Repro Flashcards
Pelvic inflamm disorder (what organs does it involve, is it always acutely known, what can form as a result)
infectious condition of the pelvic cavity
May involve infection of cervix, fallopian tubes, and pelvic peritoneum
Ovarian abscess may form (Pocket full of pus)
May be “silent” when women do not perceive any symptoms; others will be in acute distress
PID often results from
Often the result of untreated cervicitis
Most common organisms causing PID
Chlamydia and Gonorhea
Also
anaerobes, mycoplasma, streptococci, enteric Gram-negative rods
How do organisms gain entrance
during sexual intercourse and after pregnancy termination, pelvic surgery, or childbirth
When should people be tested
Women at risk for chlamydial infections should be routinely tested
Younger women in repro years
People with more than one partner
People having intercourse with more than one partner
PID clinical man
Lower abdominal pain
Starts gradually & becomes constant
Varies from mild to severe
Pain with intercourse
Spotting after intercourse
Purulent cervical or vaginal discharge
Fever & chills
Less acute ss of PID
Increased cramping pain with menses, irregular bleeding, some pain with intercourse
May be undiagnosed & untreated if mild
PID diagnosis
Based on ss
Bimanual portion of pelvic exam
Abnormal discharge
C&S
Pregnancy tst to rule pit ectopic pregnancy
Vaginal Ultrasound
PID Complications
Septic shock (If abcesses rupture)
Fitz-Hugh-Curtis syndrome – PID spreads to liver
Pelvic or generalized peritonitis
Embolisms
Adhesions & strictures in fallopian tubes
- increased risk of ectopic pregnancy (10x)
Risk of recurrent infection
Infertility
PID collab care
Treated as outpt
Broad spectrum antibiotics – e.g. Cefoxitin & Doxycycline
No intercourse for 3 weeks
Examination & treatment of partner
Rest
Oral fluids
Tx of abcess
Hospitalization
Corticosteroids
Bed rest in semi-Fowler’s position
Drainage of abscess
Hysterectomy
Endometriosis
presence of endometrial epithelial and/or stromal cells normally found in the lining of your uterus growing in sites outside the uterus
Most frequent sites are in or near the ovaries, uterosacral ligaments and uterovesical peritoneum.
Can also be in other locations: stomach, lungs, intestines, & spleen
How does endometriosis cause SS?
Tissue responds to hormones of ovarian cycle & undergoes a “mini-menstrual cycle like the uterine endometrium but because it has nowhere to exit becomes trapped irritating tissues and causing scar tissue and adhesions.
Typical patient is late 20s or early 30s, white, never had a full-term pregnancy
Not life-threatening but can cause considerable pain
Why does endometriosis occur?
Poorly understood- Retrograde menstrual flow passes through fallopian tubes carrying viable endometrial tissues into pelvis tissue attaches to various sites
SS of endometriosis
Secondary dysmenorrhea
Infertility
Pelvic pain
Painful intercourse
Irregular bleeding
Backache
Painful bowel movements
Dysuria
Collab care of endometriosis
History & physical
Pelvic exam
Laparoscopy, U/S, MRI
tx of endometriosis
- Watch and wait
Drug tx of endometriosis
NSAIDS
Oral contraceptives
Danazol - synthetic andorgoen (Ovarian suppression)
Gonadotropin hormone agonist
Sx tx of endometriosis
Laparotomy
Total hysterectomy & removal of ovaries
Types Benign Ovarian Tumors
Cysts: soft; surrounded by thick capsule
Detected during reproductive years
Neoplasms: Cystic or solid
Small or extremely large
May originate from germ cells & can contain bits of any type of body tissue (e.g. hair, teeth)
Tx of ovarian tumor
Immediate surgery necessary for ovarian torsion (twistinging)
Why is ovarian cancer so deadly
Most go without SS, and aren’t caught until it’s too late
Ovarian cancer ss
Often result in bowel blockage
Bloating
Irregular periods
Those at risk for Ovarian cancer
Family hx - breast or colon
BRCA1 and BRCA2 gene mutations
nulliparity, age, high-fat diet, increased ovulotory cycles ep
Types of ovarian cancer cells
About 90% are epithelial , 10% germ cell tumours
Collab care of ovarian cancer
Chemotherapy, radiation and surgery
Cervical Cancer
2nd most common female cancer in the world 83% in under-resourced countries
- Not appropriate screening
Most important prevention
for cervical cancer is
HPV
Vaccines against prevent 70% of types of cervical cancers
What is the number one prevention of cervical cancer
Regular pap tests
- slow growing, can be caugt
BC cervical cancer screening
Start at age 25 if sexually active
Every 3 years
Stop at age 69 if results have always been normal
Link bw HPV and Cervical Cancer
HPV
Includes > 100 different
types of related viruses;
15 of these may cause anogenital cancer
Very common – will affect almost all individuals at some point
Most infections clear on their own
Long-term infection with high-risk HPV (hr-HPV) can cause precancerous changes to cells of cervix can lead to cervical cancer if left undetected or untreated
HPV Vaccine
have been developed and approved for use in Canada
Protect against HPV types 16 and 18 which cause approx. 70% of cervical cancers, 80% of anal cancers & a significant proportion of other cancers
Also protect against HPV types 6 and 11 which cause approx. 90% of anogenital warts
Do vaccinated people need to be screened for Cervical cancer?
