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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
Q

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?

A

Placenta previa (implantation of placenta, over/near cervix internal os)

26
Q

definition of
abruptio placentae?
(spell- aresto momentum :)

A
  • premature separation
  • from uterus
  • of a normally implanted placenta
27
Q

eti of
abruptio placentae?

assoc w diseases or drugs?

A

unknown
(0.4-3.5%)

  • hypertensive
  • cardiovascular
  • rheumatoid
    diseases
  • cocaine use (in any form)
28
Q

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
A

abruptio placentae

29
Q

definition of

threatened abortion?

A
  • any bleeding
  • or cramping of uterus
  • in first 20wks
30
Q

definition of

inevitable abortion?

A
  • bleeding
  • or rupture of membranes

accompanied by

  • pain
  • dialation of cervix
31
Q

definition of

incomplete abortion?

A
  • expulsion of part (of the products of conception)

- or rupture of the membranes

32
Q 
spontaneous abortion
vs
induced abortion
vs 
therapeutic abortion
A

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
Q

definition of

pre-term labour?

A
  • onset of labour
  • effacement
  • dilation of cervix
  • before 37 wks
34
Q

definition of

premature rupture of membranes (PROM)?

A

> /= 1h before onset labour

35
Q

definition of
post-datism?

post-maturity?

A
  • preg continuing after 42wks
  • placental function failing
    and
  • fetal jeopardy
  • after 42wks

*uncommon
ss
- redution in ute size
- fetal motion decreased

36
Q

3 stages of labour?

A

stage 1 labour = cervix open
stage 2 labour = delivery (baby being born)
stage 3 labour = placenta delivery

37
Q

problem during or after stage 3 labour (placenta delivery)

A

maternal hemorrhage
= post-partum hemorrhage (PPH)
> 500ml blood loss

(PPH is 2nd main cause of maternal mortality, after infection)

38
Q

normal amount of blood loss in delivery?

A

400-500ml

39
Q

causes of PPH?

A
  • atonic uterus (lacking muscular tone)
  • lacerations (vag or cervical)
  • retained placenta (portions)
40
Q

ss

puerperal infection?

A
  • 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
Q

definition of

infertility?

A
  • 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
Q

definition of

endometriosis?

A
  • non malignant disorder
  • functioning endometrial tissue
  • outside ute cavity
43
Q

endometriosis usually confined to?*1

commonly?*4

A
  • adominal organs (peritoneal surfaces, serosal surfaces)

commonly

  • ovaries
  • peritoneum (retro-vaginal cul-de-sac of pouch of douglas)
  • colon (sigmoid)
  • ligaments (broad, uterosacral)
44
Q

less common sites of endometiosis? *11

A
  • cervix
  • ligament (round)
  • bladder
  • umbilicus
  • appendix
  • surgical scars (laparotomy)
  • small/large bowel (serosal surfaces)
  • uterus
  • vagina
  • pleura
  • pericardium
45
Q 
clinical presentation dx?
- asymptomatic/no symptoms
or
- *pelvic pain
- pelvic mass
- alternation of menses
- *infertility
- dyspareunia (painful intercourse)
- *dysmenorrhea
A

endometriosis

46
Q

definition of

adenomyosis?

A
  • functioning endometrial tissue

- penetrated the myometrium

47
Q

definition of
uterine fibroids?

types? med terms *3

A

neoplasms
(most common pelvic neoplasms)

  • myomas
  • leiomyomas
  • fibromyomas
48
Q

fibroids probably arise from…?

A
  • a single smooth mus. cell (monoclonal= replicating from one cell)
49
Q

fibroids have…?

A

estrogen receptors

50
Q 
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)
A

uterine fibroids

51
Q 
risk factors for
endometrial cancer (adenocarcinoma)?*5
A
  • obesity (dietary fat intake)
  • estrogen therapy (unopposed, w/out progesterone)

other

  • age (peak 60yr)
  • diabetes
  • lack exercise
52
Q

what usually precedes endometrial cancer?

A

endometrial hyperplasia

53
Q 
clinical presentation
- asymptomatic
or 
- bloating
- pain (pelvic, abdominal)
- difficulty eating/feeling full quickly
- urgency/frequency
A

ovarian cancer
(deadliest gyn malig.)
(75% dx adv. stage)
(2nd most dx gyn malignacy)

54
Q 
clinical presentation
- female
- *pain/pressure/fullness (lower abdo)
- *dull ache (LBP, thighs)
- nausea/vom (nonspecific)
or
- asymptomatic
A

ovarian cyst

55
Q 
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
A
  1. adenexal torsion (F <30yrs)
  2. rupture ovarian cyst

*same as ectopic preg presentation

56
Q

definition of

PCOS (stein-leventhal syndrome)?

A
  • accumulation of
  • many incompletely dev. follicles
  • in ovaries
57
Q

PCOS image dx?

A
  • ultrasound
58
Q 
clinical presentation
- irreg period
- amenorrhea
- menorrhagia
- obesity
ss exc androgen
- infertility
- hirsutism
- decreased breast size
- acne aggravation
A

PCOS

59
Q

complications of PCOS?*5

A
  • sterility
  • complicatons secondary to obesity
  • diabetes (inc. insulin resistance)
  • endometrial hyperplasia/cancer
  • inc. risk hypertension + CV disease
60
Q

cervical cancer and dev. of cervical neoplasms is strongly assoc. with?

what is also a risk factor for cervical cancer?

A
  • HPV virus infection

- smoking

61
Q 
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
A

cervical cancer (assoc. w HPV)

62
Q

more than 90% of early asymptomatic cases of
- cervical intra-epithelial neoplasia (cervical cancer)
can be detected…?

A
  • pre-clinically
  • by cytological examination
  • of pap smears
    (15-40% false neg rate)

deanne's - GYN (4 decks)

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