Repro Flashcards
1
Q
Epidemiology of Preeclampsia
A
Increased incidence with: - multiple gestations - Chronic HTN - Previous history of preeclampsia - Renal disease - DM Prior to 20 weeks, preeclampsia pathognomonic for molar pregnancy
2
Q
Pathophysiology of preeclampsia
A
Abberation in normal interaction between fetal allograft and maternal tissue
Vascular Changes: normal migration of trophoblast into uterus with spiral arterioles causes uteroplacental arteral bed into low resistance, high flow system
Preeclampsia= defective vascular changes–> decreased blood supply, fibrotic vascular changes, endothelial injury
- see vasospasm, coagulation system activation, abnormal hemostasis–> endothelial injury, increased platelet activation, platelet consumption–> decreased intravascular volume
3
Q
Renal system changes in preeclampsia
A
Renal: nL= increased renal plasma flow, GFR
Preeclampsia = vasospasm, capillary endothelial swelling–> reduced GFR, increased uric acid, creatinine
4
Q
Hemodynamic changes in preeclampsia
A
Normal= Prostacyclin, thromboxane A2 increased in pregnancy (PGI > TXA) - PGI allows for vasodilation, inhibits platelet aggregation Preeclampsia= TXA>PGI Capillary leak (proteinuria, edema) NO reduced (less vasodilation)
5
Q
Hepatic system changes in preeclampsia
A
Transaminase elevations in about 10% cases
6
Q
Hematologic changes in preeclampsia
A
Thrombocytopenia
Severe= decreased fibrinogen, increased PT, PTT (seen in DIC)
7
Q
Severe preeclampsia
A
BP >= 160/110 Proteinuria= 5 g/24 hour urine or dip +3 to +4 Oliguria Cerebral/visual disturbances (could be close to developing eclampsia) Epigastric pain (HELLP) Pulmonary edema Impaired liver function Thrombocytopenia
Treatment: delivery if maternal complications of abNL fetal testing
32 weeks: deliver
8
Q
HELLP sydrome
A
Hemolysis, Elevated Liver enzymes, Low Platelets
2-12% cases of preeclampsia (severe)
DIC, periportal liver necrosis, hemorrhage, coma, nephrogenic diabetes insipidus, subcapsular liver hemotoma
May see NO HTN, proteinuria
Present with RUQ/epigastric pain, N/V
9
Q
Maternal Complications of Preeclampsia
A
Death CVA DIC Placental abruption- 5% renal failure Subcapsular liver hematoma/rupture Pulmonary edema Eclampsia Liver failure
10
Q
Fetal complications of Preeclampsia
A
Death- 10% Prematurity RDS (respiratory distress syndrome) IVH (intraventricular hemorrhage) Retinopathy Necrotizing enterocolitis BPD (bronchopulmonary dysplasia) IUGR (intrauterine growth restriction)- 18% Fetal asphyxiation
11
Q
Treatment of preeclampsia
A
Only cure= delivery
Mild preeclampsia: deliver if >= 36 weeks
Severe preeclampsia: deliver if >= 32 weeks
Magnesium sulfate= best agent for treatment of eclampsia seizures, prophylaxis in preeclampsia
12
Q
Mild preeclampsia
A
HTN: 120-140/70-90
Proteinuria= 300 mg/24 hours or 0.1 g/L spot
Deliver greater than 36 weeks
delivery
13
Q
Magnesium sulfate
A
anticonvulsant, more efficacious than dilantin
Slows NM conduction, depresses CNS irritability
Renal excretion
Toxic levels= somnolence, respiratory difficulty, cardiac arrest
14
Q
Eclampsia
A
Convulsions unrelated to other condutions, + evidence of preeclampsia
2-4% of preeclampsia patients
Headache, visual symptoms, RUQ/epigastric pain
Short-lived convulsions (60-75 seconds)
15
Q
Recurrence rates of preeclampsia
A
25% in second pregnancy
severe preeclampsia–> 65% recurrence
HELLP recurrence low
Prevention: low dose aspirin (10-20% reduction in recurrence), calcium
16
Q
Low risk HPV types
