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Clin med sem 2 > Uterus/FT > Flashcards

Uterus/FT Flashcards

1
Q

PCOS- pathophysiology

A

Most Common endocrinopathy in females

Insulin resistance?

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2
Q

PCOS- S/S & PE

A 
Abnormal menstrual cycle
Terminal hair - hirsutism 
acne
Alopecia
Acanthosis nigricans
Skin tags
Truncal obesity

Stein Leventhal Syndrome - anovulation/hyperandrogenism, oligomenorrhea/amenorrhea, hirsutism, obesity, enlarge polycystic ovaries, infertility

Anovulation

  • persistent high concentration of LH
  • low concentration of FSH
  • Low day 21 progesterone level
  • Sonographic follicular monitoring
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3
Q

PCOS- diagnosis

A

Rotterdam criteria - 2 of 3

  • Hyperandrogenism
  • ovulary dysfunction
  • polycystic ovaries

U/S
Ovary containing 12+ follicles sized 2-9mm OR
Ovary >10mL

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4
Q

PCOS- labs & imaging

A

Serum androgen - inc

LH - inc
FSH - dec
- inc ration 3:1

U/S - multiple cysts on ovaries

Lipids

A1C - insulin resistance

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5
Q

PCOS- treatment

A

OCP - irregular menses/acne
Metformin - hyperglycemia
Wt Loss
Clomiphene - ovulation stimulant

Chronically anovulatory

  • endometrial hyperplasia - progesterone - refer to GYN
  • Repeat U/S
  • endometrial biopsy
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6
Q

Dysmenorrhea- pathophysiology

A

Painful menstruation

Prevents nl activity and requires meds

Associated w/ ovulatory cycles
Prostaglandin activity

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7
Q

Dysmenorrhea- cause

A

Primary - excessive prostaglandin E2 secretion in menstrual fluid -> painful cramping
- starts 3-6m after menarche

Secondary - pathologic

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8
Q

Dysmenorrhea- S/S & PE

A

History

Primary

  • No specific findings
  • generalized pelvic tenderness
  • N/V, diarrhea
  • Fatigue, low back pain, HA
  • 1st day of menses

Secondary

  • Pain lasts longer than a menstrual period
  • starts before bleeding begins - worse throughout - persists after
  • > 25yo
  • blatting, menorrhagia, dyspareunia
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9
Q

Dysmenorrhea- labs & imaging

A

Labs - primary -> nl

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10
Q

Dysmenorrhea- treatment

A 
NSAIDs
Heat to abdomen
Oral contraceptives
Exercise
Transcutaneous electrical nerve stimulation 
Surgery
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11
Q

Abnormal Uterine Bleeding - in reproductive aged women- pathophysiology

A

Abnormal menstrual bleeding and bleeding due to causes - preg, systemic, cancer

If exclude everything -> dysfunctional uterine bleeding

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12
Q

Abnormal Uterine Bleeding - in reproductive aged women - cause

A 
PALM - COEIN
Polyp
Adenomyosis
Leiomyoma
Malignancy + Hyperplasia
Coag
Ovulatory Dysfunction
Endometrial 
Iatrogenic
Not otherwise classified
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13
Q

Abnormal Uterine Bleeding - in reproductive aged women - epidemiology

A

Any age

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14
Q

Abnormal Uterine Bleeding - in reproductive aged women - S/S & PE

A

Bleeding b/t periods, after intercourse, spotting anytime in menstrual cycle, bleeding heavier or for more days than normal, bleeding after menopause

Good Hx

  • LMP, LNMP
  • age of menarche/menopause
  • etc
PE
Speculum
Bimanual Exam 
Eval for other bleeding sites 
Pap
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15
Q

Abnormal Uterine Bleeding - in reproductive aged women - diagnosis

A 
Cytological exam 
- pap - cervical dysplasia
Hysteroscopy - GOLD
- direct visualization of endometrium 
D&C
- remove tissue from uterus
- diagnose and treat certain uterine conditions - heavy bleeding or clear uterine lining after miscarriage/abortion
- local anesthesia
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16
Q

Abnormal Uterine Bleeding - in reproductive aged women - labs & imaging

A 
"\Urine/Serum HCG
CBC
TSH
Hormone - prolactin, androgen, estrogen 
Endometrial biopsy ->45
- curette, cervical dilation not always needed
- small samples of tissue removed from endometrium
- looked at under microscope
- may need a D&C

