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deanne's - GYN > w7 OT: CM endo, fibroids, cancer (endo, ov, cervical), PCOS, labour, preg, ov cyst > Flashcards

w7 OT: CM endo, fibroids, cancer (endo, ov, cervical), PCOS, labour, preg, ov cyst Flashcards

1
Q

causes of endo CM?*3

A
  1. qi stag
  2. qi stag + phl ret
  3. phl ret + late stage bld stag
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2
Q

endo Fx Rx for 3 types?

A
  1. qi stag = chai hu shu gan san
  2. qi stag + phl ret = chai hu shu.. + er chen tang
  3. phl ret + LS bld stag = er chen tang + tao hong si wu tang
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3
Q

when nodules/masses involved use what category herbs?

A
  • expectorant herbs(phl)
  • no damp involved in masses, just phl, so don’t use aromatic herbs

~jing, w7 gyn OT ts25:52

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4
Q

fibroids sometime have _?

A

no ss

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5
Q

the problem with fibroids located in the uterine cavity is..?

A

can c. ute ble (beng lou)

> fibroids c. endometrium to grow thicker
>c.ing uterine bleeding (beng lou)

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6
Q

bld stag type fibroids Fx Rx?

A 
depending on case...
- tao hong si wu tang
- xue fu zhu yu tang
or
- xiao yao san
- jia wei xiao yao san
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7
Q

fibroids might cause..

A
  • miscarrage
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8
Q 
clinical presentation
- 65yr pt 
- menopause 10 years ago
- now is having bleeding (abn. ute bleed/metrorrhagia)
possible dx WM?
A
  • endometrial cancer ^ref to GP

(>90% postmenopausal bleeding or premenopausal recurrent metrorrhagia = abn. ut ble eg. btw periods)

(>80% most common gyn malignancy = adenocarcinoma type

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9
Q

ovarian cyst term in CM

A

ji je (not sure of spelling)

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10
Q 
clinical presentation
- 35yr female 
- trying to have child but not able to get preg
accompanying
- irreg period
- or amenorr
- hirsutism
common dx WM?
A
  • PCOS (polycystic ovary syndrome)
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11
Q 
Rx plan 
for PCOS pt trying to get pregnant?
ddx type 
- qi and bld def + bld stag 
*2 stages
A

before ovulation stage 1
- take IBC’s = day 7 - 14 (after period stops - before ovulation)

after ovulation stage 2

  • take tonics = after day 14-28
    eg. ba zhen tang, delete chuang xiong, dang gui {ibc’s, incase patient has already conceived this month, we don’t know}

*stop taking CHM always when having period (just as precaution and to monitor progress)

track ovulation
- test from chemist
- or create your own chart by taking your temperature every day and tracking
> have thermometer under pillow
>when wake up, before any body movement or drinking water, take temp
before ovulation = eg. 36 degrees
at ovultion = going up eg. 36.5 degrees

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12
Q

china method for turning fetus, to bring head down into position?

clinical presentation
- after 36wks/8mth the head is still up

A

moxa on
BL67 (baby spinner)

*we don’t use aust. incase something adverse event happens after moxa, we would get in trouble as a registered TCM practitioner

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13
Q

duration of pregnancy in CM?

A

full term CM = 280days/10mth/40wks in CM

*count from 1st day of last period (LMP) before preg (if period reg 28 day cycle)

or
time of conception + 266 days

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14
Q

what weeks of pregnancy is the important time for a baby to received essence from parents sperm and egg?

A

36-40wks/9-10mth

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15
Q

definition of

abortion?

A
  • Delivery or loss of the products of conception
  • before 20 weeks
  • fetal weight ~500g (1.1 pounds)

(which corresponds to a foetal weight of about 500g/0.5kg/1.1pound)

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16
Q

definition of

pre-term birth?

A
  • delivery

- btw 20-37wks

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17
Q

definition of

ectopic pregnancy?

A

implantation

  • outside the endometrium
  • and endometrial cavity

eg. fallopian tube, cervix, ovary, abdominal or pelvic cavity

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18
Q

most common site of ectopic pregnancy implantation?

caused by?

A
  • fallopian tube (>50% cases)

- previous tubal infection

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19
Q

clinical presentation ss

- normally reg periods, but now missing period >/= 1wk
accompanied by
1
- cramping or vag bleed/both
- pain and pelvic pressure
2
- sudden severe pain (pelvic)
- internal hemorrhage
- hemorrhagic shock and/or peritonitis
-
A 
1 = ectopic preg
2 = RUPTURED ectopic preg

normally reg periods, but now missing period >/= 1wk (is presumptive ev. of preg~merck man.)

