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Pathophysiology Final > Female Reproductive Disorders > Flashcards

Female Reproductive Disorders Flashcards

1
Q

Pelvic Inflammatory Disorder

A
  • = infectious condition of the pelvic cavity
  • may involve infection of cervix, fallopian tubes, and pelvic peritoneum
  • tuba-ovarian abscess may form
  • may be “silent” when women do not perceive any symptoms; others will be in acute distress
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2
Q

PID: Etiology

- often the result of…

A

untreated cervicitis

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3
Q

PID is caused by what organisms and how to they gain entrance

A

Chalmydia and Neisseria Gonorrhea

  • anaerobes, mycoplasma, streptococci, enteric Gram-negative rods
  • organisms gain entrance during sexual intercourse and after pregnancy termination, pelvic surgery, or childbirth
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4
Q

testing for PID

A
  • women at risk for chlaydial infections should be routinely tested
  • often asymptomatic & can lead to infertility
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5
Q

Pain with PID

A
  • up to 1/3 of women have chronic pelvic pain after PID

- 6 months or longer in duration in region below umbilicus and between hips

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6
Q

Clinical manifestations PID

A
  • Lower abdominal pain (starts gradually & becomes constant. Varies from mild to severe. Pain with intercourse)
  • fever & chills
  • spotting after intercourse
  • less acute syndrome (increased cramping pain with menses, irregular bleeding, some pain with intercourse)
  • purulent cervical or vaginal discharge
  • may be undiagnosed & untreated if mild
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7
Q

PID - Diagnosis

A
  • based on S&S
  • bimanual portion of pelvic exam
  • abnormal discharge
  • cultures (C&S)
  • pregnancy test to rule out ectopic pregnancy
  • vaginal U/S
  • pelvic examination and palpate abdomen (tender abdomen, fallopian tubes, and ovaries)
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8
Q

PID complications

A
  • Septic Shock
  • Fitz-Hugh-Curtis syndrome (PID spreads to liver - RUQ pain with normal LF test)
  • Pelvic or generalized peritonitis
  • Embolisms
  • Adhesions & strictures in fallopian tubes
  • Increased risk of ectopic pregnancy (10x)
  • Risk of recurrent infection
  • Infertility
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9
Q

PID Collaborative Care: Usually treated as outpatient

A
  • Broad spectrum antibiotics (cefoxitin & doxycycline)
  • no intercourse for 3 weeks
  • examination & treatment of partner
  • rest
  • oral fluids
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10
Q

PID Collaborative Care: Hospitalization if abscess present

A
  • high doses of antibiotics
  • corticosteroids (improve fertility and aid in fast recovery)
  • Bed rest in semi-Fowler’s position
  • Drainage of abscess
  • Hysterectomy
    Re-evaluated every 48-72 hr
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11
Q

PID Collaborative Care: Hospitalization if abscess present

A
  • high doses of antibiotics
  • corticosteroids (improve fertility and aid in fast recovery)
  • Bed rest in semi-Fowler’s position
  • Drainage of abscess
  • Hysterectomy
    Re-evaluated every 48-72 hr
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12
Q

Endometriosis

A

presence of endometrial epithelial and/or stromal cells in sites outside the uterine cavity

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13
Q

Most frequent sites of endometrial cells

A
  • in or near the ovaries, uterosacral ligaments, & uterovesical peritoneum
  • can also be in other locations: stomach, lungs, intestines & spleen
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14
Q

Endometriosis tissue

A

Tissue responds to hormones of ovarian-cycle & undergoes a “mini-menstrual cycle” similar to the uterine endometrium

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15
Q

Most common population to get endometriosis

A

typical patient is late 20s or early 30s, white, never had a full-term pregnancy.

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16
Q

Dangers of Endometriosis

A
  • Not life-threatening but cam cause considerable pain

- increased risk of ovarian cancer

17
Q

Etiology of Endometriosis - poorly understood etiology

A

retrograde menstrual flow passes through fallopian tubes carrying viable endometrial tissues into pelvis –> tissue attaches to various sites

  • undifferentiated embryonic peritoneal cavity cells remain dominant in pelvic tissue until ovaries produce sufficient hormones to stimulate their growth
  • genetic predisposition
  • altered immune function
18
Q

Most common clinical manifestations of Endometriosis

A
  • secondary dysmenorrhea
  • infertility
  • pelvic pain
  • painful coitus
  • irregular bleeding
19
Q

