MOD 12 Flashcards
AUB
abnormal uterine bleeding
Amenorrhea
absence of menses
dysmenorrhea
painful menses
Dyspareunia
painful sexual intercourse
menometrorrhagia
abnormally heavy bleeding at irregular intervals
menopause
cessation of menses
menorrhagia
abnormally heavy and prolonged menstrual period at regular intervals
metrorrhagia
bleeding occurring irregularly
oligomenorrhea
infrequently occurring menses at intervals greater than 35 days
polymenorrhea
menses at intervals of 21 days or fewer
premenstrual syndrome
etiology: a group of physical, emotional, and behavioral s/s associated with the menstrual cycle.
incidence: 5-10% disabling symptoms
pathophys: s/s begins with the luteal phase of the menstrual cycle
s/s: begin with the luteal phase of the menstrual cycle
Rx: medication, application of heat; hormone meds, and antidepressants
Menopause
etiology: transition from reproductive capability to cessation of menses: may span 10-15 years; age 51 or older
patho phys: follicles are unresponsive to gonadotropin stim → decreased production of estrogen → LH/FSH fluctuate to stim ovaries → ovarian failure
s/s: Dysparenuria, vaginal atrophy/dryness, vasomotor instability (HOT FLASHES), osteoporosis, DEPRESSION/ MOOD SWINGS,
Rx: symptomatic treatment with hormone replacement therapy, avoid caffeine
Ovarian Cyst
cystic lesion and functional cyst
Etiology: The most common cause of enlarged ovaries - is usually benign. Caused by fluid-filled egg sac that does not release on schedule. the cyst takes up space in pelvis.
S/S: range from NO to significant pain
-low back and pelvic from mid-cycle to menses
-usually resolves spontaneously without tx by the next menstrual cycle
-Tx: NSAIDs, possibly surgery to remove cyst or ovary
polycystic ovary syndrome
etiology: endocrine disorder (EXCESS LH compared to FSH) - possibly genetic. no cure at the present time. affects 1 in 10 women.
pathophys: unbalanced hormones lead to ovulation and menstrual irregularities that cause polycystic ovaries to develop. lack of progesterone may predispose women to increased CA
LEADING CAUSE OF FEMALE INFERTILITY
polycystic ovary syndrome s/s
Male pattern baldness (due to higher level of male hormones)
metabolic syndrome with insulin resistance (and subsequent obesity)
irregular menstrual cycles
Rx: for polycystic ovary syndrome
relief of symptoms; replacement (bc pills), anti-androgen drugs; antidiabetic drug (such as metformin to treat insulin resistance); laparoscopic ovarian drilling procedure (see PCOS video above)
Leiomyoma (uterine fibrosis)
etiology: unknown. benign growths in the muscular lining of the uterus
Incidence:30% Caucasians/ 50% blacks by age 50; decreases with menopause
S/s: can be asymptomatic or cause heavy menses and dysmenorrhea
Rx: menopause, hysterectomy, myomectomy
Endometriosis
Etiology: unknown cause. Growth of endometrial tissue outside the uterus such as on the ovaries, bowel, or bladder
Pathophys: Bleeding from endometriosis goes into the surrounding tissue and causes pain as well as significant pelvic adhesions
Adhesions cause: obstruction, constrictions, or distortion of pelvic/ abdominal organs that can cause blockages (pain on defecation), bladder constrictions (dysuria), and infertility (blockage or malformation of fallopian tubes
S/S: may be asymptomatic or cause severe debilitating pain
Rx: pain meds; estrogen suppressing drugs; surgery to remove endometriosis lesions; total hysterectomy and removal of fallopian tubes and ovaries
Vaginitis
infection of the vagina
Etiology: infection (usually fungal), atrophy due to aging, chemicals
Pathophys: alteration of vaginal flora→overgrowth of normal flora or growth of pathogen
S/s: itching, burning, abnormal vaginal discharge, (cottage cheese looking and malodorous)
Rx: treat underlying cause with antifungal meds
Vaginitis has diff causes depending on the age of the patient
Premenarchal girls: poor hygiene, intestinal parasites, the presence of foreign bodies
childbearing women: c. albicans (fungus - “yeast”), trichomonas vagninalis (protozoa)
Menopausal women: atrophic vaginitis (hormone changes)
Candidiasis
Etiology: fungal infection with candida albicans. Vaginal yeast infections are one of the most frequent reasons that women go to the doctor.
