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Nursing Science 3 > WEEK 4 - Female Reproductive/Genitourinary > Flashcards

WEEK 4 - Female Reproductive/Genitourinary Flashcards

1
Q

Define infertility

A

The inability to conceive after at least one year of regular, unprotected sex

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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
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3
Q

What are some female factors of infertility? (x3)

A
  • Problems with ovulation
  • Tubal obstruction of dysfunction
  • Uterine or cervical factors
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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
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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
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6
Q

Name the three assisted reproductive technologies

A
  1. IVF
  2. GIFT - gamete intra-fallopian transfer
  3. ZIFT - zygote intra-fallopian transfer
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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.

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8
Q

What is a spontaneous abortion?

A

The natural loss of pregnancy before 20 week’s gestation.

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9
Q

What are the causes of spontaneous abortion?

A 
Foetal chromosomal abnormalities 
Endocrine abnormalities
Acquired abnormalities
Immunological factors
Environmental factors
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10
Q

Signs and symptoms of spontaneous abortion?

A

Uterine cramping coupled with vaginal bleeding

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11
Q

Examinations required for spontaneous abortion?

A
  • Beta-HCG testing (more than one measurement)

- Vaginal ultrasound (examination of the pelvis)

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12
Q

Treatment for spontaneous abortion? Are these useful?

A

Treatment = bed rest, avoidance of vaginal intercourse

No - most women progress to abortion anyway

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13
Q

Define induced abortion

A

Intentional or elective termination of pregnancy (for personal or medical reasons)

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14
Q

What are the four methods of induced abortion for an early termination?

A
  1. Menstrual extraction
  2. Suction aspiration
  3. Mifepristone with misoprostol
  4. Methotrexate with misoprostol
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15
Q

What are the three methods of induced abortion for a late termination?

A
  1. Hypertonic saline solution
  2. Prostaglandins
  3. Hysterectomy
  • First two for 16+ weeks, last for 20+ weeks
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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)
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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
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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

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19
Q

What can an ectopic pregnancy cause?

A

Tubal rupture

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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
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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
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22
Q

How far into an ectopic pregnancy do signs and symptoms arise?

A

6-8 weeks

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23
Q

What tools are used to diagnose a ectopic pregnancy?

A
  • Serum pregnancy test immunoassay

- Ultrasound

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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
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25
Q

What is pelvic inflammatory disease?

A

Infectious condition of the pelvic cavity that may involve salpingitis, oophoritis and peritonitis

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26
Q

Which STDs does PID occur in?

A

Gonorrhoea
Chlamydia

Not always due to STDs, may just be a bacterial infection

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27
Q

Signs and symptoms of PID?

A 
Lower abdo pain
Pain with intercourse
Adrenal tenderness
Spotting after intercourse 
Purulent discharge
Cramping with menses
Irregular bleeding
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28
Q

Diagnosis of PID occurs via which tools?

A 
Cultures
Pregnancy test (first step)
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29
Q

Treatment for PID?

A
  • 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

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30
Q

What is endometriosis?

A

The presence of endometrial tissue outside of the uterine cavity, occurs in 10% of women

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31
Q

What is the pathophysiology of endometriosis?

A
  • 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
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32
Q

Signs and symptoms of endometriosis? Are they indicative of severity of endometriosis?

A
  • Dysmenorrhea after pain-free menses
  • Backahce, painful bowel movements and dysuria
  • Infertility
  • Painful intercourse
  • Irregular bleeding

Do not correlate with severity of endometriosis

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33
Q

Diagnostic studies for endometriosis?

A
  • Hx and physical exam
  • Pelvic exam and US
  • MRI
  • Laparoscopy
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34
Q

Management of endometriosis?

A
  • NSAIDs
  • Oral contraceptives
  • Danazol
  • GnRH antagonists
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35
Q

Treatment of endometriosis?

A

Laparotomy to remove implanted tissues and adhesions

Bilateral oopherectomy

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36
Q

What is a leiomyoma?

