WEEK 4 - Female Reproductive/Genitourinary Flashcards
1
Q
Define infertility
A
The inability to conceive after at least one year of regular, unprotected sex
2
Q
What are some male causes of infertility? (x4)
A
- Disorders of the hypothalamic-pituitary system
- Disorders of the testes
- Abnormalities of ejaculation
- Physical causes
3
Q
What are some female factors of infertility? (x3)
A
- Problems with ovulation
- Tubal obstruction of dysfunction
- Uterine or cervical factors
4
Q
What are some of the diagnostic tests for fertility in females?
A
- Review of gynaecological and menstrual hx
- Assessment of possible STIs
- PAP test
- Pelvic US
- Test for levels of LH, FSH, Prl
- Post coilital test
- Genetic testing
- Ovulation studies
- Tubal patency studies
5
Q
What are some of the diagnostic tests for fertility in males?
A
- Physical exam for varicocoele/Peyronie disease
- Semen analysis
- Plasma testosterone and serum LH and FSH
- Medications/lifestyle changes/corrective surgery
6
Q
Name the three assisted reproductive technologies
A
- IVF
- GIFT - gamete intra-fallopian transfer
- ZIFT - zygote intra-fallopian transfer
7
Q
Define abortion
A
The loss or termination of pregnancy before the foetus has reached a state of viability
May be spontaneous or induced.
8
Q
What is a spontaneous abortion?
A
The natural loss of pregnancy before 20 week’s gestation.
9
Q
What are the causes of spontaneous abortion?
A
Foetal chromosomal abnormalities Endocrine abnormalities Acquired abnormalities Immunological factors Environmental factors
10
Q
Signs and symptoms of spontaneous abortion?
A
Uterine cramping coupled with vaginal bleeding
11
Q
Examinations required for spontaneous abortion?
A
- Beta-HCG testing (more than one measurement)
- Vaginal ultrasound (examination of the pelvis)
12
Q
Treatment for spontaneous abortion? Are these useful?
A
Treatment = bed rest, avoidance of vaginal intercourse
No - most women progress to abortion anyway
13
Q
Define induced abortion
A
Intentional or elective termination of pregnancy (for personal or medical reasons)
14
Q
What are the four methods of induced abortion for an early termination?
A
- Menstrual extraction
- Suction aspiration
- Mifepristone with misoprostol
- Methotrexate with misoprostol
15
Q
What are the three methods of induced abortion for a late termination?
A
- Hypertonic saline solution
- Prostaglandins
- Hysterectomy
- First two for 16+ weeks, last for 20+ weeks
16
Q
Abnormal vaginal bleeding is common in which gynaecological conditions?
A
- Oligomenorrhea (for 35+ days)
- Amenorrhea (primary and secondary)
- Metrorrhagia ( irregular spotting)
- Menorrhagia (more than 80mLs per day for 7 days)
17
Q
Diagnostic studies and management for abnormal vaginal bleeding?
A
- Health hx and physical exam
- OCP for amenorrhea
- Hysterectomy
- Myomectomy
- Balloon thermotherapy
- Hormones oestrogen and progesterone
18
Q
Define ectopic pregnancy
A
Any blockage of the fallopian tubes or reduction of tubal peristalsis that impedes or delays the zygote passing to the uterine cavity, leading to tubal implantation
19
Q
What can an ectopic pregnancy cause?
A
Tubal rupture
20
Q
Risk factors for ectopic pregnancy?
A
PID Previous ectopic pregnancy Progestin-releasing IUD Progesterone-only birth control Prior pelvic or tubal pregnancy IVF embryo transfer Ovulation induction
21
Q
Signs and symptoms of ectopic pregnancy?
A
Abdominal pain Shoulder tip pain (referred pain) Missed menses Irregular vaginal bleeding Morning sickness Breast tenderness Hypovolaemic shock, syncope GI upset
22
Q
How far into an ectopic pregnancy do signs and symptoms arise?
A
6-8 weeks
23
Q
What tools are used to diagnose a ectopic pregnancy?
A
- Serum pregnancy test immunoassay
- Ultrasound
24
Q
Medical and surgical management of an ectopic pregnancy?
