Him Medical Terminology

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Pathology – Endometrial tissue found outside the uterus, including ovaries, fallopian tubes, supporting ligaments, or small intestine causes inflammation and scar tissue. Most cases develop as a result of bits of menstrual endometrium that pass backward through the lumen (opening) of the fallopian tube and into the peritoneal cavity. Often, when disease affects the ovaries, large blood-filled cysts, called chocolate cysts, develop.
Signs and symptoms – dysmenorrhea, pelvic pain, infertility (inability to become pregnant), and dyspareunia (painful intercourse)
Treatment – ranges from symptomatic relief of pains and hormonal drugs that suppress the menstrual cycle to surgical removal of ectopic endometrial tissue and hysterectomy

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Endometriosis

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Pathology – inflammation and infection of organs in the pelvic region; salpingitis, oophoritis, endometritis and endocervicitis
Etiology – leading causes are bacterial infections such as gonorrhea and chlamydia (sexually transmitted diseases or STDs).
Signs and symptoms – foul-smelling vaginal discharge, abdominal pain in the left and right lower quadrants, fever and tenderness on palpation (examining by touch) of the cervix.
Treatment - antibiotics
Complications – Repetitive episodes of these infections lead to formation of adhesions and scarring within the fallopian tubes. After PID, women have increased risk of ectopic pregnancies and infertility.

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Pelvic inflammatory disease

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Pathology – benign tumors in the uterus composed of fibrous tissue and muscle
Signs and symptoms – if large they can cause symptoms such as metrorrhagia, pelvic pain, or menorrhagia
Treatment – if large, hysterectomy or myomectomy; Fibroid removal without surgery includes uterine artery embolization (UAE), in which tiny pellets are injected into a uterine artery supplying blood to the fibroids. Blood flow is blocked by the pellets (emboli), causing fibroids to shrink in size.

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Leiomyomas or fibroids

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Pathology – inflammation of vagina
Etiology – bacteria and yeast (Candida) commonly cause this infection. Use of antibiotics can change the internal environment (pH) of the vagina and destroy normally occurring bacteria, allowing yeast to grow.

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Vaginitis

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Pathology – uterus falls, droops
Signs and symptoms – 1st degree – no symptoms; 2nd degree – pelvic pain, 3rd degree – cervix protrudes through the vaginal opening
Treatment - hysterectomy

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Uterine prolapse

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Pathology – occurs when part of the urinary bladder herniates through the vaginal wall as a result of weakened pelvic muscles

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Cystocele

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Pathology – protrusion of a portion of the rectum toward the vagina through a weak part of the vaginal wall muscle

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Rectocele

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Pathology – malignant cells within the cervix; carcinoma of cervix; Although most HPV infections do not progress to cervical cancer, early neoplastic changes in the cervix can range from dysplasia (abnormal cell growth) to carcinoma in situ (CIS) (localized cancer growth).
Etiology – Human papillomavirus (HPV) is one of the most common causes of sexually transmitted infection in the world. Some types of HPV cause genital warts – benign growths on the vulva, cervix, vagina, or anus.
Diagnosis – Pathologists diagnose preinvasive neoplastic lesions called cervical intraepithelial neoplasia (CIN) from a Pap smear (microscopic examination of cells scraped from cervical epithelium) and grade them as CIN I to CIN III.
Treatment –Biopsy and resection (conization) may be necessary to diagnose and treat CIS. Surgery (hysterectomy) and radiation therapy combined with chemotherapy treat more extensive and metastatic disease.
Public Health – occurs more commonly in women who have sexual intercourse at an early age, multiple sexual partners, a history of sexually transmitted diseases, and evidence of human papilloma virus (HPV) infection.

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Cervical cancer

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Pathology – malignant tumor of the uterus (adenocarcinoma)/ most common gynecological tumor
Signs and symptoms – major symptom is postmenopausal bleeding
Diagnosis – Physicians perform endometrial biopsy, hysteroscopy and dilation (opening the cervical canal) and curettage (scraping the inner lining of the uterus
Treatment – When confined to the uterus, surgery (hysterectomy) is curative. Radiation oncologists administer radiation therapy for patients with more advanced disease. Progresterone treatment often causes regression of endometrial cancer.
Public health – occurs most often in women exposed to high levels of estrogen, either from exogenous estrogen (pills) or estrogen-producing tumors, or with obesity (estrogen is produced by fat tissue) and in nulliparous women

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Endometrial cancer

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Pathology – malignant tumor of the ovary (adenocarcinoma); may be cystic or solid in consistency; in most patients, the disease metastasizes within or beyond the pelvic region before diagnosis and often causes abdominal ascites (accumulation of fluid in the abdominal cavity.
Signs and symptoms – usually discovered in the advanced stages as an abdominal mass and may produce few symptoms in its early stages.
Treatment – surgery (oophorectomy and salpingectomy) and chemotherapy are used as therapeutic measures. – A protein marker produced by tumor cells, CA 25, can be measured in the bloodstream to assess effectiveness of treatment.
Prognosis – Carcinomas of the ovary account for more deaths than those of cancers of the cervix or the uterus together.

