Disorders of the Pelvis and Ovaries Flashcards
Pain of at least 6 months’ duration that occurs below the umbilicus
chronic pelvic pain
Most common gynecological cause of chronic pelvic pain
endometriosis
Signs of depression associated with chronic pelvic pain
early morning awakening, weight loss, anorexia
Finding from a bimanual/rectal exam that suggest an acute process such as PID, ectopic pregnancy, or ruptured ovarian cyst
tenderness
During a bimanual exam what does non-mobility of the uterus suggest?
pelvic adhesions
During a bimanual exam what does cul-de-sac nodularities suggest?
endometriosis
Medications for chronic pelvic pain
NSAIDs, antidepressants, oral contraceptives
Surgical intervention for chronic pelvic pain
diagnostic and therapeutic laparoscopy or hysterectomy
ascending spread of microorganisms from the vagina or cervix to the endometrium, fallopian tubes, ovaries, and contiguous structures.
Pelvic Inflammatory Disease (PID)
Primary reason outpatient visits for PID have declined
aggressive population-based chlamydia screening and treatment
Most common pathogens implicated in PID and can cause infertility if left untreated
N. gonorrheae and C. trachomatis
Pathway of ascendence for PID infection
cervicitis–>endometritis–> salpingitis/oophoritis–> peritonitis
How many episodes of PID are necessary for a woman to potentially experience tubal infertility?
three episodes
What is the minimum criteria for the diagnosis of PID?
Uterine/adnexal tenderness or Cervical motion tenderness
What increases antibiotic levels in the blood and is sometime used as adjunct therapy for treating gonorrhea and chlamydia?
probenecid
What are the screening recommendations for chlamydia?
annually for sexually active women 25 and under sexually active women >25 at high risk
What are the recommendations for partners of women with PID?
should be examine and treated if they had sexual contact during the preceding 60 days
STDs reportable in all states
gonorrhea and chlamydia
STD that is more of a risk factor for subsequently contracting HIV
gonorrhea
Absence of menses by age 13 with no secondary sexual characteristics OR by age 15 with secondary sexual characteristics present
primary amenorrhea
absence of menses for 3 – 6 cycles in women who have had a history of menstruation
secondary amenorrhea
Suggestive of ovarian or pituitary failure or a chromosomal abnormality
lack of pubertal development
Suggestive of Turner syndrome or hypothalamic-pituitary disease related to primary amenorrhea
short stature
Medications that can cause amenorrhea by increasing serum prolacin concentrations
metoclopramide and antipsychotics
Drugs that can alter hypothalamic gonadotropin secretion leading to primary amenorrhea
heroin or methadone
Features include: low hair line, web neck, shield chest, and widely spaced nipples
Turner syndrome
What should be measured in both arms if Turner syndrome is suspected due to increased incidenced of coarctation of the aorta?
blood pressure
How is primary amenorrhea best evaluated?
breast development, presence of uterus, and the FSH level
Probable diagnosis if there is no breast development and the FSH level is elevated?
gonadal dysgenesis
Probable diagnosis if ultrasound indicates absence of uterus, but FSH levels are normal
Mullerian agenesis or androgen insensitivy syndrome
First step in evaluating any women with secondary amenorrhea
rule out pregnancy
Suggested by h/o of obstetrical catastrophe, severe bleeding, D&C, or endometritis or other infection that might have caused scarring of the endometrial lining
Asherman’s syndrome
Most common cause of primary amenorrhea
chromosomal anomalies resulting in gonadal dysgenesis
Most common cause of secondary amenorrhea
pregnancy
Most common pituitary cause of secondary amenorrhea
hyperprolactinemia
Most common uterine disease that causes secondary amenorrhea
Asherman’s syndrome
Most common cause of androgen excess and hirsuitism in women and is also the most common hormonal disorder among women of reproductive age
polycystic ovarian syndrome (PCOS)
What is polycystic ovarian syndrome (PCOS) frequently associated with?
insulin resistance
Ultrasound findings of polycystic ovarian syndrome (PCOS)
multiple follicles around the periphery of the ovary
Why do we treat polycystic ovarian syndrome (PCOS)?
decrease risk of endometrial hyperplasia/cancer, breast CA, and sequellae of DM
diuretic that antagonizes the DCT aldosterone receptor. acts as an antiandrogen (will help with hirsutism in conjunction with OCPs) by binding with androgen receptors
spironolactone
Treatment option for PCOS that acts as an antiandrogen for those trying to become pregnant and are still anovulatory after diet, exercise, and Metformin have been tried
clomiphene (Clomid)
binds to estrogen receptors in the hypothalamus to create a state of hypoestrogenicity, causing an enhanced GnRH release followed by an increased secretion of gonadotropins which induces ovulation.
clomiphene (Clomid)
