Witwer - Female GU Flashcards by Alice Richards

fxn of the menstrual cycle (2)

production of oocytes

preparation of uterus for pregnancy

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common sx of pre-menstruation (6)

acne

tender breasts

bloating

malaise

irritability

mood changes

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what is PMS

sx of pre menstruation interfere w. normal activities

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usual age for menopause

45-55 yo

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3 components of menstrual cycle

hypothalamus/pituitary cycle

ovarian cycle

uterine cycle

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hormones involved in the hypothalamus/pituitary cycle

GnRH

FSH

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3 phases of ovarian cycle

follicular

ovulation

luteal

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in the follicular phase, granulosa cells proliferate in response to __

and produce __

FSH

estradiol

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in the follicular phase, __

stimulates theca cells to produce __,

which promotes __ in granulosa cells

andorgens

estradiol

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in the follicular phase, __

and __ stimulate GnRH,

which stimulates __

and __

estradiol and progestins

FSH and LH

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in the luteal phase, __ stimulates follicular cell transformation into

corpus luteum

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in the follicular phase, the corpus luteum produces __

and __

progesterone and estradiol

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progesterone, estradiol, and inhibin are produced by __

and suppress __ (2)

granulosa cells

LH and FSH

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without fertilization, the __ regresses and the ovarian cycle begins again

corpus luteum

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3 phases of the uterine cycle

menstruation

proliferative

secretory

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the __ is critical in initiation and maintenance of all the cycles of menstruation

hypothalamus-pituitary-ovarian axis

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what is the primary signal in the hypothalamus-pituitary-ovary axis

GnRH from hypothalamus

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GnRH stimulates the release of __ (2)

from the __

FSH and LH

anterior pituitary

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what do FSH and LH stimulate (2)

gamete (ovum) maturation

hormone production

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in embryology, the egg divides into (2)

morula

blastocyst

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fertilization occurs __ hours after ovulation

and implantation occurs ~ __ days after fertilization

12-24 hr

7+ days

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day 0 of fertilization/implantation

ovulation –> ovary releases oocyte

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12-24 hr of fertilization/implantation

fertilization → zygote (fertilized egg)

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day 2 of fertilization/implantation

first cleavage

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day 4 of fertilization/implantation

morula 8 cell stage

day 5 of implantation

blastocyst → inner cell mass

day 8-9 of fertilization/implantation

implantation of blastocyst

2 normal variations in positioning/configuration of the uterus

version flexion

tilting of uterus

version

bending of body of uterus

flexion

position of uterus in regards to normal

cession

4 supporting structures of the uterus

pelvic diaphragm urogenital diaphragm/perineal membrane perineal body true supporting ligaments

pelvic diaphragm is composed of (3)

levator ani coccygeus fascia

what are the 3 true supporting ligamentous structures of the uterus

transverse (cardinal) anterior pubocervical uterosacral

ligament from either side of the cervix to the pelvic walls

transverse (cardinal)

ligament from the posterior cervix to the front of the sacrum

uterosacral

ligament from the uterus to the pubic symphysis

anterior pubocervical

the uterosacral ligament is composed of (3)

rectouterine folds fibrous tissue muscular fibers

ligaments of the ovary that are not true support structures

broad round suspensory peritoneal folds

supporting structure of the bladder

pubocervical fascia

mechanism of cystocele

weakness of pubocervical fascia → posterior portion of bladder drops down → cystocele

cystocele w. prolapse is usually associated w.

childbirth

sx of cystocele

stress incontinence bulge in anterior vaginal wall that is worse w. cough

supporting structures of the uterus and/or vagina weaken

uterine prolapse

rectal support structures weaken

rectal prolapse

what are the 2 rectal supporting structures

sacrum levator ani

mc oragnisms responsible for STIs

neisseria gonorrhea chlamydia trachomatis

ovarian tumors mc arise from __ cells (2)

epithelial germ

mc benign ovarian tumors (3)

cystadenomas serous mucinous

malignant ovarian tumor

cystadenocarcinoma

less common type of ovarian tumor

ovarian germ cell tumor

the majority of ovarian germ cell tumors are \_\_ and occur in \_\_

benign young females

what do ovarian germ cell tumors contain

hair skin teeth

ovarian tumors in pt's \< 45 yo are usually \_, and the mc type is \_\_

benign serous cystadenomas

very large tumors that sometimes appear on the news

mucinous

what are papillary elements of tumors

growths on cyst wall

on imaging, benign ovarian tumors usually appear (3)