A
Associated with warts
6, 11
40, 42, 43, 44, 53, 54, 61, 72, 73, 84
17
Q
High risk HPV types
A
Associated with cervical cancers (at least found in any case of cervical cancer), other cancers of genital tract
16, 18, 45
31, 33, 35, 39, 51, 52, 56, 58, 59, 68, 82
18
Q
HPV and cervical cancer
A
HPV 16 found in 50% of cervical cancers, most commonly identified in HSIL
HPV 18= squamous carcinoma, adenocarcinoma, cervical adenocarcinoma in situ
* HPV clearance: 50% by 6 months, 66% at 12 moths, 80% at 2 years- only when integrated into genome can lesion progress from LSIL to HSIL or carcinoma
19
Q
ASCUS (pap smear)
A
Atypical squamous cells of undetermined significance
- 5-7% chance of biopsy confirmed CIN 2/3, but only 0.1% chance of invasive carcinoma (therefore need follow-up hr-HPV DNA testing)
- ASCUS pap with positive HPV DNA has 30% incidence of high-grade lesion on colposcopy
20
Q
ASC-H (pap smear)
A
Atypical squamous cells, cannot exclude high grade lesion
* colposcopy reading shows 25% to have severe pre-cancerous changes
21
Q
AGC (pap smear)
A
Atypical glandular cells
22
Q
AIS (pap smear)
A
Adenocarcinoma in situ
23
Q
Possible high risk HPV
A
22, 66, 73
24
Q
Detection of HPV
A
Liquid-based pap: can use residual material to detect high risk HPV DNA via:
Hybrid capture 2
Cervista
PCR
- only recommended for women >30, performed every 3 years (or 6 years with pap smear)
25
Hybrid capture 2 HPV detection
Detection of 13 high-risk types of HPV DNA in cervical specimens
Nucleic acid hybridization assay with signal amplification
Qualitative detection using microplate chemiluminescence
* See which strands light up to indicate a high risk HPV strain present in sample
26
Cervista HPV detection
Screens for 14 types of HPV strains
27
Indications for using high-risk HPV DNA testing
1. Women over age 20 with ASCUS results (unclear significance of pap smear)
- If negative for hr-HPV, no need to perform culposcopy
- If patient < 20 years, perform repeat cytology in 12 months
2. Post-treatment surveillance of women with CIN 2/3
* Failure of surgical excision 1-25%: need to perform to ensure no persisting cancer cells
3. Adjunct to pap test in primary cancer screening in women over 30 (not recommended for women <30 because HPV so prevalent but most cases handled by immune system)
28
Management of CIN (cervical intraepithelial lesions)
1. ASCUS: 20 years: hrHPV, if +, colposcopy
2. LSIL: < 20 years: reperform cytology in 12 months
> 20 years: colposcopy
3. HSIL: 70% chance of CIN2-3
1% risk of invasive cancer
Colposcopy for diagnosis followed by excision
29
Recommendations for HPV screening
< 21 years: no screening
21-29 years: cytology alone every 3 years
30-65 years: HPV and cytology every 5 years (preferred), cytology every 3 years (acceptable)
>65 years: no screening follwing adequate negative prior screening
After hysterectomy: no screening (if no history HSIL)
HPV vaccinated: continue to follow screening recommendations for age group
High risk women need to be screened more frequently (high risk= HIV, organ transplant, exposure to DES)
30
Fertilization to implantation timeline
30 hrs: 2 cell organism
3rd day: 12-32 cell solid morula (totipotent)
- Arrives in uterus
6th day: Hollow blastocyst (250 cells) implants into uterus
31
Implantation to 12 weeks LMP timeline
6-9 days post fertilization= implantation
- inner layer= ecto, endo, mesoderm (fetus)
- outer layer= trophoblast (placenta, fetal membranes)
4 weeks: 6 mm embryo, 1,000,000s cells