A

Uterine fibroid

Benign smooth muscle tumours that occur within the uterus.

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37
Q

What is the cause of a uterine fibroid?

A

Unknown cause!

Rely on ovarian hormones to grow during reproductive years

38
Q

Signs and symptoms of uterine fibroids?

A
  • May be asymptomatic
  • Abnormal uterine bleeding - most common sign
  • Pain
  • Pelvic pressure
39
Q

Diagnostics and management of uterine fibroids?

A
  • 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
Q

What is a cervical polyp?

A

Benign pedunculated lesion. Arise from the endocervical mucosa and protrude through the cervix, have an unknown cause

41
Q

What do cervical polyps look like?

A

Bright red, soft and fragile. 3cm in length, may be single or multiple

42
Q

Symptoms of cervical polyps?

A
  • Spotting
  • Bleeding after straining during bowel movement
  • Bleeding after sex
43
Q

Management of cervical polyps?

A

Excised and sent to pathology for review (polypectomy)

44
Q

What is a cyst?

A

Benign ovarian tumour, soft and small, thin capsule.

Follicle and corpus luteum cysts are most common

45
Q

What is an epithelial ovarian neoplasm?

A

Benign ovarian tumour, can have bits of body tissue in them.

May be cystic/solid, small or large.

46
Q

Signs and symptoms of ovarian masses?

A

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
Q

What is PCOS?

A

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
Q

Signs and symptoms of PCOS?

A
  • Irregular menstrual periods
  • Amenorrhea
  • Hirsutism
  • Obesity = oligorrhea, amenorrhea, infertility
49
Q

Diagnostic studies for PCOS?

50
Q

Management of PCOS?

A

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
Q

What are the risk factors for cervical cancer?

A
  • 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
Q

Signs and symptoms of cervical cancer?

A

Precancerous changes are asymptomatic

  • Leucorrhea, spotting
  • Pain and weight loss
  • Anaemia and cachexia
  • Thin and watery discharge, may be offensive smelling
53
Q

Diagnostics and management of cervical cancer?

A
  • Colonoscopy

- Biopsy

54
Q

Stage 0 of cervical cancer and treatment?

A
  • Cancer in situ

- TX: Hysterectomy, cryosurgery, laser surgery

55
Q

Stage 1 of cervical cancer and treatment?

A
  • Confined to cervix

- TX: Radiation, radical hysterectomy

56
Q

Stage 2 of cervical cancer and treatment?

A
  • Spread to upper 2/3 of vagina

- TX: radiation, hysterectomy, chemo

57
Q

Stage 3 of cervical cancer and treatment?

A
  • Spread to lower 1/3 of vagina, +/- kidneys

- TX: radiation, chemo (cisplatin based)

58
Q

Stage 4 of cervical cancer and treatment?

A
  • Spread to bladder, rectum, lungs and bones

- TX: radiation, chemo, pelvic exteneration

59
Q

What are the two types of endometrial cancers and where do they originate?

A
  • Endometrial cancers: develop in the uterus

- Uterine sarcomas: develop in the myometrium

60
Q

Risk factors of endometrial cancer?

A
  • Oestrogen
  • Increased age
  • Multiparity
  • Obesity
  • Smoking
  • T2DM
  • Family or personal Hx of colorectal cancer
61
Q

What are protective factors against endometrial cancer?

A

Pregnancy and OCP - no making of eggs = decreased likelihood of abnormalities

62
Q

What is an adenocarcinoma?

A

A tumour that arises from the lining of the endometrium

63
Q

What is the precursor of an adenocarcinoma?

A

A hyperplastic state that progresses to invasive carcinoma, occurs when oestrogen is not counteracted by progesterone

64
Q

Where does an adenocarcinoma spread to?

A

Extends to the myometrium and regional lymph nodes.

Metastasises in bone, lungs, liver and brain

65
Q

What are the signs and symptoms of endometrial cancer?

A
  • Abnormal uterine bleeding in post-menopausal women
  • Sporadic periods in premenopausal women
  • Pain late in disease
66
Q

Diagnostic test for endometrial cancer?