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Ovarian cancer

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visual examination of the abdominal cavity using an endoscope; In this procedure, a form of minimally invasive surgery (MIS), small incisions are made near a woman’s navel with introduction of a laparoscope and other instruments. Uses of laparoscopy include inspection and removal of ovaries and fallopian tubes, diagnosis and treatment of endometriosis, and removal of fibroids. Laparoscopy also is used to perform subtotal (cervix is left in place) and total hysterectomies.

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Laparoscopy

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widening of the cervix and scraping the endometrium of the uterus. Dilation is accomplished by inserting a series of probes of increasing size. A curet (metal loop at the end of a long, thin handle) is then used to sample the uterine lining. This procedure helps diagnose uterine disease and can temporarily halt prolonged or heavy uterine bleeding. When necessary, a D&C is used to remove the tissue during a spontaneous or therapeutic abortion.

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dilation and curettage

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is removal of the entire uterus (including the cervix) through an abdominal incision

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a total abdominal hysterectomy (TAH)

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is removal through the vagina.

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total vaginal hysterectomy (TVH)

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Removal of tubes and ovaries is separate

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salpingo-oophorectomy

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when the cervix is left intact

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subtotal hysterectomy

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microscopic examination of stained cells removed from the vagina and cervix. After inserting a vaginal speculum (instrument to hold apart the vaginal walls), the physician uses a small spatula to remove exfoliated (peeling and sloughing off) cells from the cervix and vagina. Microscopic analysis of the cell smear (spread on a glass slide) detects cervical or vaginal carcinoma

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Papanicolaou test/pap smear

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removal of a cone-shaped section(cone biopsy) of the cervix. The physician resects the section with a LEEP (loop electrocautery excision procedure), or carbon dioxide laser, or surgical knife (scalpel).

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conization of cervix

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loop electrocautery excision procedure

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LEEP

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– blocking the fallopian tubes to prevent fertilization from occurring. This sterilization procedure is performed using laparoscopy or through a hysteroscope inserted into an incision in the cervix. Ligation means to tie and doesn’t pertain solely to tying off the fallopian tubes – which may be “tied” using clips or bands, or by surgically cutting or burning through the tissue

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tubal ligation

Front 21

Pathology – numerous small sacs of fibrous connective tissue and fluid in the breast
Signs and symptoms – nodular (lumpy) consistency of the breast, often associated with premenstrual tenderness and fullness
Diagnosis – Mammography and surgical biopsy are indicated to differentiate fibrocystic changes from carcinoma of the breast

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Fibrocystic disease of the breast/mammary fibroplasia

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pathology - solid tumor in the breast
diagnosis – surgical biopsy

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Fibroadenoma

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Pathology – malignant tumor of the breast (arising from milk glands and ducts). The most common type is invasive ductal carcinoma. Other histopathologic types are medullary carcinoma and lobular carcinoma. Breast cancer first spreads to lymph nodes in the axilla (armpit) adjacent to the affected breast and then to the skin and chest wall. From the lymph nodes it may also metastasize to other body organs, including bone, liver, lung, or brain.
Diagnosis – first established by a biopsy, using either a needle core, a needle aspiration, or surgical removal of a specimen
Treatment – For small primary tumors, the lump and immediately surrounding tissue is removed (lumpectomy). To determine whether the tumor has spread to lymph nodes, a sentinel node biopsy (SNB) is performed to determine whether the tumor has spread to the lymph nodes. For this procedure a blue dye or a radioisotope is injected into the tumor site and tracks to the axillary lymph nodes. By visualizing the path of the dye or radioactivity, it is possible to identify the lymph nodes most likely to contain tumor. These lymph nodes, the sentinel nodes, are removed first, and if tissue studies give negative results, the procedure can be stopped at this point. Radiation to the breast and to any involved lymph nodes then follows to kill remaining tumor cells. An alternative surgical procedure is mastectomy which is removal of the breast. After either lumpectomy or mastectomy if lymph nodes are involved with cancer, adjuvant (aiding) chemotherapy may be given to prevent recurrence of the tumor.
After surgery, further treatment (adjuvant therapy) may be indicated to prevent recurrence. To determine what kind of treatment to use, it is important to test the breast cancer tumor for the presence of estrogen receptors (ER). These receptor proteins indicate that the tumor will respond to hormonal therapy. If metastases should subsequently develop, this information will be valuable in selecting further treatment. There are two types of drugs that block the effects of estrogen and thereby kill ER-positive breast cancer cells. Drugs of the first type directly block the ER reception. An example is tamoxifen. Drugs of the second type block the production of estrogen by inhibiting the enzyme aromatase. These aromatase inhibitors (AI) are particularly useful in treating post-menopausal women. Examples of AI are anastrozole (Arimidex) and letrozole (Femara). A second receptor protein, her-2/neu, is found in some breast cancers and signals a high risk of tumor recurrence. Herceptin, an antibody that binds to and blocks her-2/neu, is effective in stopping growth when used with chemotherapy.

