Patho - Disorders of the Female Reproductive System Flashcards
what is amenorrhea? etiology?
Absence or suppression of menstruation.
Etiology: hormonal disturbances.
Stress & neoplasm’s interfere with normal hormonal secretion
what is metrorrhagia? etiology?
Bleeding between menstrual periods
Etiologies: Slight bleeding from endometrium during ovulation, uterine malignancy, cervical erosions, endometrial polyps, estrogen therapy
what is hypomenorrhea? etiology?
Deficient amount of menstrual flow; reduced flow
Etiologies: Endocrine or systemic disorders interfering with hormones, partial obstruction of menstrual flow
what is oligomenorrhea? etiology?
Infrequent menstruation
Etiology: Endocrine/systemic disorder causing failure to ovulate
what is polymenorrhea? etiology?
Increased frequency of menstruation
Etiology: Endocrine/systemic disorder causing ovulation
what is menorrhagia? etiology? treatment?
Increase in amount or duration of bleeding; prolonged and heavy bleeding
Etiology: Lesions of reproductive organs
Treatment: Surgery, oral contraceptives, and/or antiprostaglandins
what is dysfunctional uterine bleeding?
Abnormal endometrial bleeding
-Most common around menarche (immaturity in functioning of pituitary & ovaries) & menopause (d/t decrease in estrogen).
what is dysmenorrhea?
painful menstruation.
-Most common menstrual abnormality.
-Suprapubic cramping severe enough to limit activity, causes NVD
what is primary and secondary dysmenorrhea?
Primary—begins at onset of menses & is life long with unknown etiology—excessive prostaglandin production in the uterus which causes strong cxns, resulting in uterine ischemia & pain.
Secondary— occurs after having regular menses & usually d/t PID, endometriosis, STD, IUD, or fertility problems.
Often have scarring from the underlying cause.
uterine prolapse pathogenesis
Supporting pelvic structures relax & cervix (cx) sags downward into vagina.
-Can occur at any age
uterine prolapse etiology
Congenital defects, pregnancy & childbirth
uterine prolapse CM
-pelvic fullness
-vaginal discomfort
-difficulty urinating
what are the degrees of uterine prolapse?
1st degree: Uterus halfway between vaginal introitus & ischial spines
2nd degree: End of cx begins to protrude through introitus
3rd degree (complete prolapse): Body of uterus outside vaginal introitus
what is retrodisplacement of the uterus?
-Body of uterus is flexed into posterior pelvis
-Common: 20%-30% of women
-Associated with congenital defects, pregnancy & childbirth
-Pelvic pain, infertility, dysmenorrhea & dyspareunia
-5 positions: anteverted, midposition, anteflexed, retroflexed, retroverted
what is cystocele? etiology? CM?
Weakness in vaginal musculature allows bladder to protrude into anterior vagina.
Etiologies: Childbirth, surgery, aging, obesity, lifting.
Clinical Manifestations: back pain, incontinence, dysuria, pelvic pressure, dysmenorrhea & dyspareunia.
what is rectocele? etiology? CM?
Protrusion of anterior rectal wall into posterior vagina at a weakened part of vaginal musculature.
Etiologies: Childbirth injury, weakness with aging, multiparity, obesity.
Clinical Manifestations: Constipation, painful BM, painful intercourse
what is pelvic inflammatory disease?
Any acute, subacute, recurrent, or chronic infxn of oviducts, ovaries, & adjacent reproductive organs
cervicitis
endometritis
salpingitis
oophoritis
Cervicitis (cervix)
Endometritis (uterus)
Salpingitis (oviducts)
Oophoritis (ovaries)
pelvic inflammatory disease etiology
STI’s (Gonorrhea & Chlamydia), pelvic procedures,
IUD’s
pelvic inflammatory disease pathogenesis
Bacteria invade uterine & tubal tissues after migrating through cervix & scar tissue is formed
what is vulvovaginitis?
Inflammation of the vulva & vagina
vulvovaginitis etiology
Candida albicans (most common organism)
vulvovaginitis CM
-Thick, white, malodorous (odor), purulent discharge
-Red, edematous mucous membranes
-Intense itching
-Pain on urination and intercourse
what is uterine leiomyomas?
-Most common uterine growths: AKA fibroids.
-20% women > 35yrs; more common in African-American women.
-Estrogen & GH influence development.
-Grow large & cause abd pain & pressure, DUB & vaginal d/c.
what are ovarian cysts?
-Sacs on ovary that contain fluid.
-Develop anytime between puberty & menopause.
-Idiopathic.
-Usually asymptomatic & may change size with menstrual cycle.
-Rupture may result in severe abd pain & hemorrhage
what is polycystic ovarian syndrome? etiology? symptoms? treatment?
Hormonal disorder that effects ovaries
-Common endocrine disorder (6-15% of females of reproductive age)
-Ovaries contain a large number of harmless follicular cysts.
-Frequent cause of anovulation (absence/irregularity)
-Etiology is unclear; probably multifactorial
-Symptoms include oligomenorrhea, signs of hyperandrogenism (acne, hirsuitism, elevated testosterone levels), polycystic ovaries, obesity, glucose intolerance
-Treatment may include clomifene in women who are trying to get pregnant, contraceptive pills to induce regular periods, and/or metformin to induce ovulation, control blood sugar, and reduce circulating androgen levels.
what is endometriosis?
Growth of endometrium outside of uterus.
-Increased risk in nulliparous women >30 yrs of age.
-Benign dse, but tends to infiltrate & spread to adjacent tissues.
-Major complication of fertility.
endometriosis etiology
Backflow of menstrual fluid through uterine tubes
endometriosis pathogenesis
-Endometrial tissue outside uterus responds to hormones causing build up, scarring & further growth.