5 weeks: human appearance (extremities, cerebral hemispheres)
6 weeks: heartbeat
12 weeks: external genitalia, fetus excretes urine
32
Spontaneous abortion
15% of known pregnancies (25-35% all pregnancies)
50% due to chromosomal abnormalities
80% in first trimester
Risk factors= toxicity (smoking, drugs, alcohol), medical illness (DM, HTN, thyroid), age (>35 for women, 50 for men), infection, uterine abnormalities
33
Missed abortion
Closed cervix
Fetus dead but still in uterus
Management=
- Expectant (wait for body to expel)
- Medical (prostaglandin--> contractions)
- Surgical (EVA, MVA)
* expectant and medical managment have a higher risk of hemorrhage
34
Threatened abortion
Close cervix
Uterine bleeding/passage of tissue before 20 weeks
25% of all pregnancies
50% of threatened pregnancies result in viable infants (but have higher incidence of prematurity, lower birth weight)
Managment:
- Expectant (not much done except avoiding sex)
- Monitor: serial beta-hCG (is it ectopic or molar pregnancy causing bleeding?), ultrasound, pelvic rest (not bed rest)
35
Complete abortion
Closed cervix
History of uterine bleeding, cramping (all products of conception passed)
Managment:
- Expectant
- Medical (uterotonics= methergine, misoprostol)
- Surgical (EVA, MVA)
* risk of another miscarriage goes up, but most women go on to have a healthy pregnancy
36
Incomplete abortion
Open cervix
Uterine bleeding, cramping, passage of some products of conception <20 weeks
Managment:
- Expectant, medical, surgical
* highest risk of post-partum hemorrhage
37
Recurrent abortion
At least 3 pregnancies lost before 20 weeks
ID and treat possible underlying causes:
- Uncontrolled DM
- Uterine synechiae (scarring), defects
- antiphopholipid antibody syndrome (autoimmune disease)
- Chromosomal abnormalities
38
Molar pregnancy
```
Complete= 46 XX (2 sperm, empty egg)- no fetal formation
Incomplete= 69 XXY (2 sperm + 1 egg)- chromosomally abnormal fetus
```
Symptoms= patient "pregnant" but sick (vaginal bleeding, nausea/vomiting, increased BP; disproportionately enlarged uterus, tachycardia, tachypnea, snowstorm ultrasound
Managment: surgical (evacuation) + post-op monitoring of beta-hCG to prevent gestational trophoblastic neoplasia
39
Diagnosis of ectopic pregnancy
Risk factors= prior ectopic pregnancy, tubal surgery, history of PID, in utero DES exposure, cigarette smoking
Symptoms= vaginal bleeding/amenorrhea, pelvic pain, adnexal mass, 50% asymptomatic
Tests= ultrasound (empty uterus), beta hCG monitoring (will not rise appropriately), low serum progesterone
40
Management of ectopic pregnancy
Medical= methotrexate 50 mg/m2 IM
Patient MUST be: hemodynamically stable, can return for follow-up, no contraindications for methotrexate, unruptured, mass < 3.5 cm, no fetal heart activity, beta hCG <15,000
Contraindications to medical managment= breast feeding, immune compromised, abnormal liver/kidney function, sensitivity
Surgical= laproscopic salpingostomy (remove tissue) or salpingectomy (remove tube) or laparotomy
41
Ovarian torsion
Twisting of ovary on blood supply
Unilateral pelvic pain (waxes and wanes until excrutiating), adnexal mass
Risk factors= ovarian cysts, < 30 years old
Treatment: surgical (laproscopy, laparotomy), oophorectomy common
42
Tubo-ovarian abscess (TOA)
Forms at end of tube, enveloping ovary
Symptoms= fever, vaginal discharge, pelvic pain
Diagnosis= cervical motion tenderness, adnexal tenderness, increased WBCs, fever, pus, palpable mass, fluid in pelvis
