Reproductive 8% Flashcards
Dysfunctional uterine bleeding
Excessive uterine bleeding with no demonstrable organic cause:
Polymenorrhea (cycles with intervals of 21 days or fewer),
menorrhagia (abnormally heavy or prolonged bleeding) and/or
metrorrhagia (uterine bleeding at irregular intervals)
Dysfunctional uterine bleeding diagnosis; treatment
Diagnosis of exclusion;
treat with oral contraceptives and NSAIDs
Endometrial cancer
Postmenopausal vaginal bleeding;
most common GYN malignancy - usually adenocarcinoma.
Endometrial cancer diagnosis
Endometrial biopsy - vaginal bleeding in post menopausal women is CA until proven otherwise.
Endometrial cancer treatment
Hysterectomy bilateral salpingo-oophorectomy +/- radiation.
Endometriosis
A disease in which the kind of tissue that normally grows inside the uterus grows outside the uterus. It can grow on the ovaries, fallopian tubes, bowels, or bladder. Rarely, it grows in other parts of the body. A benign disease related to the menstrual cycle, usually cyclical
Endometriosis findings
Uterus is fixed and retroflexed. Tender nodularity of cul de sac and uterine ligaments.
Endometriosis diagnosis; treatment
Laparoscopy: Chocolate cysts observed. Definitive study.
Treatment: Resect endometriosis, oral contraceptive therapy.
Endometriosis associated with the 3 D’s:
Dyspareunia (painful intercourse),
dyschezia (difficulty in defecating),
dysmenorrhea
Leiomyoma
Also known as fibroids, is a benign smooth muscle tumor that very rarely becomes cancer (0.1%).
Leiomyoma presentation
Black women, family history.
Abnormal uterine bleeding; polymenorrhea, menorrhagia, intermenstrual bleeding and/or metrorrhagia along with urinary symptoms (eg, urinary frequency or urgency).
Uterine mass.
Leiomyoma diagnosis; treatment
Ultrasound: Intramural fibroids are most common. Definitive treatment: myomectomy or hysterectomy.
Prolapse presentation
Caucasian women, after labor/delivery, chronic cough. Vaginal fullness, abdominal pain worse late in day, after prolonged standing. Relieved by lying down.
Prolapse, uterus
Prolapse of the uterus into the vaginal canal - graded by uterine descent: 0°- No descent. 1° - descent between normal and ischial spine. 2°- between ischial spines and hymen. 3°- within hymen. 4° - through hymen.
Prolapse, bladder
Prolapse of the bladder into the front wall of the vagina (cystocele) - leads to a “reservoir effect” where the bladder is not completely emptied when the urine is passed.
Prolapse, rectum
Prolapse of the rectum into the back wall of the vagina (rectocele) - complain of a sensation of bulging in the vagina when they strain to open their bowels.
Ovarian Cysts
Pain, menstrual delay, hemorrhagic shock from cyst rupture. Follicular cysts are most common.
Ovarian Cysts diagnosis; treatment
Ultrasound.
Observe - Most resolve within 6-8 weeks (2 menstrual cycles). Persistent cysts, large cysts (>6 cm) or complex cysts can be removed.
PolyCystic Ovary Syndrome (PCOS)
Obesity, hirsutism, acne, amenorrhea or oligomenorrhea, menarche occurs at expected age. Strongly associated with obesity, acanthosis nigricans, insulin resistance and hyperinsulinemia.
PolyCystic Ovary Syndrome (PCOS) diagnosis; treatment
Ultrasound: String of pearls. Labs: LH:FSH > 2.0, increased androgens, increased testosterone.
Treat with oral contraceptives, metformin.
Ovarian Neoplasms
Patient in mid-50’s with abdominal fullness, bloating, fatigue, weight loss and ascites.
Ovarian Neoplasms diagnosis; treatment
Tumor marker: CA 125, second most common gynecological cancer (first is endometrial).
Asymptomatic premenopausal patients with simple ovarian cysts < 10 cm in diameter can be observed or placed on suppressive therapy with oral contraceptives.
Postmenopausal women with simple cysts < 3 cm in diameter may also be followed, provided the serum CA 125 level is not elevated and the patient has no signs or symptoms suggestive of malignancy. If the cyst is > 3 cm or the CA 125 is elevated, further evaluation is necessary.
Cervical cancer exam
Friable, bleeding cervical lesion.
Cervical cancer etiology
Squamous cell carcinoma. Most caused by HPV (High risk types, 16 and 18).