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20
Q

definition of

gestational diabetes mellitus (GDM)?

A

any degree of
- glucose intolerance
- onset or first recognition during pregnancy.
(1-14% cases, about 4% USA)

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21
Q

definition of

hyperemesis gravidarum?

A
  • uncontrollable nausea and vom
  • during preg
  • result in dehydration and acidosis

(peak at 8-12wks, usually resolved 16wks)
(younger females >older females)

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22
Q

definition of
pre-eclampsia

what is a major complication of preeclampsia?

A
  • dev of hypertension
  • w albuminuria (proteinuria)
  • or edema
  • btw wk 20 - end of wk 1 postpartum
    (5% preg cases)

complication
- abruptio placentae

  • Albuminuria
  • sign of kidney disease
  • means that you have too much albumin in your urine.
  • A healthy kidney doesn’t let albumin pass from the blood into the urine. A damaged kidney lets some albumin pass into the urine. The less albumin in your urine, the better.

Albumin is
- a protein found in the blood.

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23
Q

definition of

eclampsia

A
  • convulsive seizures
  • or coma
  • no other causes occurring in same time period
    (1/200 pt w preeclampsia)

> pregnancy induced HTN
preeclampsia
>eclampsia

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24
Q

what is
placenta previa?

types?*3

A
  • implantation of the placenta
  • over internal os of cervix (total)
  • or near internal os of cervix (marginal/low)
    (1/200, multiparas, cesarean, ute abnormities - eg. fibroids)
  1. total previa = plac. covering whole os
  2. partial previa = plac. partially covering
  3. marginal previa/low implantation = plac. near the os
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25
clinical presentation (SS) - late in pregnancy - sudden vag bleeding that is painless may be followed by - painless massive bright red bleed * PE contraindicated (pelvic exam) what is the DX?
Placenta previa (implantation of placenta, over/near cervix internal os)
26
definition of abruptio placentae? (spell- aresto momentum :)
- premature separation - from uterus - of a normally implanted placenta
27
eti of abruptio placentae? assoc w diseases or drugs?
unknown (0.4-3.5%) - hypertensive - cardiovascular - rheumatoid diseases - cocaine use (in any form)
28
clinical presentation (SS) - pregnant women 24-26wks (or before 37wks) - vag bleeding - severe abdo pain (tender, tightly contracted uterus) - retroplacental bleeding (behind placenta) - fetal cardiac distress/death - maternal shock
abruptio placentae
29
definition of | threatened abortion?
- any bleeding - or cramping of uterus - in first 20wks
30
definition of | inevitable abortion?
- bleeding - or rupture of membranes accompanied by - pain - dialation of cervix
31
definition of | incomplete abortion?
- expulsion of part (of the products of conception) | - or rupture of the membranes
32
``` spontaneous abortion vs induced abortion vs therapeutic abortion ```
spontaneous - loss of fetus w/out induction or instrumentation induced - termination for medical or elective reasons therapeutic - termination to preserve life or health of woman - or bec. of fetal malformation incompatible with life
33
definition of | pre-term labour?
- onset of labour - effacement - dilation of cervix - before 37 wks
34
definition of | premature rupture of membranes (PROM)?
>/= 1h before onset labour
35
definition of post-datism? post-maturity?
- preg continuing after 42wks - placental function failing and - fetal jeopardy - after 42wks *uncommon ss - redution in ute size - fetal motion decreased
36
3 stages of labour?
stage 1 labour = cervix open stage 2 labour = delivery (baby being born) stage 3 labour = placenta delivery
37
problem during or after stage 3 labour (placenta delivery)
maternal hemorrhage = post-partum hemorrhage (PPH) > 500ml blood loss (PPH is 2nd main cause of maternal mortality, after infection)
38
normal amount of blood loss in delivery?
400-500ml
39
causes of PPH?
- atonic uterus (lacking muscular tone) - lacerations (vag or cervical) - retained placenta (portions)
40
ss | puerperal infection?