Transvaginal U/S or Saline infusion sonohysterography

  • only if palpated mass on PE
  • persisting
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17
Q

Abnormal Uterine Bleeding - in reproductive aged women - treatment

A

Treat underlying problem

Mirena - IUD
OCA - estrogen + progestin
PO progestin
Tranexamic acid  - safe when trying to get preog
Myomectomy and uterine artery emboization 
Polypectomy
Hysterectomy
Endometrial ablation
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18
Q

Postmenopausal bleeding- pathophysiology

A

Menopause - 12m of amenorrhea

  • FSH>30
  • estradiol <20
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19
Q

Postmenopausal bleeding- epidemiology

A

Exogenous hormones

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20
Q

PMS- S/S & PE

A

Mood symptoms - irritability, mood swings, depression, anxiety
Physical symptoms - bloating, breast tenderness, insomnia, fatigue, hot flashes, changes in appetite
Cognitive symptoms - confusing and poor concentration
Symptoms must occur in sec half of menstrual cycle - luteal phase

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21
Q

PMS- diagnosis

A

5days prior and 4 days after menses

S/S consistent

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22
Q

PMS- labs & imaging

A

CBC
TSH
Pregnancy

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23
Q

PMS- treatment

A

Do all mammograms post cycle

Psych hx

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24
Q

Premenstrual dysphoris disorder (PMDD)- diagnosis

A

5 or 11present

  • marked dpressed mood, feelings of hopelessness
  • marked anxiety, tension, feelings,
  • affective lability
  • persistent/marked anger
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25
Premenstrual dysphoris disorder (PMDD)- treatment
SSRI - GOLD - Fluoxetine - Prozac - Sertraline - Zoloft - Paroxetine controlled-release - Paxil CR - daily 14d prior to menses CBT NSAID Vit Bromocriptine OCA Benzos Spironolactone Lifestyle mod - caffeine, dec ETOH, smoking etc, salt restriction, inc exercise
26
Leiomyoma (Uterine Fibroid)- pathophysiology
Common, benign uterine tumor Smooth muscle and connective tissue Depend on estrogen Classified by location - subserous, intramural, submucous, intraligamentous, pedunculated, parasitic
27
Leiomyoma (Uterine Fibroid) - S/S & PE
Discrete, round firm uterine mass Asymptomatic Menorrhagia, metrorrhagia, intermenstrual bleeding, dysmenorrhea Bleeding - most common presenting S/S anemia Infertility - distort uterine cavity
28
Leiomyoma (Uterine Fibroid) - labs & imaging
``` Pelvic U/S D&C Saline Hysteroscopy Hysterosalpingography - die injected into uterus and fallopian tubes Lapaorscopy Pelvic MRI/CT ```
29
Leiomyoma (Uterine Fibroid) - treatment
Observation - mild symptoms Myomectomy or D&C - symptomatic Depo-provera - medroxyprogesterone acetate - 150mg IM every 28d - can have bleeding at times Danazol - synthetic modified testosterone - 400-800mg daily - put pt in amenorrhea, usually before surgery Uterine arterial embolization or endometrial ablation - if they don't want kids Hysterectomy - final step
30
Endometriosis- pathophysiology
Endometrial tissue found outside of endometrial cavity Common locations - ovaries - uterosacral ligament - GI tract - lungs/brain 3 theories - Retrograde menstruation - reflux of endometrial cells -> peritoneum -> ovary - Vascular & lymphatic dissemination - Transformation of peritoneal cells -> endometrial cells Genetic - 7-9% have 1st deg relative - HLA-B7 allele Stimulated by hormones
31
Endometriosis- cause
Early - implants are red, petechial lesions on peritoneal surface Older - dark brown, blue, black implants - filled w/ menstrual debris Surround tissue - thick and scarred Adhesions developed -> bowel obstruction On ovaries - endometriomas ""Chocolate Cysts"" - old menstrual blood - grow in several cm - erodes into underlying tissue
32
Endometriosis - epidemiology
20-30 Infertile W ``` Fmhx Early menarche Long duration of menstrual flow Heavy bleeding Shorter cycles ```