A
- Medical - methotrexate for masses less than 3cm
- Surgical - laparoscopic removal of the foetus from the uterine tube or emergency removal of the tube and fluid resuscitation
25
What is pelvic inflammatory disease?
Infectious condition of the pelvic cavity that may involve salpingitis, oophoritis and peritonitis
26
Which STDs does PID occur in?
Gonorrhoea
Chlamydia
Not always due to STDs, may just be a bacterial infection
27
Signs and symptoms of PID?
```
Lower abdo pain
Pain with intercourse
Adrenal tenderness
Spotting after intercourse
Purulent discharge
Cramping with menses
Irregular bleeding
```
28
Diagnosis of PID occurs via which tools?
```
Cultures
Pregnancy test (first step)
```
29
Treatment for PID?
- Antibiotics (at least three)
- Pain relief (oral fluids, heat pack)
- No intercourse for 3 weeks or until the antibiotic course is finished
- Admission to hospital if IV ABs and corticosteroids needed
Severe cases: drainage and removal of abscesses, hysterectomy
30
What is endometriosis?
The presence of endometrial tissue outside of the uterine cavity, occurs in 10% of women
31
What is the pathophysiology of endometriosis?
- Endometrial tissue responds ovarian hormones - menstrual cycle
- Retrograde menstruation - causes endometrial tissue to move through the tubes and be extruded via the fimbriae of the uterine tubes
- Endometrial tissue attaches to the outside of the uterus
- Endometrial tissue grows with menstrual cycles through continual response to ovarian hormones
32
Signs and symptoms of endometriosis? Are they indicative of severity of endometriosis?
- Dysmenorrhea after pain-free menses
- Backahce, painful bowel movements and dysuria
- Infertility
- Painful intercourse
- Irregular bleeding
Do not correlate with severity of endometriosis
33
Diagnostic studies for endometriosis?
- Hx and physical exam
- Pelvic exam and US
- MRI
- Laparoscopy
34
Management of endometriosis?
- NSAIDs
- Oral contraceptives
- Danazol
- GnRH antagonists
35
Treatment of endometriosis?
Laparotomy to remove implanted tissues and adhesions
| Bilateral oopherectomy
36
What is a leiomyoma?
Uterine fibroid
| Benign smooth muscle tumours that occur within the uterus.
37
What is the cause of a uterine fibroid?
Unknown cause!
| Rely on ovarian hormones to grow during reproductive years
38
Signs and symptoms of uterine fibroids?
- May be asymptomatic
- Abnormal uterine bleeding - most common sign
- Pain
- Pelvic pressure
39
Diagnostics and management of uterine fibroids?
- Hysteroscopy and laser resection
- Uterine artery embolisation
- Heavy bleeding and anaemia indication for surgery
- Leuprorelin GnRH antagonist may be used to shrink fibroid
- MRI-guided focussed US to target and destroy fibroids
40
What is a cervical polyp?
Benign pedunculated lesion. Arise from the endocervical mucosa and protrude through the cervix, have an unknown cause
41
What do cervical polyps look like?
Bright red, soft and fragile. 3cm in length, may be single or multiple
42
Symptoms of cervical polyps?
- Spotting
- Bleeding after straining during bowel movement
- Bleeding after sex
43
Management of cervical polyps?
Excised and sent to pathology for review (polypectomy)
44
What is a cyst?
Benign ovarian tumour, soft and small, thin capsule.
| Follicle and corpus luteum cysts are most common
45
What is an epithelial ovarian neoplasm?
Benign ovarian tumour, can have bits of body tissue in them.
| May be cystic/solid, small or large.
46
Signs and symptoms of ovarian masses?
May be asymptomatic
- Pressure in the pelvis, tenderness
- Constipation, menstrual irregularities, urinary frequency, abdominal fullness, anorexia, increasing abdominal girth, peripheral oedema
- Pelvic pain (commonly at the R iliac fossa)
- Rupture = haemorrhage and infection
47
What is PCOS?
Polycystic ovarian syndrome.
