Reproductive Flashcards
dysmenorrhea occurs due to the release of:
prostaglandins
abnormal uterine bleeding can be attributed to the lack of corpus luteum that produces:
progesterone
dermoid cysts contain:
all 3 embryo layers
simple cysts have ______:
clear
dermoid cysts are potentially:
cancerous
vaginal prolapse of posterior bladder due to weakening of vaginal wall
cystocele
prolapse of the rectum into the posterior vaginal wall
rectocele
ovarian cancer has often ________ prior to diagnosis
metastasized
The epithelial, stromal, adipocytes, or vascular parts of the breast may be affected by _______
benign breast disease
ovarian cancer has often ________ prior to diagnosis
metastasized
Changes that occur in \_\_\_\_\_\_ breast disease: ● Irregular lumps ● Cysts ● Sensitive nipples ● Itching
Benign
Common Reported Symptoms of _______:
pain
palpable mass
nipple discharge
benign breast disease
Examples of ________:
▪ Simple cysts
▪ Fibrocystic changes
▪ Simple fibroadenomas
benign breast lesions
Most common non-proliferative breast disease that are fluid-filled sacks occuring in women in 30s, 40s, and early 50s
***feel “squishy” when they appear closer to the breast, but feel firm when they are deep in the breast tissue
Simple cysts
excessive hair growth
hirsutism
pelvic inflammatory disease is caused by ______
multiple different microbes
prolonged ROM in mothers with gonorhhea, the babies need to be treated to prevent _______
blindness
what STD will cause pneumonia in newborns passed through birth?
chlamydia
o Physiologic nodularity – Terms such as fibrocystic changes (FCCs) (or physiologic nodularity and cysts), fibrocystic disease, chronic cystic mastitis, and mammary dysplasia refer to non-proliferative lesions that are not clinically definitive b/c they encompass a heterogeneous group of diagnoses.
o Incidence probably r/t systemic factors such as hormonal changes, will see in clients right before they are due to get their period – after they begin menstruating, symptoms will dissipate.
o Symptoms influenced by genetic background, age, parity, hx of lactation, caffeine consumption, use of exogenous hormones
Fibrocystic Changes in Breast
o Benign, solid lumps or masses composed of stromal and glandular tissue
o Well-defined mobile solid mass upon US
o Smooth/hard like a marble on physical exam
o Common, common ages 15-35 years, can occur at any age (older women receiving hormone therapy possibly)
o Etiology is unknown, hormonal role is likely b/c they persist thru reproductive years, increase in size during pregnancy or estrogen therapy and usually regress after menopause
o Increase in size
o No increased risk of breast cancer in majority of women
Simple Fibroadenomas
cysts that may occur at any time during lifespan – most commonly occur during reproductive years (at the extremes of those years)
o An increase occurs when there are hormonal imbalances
▪ More likely during puberty & menopause
o Can occur during fetal development and throughout childhood
o 4th leading diagnosis for gynecologic hospital admissions
Benign Ovarian Cysts
The 2 common causes of benign ovarian enlargement in ovulating women:
● These cysts are functional cysts – result of variations of normal physiologic events and are
● Often asymptomatic
● Usually unilateral 5-6cm diameter as large as 8-10 cm
● Produced when a follicle or number of follicles are stimulated but no dominant follicle develops and completes maturity process.
Follicular Cysts & Corpus Lutetium Cysts
These cysts can be caused by a transient condition in which the dominant follicle fails to rupture or one or more of the nondominant follicles fails to regress.
o A type of functional cyst
o 5-6cm diameter as large as 8-10 cm
o Every month about 120 follicles are stimulated, but in most cycles only 1 follicle results in a mature ovum
o During the early follicular phase of the menstrual cycle, follicles of the ovary respond to hormonal signals from the pituitary gland.
o A small cyst on the ovary during the follicular phase is normal
o After several subsequent cycles when hormone levels follow a regular cycle & progesterone levels are restored, cysts usually are absorbed or regress.