Incidence: antibiotic use, pregnancy, uncontrolled diabetes, compromised immune system,not usually transmitted sexually unless through oral sex
S/s: thick white creamy or clumpy or cottage cheese looking vaginal discharge, itching, redness, burning pain with urination, dyspareunia
Rx: antifungal meds and prevention
Cervitis
infection of the cervix
Etiology: sexually transmitted disease, and trauma
pathopys: trigger →cervix becomes red, edematous, muco-purulent discharge (if infectious) → infections may ascend to PID if untreated
S/s: dysuria, spotting/bleeding, vague pain, dyspareunia (painful sex)
Rx: antibiotics- treat partners, avoid reinjury
Bartholinitis
infection of bartholin glands
Etiology: bacterial infections, STD’s
Pathophys: contamination of opening of bartholin’s gland → infection/ trauma obstructs flow of secretions → swelling, pain, erythema
Rx: warm compresses, antibiotics, incision and drainage
Pelvic inflammatory disease definition
Pid is an infection and inflammation of the uterus, ovaries, and other female reproductive organs which causes scarring in these organs. this can lead to infertility, pelvic pain, abscesses, and other serious problems.
Etiology of PID
gonorrhea and chlamydia are the most common causes of PID
women are at greater risk if they are sexually active and younger than 25; or have more than one sex partner
S/s of PID
pain in the lower abdomen, fever, smelly vaginal discharge, irregular bleeding, and pain during intercourse or urination
Uterine cancer
(endometrial) 40% of GYN CA; most common in postmenopausal women. increase risk due to age, late menopause, never giving birth, infertility, obesity/ diabetes,/ high bp, and hormone replacement estrogen treatment
S/s: RED FLAG SIGN IS PAINLESS ABNORMAL VAGINAL BLEEDING IN 90% OF CASES
Cervical cancer
20% of Gyn CA 40-45 peak incidence- one cause is HPV virus. The highest risks are females who have had more than 10 sexual partners and early age start of sexual activity
DX: pap smear (obtain cells from the cervix to examine in the cervical cells for atypical changes)
Rx: chemotherapy, radiation, and brachytherapy, hormone and other meds, also surgery
Ovarian cancer
according to the CDC ovarian cancer causes more deaths than any other cancer of the female reproductive system.
There are no screening tests for ovarian cancer
Note: the CA-125 test is not specific to ovarian CA
Peyronie’s disease
Etiology: begins with an inflammatory process that results in dense fibrous plaque (hard mass formation) on the tunica albuginea of the penis
Incidence: increased with diabetes, keloid formation, 50% spontaneous remission
Pathophys: inflammation → plaque fibrosis → abnormal penile curvature with erection
S/s: Painful erection, dyspareunia (painful sexual intercourse), unable to penetrate partner
Rx: meds to break down the collagen that causes the curvature; penile traction (acute phase); surgical implant (chronic phase)
Priapism
Etiology: idiopathic, or due to neurological injury, involuntary prolonged (>4 hrs) abnormal and painful erection that either continues beyond or is unrelated to sexual stim
Incidence: Most common in sickle cell disease, cancers, or neurologic disorders. Can be caused by stroke or spinal cord injury
Pathophys: trigger→penile erection→ tissue ischemia→ necrosis. UROLOGIC EMERGENCY BECAUSE OF TISSUE DEATH THAT WILL LEAD TO IMPOTENCE
S/S: excruciating painful erection
Rx: iced enemas, spinal anesthesia, aspiration
Inguinal hernia
Etiology: weakness or opening in the inner groin canal - occurs when soft tissue, protrudes through a weak point in ab muscles
Incidence: 70%-80% of all hernia cases and is surprisingly common in men
Pathophys: soft tissue, particularly lower intestines, starts to come through the lower ab wall through small hole or tear in the wall fo the inguinal canal
S.s: asymptomatic if small. But in serious cases the hernia could allow a loop of bowel could slip through the wall and get trapped leading to strangulation of an intestinal loop
Dx: turn your head and cough exam is done while standing to palpate for inguinal canal weaknesses and or tissue pushing through the weekend area. Standing and causing causes internal pressure to accentuate the tissue bulge so it can be detected easier
Rx: gently push the hernia back into the ab when lying down. same day surgery could also be done.
Cryptorchidism
undescended testicle
Etiology: in utero developmental delay
Incidence: 20% premature boys, 75%-90% descended by age 1
Pathophys: failure of testes to descend into scrotal sac RISK OF TESTICULAR CANCER by 4-10 times higher reduced fertility possibly due to length of time the testes were in the abs
s/s: no testes palpable in scrotum. may do laparoscopy to confirm diagnosis since other imaging is not reliable
Rx: non (wait to see if the testicle descends spontaneously by age 1 to maximize fertility)
*orchiopexy is a surge to move an undescended testicle into the scrotum and permanently fix it there
testicular torison
Potential urologic EMERGENCY
Etiology: Twisting of spermatic cord that suspends the testis
Incidence: increased in neonates and adolescents. Spontaneous onset, especially for boys at puberty.