* confirmed by ultrasound, or finding fluid in pelvis (gold standard diagnosis)
```
Risks= STD infections
Treatment= surgical, drainage +/- removal of tube/ovary; surgical antibiotics
```
43
Abruptio Placenta
Premature separation of placenta
- 3rd trimester bleeding with fetal distress
- Risk factors= cigarette smoking, HTN, abdominal trauma, illicit drug use
- Treatment= c-section, hemodynamic support
44
Non-reassuring fetal testing (NRFT)
Fetal HR monitored to assess acid/base status or oxygenation of tissues
Symptoms= late decelerations, prolonged bradycardia
Causes= prematurity, abruption, uteroplacental insufficiency, umbilical cord compression, infection, congenital anomalies
45
Placenta previa
Placenta implants at base of uterus (near cervix) instead of fundus
- Painless bright red bleeding in 3rd trimester
- Risk factors= previous c-section, multiparity
- Diagnosis= ultrasound
- Treatment= tocolysis, expectant, c-section (induce labor)
* * AVOID digital exam
46
Shoulder dystocia
Delivery of fetal head with failure to deliver shoulder
Risk factors= fetal macrosomia (big baby), gestational diabetes (big baby), rapid labor
Treatment= McRobert's, episiotomy, suprapubic pressure, deliver posterior arm, Wood's corkscrew, Zavenelli maneuver (push baby back in, c-section)
47
Pre-term labor
- Contractions, cervical changes < 37 weeks estimated gestational age
Risk factors- previous pre-term labor, multiple pregnancies, infection, low SES, AA race, drugs, smoking, preterm rupture of membranes, macrosomia/ polyhydramnios
```
Treatment= underlying conditions, bedrest, tocolysis, betamethasone (increase lung maturity)
Tocolytics= magnesium sulfate, terbutaline, procardia (decrease contractions)
```
48
Pre-eclampsia
HTN and proteinuria
- HTN >140/90 after 20 weeks gestation (2+ measurements)
- - Severe HTN >160/110
- Proteinuria= 300 mg protein in 24 hours or 0.1 g/L on spot speciment
- - Severe proteinuria= 5g/24 hour period or dip +3 to +4 + oliguria
*20% of women with chronic HTN develop pre-eclampsia
49
Risk factors for endometrial cancers
Caused by estrogen stimulation, which increases with:
Age, obesity, late menopause (hyper-estrogenic state), high fat diet, DM, HTN, genetics, tamoxifen use (estrogen receptor stimulation in uterus vs supression in breast tissue)
50
Protective factors against endometrial cancers
Pregnancy (50% reduction with first pregnancy)
Use of progesterone (OCP)
Tobacco smoking
51
Genetic endometrial cancer
HNPCC (Lynch syndrome)
- DNA mismatch repair gene mutations
- Lifetime risk of developing endometrial cancer= 50%, ovarian= 10%
- Associated with colon cancer, endometrial cancer at young age
- 2% endometrial cancers due to Lynch syndrome
52
Symptoms of ovarian cancer
Bloating
Pelvic/abdominal pain
Trouble eating/feeling full quickly
Feeling the need to urinate urgently/often
Other: fatigue, upset stomach/heartburn, back pain, pain during sex, constipation, menstrual changes
*Symptoms persisting for more than two weeks warrant prompt medical attention
53
Stages of ovarian cancer
1: ovaries
2: pelvis
3: upper abdominal disease/lymphatic invasion
4: spread elsewhere outside abdominal cavity
54
Ovarian cancer risk factors
```
Women with ovaries
Long ovulation history
Unexplained infertility
Nuliparity
Family history of breast/ovarian cancer
- 90% sporadic, 10% genetic
-- 7% BRCA (40% risk if carrying BRCA1, 20% for BRCA2)
-- 9% for lynch syndrome
Diet
Estrogen replacement therapy?
Talcum powder?
