Repro Flashcards
beta-hCG value of 2000 milli-units/mL or more can be indicative of an ____.
What test is gold standard to determine this - and what results indicative?
ectopic pregancy
If no products of conception are detected within the uterine cavity by transvaginal ultrasound (gold standard radiology in this case).
ACE inhibitors are contraindicated in what type of female?
pregnant
All are DDx of what?
- Ectopic Pregnancy
- Aborting uterine pregnancy/hydatidiform mole
- Ovarian Torsion
- Ovarian cyst
- Appendicitis
- Urinary tract calculi
- Endometriosis
- Adhesions/obstruction
- PID
- IBD (CD)
RLQ abdominal pain in F
What is the GPA system? GTPAL?
Gravida/Para/Abortus
Gravida/Term/Para/Abortus/Live
Failure of serum hCG to ____ every two days indicates possibly what?
fails to double, ectopic pregancy
Abdominal distention and mild paralytic ileus are often present in ___
ectopic pregnancy
what type of ectopic pt?
3.5 cm in largest dimension and unruptured, with no active bleeding and no fetal heart tones.
stable
**Tx of stable v. unstable ectopic pregancy pt.
Stable, tx with methotrexate. Unstable = surgery!
**Methotrexate is CI in what pt?
UNstable ectopic pregnancy!
Initial surgical procedure in ectopic pregnancy.
diagnostic laparoscopy
**When should Rho(D) IMMUNE THERAPY be given to pts?
if they are Rh(-)
OA and AA, S2-S4 pelvic splanchnic are PSNS reflexes for ___ and ___
Ovaries and testes
S2-4 for uterus/prostate/genitalia
T10-L2 is SNS for __ and __
uterus and cervix
What is this? Chronic anovulation (irregular periods: amenorrhea to menorrhagia) Hyperandrogenism (hirsutism) Polycystic ovaries Obese woman with Hyperlipidemia
PCOS
Increased risk of what three things if a woman has PCOS.
Increased risk of DM2 (insulin resistance), CVD, and metabolic syndrome
What drug is beneficial for PCOS?
methotrexate
PID, IUD, smoking at the time of conception, previous C-section - all are risk factors for…
ectopic pregnancy
When do you give whole blood?
can consider in trauma, when needs all components including clotting factors
When do you give PRBC?
Usually the first choice for transfusion due to decreased risk of reaction as compared to whole blood
What is endometriosis?
ECTOPIC ENDOMETRIAL TISSUE
99% of women with endometriosis associated pelvic pain who report sx before 15 (and before 20.2years) also had what?
dysmeorrhea
Endometriosis is associated iwth higher incidence of what sensitivity?
multiple allergic sensitivities
What SD should prompt you to look further into pelvic/endometriosis related dz?
Extended lumbar type II dysfunctions are frequently the product of segmental muscle contraction that results from a viscerosomatic reflex and should prompt the search for visceral disease and dysfunction
What sx indicate possible endometriosis rupture?
abrupt increase in severity and radiation
Women who have a sister or mother with endometriosis are more likely to have _____ endometriosis.
severe rather
than mild or moderate
The genetic predisposition for endometriosis is more
consistent with ______ than with a single mutant gene
polygenic and multifactorial inheritance
Ruptured ovarian cysts may mimic ovarian malignancy bc…
It causes extremely high serum CA-125
In a patient suffering from hemoperitoneum, active bleeding as depicted on CT by the active ____ with a measured attenuation value higher than that of free or clotted blood is indicative _____.