-Bleeding results in inflammation & pain in tissues, dysmenorrhea, dyspareunia.
-Repeated irritation causes formation of dense tissue adhesions
cervix cancer etiology
-HPV (16,18)
-Herpesvirus type 2
-Other STI´s
who is at risk for cervix cancer?
-Intercourse at young age
-Multiple sexual partners
-Multiple pregnancies
how do you prevent cervix cancer?
HPV Vaccine
-11-12yrs (as young as 9)
-Recommended 13-26yrs females who have not received or completed vaccine series
-Ideally, vaccination before onset of sexual activity
cervix cancer CM (pre-invasive & early invasive)
Pre
-Asymptomatic; changes in cells
Early
Abnormal vaginal bleeding & DC
Pain & bleeding after intercourse
-May spread to vaginal wall, pelvis, bladder, rectum & pelvic lymph nodes
-5yr survival rate stage 1-93%
-5yr survival rate stage 4-15%
endometrial cancer diagnosis? treatment?
Diagnosis
No screening tests
Histologic tissue examination
Treatment
Radiation therapy
Total hysterectomy with removal of ovaries & oviducts
5yr survival rate with early diagnosis: 96%
5yr survival rate to 17% if CA
what is ovarian cancer? CM?
Cancer on ovaries
-Leading cause of death from genital cancer
-Peak incidence 60-80yrs
-High mortality rate
-45% long-term survival rate
Clinical manifestations
-None until late in disease
-Increased abdominal girth
-Weight loss
-Abdominal pain
-Dysuria or urinary frequency
-Constipation
what is vaginal cancer? CM?
-Most over 60 at time of Dx
-Women whose mothers took diethylstilbestrol (DES) during pregnancy
-Possible metastasis to bladder, rectum, vulva, pubic bone, other surrounding structures
Clinical manifestations
-Vaginal spotting & DC
-Pain, groin masses
-Changes in urinary pattern
what is vulvar cancer? CM?
Cancer that occurs on the outside of genitalia
-5% all gynecologic malignancies
-Occurs any age, peak in mid-60s
Predisposing factors
-STDs
-Chronic vulvar pruritus with swelling & dryness
-Obesity, HTN, DM
-Never being pregnant
Clinical manifestations
-Leukoplakic changes (whitish plaque-like or ulcerated lesions) in vulva
-Abnormal urination & defecation
what is pregnancy-induced hypertension?
-Also known as toxemia or preeclampsia.
-0.5-10% all pregnancies
Rapid rise in BP & proteinuria.
-Characterized by Na+ & water retention.
-Leading cause of pregnancy-related death
pregnancy-induced hypertension etiology
Poor nutrition, teenager, multiple fetuses, pre-existing conditions
pregnancy-induced hypertension CM
wt gain, edema, decreased GFR, HTN, seizures
what is hyperemesis gravidarum?
-Excessive vomiting during pregnancy.
-Occurs in 1 in 1000 pregnancies
-Severe vomiting, dehydration & electrolyte imbalance.
-Cause is thought to be large amts of chorionic gonadotropin by the placenta.
-Treat with IV fluids, supportive care
what is placenta previa?
-Placenta is implanted abnormally over internal os.
-More common in multiple pregnancies.
-Occurs in 1 in 200 deliveries.
-Idiopathic
-Interrupts fetal oxygen supply.
-Treatment—C-section
what is abruptio placenta? etiology?
-Premature separation of placenta—1% of deliveries.
-Decreased fetal oxygen supply & causes maternal hemorrhage.
-Etiologies: trauma, short umbilical cord, PIH.
what is miscarriage?
-Expulsion of products of conception from uterus before period of fetal viability
-10%-20% of all pregnancies
miscarriage etiology? CM?
Etiologies: Fetal abnormalities, faulty implantation, infections & trauma
Clinical manifestations: vaginal bleeding, abdominal cramping
what is mammary duct ectasia?
chronic inflammatory process (mastitis)
what is breast abscess?
common in persons predisposed to infxns such as DM or on steroid therapy
what is fat necrosis?
death of tissue after trauma or injury
what is fibrocystic breast disease?
Benign breast lesions, common in women 20-50yrs
fibrocystic breast disease etiology
Hormonal changes, aging, high caffeine intake
fibrocystic breast disease pathogenesis
Mammary tissue retains fluid & forms cysts during later half of menstrual cycle & resolves with menses.
-Inflammation d/t repeated filling of cyst causes fibrosis & blocks drainage of fluid.
-Tender, firm, regular in shape, mobile on palpation
-Not at increased risk for breast CA
what is carcinoma of the breast?
-Most common CA in women 25-75yrs, affects 1 in 8 women.
-10% linked to mutations of BRCA1 or BRCA2 gene.
-Hormone dependent; early menarche
-Invasive & noninvasive
carcinoma of the breast pathogenesis?
-Arises in epithelium of glandular ducts of breast
-Malignant cells disseminate into lymph system of axilla
-Metastases to other sites: liver, lung, bone, brain, lymph nodes
-5-year survival rate 98% with no lymph involvement & 23% with metastasis
-More positive lymph nodes, less favorable the prognosis
carcinoma of the breast CM
-Painless, hard, poorly mobile lump
-Dimpling of skin
-Nipple retraction
-Changes in breast contour
-Bloody d/c from nipple
carcinoma of the breast treatment
Depends on extent of spread
-Lumpectomy: Removal of lump
-Mastectomy: Removal of breast
-Modified radical mastectomy: Removal of breast with portion of axillary lymphatic system dissected
-Radical mastectomy (rare): Removal of breast, lymphatic drainage, & pectoral muscles
-Chemotherapy
-Radiation therapy
-Supportive measures
Education
Follow-up care