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cancer of the breast

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x-ray imaging of the breast. Women are advised to have a baseline mammogram at 50 years of age for later comparison if needed. A mammogram every 1 to 2 years is recommended for women older than 50 to screen for breast cancer. Full-field digital mammography is faster than traditional mammography and displays images on a computer screen

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Mammography

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insertion of a needle into a tissue to remove a core of cells for microscopic examination. The physician uses needle aspiration to withdraw free cells from a fluid-filled cavity (cystic areas of the breast), or from a solid mass of tumor.

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Needle Biopsy

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piece of tumor is removed for examination to establish a diagnosis. More extensive surgical procedure or other forms of treatment, such as chemotherapy or x-ray, then are used to treat the bulk of the tumor.

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incisional biopsy

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removal of a tumor and a margin of normal tissue. This procedure provides a specimen for diagnosis and may be curative for small tumors.

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excisional biopsy

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is the removal of not only the breast but also the regional lymph nodes and the pectorals or chest wall muscles

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A radical mastectomy

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is the removal of not only the breast but also the regional lymph nodes. The chest wall muscles are not removed.

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A modified radical mastectomy

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breast only removed

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A Simple mastectomy

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is a serious complication of pregnancy
signs and symptoms - persistent nausea and vomiting which threaten the nutrition of the mother. These patients usually do not gain weight; they tend to lose weight.

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Hyperemesis gravidarum

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spontaneous or induced termination of pregnancy before the embryo or fetus can exist on its own. Major methods for abortion include vaginal evacuation by dilation and curettage or vacuum aspiration (suction) and stimulation of uterine contractions by injection of saline (salt solution) into the amniotic cavity (in second-trimester pregnancies).

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Abortion

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is a natural termination of pregnancy, usually referred to as a Miscarriage

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A spontaneous abortion

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induced because of the mother’s physical or mental health

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therapeutic abortion

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When partial or total retention of the placenta occurs after the fetus is expelled, it is termed an

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Incomplete Abortion

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no tissue is left in the uterus

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Complete Abortion

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early, fetus quits growing
signs and symptoms – no weight gain
diagnosis – ultrasound confirms no heartbeat
treatment – dilation and evacuation

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Missed Abortion

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spotting blood, no tissue passed

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threatened abortion

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three or more miscarriages in a row, sign of some problem that needs workup for diagnosis

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habitual or recurrent abortion

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retained placenta is a

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complication

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pathology – implantation of the fertilized egg in any site other than the normal uterine location; 90% occur in the fallopian tubes. Rupture of the ectopic pregnancy within the fallopian tube can lead to massive abdominal bleeding and death. Other sites of ectopic pregnancies include the ovaries and abdominal cavity; wherever the location, ectopic pregnancy always constitutes a surgical emergency
Treatment – surgeons can remove the implant or treatment with medication (methotrexate) can destroy it, thereby preserving the fallopian tube before rupture occurs.
public health – occurs in up to 15 percent of pregnancies

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Ectopic pregnancy

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term that includes eclampsia and preeclampsia; newer term is pregnancy-induced hypertension

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Toxemia

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Signs and symptoms – abnormal condition associated with pregnancy marked by high blood pressure, proteinuria (loss of protein in urine), and edema.
Treatment – mild preeclampsia can be managed by bed rest and close monitoring of blood pressure. Women with severe preeclampsia are treated with medications such as magnesium sulfate to prevent seizures, and the baby is delivered as quickly as possible