```
55
Protective factors against ovarian cancer
```
Increased parity (decreased ovulations), breast feeding
Later onset of menses, earlier menopause
OCP use
Tubal ligation
Hysterectomy
```
56
Significant family history for ovarian cancer
- 2 first degree relatives with breast/ovarian cancer (1 must be < 30 years
- 1 relative with bilateral breast cancer < 40 years
- 1 male relative with breast cancer
57
Screening for ovarian cancer
Individual has family or personal history of estrogen-related cancer (breast cancer)
- Annual vaginal exam for women 18 and above
- Annual rectovaginal exam for women age 35 and above
- Transvaginal sonography
- Blood test (CA-125 gene): associated with many cancers, diseases, pregnancy, mid-menstrual cycle (therefore only when mass in pelvis- don't screen asymptomatic patient)
- Strategies for Risk reduction in BRCA patients: screening (no reduction in mortality), chemoprevention (but don't want to enhance breast cancer risk), surgery (must remove ovaries AND tubes)
58
BRCA risks for cancer
BRCA 1: remove everything once woman is no longer bearing children
BRCA2: can wait until post-menopausal stage to perform surgery as risk only increases post-menopause
59
Cervical cancer risk factors
```
Early onset of sexual activity
Multiple sex partners
High risk partner
History of STDs
Smoking
Immunosuppression (HIV, transplant)
```
60
Symptoms of cervical cancer
Blood tinged watery discharge
Post-coital bleeding
Painless intermittent spotting
61
Staging of endometrial and ovarian cancer
```
Chest x-ray
Exploratory laparotomy
Peritoneal washing for cytology
Total abdominal hysterectomy
Bilateral salpingo-oophorectomy
Bilateral pelvic, paraaortic lymph node dissection
Omentectomy
```
* Endometrial cancer: 80% diagnosed at stage 1 due to bleeding
* Ovarian: 70% diagnosed at Stage 3, 15% at stage 4
62
Pelvic prolapse
Loss of pelvic floor muscle support causing herniation of viscera into vagina. Can be caused by:
- Vaginal delivery
- Constipation
- Co-morbid medical conditions (obesity)
- Heavy lifting
- Surgery
63
Pelvic Anterior compartment prolapse
Cystocele= central or parvaginal defect
64
Pelvic mid-compartment prolapse
Uterine prolapse, vaginal prolapse, vaginal vault prolapse, enterocele
65
Pelvic posterior compartment prolapse
Enterocele, rectocele
66
Treatments for pelvic organ prolapse
Non surgical= pessary (uses bony pelvis/muscles for support)
Surgical= attach suture material/grafts to bony pelvis to restore anatomy/function
67
Stress urinary incontinence
Etiologies= childbirth, radical surgery, trauma, chronically increased intraabdominal pressure
Scenarios:
1. Lack of support in pelvic floor + abnormal pressure transmission + malposition of urethra--> urine loss
2. Denervation of urethra--> lack of tone--> urine loss
3. Damage to venous plexus and submucosal collagen/elastin--> loss of tone to urethral mucosa--> urine loss
4. Damage to mucosa due to hypoestrogenism/radiation--> no coaptation--> urine loss
Treatments: keigel exercises, providing lost support, restablishing coaptation of mucosa
68
Urge incontinence
People learn to control micturation reflex over time by suppressing detrusor muscle contraction and enhancing urethral sphincter control.