33
Endometriosis- S/S & PE
3Ds - Dysmenorrhea, Dyspareunia, dyschezia Asymptomatic -> severe pelvic pain - deep pain from infiltrating lesions Infertility PE - tender nodules in posterior vaginal fornix - pain w/ uterine motion - Tender adnexal masses - nothing
34
Endometriosis- diagnosis
Tissue biopsy - laparoscopy | - direct visualization
35
Endometriosis- treatment
``` Depends on severity, location, desire for prego Observation NSAIDs - for discomfort Surgery - conservative or definitive Med treatment - OCP - IUD - Progesterone therapy - Danazol - 19-nortestosterone derivative - GnRH agonist - lupron ``` Pregnancy - dec/improved symptoms - doesn’t cure Hysterectomy
36
Endometriosis- prognosis
Dec risk - >4hr/wk exercise - higher parity - longer duration of lactation
37
Adenomyosis- pathophysiology
Endometrial tissues exist w/in and grows into muscular wall of uterus
38
Adenomyosis - epidemiology
Middle age, severe dysmenorrhea, hx of childbearing, symmetrically enlarged uterus, menorrhagia
39
Adenomyosis - S/S & PE
``` Asymptomatic Severe dysmenorrhea Abdominal pressure + bloating Symmetrically enlarged uterus - can palpate Heavy bleeding ```
40
Adenomyosis - diagnosis
Pelvic US MRI Hysterectomy - DEFINITIVE - look at cells under microscope
41
Adenomyosis- treatment
NSAIDs Hormones Hysterectomy
42
Uterine Prolapse- pathophysiology
Post pregnancy, labor, vaginal delivery
43
Uterine Prolapse- cause
Any condition that inc intra-abdominal pressure | - obesity, chronic cough, heavy lifting, pelvic tumors, ascites, constipation
44
Uterine Prolapse- epidemiology
>50% post menopause | White women
45
Uterine Prolapse- S/S & PE
``` Vaginal fullness Lower abdo pain Low back pain ""falling out"" sensation Relief w/ lying down ``` W/ - cystocele, rectocele, enterocele
46
Uterine Prolapse- diagnosis- grade
Graded 0-4 Grade 0 - no prolapse Grade 1 - Descent >1cm above hymen Grade 2 - Descent to hymen Grade 3 - protrudes but no less than 2cm total vag length Grade 4 - total eversion of lower genital tract
47
Uterine Prolapse- treatment
Pessary Refer to GYN Wt reduction, smoking cessation, kegels Surgery
48
Functional Cysts- pathophysiology
Monthly follicle keeps growing
49
Follicular Cyst- pathophysiology
Most common functional cyst Failure in ovulation - 2nd to disturbances in release of pituitary gonadotropins - failure to ovulate and fluid fails to be reabsorbed 3-8cm Lined by inner layer of granulosa cells and outer layer of theca interna cells
50
Follicular Cyst- S/S & PE
Asymptomatic Large cysts - aching pelvic pain, dyspareunia, occasional abnormal uterine bleeding Complications - ovarian torsion and bleeding - >6cm - turn on stalk -> torsion
51
Follicular Cyst- treatment
``` Watch and Wait - disappear spontaneously in 60d w/out treatment Reeval in 6w by U/S Benign vs Mal Sugery eval OCP - help establish nl rhythm ```
52
Corpus Luteum Cyst- pathophysiology
Thin walled uniocular cysts from after ovulation when corpus luteum fails to regress 3-11cm Less common
53
Corpus Luteum Cyst- epidemiology
Amenorrhea | Delayed menstruation
54
Corpus Luteum Cyst- S/S & PE
Localized pain, tenderness Amenorrhea Delayed menstruation
55
Corpus Luteum Cyst
Watch and Wait - regress in 1-2m OCP - recom, but maybe not beneficial Laparoscopy or laparotomy - required to control hemorrhage to perform detorsion of ovary
56
Ovarian Torsion- pathophysiology
2nd to enlarged ovary by mass
57
Ovarian Torsion - S/S & PE
Severe abdominal pain Pelvic pain N/v
58
Ovarian Torsion- treatment
Surgical Emergency
59
Hydrosalpinx- pathophysiology
Distally blocked fallopian tube, filled w/ fluid Distended -> sausage appearance
60
Hydrosalpinx- cause
Hematosalpinx - filled w/ blood Pyosalpinx - filled w/ pus PID Endometriosis surgery Ruptured appendix
61
Hydrosalpinx- S/S & PE
Asymptomatic Pelvic pain Abd pain Infertility
62
Hydrosalpinx- labs & imaging
U/S Hysterosalpingogram Laparoscopy

Clin med sem 2 (30 decks)

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