o Follicular cysts can vary in size & symptoms from one episode to the next & can often recur
o Most are fluid-filled
o The more solid, the greater chance of being malignant
Follicular Cyst
CM of ______:
bloating
swollen/tender breasts
heavy or irregular menses
Follicular Cyst
Cysts formed by the granulosa cells left behind after ovulation
o Highly vascularized cyst that spontaneously regresses as part of normal menstrual cycle
o An abnormal or hemorrhagic cyst may develop b/c of a hormonal imbalance
o Low luteinizing hormone (LH) and progesterone levels cause an inadequate development of the corpus luteum
o Large cysts can rupture, causing hemorrhage & excruciating pain
o Usually resolve spontaneously in non-pregnant women; a persistent corpus luteum cyst is a normal finding within first trimester of pregnancy since it produces progesterone to support pregnancy until placenta is established
o Less common than follicular cysts, but typically cause more symptoms, esp. if they rupture
Corpus Luteum Cyst
CM of _______:
dull, unilateral pelvic pain
amenorrhea or delayed menstruation
followed by irregular or heavier than usual bleeding
Corpus Luteum Cyst
Ovarian teratomas that o contain elements of all three germ layers; o they are common ovarian neoplasms. o May contain: ▪ Skin ▪ Hair ▪ Sebaceous & sweat glands ▪ Muscle fibers/cartilage ▪ Teeth/bone o Usually asymptomatic o Found incidentally on pelvic exam o Should be carefully evaluated for removal b/c of malignant potential
Dermoid Cyst
o Benign smooth muscle tumors in the myometrium (the smooth muscle tissue of the uterus)
o Most common benign tumors of uterus and affect as many as 70-80% all women
o Asymptomatic usually & clinically insignificant
o Prevalence increases in women ages 30-50 but decreases w/menopause
o Incidence in black/Asian women is 2-5x higher than in white women & age of onset 10 yrs earlier
o Complications r/t leiomyomas are primary reason for gynecologic hospitalizations & account for 30% of all hysterectomies in women less than 40
o Size appears to be r/t estrogen, progesterone, & growth factors but etiology unknown.
o Possibly genetic component
o Not seen before menarche
o Those that develop during reproductive years decrease in size after menopause
o B/c they occur at times of estrogen exposure, tumors may enlarge rapidly but often decrease in size after the end of pregnancy
Leiomyomas aka Myoma or Uterine Fibroids
Risk Factors for \_\_\_\_\_\_: nulliparity obesity PCOS African American race postmenopausal hormone use HTN
Leiomyomas aka Myoma or Uterine Fibroids
Patho of _______:
Most occur in multiples in the fundus of the uterus, although may occur singly & throughout uterus
▪ Classified according to their location within layers of uterine wall:
● Subserous
● Submucous
● Intramural
▪ Usually firm & surrounded by connective tissue later
▪ Unlike cancer, unable to cause blood vessel proliferation to promote their growth. When it outgrows its blood supply, it degenerates & the subsequent tissue necrosis does cause severe pain for woman
Leiomyomas aka Myoma or Uterine Fibroids
CM of ______:
▪ Abnormal uterine bleeding
▪ Pain (not an early symptom, but if it degenerates, will experience excruciating pain)
▪ Pressure symptoms (on bladder – frequency, urgency, dysuria; constipation)
▪ May distort the uterine cavity and increase the endometrial surface area. This increase may account for the increased menstrual bleeding that is associated with leiomyomas.
▪ Slow-growing, making symptoms slow to develop
▪ May contribute to infertility and subfertility
Leiomyomas aka Myoma or Uterine Fibroids
The presence of endometrial tissue within the uterine myometrium
o Endometrial cells migrate into the myometrial layer thru unknown mechanisms
▪ Estrogen and progesterone likely play a role
o Unlike endometriosis, this tissue does not respond to cyclic hormone changes
o Found during late reproductive years
o Usually diagnosed after hysterectomy
o Women diagnosed are usually not of childbearing age
▪ Those with this that become pregnant are at risk for poor outcomes:
● Preterm labor
● Preterm premature rupture of membranes
● Low birth weight
Adenomyosis
Risk Factors for ______:
Parit
History of uterine surgery.