In urge incontinence, there's a denervation of detrusor muscle inhibitory reflex--> disruption of normal voiding
Etiologies= suprapontine lesions (frontal lobe disease, Parkinsonism), pontine lesions (MS, encephalitis), spinal cord lesions (trauma, myelitis), subsacral lesions (spina bifida, cauda equina injury, small fiber neuropathy)
Treatment= Retrain neural pathways, block muscarinic receptors at detrusor muscle (Botox injection--> direct m. paralysis or anticholinergics)
69
Overflow incontinence
Complete denervation of bladder with loss of detrusor function--> inability to contract/expel urine--> overflow
Etiologies= end-stage DM, denervation due to surgery, medications causing muscarinic receptor blockade
Treatment= self-catheterization
70
PCOS
```
Polycystic ovary syndrome
Diagnostic criteria (needs 2/3)
- oligo or anovulation
- hyperandrogenism
- polycystic ovaries
```
Seen with obesity, multiple ovarian cysts, insulin resistance
71
Aging and infertility
Successful pregnancy declines 3.5%/year after 30 (Diminished ovarian reserve) as number and quality of eggs declines
- Spontaneous abortion increases with age; women >40 years have 75% risk of spontaneous risk of abortion
*FSH level testing on day 3 >15mIU/mL--> lower probability of pregnancy
72
Ovulatory disorders causing infertility
1. PCOS
2. Hypothalamic dysfunction (stress, weight change, excess exercise, anorexia)
3. Hypothalamic/pituitary lesions (tumors, trauma, CVA, surgery)
4. Endocrine disorders: hyperprolactinemia, thyroid abnormalities
5. Ovarian lesions: menopause, infections, tumors
6. Inadequate luteal phase (corpus luteum fails to secrete adequate progesterone--> change in blastocyst implantation, survival)
73
Endometriosis and fertility
Can cause fibrosis, adhesions--> tubal function impairment, decreased ovarian access
May also increase prostaglandins/ macrophages in peritoneal fluid
*No test for endometriosis: must biopsy or directly visualize tissue
74
Male disorders causing infertility
```
Testicular diseases (mumps orchitis)
Prostatitis
Epididymitis
Endocrine disorders
Severe medical disorders, drugs
Trauma, surgery
Congenital abnormalities, varicocele (?)
```
*35% of infertility in couples due to single defect with male
75
Tests to determine fertility
```
Urinary LH kit
Basal Body Temperature change at ovulation
Endometrial biopsy
Serum progesterone (above 3ng/mL= ovulation; 15-25 at days 18-22)
Semen analysis (number, MOTILITY, morphology of sperm)
```
76
Clomiphene citrate
Synthetic nonsteroidal estrogen (like DES) that blocks hypothalamus estrogen receptors--> "low estrogen"--> increased GnRH pulse amplitude/frequency--> increased FSH/LH--> ovulation!
ONLY effective in patients with intact hypothalamic-pituitar-ovarian axis
*50-70% pregnancy success, only 5% risk of twin gestation
77
hCG for infertility
Does not requiring functioning hypothalamus/pituitary: causes dominant follicle to release egg, stimulates progesterone release from corpus luteum
* Expensive, difficult to administer, hyperstimulates ovaries/multiple gestation risk increased BUT pregnancy rate 60-70%
78
hMG for infertility
Human menopausal gonadotropin= urinary product (LH and FSH components) from post-menopausal women. VERY potent, given in injection and causes follicle growth/maturation. MUST be given with hCG to induce ovulation
* Expensive, difficult to administer, hyperstimulates ovaries/multiple gestation risk increased BUT pregnancy rate 60-70%
79
FSH for infertility
Stimulates ovarian follicle growth in women without ovarian failure. Must be given with hCG
* Expensive, difficult to administer, hyperstimulates ovaries/multiple gestation risk increased BUT pregnancy rate 60-70%
80
GnRH antagonist administration in infertility
Block action of endogenous GnRH/suppresses pituitary LH/FSH to ensure pituitary exposed to constant GnRH, and allows hMG to be sole source of follicle stimulation
81
In vitro fertilization (IVF)
Woman's ovaries hyperstimulated with gonadotropins + as many eggs as possible aspirated from ovaries under ultrasound guidance. Fertilization in petri dish, incubated to blastocyst, injected into uterus--> implantation. 50-60% success/cycle ($10,000 per cycle)
82
Endometrial cancer types and prognosis
Type 1= 80% of endometrial cancers, related to unopposed estrogen, seen in more caucasian women, stage I/II. Favorable prognosis
Type 2= 20% of endometrial cancers, unrelated to estrogen exposure. Equal incidences among races. More likely Stage III/IV (less differentiated, non-endometrial appearing tissue). Unfavorable outcomes
83
Premature menopause
Ovarian failure before age 35:could be due to genetics (X-chromosome mosaicism), autoimmune (anti-ovarian antibodies), idiopathic
84
Hormonal changes in menopause
Estrogen: greatly decreased
FSH: greatly increased (Inhibin decreased)
LH: moderately increased
Testosterone: moderately decreased
85
Changes to urogenital tract in menopause
Vaginal muscosal atrophy (atrophic vaginitis): dryness, dyspareunia, pruritis
Urothelial atrophy: cystitis, urethritis, urinary frequency, incontinence
86
Non-menopausal causes of vasomotor symptoms
```
Hyperthyroidism
Pheochromocytoma
Carcinoid (Leukemia, pancreatic)
Psychosomatic/stress disorders
Drugs, alcohol
```
87
Hormone Replacement Therapy benefits
Estrogen:
- neuronal growth, synaptic proliferation (mental health benefits)
- Decreases CAD risk in women in peri- to post-menopausal years by 50% (not protective with pre-existing CAD)
- - Improved lipid profile, anti-atherosclerotic, augmentation of vasodilation/anti-platelet aggregation factors, antioxidant
- Prevents osteoporosis
- Prevents vaginal/urothelial atrophy
- Prevents colon cancer
- Relieves vasomotor symptoms
- Prevents tooth loss (?)