Hormonal abnormalities in which the ovaries produce oestrogen and testosterone but not progesterone, fluid filled cysts develop form mature ovarian follicles that fail to rupture.
48
Signs and symptoms of PCOS?
- Irregular menstrual periods
- Amenorrhea
- Hirsutism
- Obesity = oligorrhea, amenorrhea, infertility
49
Diagnostic studies for PCOS?
Pelvic US
50
Management of PCOS?
Oral contraceptives
Clomiphene if the patient wishes to become pregnant
Spironolactone for hirsutism
Flutamide and Leuprorelin for hyperandrogenism
Metformin for hyperandrogenism and restoration of ovulation
Hysterectomy, bilateral salpingectomy and oopherectomy
51
What are the risk factors for cervical cancer?
- Genital HPV types 16 and 18 - cause 70% of cervical cancer
- Having multiple partners, unprotected sex, beginning sexual activity before 17
- Smoking
- Failure to have a regular PAP smear
52
Signs and symptoms of cervical cancer?
Precancerous changes are asymptomatic
- Leucorrhea, spotting
- Pain and weight loss
- Anaemia and cachexia
- Thin and watery discharge, may be offensive smelling
53
Diagnostics and management of cervical cancer?
- Colonoscopy
| - Biopsy
54
Stage 0 of cervical cancer and treatment?
- Cancer in situ
| - TX: Hysterectomy, cryosurgery, laser surgery
55
Stage 1 of cervical cancer and treatment?
- Confined to cervix
| - TX: Radiation, radical hysterectomy
56
Stage 2 of cervical cancer and treatment?
- Spread to upper 2/3 of vagina
| - TX: radiation, hysterectomy, chemo
57
Stage 3 of cervical cancer and treatment?
- Spread to lower 1/3 of vagina, +/- kidneys
| - TX: radiation, chemo (cisplatin based)
58
Stage 4 of cervical cancer and treatment?
- Spread to bladder, rectum, lungs and bones
| - TX: radiation, chemo, pelvic exteneration
59
What are the two types of endometrial cancers and where do they originate?
- Endometrial cancers: develop in the uterus
| - Uterine sarcomas: develop in the myometrium
60
Risk factors of endometrial cancer?
- Oestrogen
- Increased age
- Multiparity
- Obesity
- Smoking
- T2DM
- Family or personal Hx of colorectal cancer
61
What are protective factors against endometrial cancer?
Pregnancy and OCP - no making of eggs = decreased likelihood of abnormalities
62
What is an adenocarcinoma?
A tumour that arises from the lining of the endometrium
63
What is the precursor of an adenocarcinoma?
A hyperplastic state that progresses to invasive carcinoma, occurs when oestrogen is not counteracted by progesterone
64
Where does an adenocarcinoma spread to?
Extends to the myometrium and regional lymph nodes.
| Metastasises in bone, lungs, liver and brain
65
What are the signs and symptoms of endometrial cancer?
- Abnormal uterine bleeding in post-menopausal women
- Sporadic periods in premenopausal women
- Pain late in disease
66
Diagnostic test for endometrial cancer?
Biopsy
| Cancer antigen CA-125 may be tested for
67
Management of endometrial cancer?
- Surgery if Dx is early (hysterectomy + bilateral salpingo-oophorectomy + lymph node resection
- Radiation to the pelvis and abdomen
- Progesterone HRT
- Chemo
- Tamoxifen +/- progesterone
68
What are the three types of ovarian cancers?
1. Common epithelial type - arise from cells on the outside of the ovary
2. Germ cell type - arise from cells that produce eggs
3. Stromal type - arise from supporting cells in the ovary
69
Risk factors for ovarian cancer?
- Age
- Family Hx
- Nulliparity
- BRCA1 and 2 genes
- Early onset periods (younger than 12)
- Late menopause
- Infertility
- No OCP use
70
Signs and symptoms of ovarian cancer?
- Abdo engorgement
- Vaginal bleeding rare
- Pelvic/abdo pain, bloating
- Urinary frequency, feeling of fullness
71
Diagnostic studies for ovarian cancer?
- Transvaginal US
- Exploratory laparotomy
- Blood test (OVA1 and CA-125)
No screening test exists for ovarian cancer
72
Management for ovarian cancer?
