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Intro > WH - Specific Pelvic Complaints/Problems > Flashcards

WH - Specific Pelvic Complaints/Problems Flashcards

1
Q

Describe Dysmenorrhea

A

Painful menstrual period (menses)

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2
Q

What are the two types of dysmenorrhea?

A
  1. Primary dysmenorrhea - pain with normal pelvic anatomy
  2. Secondary dysmenorrhea - pain associated with underlying pathology
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3
Q

Describe primary dysmenorrhea

A
  1. Usual onset between menarche and 20 years of age
  2. Pain begins 24-36 hours before onset of menses and can continue for the first 3 days
  3. Pain is cyclic and described as crampy
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4
Q

Describe secondary dysmenorrhea

A
  1. Pain is usually progressive
  2. Onset after age 20
  3. Not always synchronous with menses
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5
Q

What is the pathophysiology of primary dysmenorrhea?

A

Linked to an increased prostaglandin (compounds with hormone like effects) activity in the uterus causing pain sensations and smooth muscle contractions

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6
Q

How is primary dysmenorrhea diagnosed?

A

Based on history and presentation alone with no confirmatory tests

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7
Q

How is secondary dysmenorrhea diagnosed?

A

Based on radiologic or laboratory evaluation

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8
Q

What is the treatment for dysmenorrhea?

A

Primary - 1. NSAIDs, 2. Birth control pills for heavy periods
Secondary - determined by nature of underlying problem

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9
Q

Describe endometriosis

A

When tissue that looks and acts like tissue of the uterus grows outside of the uterus (ovaries, ligaments supporting uterus, bowel, bladder); responds to hormones same way, by building up and shedding

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10
Q

Is endometriosis a benign or dangerous condition?

A

Benign, but may contribute to infertility

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11
Q

What are the signs/symptoms of endometriosis?

A
  1. Dysmenorrhea
  2. Low back pain
  3. Dyspareunia
  4. Intestinal pain
  5. Loose BM’s with menses
  6. Infertility
  7. Constipation, diarrhea, bloating
  8. Urinary symptoms
  9. Irregular/heavy periods
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12
Q

How is endometriosis diagnosed?

A
  1. Pelvic exam (may feel implants)
  2. Ultrasound (US)
  3. MRI
  4. Laparoscopy - diagnostic tool of choice
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13
Q

How is endometriosis treated?

A

Depending on the goal
1. OC’s or NSAID’s for pain control
2. Hormonal therapy (BC pills)
3. Conservative surgery (laser)
4. Total abdominal hysterectomy
5. Bilateral salpingo oophorectomy

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14
Q

Describe ovarian cysts

A

Can be solid or cystic; can be benign or cancerous

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15
Q

What are the symptoms of ovarian cysts?

A

Pain and pressure due to cyst taking up small amount of space of the ovary

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16
Q

How are ovarian cysts diagnosed?

A
  1. May be appreciated on bimanual exam
  2. Confirm with ultrasound vaginally with transducer or abdominally
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17
Q

How are ovarian cysts treated?

A
  1. If cyst is small (<6cm) and unilocular (simple), may be treated symptomatically with NSAIDs and seen back in a month
  2. If greater than 6cm, solid, or mixed, refer patient to gyno
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18
Q

Describe a cervical polyp

A
  1. Defined as a finger-like growth that originates on the cervix or in the cervical canal and hang from a stalk; attached to endocervix
  2. May be associated with chronic inflammation or increase of estrogen levels (ex. pregnant women)
  3. Fairly common, so may be an incidental finding
  4. Rarely malignant
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19
Q

What are the symptoms of a cervical polyp

A
  1. Vaginal bleeding/discharge between periods
  2. Bleeding after intercourse
  3. May be asymptomatic
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20
Q

Define nulliparous

A

Never delivered vaginally; very small round cervical os vs. elongated after vaginal birth

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21
Q

What is a Nabothian cyst

A

A very common cyst that does not need treatment and is often an incidental finding

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22
Q

What are the exam findings for a cervical polyp

A

Smooth purple/red projection from the cervical os

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23
Q

How are cervical polyps treated

A

Excision - cut off at base if base can be accessed; may resolve on their own

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24
Q

Describe an ectopic pregnancy

A
  1. pregnancy outside of the uterus
  2. Most common location is in the fallopian tube but have appeared in ovary, stomach and cervix
  3. Most are the result of scarring from prior condition/infection, fallopian tubes surgery, prior ectopic pregnancy
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25
Q

What is the classic triad of symptoms of ectopic pregnancy?