thin walls homogenous fluid no masses

only definitive determination of benign vs malignant ovarian tumor

what do you think when you see bilateral ovarian tumor

malignant

rf for malignant ovarian tumors

age nulliparity BRCA 1 and 2 lynch syndrome hx of breast ca postmenopausal estrogen therapy obesity

what do you think when you see, hereditary non-polyposis colorectal ca

lynch syndrome

ovarian tumors mc metastasize to (2)

omentum perineum

60% of ovarian tumors present w. advanced dz; what are 5 signs of advanced ovarian tumor metastasis

sister mary joseph sign malignant ascites palpable ovarian mass malignant pleural effusion tumor marker: CA125

menorrhagia definition

heavy or prolonged flow

spotting/heavy bleeding btw menstrual flow

metorrhagia

uterus and cervix d.o include (4)

menstruation d.o pregnancy d.o tumors infxn

d.o of the ovary or adnexa include (3)

tumors endometriosis PID

hormonal d.o include (3)

pituitary ovarian endogenous

the PAP test evaluates

appearance of cervical cells

on PAP, malignant cells appear (2)

enlarged misshaped nuclei

least common gynecologic ca

cervical carcinoma

majority of cervical carcinomas are

squamous cell

rf for cervical carcinoma (6)

hpv 16 and 18 early onset of sex multiple partners smoking OCP immunodeficiency

mc sx of cervical carcinoma

abnormal vaginal bleeding

other sx of cervical carcinoma (2)

malodorous d.c ureter blockage from tumor → post renal failure

mc diagnosed gynecologic tumor

leiomyoma

leiomyoma is same same

uterine fibroids

leiomyoma is a \_\_ \_\_ muscle tumor

benign smooth

2 rf for leiomyoma

AA \>30 yo

why are fibroids larger in pregnancy

they are estrogen dependent

sx of fibroids

menorrhagia obstructive delivery constipation frequency/urgency/incontinence +/- infertility

dx for fibroids

US MRI

tx for fibroids

myotomy hysterectomy

what do you think when you see: endometrial glandular tissue w.in the myometrium → enlarged uterus

uterine adenomyosis

3 sx of uterine adenomyosis

pelvic pain menorrhagia dysmenorrhea

dx for adenomyosis

myometrial bx

tx for adenomyosis

hysterectomy

t/f: adenomyosis and endometriosis are caused by the same estrogen sensitive endometrial glandular tissue

mc malignant gynecologic tumor

endometrial carcinoma

what do you think when you see post menopausal bleeding

endometrial ca

rf for endometrial ca

prolonged estrogen stimulation OCPs

3 types of endometrial ca

adenocarcinoma adeno-squamous papillary

mc type of endometrial carcinoma

adenocarcinoma

where does endometrial ca mc spread

superiorly into intestines

dx for endometrial ca

endometrial bx

what do you think when you see: functioning uterine glands and stroma outside of the uterus → cyclic bleeding of glandular and stromal elements

endometriosis

what do you think when you see a 25-59 yo pt w. dysmenorrhea

endometriosis

mc pathogenesis of endometriosis

reverse menses thru tubes

common sites of endometriosis

ovaries rectal pouch fallopian tubes intestines

mc location for endometriosis

ovaries

sx of endometriosis

**dysmenorrhea → mc** abnormal bleeding painful bm during menses dyspareunia enlarged ovaries

endometriosis increases risk for (3)

intestinal obstruction ectopic pregnancy infertility

dx for endometriosis (2)

laparoscopy tumor marker CA125

outer portion of blastocyst that develops into the placenta

trophoblastic cells

trophoblastic tumors arise from

placental tissue

hyatidiform mole is same-same

molar pregnancy

in a molar pregnancy, the fertilized egg does not have \_\_ and does not develop into \_\_

maternal DNA fetal tissue

molar pregnancies grow from (2)

chorion placenta

4 sx of molar pregnancy

vaginal bleeding at 6-16 weeks severe hyperemesis enlarged uterus markedly increased beta HCG

tx for molar pregnancy (2)

D&C follow bHCG

malignant trophoblastic tumor

choriocarcinoma

choriocarcinoma mc arise from

molar pregnancy (trophoblastic cells)

choriocarcinoma can also arise from (2)

spontaneous abortion full term pregnancy

sx of choriocarcinoma

hemorrhagic lesions → vaginal bleeding SOB/hemoptysis CP multiple lung metastases elevated bHCG

choriocarcinoma mc metastasizes to (3)

lungs vagina brain

tx for choriocarcinoma

chemo → great response → low mortality