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preeclampsia

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Signs and symptoms - occurrence of one or more convulsions or a coma, in a patient with preeclampsia which cannot be attributed to other cerebral conditions such as epilepsy. Eclampsia develops in 1 of every 200 pre-eclampsia patients. (Educode)
Treatment - The condition should be stabilized within 4 to 6 hours with delivery as the objective. (Educode)
Prognosis - usually fatal if left untreated; Twenty-five percent of eclampsia occurs in the postpartum period

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Eclampsia

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pathology – premature separation of the implanted placenta
etiology – occurs because of trauma, such as a fall, or secondary to vascular insufficiency resulting from hypertension or preeclampsia
signs and symptoms – sudden searing (burning) abdominal pain in bleeding; it is an obstetrical emergency

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Abruptio placenta

Front 46

pathology – placental implantation over the cervical os (opening) or in the lower region of the uterine wall
symptoms – painless bleeding, hemorrhage, and premature labor
treatment – Cesarean delivery is usually recommended.
complications – result in less oxygen supply to the fetus and increased risk of hemorrhage and infection for the mother

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Placenta previa

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pathology – placenta grows into the wall of uterus
treatment – if grows into muscle layer, remove placenta; if grows deep into wall of uterus, hysterectomy

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placenta accreta

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Pathology – benign abnormal growth of placenta
Signs and symptoms – increased blood pressure is common; large for dates uterus
Diagnosis – snowflake pattern seen on ultrasound

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Hydatidiform mole

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pathology – malignant tumor of the pregnant uterus; it may spread to lungs and other organs.
etiology – the tumor may appear following pregnancy or abortion
signs and symptoms – May appear with signs of enlarged ovaries, bleeding and a positive pregnancy test.
treatment – Treatment is with dilation and curettage (D&C) and chemotherapy

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choriocarcinoma

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recording images of sound waves as they bounce off organs in the pelvic region. This technique can evaluate fetal size, maturity, and organ development as well as fetal and placental position. Uterine tumors and other pelvic masses, including abscesses, are also diagnosed by ultrasonography

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pelvic ultrasonography

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allows the radiologist a closer, sharper look at organs within the pelvis. The sound probe is placed in the vagina, instead of across the pelvis or abdomen

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Transvaginal ultrasound

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needle puncture of the amniotic sac to withdraw amniotic fluid for analysis. The cells of the fetus, found in the fluid, are cultured (grown), and cytologic and biochemical studies are performed to check fetal chromosomes, concentrations of proteins and bilirubin, and fetal maturation

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Amniocentesis

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sampling of placental tissues (chorionic villi) for prenatal diagnosis. The sample of tissue is removed with a catheter inserted into the uterus. The procedure can be performed earlier than amniocentesis, at about 9 to 12 weeks of gestation

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Chorionic villus biopsy/sampling (CVS

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elevated levels in amniotic fluid and maternal blood are associated with congenital malformations of the nervous system, such as anencephaly and spina bifida

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Alpha Fetal-Protein (AFP)
(Feto)

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pathology – A person who is Rh+ has a protein coating (antigen) on his or her red blood cells. This specific antigen factor is something that the person is born with and is normal. People who are Rh negative (Rh-) have normal red blood cells as well, but their red cells lack the Rh factor antigen.
If an Rh- woman and an Rh+ man conceive an embryo, the embryo may be Rh- or Rh+. A dangerous condition arises only when the embryo is Rh+ (because this is different from the Rh- mother). During delivery of the first Rh+ baby, some of the baby’s blood cells containing Rh+ antigens can escape into the mother’s bloodstream. This sensitizes the mother so that she produces a low level of antibodies to the Rh+ antigen. Because this occurs at delivery, the first baby is generally not affected and is normal at birth. Sensitization can also occur after a miscarriage, abortion or blood transfusions (with Rh+ blood). Difficulties arise with the second Rh+ pregnancy. If the embryo is Rh+ again, during pregnancy the mother’s acquired antibodies (from the first pregnancy) enter the embryo’s bloodstream. These antibodies attack and destroy the embryo’s Rh+ red blood cells. The embryo attempts to compensate for this loss by making many new, but immature red blood cells (erythroblasts). The infant is born with hemolytic disease of the newborn (HDN) or erythroblastosis fetalis. HDN can occur in the first pregnancy if a mother had an Rh+ blood transfusion
Signs and symptoms – jaundice (yellow skin pigmentation) resulting from excessive destruction of RBCs. When RBCs break down (hemolysis), the hemoglobin within the cells produces bilirubin (a chemical pigment). High levels of bilirubin in the bloodstream (hyperbilirubinemia) cause jaundice. Prevention – To prevent bilirubin from affecting the brain cells of the infant, newborns are treated with exposure to bright lights (phototherapy). The light decomposes the bilirubin, which is excreted from the infant’s body.
Physicians administer Rh immune globulin (Rhogam) to an Rh- woman within 72 hours after each Rh+ delivery, abortion, or miscarriage. The globulin binds to Rh+ cells that escape into the mother’s circulation and prevents formation of Rh+ antibodies. This protects future babies from developing hemolytic disease of the newborn.