Pathophys: inadequate attachment of testes to tunica vaginalis → spermatic cord twists → ischemia and loss of the testis
S/s: extreme testicular pain (sudden onset), scrotal edema, nausea/ vomiting, creamsteric reflex is absent
Rx: manual or surgical reduction within 6 hours to save the testis (elevation of the scrotum increases pain)
Epididymitis
Etiology: inflammation of the epidymis secondary to UTI or STD
Incidence: < 35 years old = STD; > 35 years old = UTI
Pathophys: pathogen ascension from urethra or bladder → inflammation.
RF: sexual activity, heavy physical exertion, and bicycle / motorcycle riding
S/S: acute scrotal/ inguinal pain, urethral discharge, dysuria
Rx: antibiotics, scrotal support (elevation of scrotum RELIEVES PAIN)
Prehn sign
when checking prehn sign during and exam the affected scrotum is elevated this action relieves pain of epididymitis but exacerbates the pain of torsion. the elevation takes the weight of the testis off the epididymal suspension
Prostatitis
etiology: idiopathic, bacteria
pathophys: inflammation/ infection
S/S: Pain (rectal or low ab and back which may be worse with BM’s), urinary frequency/urgency, pain with erection, painful ejaculation, fever (infection), enlarged/ tender prostate. Can give false positive PSA test
Rx: bed rest, anti-inflammatories, antibiotics
Benign Prostatic hyperplasia
Etiology: nonmalignant enlargment of prostate. Age related but otherwise unknown etiology
Incidence: 70% in 60-70 year old males, 80% in 70+ year old males.
Pathophys: Diminished hormone→ glandular cells hyperplasia → urethral obstruction.
S/S in benign prostatic hyperplasia
Similar to UTI, incomplete emptying of the bladder, straining to void, frequency, urgency, weak/decreased urine stream, incontinence, nocturia, urine retention and backflow up the ureters can lead to kidney failure. can give false positive PSA test
RX for benign prostatic hyperplasia
Temporary Tx: urinary catherterization
surgical intervention canc ause impotence (during transurethral resection of the prostate (TURP), an instrument is inserted up the urethra to remove the section fo the prostate that is blocking urine flow.
Testicular CA
1% of male CA; 15-35 yrs old- self exam to check for painless mass. Highest risk among men who have a history undescended testicle as an infant or who have a family hx, HIGH CURE RATE.
Rx: removal (orchiectomy) of affected testical and chemo
Prostate CA
3rd highest cause of cancer deaths in America. Most common male cancer
Prostate CA RF
over 50 (60% > 65 years)
Family HX
Black men
Diet
Prostate S/s
Early stage: no initial s/s so prostate cancer has usually metastasized before discovered
late stage: s/s can be similar to s/s of bph (urgency, frequency, nocturia, hematuria or blood in ejaculate)
Sites of metastasis for prostate CA
lungs (via lymph system) and spinal column/ pelvis (bone pain is often the 1st presenting s/s)
How to diagnosis prostate CA
Combination of two tests - PSA blood test and DRE physical exam
- Prostate specific antigen (PSA) blood test and prostate biopsy if PSA is high (PSA can also be high in BPH and prostatitis)
2.Digital rectal exam (DRE): finger up the butt to check size of prostate and to palpate abnormal bumps if present. less effective in detecting prostate CA than PSA tests but may find CA in men with normal PSA level
- Transrectal ultrasound may detect cancers that are too small to be detected by DRE
Screenig recommendations for prostate CA
Age 50 for men who are at average risk of prostate cancer and are expected at least 10 more years
age 45 for men at high risk- like African Americans and men who have first degree relative
Age 40 for men at even higher rsk
CDC estimates how many std infections each year
20 million new std infections each year
half of them among young people ages 15 to 24.3 the cost of stds to the u.s. health care system is estimated to be as much as $16 billion annually
STD can lead to reproductive organ scarring
STD can be caused by viruses bacteria and parasites
Trichomoniasis
etiology: protozoa
incidence: anyone, but greater with multiple sexual partners
pathophys: parastitic infection 3rd most commonly reported std can also be transmitted via fomites. (like swimming pools and hot tups)
Infextion with trick makes it easier to get infected with other STD pathogens
S/s: Frequently asymptomatic in men, in women there is a thick foamy or frothy foul smelling green discharge
RX: antiprotozoal meds
Human papillomavirus
Etiology: virus (over 150 diff types of HPV) in most cases, HPV goes away on its own and does not cause any health problems in 1-2 years (80-90% of sexually active people will be infected with a tupe of HPV)
Pathophys: virus is spread by having vaginal, oral, anal, sex with someone who has the virus
S/s: possibly genital warts, evidence of cervical cancer (positive pap smear), cancer of the throat or penis or anus
Rx: HPV vaccination for males and female (series of 2-3 injections over 6 months)
Herpes simplex virus (genital herpes)
etiology: viral infection with herpes simplex 1 (cold sores found around the mouth) or herpes simplex 2 (genital herpes)
Incidence: anyone but having multiple sex partners increase the risk for contracting virus
Pathophys: viral infection transmission b y direct contact with active lesions or by virus-containing fluid such as saliva or cervial secretions os virus can be transmitted when there are no visible lesions or evidence of active disease; recurrence is common. Herpes can be passed on to babies during childbirth causing a potentially fatal disease in baby.
