module 16 women abnormalities 2 Flashcards
gonorrhea
- subjective: partner with STI, no s/s or s/s of PID
- objective: purulent discharge from cervix; Skene/Bartholin gland inflammation; cervix and vulva may be inflamed
- Dx: gram stain, culture, DNA probe
chlamydia
- subjective: often no s/s, spotting after intercourse or urethritis
- objective: purulent discharge; cervix may or may not be red or friable
- Dx: DNA probe
atrophic vaginitis
- subjective: dysparenunia, vaginal dryness, peri/postmenopausal
- objective: pale, thin vaginal mucosa
- Dx: wet mount: folded, clumped epithelial cells
allergic vaginitis
- subjective: new bubble bath, soap, douche, or other hygiene products
- objective: foul smell, erythema
- Dx: wet mount: WBC
foreign body
- subjective: red and swollen vulva, vaginal discharge, hx of use of tampon, condom, diaphragm
- objective: bloody or foul-smelling discharge
- Dx: wet mount: WBC
cervical cancer patho
classified according to the type of tissue from which the cancer arises
- squamous: dysplastic or premalignant lesion at active squamocolumnar junction
- adenocarcinoma:
- usually caused by HPV
cervical cancer subjective
usually no s/s
may report unexpected vaginal bleeding or spotting
cervical cancer objective
- often no findings on physical exam
- hard granular surface at or near the cervical os
- lesion can evolve to form extensive irregular cauliflower growth that bleeds easily
- early lesions are indistinguishable from ectropion
- precancerous and early cancer changes detected by pap smear
uterine prolapse patho
descent or herniation of the uterus into or beyond the vagina
- weakened supporting structures of the pelvic floor
uterine prolapse subjective
sensation of pelvic heaviness and or uterus follow out tissue protruding from vagina urine leakage or urge incontinence difficulty having a BM low back pain
uterine prolapse objective
1st degree: cervix remains within the vagina
2nd degree: cervix is at the introitus
3rd degree: cervix and vagina drop outside the introitus
uterine bleeding patho
abnormality in menstrual bleeding and inappropriate uterine bleeding are common gynecologic problems
uterine bleeding subjective
shortened or lengthened interval between periods
absence of menstruation
normal intervals between periods, inc. or dec. flow, longer duration
irregular intervals between periods with excessive flow and duration
bleeding between periods
uterine bleeding objective
dysfunctional: none
endocrinopathies:
- pelvic exam normal, physical findings consistent with endocrine disorder
Coagulopathies:
- findings consistent with specific coagulaopathy
Pregnancy related:
- consistent with stage of pregnancy
myoma (leiomyomas, fibroids) patho
common, benign, uterine tumors
- arise from the overgrowth of smooth muscle and connective tissue in the uterus
myoma subjective
related to the number of tumors as well as location and size, may include
- heavy menses
- abd. cramping usually felt during menstruation
- urinary freq., urgency, and/or incontinence from pressure on bladder
- constipation, difficult defecation ,or rectal pain from pressure on the colon
- generalized pelvic and or lower abd discomfort
myomas objective
firm, irregular nodules in the contour of the uterus on bimanual exam
uterus may be enlarged
endometrial cancer patho
most often in postmenopausal pt
cancers of the glandular cells in the lining of the uterus
- inc. risk: pt with uterus taking tamoxifen
endometrial cancer subjective
postmenopausal vaginal bleeding
- red flag for endometrial cancer
endometrial cancer objective
none
dx with endometrial biopsy
ovarian cyst patho
fluid-filled sac in an ovary
- follicle undergoes varying rates of maturation and cysts can occur
- > hypothalmaic-pituitary dysfunction, native anatomic defects
ovarian cyst subjective
usually no s/s
may report lower abd. pain: sharp, intermittent, sudden, and severe
sudden onset of abd. pain suggest cyst rupture
ovarian cyst objective
pelvic mass may be palpated
cervical motion tenderness may be elicited
ovarian cancer patho
- epithelial: arise from a layer of germinal epithelium on the outside of the ovary
- stromal: from connective tissue cells that help form the structure of the ovary and produce hormones
- germ cell: from germ cells (produce the egg)
ovarian cancer subjective
no s/s at first
pt > 40 with persistent and unexplained vague GI s/s
- abd. discomfort, gas, indigestion, pressure, swelling, bloating, cramps, felling full even after a light meal
ovarian cancer objective
no physical findings
bimanual exam: enlarged ovary in premenopausal pt or a palpable ovary in postmenopausal pt
tubal/ectopic pregnancy patho
pregnancy occurring outside the uterus
tubal pregnancy subjective
abnormal vaginal bleeding low back pain mild cramping on one side of the pelvis pain in lower abd. or pelvic area if pregnancy ruptures: s/s may worsen light-headed/syncope pain in shoulder area severe, sharp and sudden pain in lower abd.
tubal pregnancy objective
- marked pelvic tenderness, with rigidity of the lower abdomen
- cervical motion tenderness; tender, unilateral adnexal mass may indicate site of pregnancy
- tachycardia, hypoTN: reflect hemorrhage of a ruptured pregnancy into the peritoneal cavity
- surgical emergency
PID patho
infection of the uterus, fallopian tubes, and the other reproductive organs
- common complication of STI
PID subjective
s/s may be mild or absent vaginal discharge with foul odor painful intercourse painful urination irregular menstrual bleeding pain in the upper abdomen
PID objective
acute PID
- very tender, bilateral adnexal areas
- pt guards and usually cannot tolerate bimanual exam
Chronic PID
- bilateral, tender, irregular, and fairly fixed adnexal areas
salpingitis patho
inflammation or infection of the fallopian tubes
- often associated with PID
salpingitis subjective
lower quadrant pain - dull, cramping, worse with motion or sex coexisting purulent vaginal discharge abnormal vaginal bleeding nausea, vomiting, fever
salpingitis objective
cervical motion tenderness and/or adnexal tenderness on bimanual exam
mucopurulent cervical discharge