- abrupt rise body temp (>/= 38 degrees) - after first 24hr postpartum - for 2 successive days - w no other apparent causes * most common cause of early puerperium fever though is? - dehydration ss dehydration fever - low grade fever - for 2-3days * puerperium: 0-6wks postpartum the period of about six weeks after childbirth during which the mother's reproductive organs return to their original non-pregnant condition.
41
definition of | infertility?
- inablility of a couple to concieve - after 1yr - unprotected intercourse (10-15% couples) (30-40% male factors eg. sperm disorder) ``` 60-70% female (30% tubal dysf.) (20% ovulatory dysf.) (10% unidentified factors) (5% cervical mucus abn.) ```
42
definition of | endometriosis?
- non malignant disorder - functioning endometrial tissue - outside ute cavity
43
endometriosis usually confined to?*1 commonly?*4
- adominal organs (peritoneal surfaces, serosal surfaces) commonly - ovaries - peritoneum (retro-vaginal cul-de-sac of pouch of douglas) - colon (sigmoid) - ligaments (broad, uterosacral)
44
less common sites of endometiosis? *11
- cervix - ligament (round) - bladder - umbilicus - appendix - surgical scars (laparotomy) - small/large bowel (serosal surfaces) - uterus - vagina - pleura - pericardium
45
``` clinical presentation dx? - asymptomatic/no symptoms or - *pelvic pain - pelvic mass - alternation of menses - *infertility - dyspareunia (painful intercourse) - *dysmenorrhea ```
endometriosis
46
definition of | adenomyosis?
- functioning endometrial tissue | - penetrated the myometrium
47
definition of uterine fibroids? types? med terms *3
neoplasms (most common pelvic neoplasms) - myomas - leiomyomas - fibromyomas
48
fibroids probably arise from...?
- a single smooth mus. cell (monoclonal= replicating from one cell)
49
fibroids have...?
estrogen receptors
50
``` clinical presentation - non preg women - menorrhagia - metrorrhagia - severe pain/pressure - urinary frequency/urgency - constipation or - asymptomatic/ no ss ``` complications - recurrent abortion - infertility - complicated pregnancy (premature contraction, needing c-section)
uterine fibroids
51
``` risk factors for endometrial cancer (adenocarcinoma)?*5 ```
- obesity (dietary fat intake) - estrogen therapy (unopposed, w/out progesterone) other - age (peak 60yr) - diabetes - lack exercise
52
what usually precedes endometrial cancer?
endometrial hyperplasia
53
``` clinical presentation - asymptomatic or - bloating - pain (pelvic, abdominal) - difficulty eating/feeling full quickly - urgency/frequency ```
ovarian cancer (deadliest gyn malig.) (75% dx adv. stage) (2nd most dx gyn malignacy)
54
``` clinical presentation - female - *pain/pressure/fullness (lower abdo) - *dull ache (LBP, thighs) - nausea/vom (nonspecific) or - asymptomatic ```
ovarian cyst
55
``` clinical presentation *3 possible dx - female <30yrs - Lower abdo pain, pressure, fullness - LBP, thigh pain (dull ache) - nausea/vom (nonspecific) with - abdo pain (*sudden onset) - after strenuous activity eg. exercise, sex ```
1. adenexal torsion (F <30yrs) 2. rupture ovarian cyst *same as ectopic preg presentation
56
definition of | PCOS (stein-leventhal syndrome)?
- accumulation of - many incompletely dev. follicles - in ovaries
57
PCOS image dx?
- ultrasound
58
``` clinical presentation - irreg period - amenorrhea - menorrhagia - obesity ss exc androgen - infertility - hirsutism - decreased breast size - acne aggravation ```
PCOS
59
complications of PCOS?*5
- sterility - complicatons secondary to obesity - diabetes (inc. insulin resistance) - endometrial hyperplasia/cancer - inc. risk hypertension + CV disease
60
cervical cancer and dev. of cervical neoplasms is strongly assoc. with? what is also a risk factor for cervical cancer?
- HPV virus infection | - smoking
61
``` clinical presentation - usually asymptomatic (discovered on pap) or - irreg vag bleed - postcoital vag bleed - vag discharge (foul smelling) - pelvic pain - obstructive uropathy - back pain - leg swelling ```
cervical cancer (assoc. w HPV)
62
more than 90% of early asymptomatic cases of - cervical intra-epithelial neoplasia (cervical cancer) can be detected...?
- pre-clinically - by cytological examination - of pap smears (15-40% false neg rate)

deanne's - GYN (4 decks)

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