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Rh Hemolytic Disease

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This stage begins with uterine contractions and ends when dilatation of the cervix is complete at 10 cm.

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Stage 1 of Labor

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This stage begins with complete dilatation of the cervix and ends upon the birth of baby

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Stage 2 of Labor

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This is the stage after childbirth when uterine contractions separate the placenta from the uterine wall. During this stage the placenta is delivered

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Stage 3 of Labor

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difficult labor mostly due to baby vs. mother size (cephalopelvic disproportion), shoulder dystocia

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dystocia

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umbilical cord falls down in birth canal where it can be compressed by the baby’s head; emergency situation
treatment – cesarean section

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cord prolapse

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baby’s head is too large to fit through mother’s pelvis
treatment – cesarean section

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cephalopelvic disproportion

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in a normal delivery position, the head appears

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first (cephalic or vertex presentation)

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Most common abnormal presentation

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Breech

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presentation is a delivery where the presenting part of the fetus is a pelvic extremity, such as buttocks, knees, or feet (footling breech).
treatment – cesarean section

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Breech

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labor in which the progress of the baby through the birth canal is obstructed or blocked
etiology – usually due to small size of pelvis

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obstructed labor

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an incision through the skin of the perineum enlarges the vaginal orifice for delivery. The incision is repaired by perineorrhaphy

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episiotomy

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are instruments used for grasping and applying traction to the baby’s head to assist delivery

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forceps

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most common type is____________ used when the baby’s head is showing (crowning) to guide the head out

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outlet forceps

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surgical incision of the abdominal wall and uterus to deliver a fetus
indications – cephalopelvic disproportion (the baby’s head is too big for the mother’s birth canal), abruptio placenta or placenta previa, fetal distress (fetal hypoxia), and breech or shoulder presentation.
types - The two types of incisions used for a cesarean section are Classical and Lower Segment.

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cesarean section

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incision is made longitudinally in the anterior of the body of the uterus

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classical

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is made in the lower portion of the uterus, either Longitudinal or Transverse

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lower segment

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widening of the cervix and scraping the endometrium of the uterus. Dilation is accomplished by inserting a series of probes of increasing size. A curet (metal loop at the end of a long, thin handle) is then used to sample the uterine lining. This procedure helps diagnose uterine disease and halt prolonged or heavy uterine bleeding. When necessary, a D&C is used to remove the tissue during a spontaneous or therapeutic abortion

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dilation and curettage

Front 73

into the amniotic cavity to stimulate uterine contractions is a method of inducing an abortion

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Saline injection

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the perineum may tear spontaneously during delivery (as opposed to an episiotomy which is an intentional cut); they are differentiated by the extent of the tear

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lacerations

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tear of the superficial layers of the perineum

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First degree

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tear of the inner and muscular layers of the perineum

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Second degree

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tear of the tissues between the vaginal and perineal muscular layers and the rectal mucosa

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Third degree

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tear that extends into the anal and rectal mucosa
Treatment – if severe, may require sutures

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Fourth degree

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six weeks following delivery

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Puerperium

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is the return of the reproductive organs to their original, non-pregnant state. takes 6 weeks following delivery for uterus to go back to normal size

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Involution of uterus

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is the normal secretion of milk. After giving birth, hormones from the pituitary gland stimulate lactation; begins about 24-48 hours after delivery

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Lactation cycle

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Obstetrics

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OB

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Total Abdominal Hysterectomy with Bilateral Salpingo-oophorectomy

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TAH-BSO

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Cervical Intraepithelial Neoplasia

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CIN

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Primipara

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Primip

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Alpha-fetoprotein

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AFP

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Follicle-Stimulating Hormone

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FSH

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Ductal Carcinoma In Situ

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DCIS

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Multipara

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Multip

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Cesarean section

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C-Section

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Dilation (Dilatation) and Curettage

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D&C