Female genitalia/breasts Flashcards
Common malady; increased frequency w/ abx usage
Not always an STD (often an overgrowth of nromal flora or rxn to a product)
Most common infectious agents
Vulvovaginitis
- Candida albicans (most common cuase of vaginitis, esp after abx usage)
- Gardnerella vaginalis (overgrowth due to decreased lactobacillus, increased pH – CLUE CELLS)
[Screen/tx for STDs based on pt hx]
Ssx of candidia vaginal infxn?
itching, dryness, whitish d/c
Ssx of gardnerella (BV)?
burning snesation, fishy d/c, CLUE CELLS
Ascending lower genital infxn…
Cervicitis -> endometritis -> salpingitis
PID (associated w/ STDS)
Fallopian tubes are particularly vulnerable to develop tubo-ovarian abscess (leading to scarring and increased risk of infertility/ectopic pregancy)
Clincal features of PID?
sever abd pn, fever, nausea, (vag bleeding/dc may be present)
HALLMARK = cervical motion tenderness (CMT)
Tx = high dose broad spectrum abx (may be inpatient)
(once cervicitis beings, infxn is presumed to be at least as high as uterus)
- Menorrhagia
- Metrorrhagia
- Metromenorrhagia
- Dysmenorrhea
- profuse/heavy/prolonged bleeding
- irregularly timed menstrual bleeding
- irregular heavy menses
- painful menses
Two main causes of excessive/irregular bleeding?
Failure of ovulation and luteal phase
Contraception induced bleeding
(often temporary and self corects)
Aka fibroids
Benign tumor of uterine smooth appearing during reproductive years (more common in black females)
Large tumors can cause endometrial bleeding/dysmenorrhea
Leiomyomas
(compression of bladder/rectum = urinary ssx/constipation)
[tx = myomectomy/hysterectomy]
Rare cancer in myometrium
DOES NOT ARISE FROM LEIOMYOMA
leiomyosarcoma
Frequently causes infertility (but does not progress to CA)
Ectopic uterine lining
Tissue is still responsive to menstrual cycle
endometriosis
Endometriosis clinical features?
dysmenorrhea/pelvic pn
Urinary/bowel ssx w/ menses
Ovaries bilaterally enlarged
High LH, low FSH
Excessive androgen production (-> hirsutism)
Insulin dysfxn (obesity)
PCOS
(may be anovulatory/infertile OR present w/ oligomenorrhea)
Tx = complex mgmt of hormones
Implantation of fertilized ovum outside the uterus (embryo may grow to wk 12 then erode through fallopian wall)
increased risk w/ PID, tubal surgery
Ssx?
Ectopic pregnancy…
Ssx = pelvic pn, frank hemorrhage -> shock
**ALWAYS CHECK HCG in pts w/ pelvic pn
(US for ectopic location)
interruption of pregnancy before fetal viability
No identifiable cause …
Complete vs incomplete?
Spontaneous abortion
Complete = fetus/placenta fully expelled, normal menses resumes
Incomplete = some products of conception retained
Fetal demise?
Threatened?
Fetal death in utero, requiring surgical evacuation
Threatened = bleeding but cervix is NOT DILATED (pregnancy may/may not continue)
More common in first pregnancy
Triad of
HTN
Edema
Proteinuria
preeclampsia
tx = delivery (may need induction; most full recover)
HTN
Edema
Proteinuria
+
sz or coma
eclampsia
(rarely seen)
tx = delivery (may need induction; most full recover)
HPV is cause usually
Most are SCC
Warty, white patches (leukoplakia)
vulvar carcinoma (vulvar intraepithelial neoplasia)
usually in women > 60
(VAGINAL carcinoma is rarer, usually an extension of vulvar carcinoma)
HPV is primary risk, others include
Early age of sexual intercourse
Multiple partners
Other STDs
Smokers
cervical carcinomas
PAP screening has decreased cervical carcinoma incidence… ID early dysplacia…. if suspicious PAP results?
Colposcopy w/ biopsy.. .early lesions treated w/ easily w/ cryotherapy or loop exceision procedure
Most common GYN CA
Primarily post menopausal women…
Risk factors?
Endometrial carcinoma…
Risk facotrs =
Estrogen supp or estrogen producing tumors
No pregnancies/early menarche w/ late menopause
Obesity/daibetes/HTN
Endometrial carcinoma clinical features?
Abnormal uterine bleeindg
POST MENOPAUSAL BLEEDING IS CANCER UNTIL OTHERWISE PROVEN
2nd most common GYN CA but MOST DEADLY
Most are epithelial tumors
Risk factors?
Ovarian CA
Nulliparous
High fat diet
Anovulation
(protective = multiparous, OCP)
congenital absence of breatst
amastia