Yes, bc vaccination does not mean you don’t have to be screened
Interventions for repro problems
Reduce shame
Reccomend counselling
Risk factors for BPH
Family history
Western cultures (more likely to experience obstructive problems)
Obesity
Diet high in zinc, butter, & margarine
Protective factors against BPH
Diet of fruit & veggies; lycopene (Cooked tomatoes)
Physical activity
Moderate alcohol consumption
Cause of BPH
Endocrine changes with ages
- Excessive accumulation of aggressive form of testosterone causing local growth of prostate
Patho: Develops in inner part of the prostate
Where is cancer more likely to develop in prostate
In the outer
therefore prostate will fell abnormally shaped
BPH develops in what part of prostate
Develops in inner part of prostate
Bothersome “LUTS”
Obstrutive symptoms
Irritative symptoms
Complications
Obstructive symptoms of BPH
Decrease in calibre & force of urinary stream, hesitancy, intermittency, dribbling
Irritative symptoms of BPH
Urinary frequency, urgency, dysuria, bladder pain, nocturia, incontinence
Complications of BPH
Urinary Retention, UTI, and possible sepsis, calculi, renal failure
Know diff bw obstuctive and irritative systems
Diagnostics of BPH
Hx and physical
DRE
PSA levels (would be increased)
Urinalysis (Post void residual (Bladder scan after pee)
Ultrasound
Urethroscopy
Watchful waiting includes
Avoids
Caffeines, artificial sweeteners
Spicy foods
Drug therapy for BPH
5_-Reductase inhibitors- slow growth
- Prevent conversion to the “super testosterone”
Alpha-Adrenergic receptor blockers-relax smooth muscle of prostate and ureters - promotes urination
Invasive therapy for BPH
Transurethral resection of the prostate (TURP)-discussed next slide
Transurethral incision of the prostate (TUIP)
Prostatectomy
transurethral microwave thermotherapy
delivery of microwaves- heat causes death of tissue
transurethral needle ablation
increases temperature & causes localized necrosis (uses low radio frequency waves)
laser prostatectomy
_ visual or U/S guidance
intraprostatic urethral stents
if contraindications to surgery or anesthesia
TURP
Prostate Cancer
Malignant tumour of prostate gland
Androgen-dependent adenocarcinoma -
after the age of 50 most men have a decrease in testosterone, but have an increase in dihydrotestosterone (a potent form of testosterone)
Majority of tumours in outer aspect of prostate
Usually slow growing but progressive if left untreated
Can metastasize through direct extension, lymph system, or bloodstream
https://youtu.be/L-VH-uX2ka8 from
Prognosis for Porstate cancer
1 in 7 men will be diagnosed
Most will survive
Prostate cancer risk factors
> 65 years of age
Ethnicity:2X higher in Black > White > Asian
Family history
High levels of testosterone
Diet high in fats & low in vegetables & fruits
Occupational exposure to cadmium
Genetic mutationo idications of Prostate
links to BRCA1 and BRCA2 (genetic mutations causing breast cancer)
Prostate cancer SS
Blood in urine or semen
Advanced
Weight loss
Fatigue
Backache or sciatica-like pain, or swelling of legs that doesn’t go away
Prostate cancer Diagnosis
Occuring before symptoms occur
DRE
PSA Screening
- Not specfici to prostate cancer
- Biopsy required for diagnosis
PSA screening
Not required in BC
If done, bw ages of 55 and 69
PSA (Prostate specific antigen) used forMonitoring established prostate cancer & metastatic disease or detection of early recurrence, where prostate cancer is already known
Living with prostate cancer
Losses of sexual funcitong
Embarrassment etc
Medications used
Flomax (Tamulosin)