A
  1. Abdominal/pelvic pain
  2. Vaginal bleeding (could be spotting or heavy)
  3. Amenorrhea
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26
Q

How are ectopic pregnancies diagnosed?

A
  1. Abnormal pelvic exam - may feel lump at implantation site
  2. Positive pregnancy test
  3. Vaginal ultrasound shows absence of IUP at 6 wks)
  4. Definitive test is laparoscopy
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27
Q

How are ectopic pregnancies treated?

A
  1. Pregnancy must be removed as it cannot survive outside of the uterus
  2. Laparoscopy is the most common surgical treatment in an unruptured ectopic pregnancy
  3. Laparotomy is indicated if pregnancy is ruptured
  4. If clinician does not feel pregnancy may rupture, methotrexate can be given; used for cancer treatment but ultimately stops cell division
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28
Q

What are the complications of ectopic pregnancy?

A

Most common complication is internal bleeding and resultant shock from rupture

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29
Q

Describe cervical cancer

A
  1. Slow growing cancer
  2. May be asymptomatic in early stages
  3. If there are symptoms they may include vaginal bleeding and bleeding after intercourse
30
Q

What are the risk factors for cervical cancer?

A
  1. Early onset of sexual activity
  2. Multiple partners
  3. Family history
  4. Maybe cigarette smoking
31
Q

Where do most cervical cancers originate from?

A

Squamocolumnar junction

32
Q

How is screening for cervical cancer done?

A

Pap smear and/or HPV testing

33
Q

What are the screening guidelines for cervical cancer?

A

HPV test alone every 5 years between ages 25 and 65 for everyone with a cervix or pap smear/HPV co-test every 5 years or pap smear every 3 years; no screening older than 65 unless history of cervical cancer or other risk factors

34
Q

How is cervical cancer diagnosed?

A

Done if HPV or pap smear is positive
1. Colposcopy - looking at cervix with colposcope which magnifies the cervix; swab with vinegar which brings out cancer
2. Biopsy - done if anything looks abnormal, sample of tissue is taken and sent to lab

35
Q

What should be done if biopsy shows cervical cancer?

A

A thorough physical exam and radiologic testing will be done in addition to potential tissue removal to determine the extent/stage of the disease. The stage tells whether the tumor has invaded nearby tissue, whether the cancer has spread, and if so, to what part of the body

36
Q

Describe the stages of cervical cancer

A

Stages 1-4; uses the TNM (tumor-nodes-metastasices) classification

37
Q

What is treatment of cervical cancer determined by?

A
  1. Stage and classification
  2. Size of the tumor, if cancer has spread and where, and if the patient wishes to become pregnant
38
Q

What are the methods of treatment of cervical cancer?

A
  1. Surgical excision
  2. Radiation
  3. Chemotherapy
  4. Combination of 1-3
39
Q

What is an important fact to remember about cervical cancer?

A

Prevention is key; if it is caught early it can be treated, slow progression

40
Q

Describe uterine/endometrial cancer

A
  1. Most common in post menopausal women (51,52)
  2. Irregular vaginal bleeding 80% of the time
  3. Pap smear is frequently negative
41
Q

How is uterine cancer diagnosed?

A
  1. Examine endometrial tissue
  2. DNC - dilation and curettage
  3. Sample is needed
42
Q

What is done if endometrial cancer is diagnosed?

A

More testing will be done to determine if the cancer has spread including chest x-ray, CT scan, blood testing (CA-125) - a substance that some endometrial and ovarian cancers release into the bloodstream

43
Q

What is the treatment for endometrial cancer?

A
  1. Surgical removal of the uterus (hysterectomy) is most common
  2. If cancer has spread, chemotherapy and/or radiation
44
Q

Describe uterine fibroids

A
  1. Known as Leiomyomas
  2. Non-cancerous tumors of the uterus
  3. Often appear during child-bearing years
  4. Identified based on anatomic position in uterus
  5. Require estrogen to grow
  6. Can be pedunculated/on a stalk
45
Q

What are the signs and symptoms of uterine fibroids?

A
  1. May be asymptomatic/ may not know until bimanual exam
  2. heavy/long periods are typical
  3. pelvic pressure
  4. urinary frequency
  5. back ache
46
Q

What are the types of fibroids?

