancy for at least 6 months

173
Q

what is mastitis?

A
  • inflammation of one or more mammary glands of the breast - s/s r inflammation of breat tissue during postpartum lactation (sudden pain, redness, heat in breasts, breasts r hot and feel doughy and tough, axillary lymph nodes may be enlarged, discharge from nipple, fever, malaise)
  • often caused by streptococcal ro staphylococcal infection (bacteria invades milk ducts, caussing inflammation and occlusion)
  • diagnose based on clinical picture
  • treat w/ firm, supportive bra, heat applied to area, progesterone, anitbiotics, rest, analgesia, warm soaks
174
Q

What is paget disease of breast?

A
  • characteristic breast lesion that signifies the presence of malignant adenocarcinoma cells (underlying carcinoma of breast is present in up to 90% of cases)
  • skin of nipple develops an erythematous, eczematous, scaly, or ulcerated lesion (often unilateral, may heal spontaneously or topical treatment may mask inflammation, bloody discharge from nipple and nipple retraction)
    = may be caused by underlying mammary adenocarcinoma or whether they represent carcinoma that is independent of any carcinomas
175
Q

ddiagnose and treat page tdisease of breast

A

diagnose - biopsy, nipple scrape cytology, mamography, MRI, estrogen and progesterone receptor positivity and for overexpression of HER2

treat - simple mastectomy, axillary lymph node dissection, whole-breast irradiation, treat underlying breast carcinoma

Pathophysiology - Diseases (22 decks)

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