Other Flashcards
Uterine leiomyomas
CLINICAL -heavy, prolonged periods -pressure symptoms pelvic pain constipation urinary frequency
-obstetric complications
impaired fertility
pregnancy loss
preterm labor
-enlarged, irregular uterus
WORKUP
-U/S
TREATMENT
- asymptomatic: observation
- symptomatic: CHC, surgery
- Hysteroscopic myomectomy to preserve fertility
Genito-pelvic pain/ penetration disorder
Previously called vaginismus
RISK
- sexual trauma
- lack of sexual knowledge
- history of abuse
CLINICAL
- pain with vaginal penetration
- distress/anxiety over symptoms
- no other medical cause
- no tenderness on external examination
TREATMENT
- desensitization therapy
- kegel exercises
Genitourinary syndrome of menopause
PATHOPHYS
- decreased blood flow
- reduced collagen and glycogen content in vulvovaginal tissues
SYMPTOMS
- vulvovaginal dryness, irritation, pruritis
- dysparenuia
- vaginal bleeding
- urinary incontinence, recurrent UTI
- pelvic pressure
- minimal vaginal discharge with pH over 4.5
PE
- narrowed introitus
- pale mucosa, low elasticity, low rugae
- petechia, fissures
- loss of labial volumes
TREAT
- vaginal moisturizer and lubricant
- topical vaginal estrogen
When to stop Pap testing
-age 65 or hysterectomy
PLUS
-no history of cervical intraepithelial neoplasia of 2 or higher
AND
-3 consecutive negative paps
OR
-2 consecutive negative co testing results
ovarian torsion
RISK
- ovarian mass
- women of reproductive age
- infertility treatment with ovulation induction
CLINICAL
- sudden-onset unilateral pelvic pain
- N/V
- palpable adnexal mass
US
-adnexal mass with absent Doppler flow to the ovary
TREAT
- laparoscopy with detorsion
- ovarian cystectomy
- oophorectomy if necrosis or malignancy
menopause
CLINICAL
- vasomotor symptoms
- oligomenorrhea/amenorrhea
- sleep disturbances
- decreased libido
- depression
- cognitive decline
- vaginal atrophy
DIAGNOSIS
- clinical manifestations
- increased FSH
TREAT
- topical vaginal estrogen
- systemic hormone replacement therapy
endometriosis
PATHO
-ectopic implantation of endometrial glands
CLINICAL
- dyspareunia
- dysmenorrhea
- chronic pelvic pain
- infertility
- dyschezia
PE
- immobile uterus
- cervical motion tenderness
- adnexal mass
- rectovaginal septum, posterior culdesac, uterosacral ligament nodules
- cervical displacement
- rectovaginal nodularity
DIAGNOSIS
-direct visulaization and surgical biopsy
TREAT
- asymptomatic: reassurance and observation only
- medical : OCPs, NSAIDs
- surgical resection
Post op intraabdominal bleeding
- hemorrhagic shock
- altered mental status
- blood soaked dressing
- blood leaking between incision staples
- treat with urgent laparotomy
Symptomatic cholelithiasis in pregnancy
PATHOPHYS
- increased biliary cholestrol excretion due to estrogen
- decreased gallbladder motility due to progesterone
- gallstones form and intermittently obstruct cystic duct when gallbladder contracts
CLINICAL
- recurrent, postprandial epigastric RUQ pain
- pain can radiate to the back
- RUQ U/S with echogenic foci
MANAGEMENT
- conservative (pain control)
- Cholecystectomy (for complicated, recurrent cases)
pelvic organ prolapse
DEF
- cystocele
- rectocele
- enterocele
- procidentia
- apical prolapse: uterus, vaginal vault
RISK
- obesity
- multiparity
- hysterectomy
- postmenopausal
CLINICAL
- pelvic pressure
- obstructed voiding
- urinary retention
- urinary incontinence
- constipation
- fecal urgency, incontinence
- sexual dysfunction
MANAGE
- weight loss
- pelvic floor exercise
- vaginal pessary
- surgical repair
Intrauterine synechiae (adhesions) AKA Asherman syndrome
RISK
- infection
- intrauterine infection
CLINICAL
- AUB
- Amenorrhea
- infertility
- cyclic pelvic pain
- recurrent pregnancy loss
EVAL
-hysteroscopy
Bartholin duct cyst
Bartholin glands
-located at 4 and 8 o clock positions of vulvar vestibule
Obstruction
- accumulation of mucus secondary to edema or trauma
- can be idiopathic
CLINICAL
- soft, mobile, nontender cyst at base of labia majora
- can cause discomfort during walking, sitting, sex
MANAGE
- asymptomatic: observation and expectant management
- symptomatic: I and D
Causes of hirsutism in women
PCOS
- oligomenorrhea, hyperandrogenism, obesity
- associated with Type 2 diabetes, dyslipidemia, HTN
IDIOPATHIC
- normal menses
- normal serum androgens
NONCLASSIC 21 hydroxylase deficiency
- similar to PCOS
- elevated serum 17 hydroxyprogesterone
ANDROGEN SECRETING OVARIAN TUMORS, OVARIAN HYPERTHECOSIS
- more common in post menopausal women
- rapidly progressive hirsutism with virilization
- very high serum androgens
CUSHING
- obesity
- increased libido, virilization, irregular menses
prolapsing leiomyoma uteri
- firm, smooth, round mass at cervical os
- aborting submucous myoma
- heavy, prolonged menstrual bleeding
- can prolapse through cervical os while hanging by a pedicle
- labor-like pains
- cervical dilation
- preceded by heavy vaginal bleeding
TREAT
-surgical removal
COMPLICATIONS
- infertility
- recurrent miscarriage
- pregnancy complications
5 alpha reductase deficiency
PATHO
- 46, XY
- impaired testosterone to DHT conversion
- impaired virilization during embryognesis
- normal male testosterone and estrogen levels
CLINICAL
- male internal genitalia
- female external genitalia (blind ending vagina)
- phenotypically female at birth
- no breast development
puberty
- clitoromeglay
- increased muscle mass
- male pattern hair development
- nodulocytic acne
- testes palpable in labia