arterial extravasation of intravenous contrast
of the need for prompt surgical intervention
Sx for... DYSMENORRHEA - PELVIC PAIN o DUE TO INTRAPELVIC BLEEDING AND PERIUTERINE ADHESIONS - MENORRHAGIA - HORMONE DEPENDENT - DYSPAREUNIA - LUMBAGO - RECTAL PAIN - DYSCHEZIA - INFERTILITY - INCREASED ALLERGIC REACTIONS - POSITIVE FAMILY HISTORY
endometriosis
exam findings for endometriosis
BEST PERFORMED DURING EARLY MENSES - PELVIC TENDERNESS - NODULES FOUND ON BIMANUAL EXAM o ON UTEROSACRAL LIGAMENT o IN POSTERIOR CUL-DE-SAC - DECREASED UTERINE MOBILITY/RETROVERSION - TENDER/FIXED NODULAR ADNEXAL MASSES - OSTEOPATHIC FINDINGS o SOMATIC DYSFUNCTION LUMBAR SPINE o CHAPMAN’S POINTS - LESS COMMON - HEMORRHAGIC CYSTS OBSERVED ON CERVIX
Endometriomas look like what on transvaginal sono?
homogenous cysts
Best way to dx endometriosis
surgical confirmation - laparoscopic biospy and visual lesions.
what are the classic visual and biopsy findings in endometriosis?
Biopsy - endometrial glands and stroma
Visual - black powder burns
Potential complications of endometriosis
PROGRESSIVELY WORSENING COURSE
o IMPLANTS SPREAD TO PELVIS, GI TRACT, URINARY TRACT, ILIOPSOAS MUSCLES, LUMBAR SPINE
What is the coelom?
CAVITY BETWEEN SPLANIC AND SOMATIC MESODERM IN THE EMBRYO FORMS THE LINING OF THE GENERAL BODY CAVITY IN THE ADULT DERIVES FROM MESOTHELIUM
how is coelomic metaplasia of multipotential cells in the peritoneal cavity a possible etiology of endometriosis?
- A single layer of flattened cells forming an epithelium that lines serous cavities; e.g., peritoneum, pleura, pericardium
- From which Mullerian ducts and endometrium originate
How is metaplasia a possible etiology of endometriosis?
Most common etiology of etiology is retrograde flow*
MESONEPHRIC REMNANTS MAY UNDERGO ENDOMETRIAL DIFFERENTIATION AND GIVE RISE TO ECTOPIC ENDOMETRIAL TISSUE - mesoephros or mullerian ducts
two cancers with increased incidence with endometriosis
Clear cell ovarian cancer, endometrioid cancer.
Significant genetic mutations in endometriosis
PTEN, ARID1A
Sx of?
Lower abd pain, pain during or shortly after menses, new vaginal discharge, dyspareunia, abnormal bleeding, pain with jarring movement.
PID
2 most important sexually transmitted organisms associated with acute PID
Chlamydia trachomatis, Neisseria gonorrhoeae
Indications for hospitalization in PID
Pregnancy, lack of response to tx, nonadherence, inability to take oral meds due to N/V, severe clinical illness
(fever, severe pain, vomiting), complication with abscess, possible need for surgical intervention or exploration.
What is this?
infection of liver capsule and peritoneal surfaces of the
RUQ, minimal stromal hepatic involvement. Patchy purulent fibrinous exudate – “violin string” adhesions
Fitz-Hugh Curtis Syndrome - a complication of PID, 10% of PID pts have perihepatitis
Long term sequelae of PID
infertility, ectopic pregnancy, chronic pain
STD risk factors that increase risk of developing PID
young age at first sex, nonbarrier contraception, multiple sexual partners
What do these factors do?
Previous PID, Sex during menses, vaginal douching, BV, IUD
potentially facilitate PID
Tx of PID
Second generation cephalosporin and doxycycline (Azithromycin also has activity against C. Tracomatis and is
sometimes used in place of doxycycline). Other options include: clindamycin and gentamicin combination.
Buzzword: IUD - think what bug?
anaerobic actinomyces
What complication of PID has to be tx inpatient with clindamycin or metronidazole(anaerobic coverage: “below the diaphragm”) OR outpatient tx - anaerobic coverage.
pelvic abscess
