PEARLS book Flashcards
if the egg is not fertilized, the corpus lutetium soon _______, causing a FALL OF ESTROGEN AND PROGESTERONE LEVELS
deteriorates!
endometrium is no longer maintained and sloughs off, “menstruation”
What predominates during the follicular phase?
estrogen!
GnRH from the hypothalamus causes an increased in FSH and LH from the pituitary gland, which…..
stimulates the ovaries
____ causes follicle and egg maturation in the ovary
FSH
____ stimulates maturing follicle estrogen production
LH
_____ builds up the endometrium (“proliferation”)
estrogen
What predominates during the luteal (secretory) phase?
Progesterone
abnormal frequency/intensity of menses due to nonorganic causes
dysfunctional (abnormal) uterine bleeding
cryptomenorrhea
light flow or spotting
Menorrhagia
heavy or prolonged bleeding at normal menstrual intervals
Metorrhagia
bleeding between menstrual cycles
Menometrorrhagia
irregular intervals with varying degrees of bleeding
Management for anovulation (due to unopposed estrogen)
OCPs
Progesterone
GnRH agonists
cluster of physical, behavioral, mood changes with cyclical occurrence during luteal phase menstrual cycle (7-14 days before onset of menses)
PMS
benign uterus smooth muscle tumor
*growth related to estrogen production (regresses with menopause)
most common in african americans
Leiomyoma (uterine fibroids)
Most commonly presents with bleeding and menorrhagia! can present with abdominal pressure also
*exam shows lg, irregular hard palpable mass in abdomen or pelvis during bimanual exam
Leiomyoma (uterine fibroids)
How is diagnosis of leiomyoma (uterine fibroids) made?
ultrasound
Most leiomyoma (uterine fibroid) cases are managed through…
observation!
sometimes inhibition of estrogen
presence of normal endometrial tissue outside the endometrial (uterine) cavity
*ectopic endometrial tissue responds to cyclical hormonal changes!
endometriosis
MC site of ectopic endometrial tissue?
Ovaries
Risk factors:
nulliparity
family hx
early menarche
onset usually under 35!!**
Endometriosis
Classic triad=
- cyclic premenstrual pelvic pain (or low back pain)
- Dysmenorrhea
- Dyspareunia
also dyschezia (painful defecation) **most common cause of infertility!!**
Endometriosis
How is endometriosis definitively diagnosed?
Laparoscopy biopsy
Endometriosis involving the ovaries large enough to be considered a tumor, usually filed with old blood appearing chocolate colored (chocolate cysts**)
Endometrioma
Conservative tx of endometriosis
ovulation suppression:
OCPs + NSAIDs
Progesterone tx
Surgical tx of endometriosis
Laparoscopy with ablation (if fertility desired)
TAH-BSO with salpingoophorectomy (if no desire to conceive)
MC GYN malignancy in US
mostly post menopausal!!!*
Estrogen dependent cancer
endometrial cancer
Risk factors= Increased estrogen exposure Nulliparity Chronic anovulation Obesity Estrogen replacement therapy Tamoxifen HTN DM
Endometrial cancer
Clinical manifestations: abnormal bleeding..post menopausal bleeding*, menorrhagia
Endometrial cancer
Diagnosis made through endometrial biopsy
(esp if endometrial stripe is greater than 4 mm!)
**majority=adenocarcinoma
Endometrial cancer
Management for stage I endometrial cancer
TAH-BSO +/- post op radiation
stage II would be TAH-BSO with lymph node excision and post op radiation
Gravida
Para
Abortus
Gravida= # times pregnant Para= # of births, including viable or nonviable births (still births) Abortus= # of pregnancies lost
Cessation of menses longer than 1 year due to loss of ovarian function
*FSH assay most sensitive initial test
Menopause
Estrogen deficiency changes: menstrual cycle alterations, vasomotor instability (i.e. hot flashes), mood changes, skin/hair/nail changes, CV events, hyperlipidemia, osteoporosis, dyspareunia
*atrophic vaginitis: thin yellow discharge with pH greater than 5.5, pruritus
Menopause clinical manifestations
Cystic enlargement of ovarian structures (mature follicle that fails to rupture)
*unilateral RLQ or LLQ pain
dx made with ultrasound
Ovarian cysts
Highest mortality rate of GYN cancers
*risk factors:
family hx, increased number of ovulatory cycles (infertility, nulliparity, under 50, BRCA genes)
Ovarian cancer
Rarely symptomatic until late stages of dz.
DOES PRESENT WITH ASCITES**
Ovarian cancer
- amenorrhea
- obestity
- hirsutism
*due to insulin resistance
PCOS
DES (a synthetic estrogen) can increase risk of…
Cervical carcinoma and vaginal cancer
HPV 16, 18, 31, 33
Related to cervical carcinoma
HPV 16, 18, 31
MC presentation= vaginal pruritus, post coital bleeding
Dx= red/white ulcerative, crusted lesions. bx!
Vaginal cancer
Ascending infection of the upper reproductive tract
MC cause= gonorrhea, chlamydia
PID
Pelvic/lower abdominal pain, dysuria, dyspareunia, vaginal discharge, N/V
Lower abdominal tenderness, fever. Chandelier sign
PID
All 3:
- abdominal tenderness
- adnexal tenderness
- cervical motion tenderness
PID
Dx made with pelvic ultrasound
**tx underlying cause!
PID
Duct obstruction leading to retained secretions and gland enlargement
*may be infectious or caused by trauma
Bartholin cyst
If infected…tender, unilateral vulvar mass, edema/inflammation
if noninfected…non tender, unilateral mass
Bartholin cyst
usually will just self resolve
Classic triad:
- unilateral/pelvic abdominal pain
- vaginal bleeding
- amenorrhea
Ectopic pregnancy
Serial beta-HCG fails to double
(normal pregnancy should double every 24-48 H)
*dx made with transvaginal ultrasound
ectopic pregnancy
Absence of gestational sac with levels of beta-HCG greater than 2000 strongly suggests…
ectopic or nonviable intrauterine pregnancy
Which drug can be give in a stable ectopic pregnancy to destroy trophoblastic tissue
Methotrexate
Management of choice if an ectopic pregnancy has ruptured?
Laparoscopic salpingostomy
Severe abdominal bleeding, dizziness, N/V, syncope, signs of shock
Signs of ruptured ectopic pregnancy
Abnormal labor progression..3 categories
- power=uterine contraxns
- Passenger= size or position of baby
- Passage=uterus or soft tissue abnormalities
Dystocia
Nonmanipulative= first line. McRoberts maneuver (increase pelvic opening with hyper flexion of hips)
Used first line for SHOULDER DYSTOCIA
Manipulative= second line. woods “corkscrew” maneuver..180 should rotation; C section
Used second line for SHOULDER DYSTOCIA
Increasing pelvic opening with hyper flexion of hips..maneuver used for shoulder dystocia
McRoberts maneuver
Chlamydia trachomatis
*MC cause cervicitis
Chlamydia
May be asymptomatic
Mucopurulent cervicitis
Increased freq, dysuria
Abdominal pain, PID, post coital bleeding
LGV; PAINLESS genital ulcer
Chlamydia
Dx with LCR***, cultures, DNA probe
Chlamydia
Neisseria gonorrheae
May be asymptomatic
Vaginal discharge, cervicitis, increased frequency, dysuria
Dx= culture, DNA
gonorrhea
Haemophilus ducreyi
Chancroid
Trepomena pallidum
Syphillis
Flat, papular pedunculate or flesh colored growths…“cauliflower like” lesions
HPV