Adenomyosis
CM of \_\_\_\_\_\_: ***may be asymptomatic ▪ Abnormal menstrual bleeding ▪ Dysmenorrhea (menstrual cramps) ▪ Dyspareunia (painful intercourse) ▪ Uterine enlargement ▪ Uterine tenderness during menstruation ▪ Chronic pelvic pain ▪ Infertility ▪ Secondary dysmenorrhea becomes increasingly severe as disease progresses o Pelvic exam: uterus is diffusely enlarged (2-3x expected size), globular, & most tender just before or after menstruation.
Adenomyosis
The presence of functioning endometrial tissue or implants outside the uterus
o Like normal endometrial tissue, the ectopic (out of place) endometrium responds to the hormonal fluctuations of the menstrual cycle
o Incidence: Primary affects younger or premenopausal women peak incidence in 30s. However,
▪ Overall incidence is difficult to determine particularly in asymptomatic adolescent and fertile women
▪ 11% asymptomatic women have it;
▪ 50% of women evaluated for pelvic pain, infertility, or a pelvic mass are diagnosed w/this
o 3rd most common reason for hysterectomy
o Women are at higher risk for cancer, esp. ovarian cancer
o Common sites of implantation include the pelvic peritoneum, ovaries, & uterosacral ligaments
Endometriosis
Theories of Etiology of _______:
▪ Impaired cellular and humoral immunity
▪ Endometrial cells may spread outside the uterus during fetal organogenesis
▪ Genetic predisposition
▪ Disruption of gene expression during embryogenesis that is responsible
▪ Transportation
▪ Autoimmune response
Endometriosis
Patho of ________:
Endometrial implants can occur throughout the body but generally occur in the pelvic and abdominal cavities
▪ Most common sites of implantation: ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum
▪ Other sites include: sigmoid colon, small intestine, rectum, appendix, bladder, uterus, vulva, vagina, cervix, lymph nodes, extremities, pleural cavity, lungs, laparotomy scars, hernial sacs.
▪ The growth of endometrial lesions depends on estrogen exposure.
▪ Endometrial lesions are affected by ovarian hormones in the same manner as endometrial tissue within the uterus, w/exception of marked progesterone resistance of the endometriosis cells.
▪ Cyclic changes depend on vascularity/blood supply of the lesion and the presence of glandular and stromal cells.
▪ If blood supply sufficient: ectopic endometrium proliferates, breaks down, and bleeds with the normal menstrual cycle
▪ Bleeding causes inflammation, triggering a cascade of cellular inflammatory mediators including cytokines, chemokines, growth factors, and protective factors such as secretory leukocyte protease inhibitor and superoxide dismutase.
▪ The inflammation may lead to fibrosis, scarring, adhesions, and pain
Endometriosis
CM of _________:
can mimic other disease processes (PID, IBS, ovarian cysts)
▪ Symptoms variable in frequency/severity
● Pain
Infertility (25-40% of women)
▪ Dysmenorrhea
▪ Dysuria (painful urination)
▪ Dyschezia (pain on defecation)
▪ Dyspareunia (pain on intercourse)
▪ May also report constipation & abnormal vaginal bleeding
▪ If implants are located within pelvis, may cause asymptomatic pelvic mass & have irregular, movable nodules and a fixed, retroverted uterus
▪ Link w/ infertility is strong, but degree of disease and infertility is not as closely associated
Endometriosis
Reasons for Infertility w/ _________:
may result from mechanical interference w/ovulation or ovum transport thru fallopian tube b/c of adhesions & the effects of inflammation & cytokine activity
● Infertility could be result of autoimmune disorder that caused endometriosis
● Conflicting reports re: effect of endometriosis on sperm activity
o Increased phagocytosis of spermatozoa by macrophages has been observed
● Uterine endometrium in women w/endometriosis appears to have an overactive response to estrogen and an underactive response to progesterone, impairing the endometrial receptivity to blastocyst implantation, decreasing the chance of successful pregnancy
● Women w/endometriosis who achieve pregnancy naturally or thru IVF seem to be at higher risk for poor obstetric outcomes: preterm birth, small-for-gestational-age babies, placental complications
Endometriosis
the line where squamous epithelium & columnar epithelial cells meet that is very vulnerable to the oncogenic effects of HPV, & where carcinoma in situ is likely to develop
Transformation Zone
CM of _______:
***predominantly asymptomatic
▪ Bleeding is variable and may occur after intercourse or between menstrual periods
▪ Vaginal discharge is a less common presenting symptom and may be serosanguinous or yellowish with a foul odor.