- Prophylactic oophorectomy and OCP
- Total abdominal hysterectomy + bilateral salpingo-oophorectomy + omentectomy + debulking
- Intraperitoneal and systemic chemo, external abdo and pelvic radiation
73
Define vaginal cancer?
Cancer that starts in the vagina, not a cancer that has spread to the vagina.
74
Risk factors of vaginal cancer?
- Hx of another gynaecological cancer
- Hx of dysplasia to the Cx, vulva or vagina
- HPV
- Smoker
- Maternal administration of DES
- Vaginal adenosis
- 50 years +
75
Signs and symptoms of vaginal cancer?
- Unusual lump in the vagina
- Painless vaginal bleeding unrelated to menses
- Pain during sex and bleeding after sex
- Offensive smelling vaginal discharge
- Pain upon voiding
- Constant pelvic pain
76
Diagnostic tests for vaginal cancer?
- Physical exam
- PAP test
- Biopsy
- Colonoscopy
77
Management of vaginal cancer?
- Surgery: partial vaginectomy/radial vaginectomy
- Radiotherapy (internal = bradytherapy, external = external beam therapy)
- Chemo
78
What is vulvar cancer?
Cancer that affects any part of the external female genitals, most commonly the labia majora, labia minora and the perineum
79
Risk factors of vulvar cancer?
- Over 60
- HPV
- Hx of Cx/vaginal cancer
- Smoker
- Organ transplant
- HIV
80
Signs and symptoms of vulvar cancer?
- Itching, burning and soreness in the vulva, presence of a lump/sore/swelling/growth
- Thickened, raised skin patches on the vulva
- Mole on the vulva that changes shape or colour
- Blood/pus/discharge coming from lesion or sore spot
- Hard or swollen lymph nodes
81
Diagnostics of vulvar cancer?
- Physical exam
- Colonoscopy
- Biopsy
- +/- PAP smear
82
Management of vulvar cancer?
- Staging, determine size and location
- Surgery - wide local excision, radial local excision, partial vulvectomy, radical vulvectomy, lymph node dissection, reconstructive surgery
- Internal radiotherapy (bradytherapy) and external (external beam radiotherapy)
- Chemo
83
Describe the anatomical location of the breasts
Extend from 2nd to 6th rib, from the sternum to midaxillary line
84
What is the tail of spence?
Axillary portion of the breast, in the upper, outer quadrant
85
Describe the external anatomy of the breast?
Nipple is located in the centre, contains lactiferous ducts that allow milk passage.
Areola surrounds the nipple, contains Montgomery glands that secrete oils
86
Describe the internal anatomy of the breast?
Contains glandular tissue with mammary ducts, fibrous tissue and fatty tissue.
Major axillary lymph nodes = pectoral, subscapular, lateral, central; anterior lymph nodes drain anterior chest and breasts, posterior lymph nodes drain posterior chest and arms
87
Risk factors of breast cancer?
- Gender
- OCP
- Smoking
- 50+ years
- BRCA1 and 2 genes
- Family Hx
- Nulliparity
- Late menopause
- HRT with progesterone
- Previous breast irradiation
88
What is the pathophysiology of non invasive breast cancer?
Ductal carcinoma in situ
Abnormal cells are contained within the ducts of the breasts.
Having DCIS = increases risk of developing invasive breast cancer
89
What is the pathophysiology of invasive breast cancer?
Cancer spreads from the breast ducts or lobules into surrounding breast tissue +/- axillary lymph nodes.
In advanced cancer - breasts appear dimpled.
90
Diagnostic studies and management of breast cancer?
- Hx and physical exam - identify signs of breast cancer, initiate early Tx
- Mammogram, US, MRI, CXR, bone scan, CT, PET scarn
- Biopsy - genetic testing
91
Treatment for breast cancer?
- Surgery: mastectomy, resection of lymph nodes, lumpectomy and reconstruction
- Chemo
- Radiotherapy: start 4 weeks after surgery or chemo
- Hormone therapy: aromatase inhibitors, ovarian treatments/oophorectomy