Note about Herpes simplex virus
both types 1&2 can be found in either the mouth or genital area as a result of oral sex practices. The virs resides on nerve ganglia and migrates to the skin/ mucuosa surface when in active phase.
Three stages of Herpes simplex virus
Primary: initial outbreak of virus occurs as blisters
Latency: virus remains dormant in ganglia
recurrent stage: virus is reactivated, travels along peripheral nerves to site of initial infection, causing characteristics symptoms
Recurrent infections of herpes simplex may be triggered by
general illness
fatigue
physical or emotional stress
immunosuppression due to aids or such meds as chemo or steroids
trauma to the affected area including sex
menstruation
S/S of herpes simplex virus
Painful blisters (pustules) break open and cause ulcerations, flu-like symptoms with the initial outbrea; recurrent outbreaks proceeded by burning or itching, less painful than initial outbreak (there are either painful genital sores present or NO s/s at all no in between)
Rx: of herpes simplex virus
antiviral meds for treatment of active outbreaks and suppression therapy
Patient teaching of herpes simplex virus
People with HSV-2 are 3 to 5 times more likey to get HIV upon exposure
Relationship between chlamydia and gonorrhea
chlamydia and gonorrhea are difficult to tell apart without testing because they have similar s/s an cause similar reproductive system damage. They are often found together in the same infected person
Chlamydia trachomatis increases chances of what
increases risk of acquiring HIV infection
Chlamydia trachomatis
etiology: bacteria
incidence: anyone but greater with multiple partners, can be transmitted to baby during vag birth. can cause PID and infertility
Pathophys: bacterial infection
S/s: frequently asymptomatic; dysuria, genital pain, dyspareunia, vaginal/penal discharge that is mucopurulent, ab pain, chlamydia can infect the rectum throat urethra and cervix
Rx: antibiotic therapy
Gonorrhea
etiology: bacteria
incidence: anyone but greater with multiple partners, common std. can cause PID and infertility. passed to baby during birth
pathophys: bacterial infection
s/s: frequently asymptomatic; genital sores, painful urination, abnormal discharge, menstrual irregularities, urinary symptoms
Rx: antibiotic therapy
Note about syphillis
syph is contagious only in the first two states (primary and secondary) but not in tertiary stage
Syphillis
etiology: bacteria spread through kissing and sex; passed to the baby during preg or childbirth
incidence: anyone but the greater risk with multiple sex partners
patho phys: bacterial infection. transfers through the placenta to the fetus causing premature birth, stillborn babies, congenital defects and active infection in the infant. divided into 3 stages
Stages of syphillis
primary stage: chancre (painless ulceration) formation around the penis, vagina, mouth, and anus
secondary stage: rash on palms/ soles of feet. Also fever, sore throat, nausea, and mucosal or wart-like genital lesions called dcondulomata lata
tertiary stage: central nervous system lesions (brain damage); cardiovascular damage (scaring of the aorta); Gumma formation. gummas are most commonly found in liver but can also be in brain, heart, skin, bone, testis, and other tissues. neurological disorders or heart valve disease. damage is permanent despite antibiotic tx.
S/s of syphillis
initially, a hard painless sore (chancre) appears on the genital area. secondly rash develops on the palms of the hands; if untreated syphilis may progress to heart disease blindness paralysis brain damage and death
Rx for syphillis
antibiotic therapy (usually penicillin)