▪ Bleeding and discharge are subtle and are likely to be disregarded by premenopausal women (they are more likely to seek tx if these signs appear)
▪ Advanced disease may cause urinary or rectal symptoms & pelvic or back pain along with anemia
Cervical Cancer
Carcinomas that arise within the glandular epithelium of the uterine lining
o Occurs mostly in postmenopausal women w/peak incidence in late 50s & 60s
o Women have a 3% lifetime risk of developing uterine cancer
o Mortality rates in black women > white women
Endometrial Cancer
Risk Factors for ________:
prolonged exposure to estrogen without the presence of progesterone(unopposed estrogen) – Exposure includes:
▪ Estrogen-only hormone replacement therapy
▪ Tamoxifen use
▪ Early menarche
▪ Late menopause
▪ Never having children
▪ Failure to ovulate
▪ PCOS & anovulatory cycles typical of the late reproductive years
o Obesity is another risk factor (known source of endogenous estrogen)
-couldn’t really find patho or genetics – although women w/family hx of colon, endometrial, or ovarian cancer may wish to explore genetic testing & more aggressive screening
Endometrial Cancer
CM of _______:
abnormal vaginal bleeding caused by disruption of the endometrial surface by neoplastic processes
Pain and weight loss are late signs
Endometrial Cancer
Screening for ______:
Transvaginal ultrasound (TVUS) may be used (if endometrium is abnormally thick, further testing warranted)
▪ PAP are not effective at detecting
Endometrial Cancer
Screening for ______:
Transvaginal ultrasound (TVUS) may be used (if endometrium is abnormally thick, further testing warranted)
▪ PAP are not effective at detecting
Endometrial Cancer
Risk Factors for _______:
increased ovulation over the lifetime, such as early menarche, late menopause, & nulliparity
▪ Hx of endometriosis
▪ Genetic component – BRCA1 & BRCA2 mutation have 40-60% lifetime risk. Women with this gene tend to be diagnosed approximately 10 years before women w/out genetic predisposition
▪ Factors that suppress ovulation decrease the risk and include:
● Pregnancies
● Prolonged lactation
● Use of hormonal contraceptives that limit ovulation (including birth control pill)
▪ Tubal ligation and hysterectomy and specifically retrograde menses around the ovary
Ovarian Cancer
Patho of _______:
Controversy about pathogenesis
▪ Great majority are sporadic and not associated w/a known pattern of inheritance
▪ Of the 20% of cancers that are familial, the majority are associated w/ the BRCA1 and smaller # w/mutations of BRCA2
Ovarian Cancer
CM of _______:
is commonly asymptomatic until the tumors have grown very large
▪ There is no sensitive and specific test and screening for low-risk women & routine screening of women w/out risk factors has not been shown to be beneficial, & may cause harm b/c more women may have unnecessary surgical prodcedures
▪ Common first symptoms are vague &include:
● Persistent abdominal distention
● Loss of appetite due
● Pelvic pain
▪ Symptoms of advanced disease include:
● Pain
● Abdominal swelling from the primary ovarian mass
● Ascites
● Abdominal distention
▪ GI manifestations include:
● Dyspepsia
● Vomiting
● Alterations in bowel habits caused by mechanical obstruction
*** The disease is most commonly diagnosed after metastasis has occurred
Ovarian Cancer
● Irritation of the vagina
● Caused by variety of micro-organisms, irritants or pathogens, or disruption of normal flora
● When looking at discharge with normal saline prep, we see an increase in WBC or abnormal foreign cells or both
● Most common are BV (Bacterial vaginosis) and yeast
Vaginitis
Clinical manifestations of \_\_\_\_\_\_\_\_: vaginal irritation odor itching abnormal discharge.