A

Biopsy

Cancer antigen CA-125 may be tested for

67
Q

Management of endometrial cancer?

A
  • Surgery if Dx is early (hysterectomy + bilateral salpingo-oophorectomy + lymph node resection
  • Radiation to the pelvis and abdomen
  • Progesterone HRT
  • Chemo
  • Tamoxifen +/- progesterone
68
Q

What are the three types of ovarian cancers?

A
  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
Q

Risk factors for ovarian cancer?

A
  • Age
  • Family Hx
  • Nulliparity
  • BRCA1 and 2 genes
  • Early onset periods (younger than 12)
  • Late menopause
  • Infertility
  • No OCP use
70
Q

Signs and symptoms of ovarian cancer?

A
  • Abdo engorgement
  • Vaginal bleeding rare
  • Pelvic/abdo pain, bloating
  • Urinary frequency, feeling of fullness
71
Q

Diagnostic studies for ovarian cancer?

A
  • Transvaginal US
  • Exploratory laparotomy
  • Blood test (OVA1 and CA-125)

No screening test exists for ovarian cancer

72
Q

Management for ovarian cancer?

A
  • Prophylactic oophorectomy and OCP
  • Total abdominal hysterectomy + bilateral salpingo-oophorectomy + omentectomy + debulking
  • Intraperitoneal and systemic chemo, external abdo and pelvic radiation
73
Q

Define vaginal cancer?

A

Cancer that starts in the vagina, not a cancer that has spread to the vagina.

74
Q

Risk factors of vaginal cancer?

A
  • 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
Q

Signs and symptoms of vaginal cancer?

A
  • 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
Q

Diagnostic tests for vaginal cancer?

A
  • Physical exam
  • PAP test
  • Biopsy
  • Colonoscopy
77
Q

Management of vaginal cancer?

A
  • Surgery: partial vaginectomy/radial vaginectomy
  • Radiotherapy (internal = bradytherapy, external = external beam therapy)
  • Chemo
78
Q

What is vulvar cancer?

A

Cancer that affects any part of the external female genitals, most commonly the labia majora, labia minora and the perineum

79
Q

Risk factors of vulvar cancer?

A
  • Over 60
  • HPV
  • Hx of Cx/vaginal cancer
  • Smoker
  • Organ transplant
  • HIV
80
Q

Signs and symptoms of vulvar cancer?

A
  • 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
Q

Diagnostics of vulvar cancer?

A
  • Physical exam
  • Colonoscopy
  • Biopsy
  • +/- PAP smear
82
Q

Management of vulvar cancer?

A
  • 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
Q

Describe the anatomical location of the breasts

A

Extend from 2nd to 6th rib, from the sternum to midaxillary line

84
Q

What is the tail of spence?

A

Axillary portion of the breast, in the upper, outer quadrant

85
Q

Describe the external anatomy of the breast?

A

Nipple is located in the centre, contains lactiferous ducts that allow milk passage.
Areola surrounds the nipple, contains Montgomery glands that secrete oils

86
Q

Describe the internal anatomy of the breast?

A

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
Q

Risk factors of breast cancer?

A
  • Gender
  • OCP
  • Smoking
  • 50+ years
  • BRCA1 and 2 genes
  • Family Hx
  • Nulliparity
  • Late menopause
  • HRT with progesterone
  • Previous breast irradiation
88
Q

What is the pathophysiology of non invasive breast cancer?

A

Ductal carcinoma in situ
Abnormal cells are contained within the ducts of the breasts.
Having DCIS = increases risk of developing invasive breast cancer

89
Q

What is the pathophysiology of invasive breast cancer?

A

Cancer spreads from the breast ducts or lobules into surrounding breast tissue +/- axillary lymph nodes.
In advanced cancer - breasts appear dimpled.

90
Q

Diagnostic studies and management of breast cancer?

A
  • 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
Q

Treatment for breast cancer?

A
  • 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

Nursing Science 3 (21 decks)

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