A
  1. Submucosal - grows into inner cavity/towards middle
  2. Subserosal - projects to outer uterus
  3. Intramural - lies within muscle body/ no projections in or out
47
Q

How are uterine fibroid treated?

A
  1. Follow clinically - small and asymptomatic = watch progression
  2. Hysterectomy - only permanent solution
  3. Myomectomy - removal of just the fibroid; relieves symptoms while preserving fertility
  4. Hormonal therapies which shrink fibroids (GNRH suppressors)
  5. Embolization - artery is occluded with synthetic material which stops blood supply
48
Q

Define a bilateral salpingo oophorectomy

A

Removal of both tubes and both ovaries

49
Q

Define a hysterectomy

A

Excision of the uterus and cervix

50
Q

Define premenstrual syndrome

A

A group of physical, emotional, and behavioral symptoms that occur premenstrually - about 7 days and not during the follicular phase (days 1-14)

51
Q

What are the signs and symptoms of premenstrual syndrome?

A
  1. Emotional lability
  2. Anger
  3. Irritability
  4. Depression
  5. Fluid retention
  6. Breast tenderness
  7. Headache
  8. Cravings
  9. Weight gain
52
Q

What is the etiology of premenstrual syndrome?

A

Research suggests that in susceptible women, the normal hormone fluctuations of the cycle trigger an abnormal response to the transmitter serotonin (which also decreases when people are deprived of sunlight)

53
Q

What are the physical exam findings of premenstrual syndrome?

A

No specific exam findings - clinical diagnosis/symptoms

54
Q

How is premenstrual syndrome diagnosed?

A

Have patient log symptoms for several months; when , what they are, duration, etc.; symptoms must be around the corresponding time of the cycle

55
Q

How is premenstrual syndrome treated?

A
  1. Patient education
  2. Make lifestyle changes like increase aerobic exercise, decrease sodium and caffeine, increase complex carbohydrates, take calcium supplements
  3. Water pill/diuretic 2 weeks before period for physical symptoms
  4. Anti-depressants for mood/depression to take every day (SSRI’s - selective serotonin reuptake inhibitors)
56
Q

What is normal uterine bleeding?

A

Cycle length: 21-35 days
Period length: 1-6/7 days

57
Q

What is Oligomenorrhea?

A

intervals >35 days

58
Q

What is polymenorrhea?

A

cycle length less than 21 days

59
Q

What is menorrhagia?

A

abnormally heavy periods

60
Q

What is metrorrhagia?

A

Abnormal bleeding between periods

61
Q

What is dysfunctional uterine bleeding?

A

Bleeding in the absence of structural uterine disease commonly caused by anovulation (not ovulating regularly)

62
Q

What is Mittelschmerz?

A

Mid-cycle pain/spotting thought to be secondary to ovulation

63
Q

What questions should be asked when taking history for abnormal uterine bleeding??

A
  1. How much bleeding (# of pads, tampons)
  2. Timing of bleeding (post coital, intermenstrual, mid cycle)
  3. Reproductive history and LNMP
  4. Medication history
64
Q

What is the P.E. for DUB?

A

Vaginal and bimanual exam

65
Q

Define menopause

A

Permanent amenorrhea secondary to lack of estrogen production

66
Q

Define perimenopause (climacteric)

A

Around menopause when periods change and start to become irregular

67
Q

What are the symptoms of menopause?

A
  1. Heat flashes
  2. Irritability
  3. Weight gain
  4. Vaginal dryness
  5. Dyspareunia
  6. Mood disturbances
  7. Sleep disturbances
  8. Libido initially decreases then may go back up
68
Q

How is menopause diagnosed?

A

FSH test - very high due to negative feedback loop

69
Q

How are vasomotor symptoms from menopause treated?

A
  1. Replace estrogen, usually in pill form
  2. Medication - estrogen + testosterone because some women don’t respond well to only estrogen; long term safety data undetermined
  3. SSRI’s - off-label use
  4. Phytoestrogens - plant substances that act similarly to the estrogen used in the body naturally, but are much weaker
70
Q

What are some common phytoestrogen containing foods?

A

Parsley, garlic, soybeans. wheat, rice, dates, coffee, cherries, licorice, red clover, thyme

71
Q

What are some risks of hormone therapy?

A
  1. Stroke
  2. Blood clots
  3. Heart attack
  4. Breast cancer
  5. Endometrial cancer
    *does not apply to phytoestrogen

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