88
Adverse effects of estrogen therapy
- Endometrial stimulation: vaginal bleeding, endometrial hyperplasia, carcinoma (add progesterone)
- Venous thrombosis
- Breast stimulation (increased risk of cancer after 4-5 years of use)
- Ovarian cancer
- Coronary risks with established CAD
89
Contraindications to hormone replacement therapy
- Current or past history of breast/ endometrial cancer
- Unexplained vaginal bleeding
- Pregnancy
- Chronic/acute liver disease
- Active venous thrombosis/ thromboembolic disease
90
Non-hormonal treatment of vasomotor symptoms (hot flashes)
- Clonidine (anti-hypertensive)
- SSRIs
- Herbal estrogens, vitamin E
91
Non-estrogen treatment of Osteoporosis
- SERMs (selective estrogen receptor modulator
- Bisphosphonates
- Calcitonin
- Calcium, Vit D, weight-bearing exercise, smoking cessation
92
Estrogen effect on bone
75% of bone loss in first 15 years after menopause due to decreased estrogen
- Estrogen affects intestinal absorption of calcium
- Modulates bone remodeling through antiresorptive effect
93
Post-menopausal osteoporosis clinical effects
Hip fractures, vertebral fractures, back pain, decreased height, kyphosis
- 50% of women over 65 have vertebral compression fractures
- 15% of caucasian women will have hip fracture (300,000 per year in US, 15-20% die within 3 months of fracture)
94
Yolk sac germ cell tumor
Ovarian cancer type: endodermal sinus
- Highly malignant
- Seen in women < 30 years
- See Schiller-Duval body
- Monitor alpha-fetoprotein
- Chemosensitive
95
Choriocarcinoma
Ovarian germ cell carcinoma
- mimics chorionic villi epithelium of placenta
- Seen in prepubertal girls
- Monitor with beta-hCG
96
Dysgerminoma
Ovarian germ cell carcinoma
- Similar to testicular seminoma, poorer prognosis
- 15% bilateral
97
Embryonal carcinoma
Ovarian germ cell tumor:
| Rarely pure germ cell tumor, usually mixed tumor cells
98
Sertoli-Leydig sex cord ovarian tumor
Androgen-secreting tumor
- low malignancy potential
- ressembles embryonal testis
- increased androgens--> virilization
99
Metastatic ovarian tumors
3% ovarian tumors metastasize. Commonly metastasize to:
| - breast, lower GI, endometrium, stomach
100
Krukenberg tumor
metastatic tumor with signet ring features, usually from stomach (metastasizes to ovaries)
101
BRCA and ovarian cancer
2-3% chance of ovarian cancer in general population
BRCA1= 35-60% chance by 70 years
BRCA2= 10-27% chance
Diagnosed 10 years earlier than general population
Recommendation: prophylactic salpingo-oophorectomy at 35 (post-reproductive)