Vaginitis
Causes of ______:
● The majority of causes are overgrowth of normal flora, STDs, or infection, and vaginal irritation from low estrogen during menopause.
● Changes in vaginal pH may predispose women to infection. Substances and conditions that alter pH include: soaps, spermicide, douches, feminine hygiene sprays, deodarants, semen, menstrual pads and tampons.
Conditions that are associated with increase glycogen content of vaginal secretions such as pregnancy and DM contribute to inflammation.
● Abx can cause disruption with normal flora and allow overgrowth of candida albicans that then causes yeast infection.
Vaginitis
common vaginal infection caused by Gardnerella vaginalis, Mobiluncus species, or mycoplasma hominis……
mostly see a thin gray malodorous discharge with a pH of 5 to 5.5 or greater. Some describe as a fishy odor
Bacterial Vaginosis
flagellated, anaerobic protozoan that causes vaginitis.
Trichomonas Vaginalis
Inflammation of 1 or both of the ducts that lead from the introitus or vaginal opening to the Bartholin or greater vestibular glands.
● The usual cause is microorganisms that affect the lower female reproductive tract such as streptococci, staph and STDs.
● Infection or trauma causes inflammation that causes narrowing of the distal part of duct that leads to stasis and obstruction of glandular secretions.
● The cyst varies from 1-8cm in diameter. Located in posterior-lateral portion of the vulva. Cyst may be reddened and painful and puss may be visible at the duct. Exudate should be tested for Gonorrhea and chlamydia. Women may experience symptoms of the initiating infection such as fever and malaise.
● Diagnosis is based on clinical manifestations and identification of infectious organism. Most are asymptomatic and require no treatment in women <40 years
Bartholinitis aka Bartholin cyst.
acute inflammatory process caused by infection and effects approximately 800k-1 million women per year and may involve any or all organs in upper genital tract-uterus, fallopian tubes, and ovaries. In it’s most severe form, the entire peritoneal cavity
Pelvic Inflammatory Disease (PID)
Inflammation of the fallopian tubes
salpingitis
Inflammation of the ovaries
oophritis
Patho of _______:
o Most pathogens migrate from vagina to the uterus to the fallopian tubes to the ovaries
o It has immediate and long term complications for women. Upper reproductive tract infections cause change to the delicate cells of the uterine and fallopian tubes which can effect fertility and increase chance of ectopic pregnancy.
o Caused when defense mechanisms fail. Virulence of organism, size of inoculum, and defense status of woman determine if infection results.
o Anaerobic bacteria have been implicated in increasing risk because they alter the pH of the vaginal environment and may cause decrease in the integrity of the mucous blocking the cervical canal.
o Bacterial vaginosis is present in up to 66% of cases
o E-Coli may contribute for older women.
o Although Chlamydia and Gonorrhea are the main pathogens, the disease is really poly-microbial. Treated with broad spectrum abx.
Pelvic Inflammatory Disease (PID)
CM of _______:
vary from sudden to severe abdominal pain with fever to no symptoms.
o Asymptomatic cervicitis with or without discharge may be present before development
o The first sign may be the onset of low bilateral abdominal pain… characterized as dull and achy with gradual onset
Symptoms usually develop during or after menstruation.
o Increased pain with walking, intercourse, or other activities involving movement.
o May have dysuria
dyspareunia (pain with intercourse)
irregular bleeding.
Pelvic Inflammatory Disease (PID)