Less common clinical manifestations of Endometriosis

A
  • backache
  • painful bowel movements
  • dysuria
20
Q

Diagnosis of Endometriosis

A
  • history and physical
  • pelvic exam
  • laparoscopy, U/S, MRI
21
Q

Conservative approach to endometriosis

A

Watch & wait

22
Q

Drug therapy: Endometriosis

A
  • NSIADs
  • oral contraceptives
  • Danazol (cyclomen) - a synthetic androgen that inhibits anterior pituitary (ovarian suppression –> pseudomenopause)
  • Gonadotropin-releasing hormone agonists - create hypoestrogenic state & amenorrhea
23
Q

Benign Ovarian Tumours: Cysts

A
  • soft; surrounded by thick capsules

- detected during reproductive years

24
Q

Benign Ovarian Tumours: Neoplasms

A
  • cystic or solid
  • small or extremely large
  • may originate from germ ells & can conatin bits of any type of body tissue (e.g., hair, teeth)
25
Q

Benign Ovarian Tumours are…

A
  • often asymptomatic until large enough to cause pressure in pelvis
  • may require surgery (immediate surgery necessary for ovarian torsion)
26
Q

Ovarian Cancer

A
  • acute onset of bloating that is persistent
  • problems with urinating and having BM
  • GI workup because symptoms are so nonspecific
  • No good screening test for ovarian cancer
  • family history - genetic testing to follow up based on results
  • Advocate if you feel like something is not right
27
Q

Ovarian Cancer: Risk

A
  • Family history - breast or colon cancer
  • BRCA1 and BRCA2 gene mutations
  • Nulliparity (women who have not given birth yet), age, high-fat diet, increased ovulatory cycles
28
Q

Ovarian Cancer: etiology/pathophysiology

A

About 90% are epithelial carcinomas, 10% germ cell tumours

29
Q

Ovarian Cancer: collaborative care/therapy

A
  • chemotherapy, radiation and surgery
30
Q

Cervical Cancer

A
  • 2nd most common female cancer in the world –> 83% in under-resourced countries
  • initially asymptomatic - slowly growing
  • most important risk factor is infection with HPV
  • Vaccines against HPV (Gardasil) prevent types that cause 70% of cervical cancers
  • number of deaths has decreased with regular screening (Pap test) which can pick up precancerous changes
  • treatment depends on stage of tumour, patients age & general health
31
Q

BC Cancer Agency Cervical Cancer Screening Policy

A
  • Average Risk
    Start at age 25
    Every 3 years
    Stop at age 69 if results have always been normal
  • higher than average risk
    treated for dysplasia or immunocompromised
    annual testing
32
Q

Guidelines based on best evidence

A
  • Invasive cervical cancers in women < 25 years are rare
  • screening is relatively ineffective in younger women
  • women < 25 years have a higher prevalence of lesions that often clear without treatment
  • there are risks associated with unnecessary follow-up & treatments, including long-term consequences for pregnancy or cause undue anxiety & stress
33
Q

HPV

A
  • includes > 100 different types of related viruses:
  • 15 of these may cause anogenital cancer
  • very common: will affect almost all individuals at some point
  • most infections clear on their own
  • Long-term infection with high-risk HPV can cause precancerous changes to cells of cervix –> can lead to cervical cancer if left undetected or untreated
34
Q

HPV Vaccine

A
  • 3 prophylactic HIV vaccines have been developed and approved for use in Canada
  • protect against HPV types 16 and 18 which cause approx 70% of cervical cancers. 80% of anal cancers & a significant proportion of other cancers.
  • also protect against HPV types 6 and 11 which cause approx. 90% of anogential warts
  • 2nd generation HPV vaccine approved by Health Canada in 2015. which covers 5 more high risk types (90% of cervical cancers)
  • not currently used in BC school-based HPV vaccination program; available for private purchase
  • Same screening process applied to vaccinated & unvaccinated individuals
  • Reduces # of women with cervical dysplasia –> reduced women with abnormal cervical cancer results & associated follow-up & treatment
  • HPV9 vaccine is used for both males and females
  • HPV2 vaccine is only approved for use in females
35
Q

Cancer of the reproductive system - nursing care

A
  • Nursing diagnosis
    1. anxiety r/t to cancer diagnosis
    2. acute pain
    3. disturbed body image r/t cancer process or treatment
    4. ineffective sexuality pattern
    5. grieving

Interventions

  • teach about the disease and treatment options
  • do not give false hope
  • provide emotional support

Pathophysiology Final (7 decks)

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