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58 Cards in this Set

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Uterine Fibroids
(Leiomyomas, myomas)
benign tumors in the muscle tissue of the uterus.
Uterine Fibroid Signs and Symptoms
Abnormal vaginal bleeding (menorrhagia or metrorrhagia)
Pain, Backache, Bloating, Constipation, Urinary Frequency or urgency, intestinal obstruction
Uterine Fibroid Diagnosis
Blood tests, palpaiton of the tumor, laparoscopy, D&C
Uterine Fibroid Risk Factors
Genetic predisposition, Ages 25-40 * a growth spurt in the decade before monepause*, May be related to high levels of estrogen
Complications
Menorrhagia, which can cause anemia
Uterine Fibroid Treatments
Observation, removal if it's large and produces pressure symptoms, blood transfusion, hysterectomy, hysteroscopic resection, laparoscopic myomectomy, laparoscopic myolysis, laparoscopic cryomyolsis, UAE, MRgFUS, Medication Therapy
Uterine Fibroid Medication Therapy
Leuprolide [Lupron] or other GnRH
Mifepristone [RU-486, Mifeprex]
Menorrhagia
Excessive vaginall bleeding
Metrorrhagia
Irregular vaginal bleeding
Hysteroscopic resection
laser removal of uterine fibroids with no incision or overnight stay required.
Laparoscopic myomectomy
removal of a fibroid through a laparoscope.
Laparoscopic myolysis
a laser or electrical needles are used to cauterize and shrink the fibroid.
Laparoscopic cryomyolsis
electric current is used to coagulate the fibroid.
Uterine artery embolization (UAE)
polyvinyl alcohol or gelatin particles are injected into the blood vessels that supply the fibroid via the femoral artery, resulting in infarction and resultant shrinkage.
UAE complications
pain, infection, amenorrhea, necrosis, bleeding, death, ovarian failure.
UAE
Percutaneous image-guided therapy that is a good alternative to hormone therapy or surgery for uterine fibroids.
Magnetic resonance-guided focused ultrasound surgery (MRgFUS)
an outpatient treatment using ultrasonic energy is passed through the abdominal wall to target and destroy the fibroid.

Non-invasive treatment, not widely used.
MRgFUS is FDA approved for
Premenopausal women with bothersome symptoms that do not want more children.
Leuprolide [Lupron] or other gonadotropin-releasing hormones (GnRH)
A monthly injection used to shrink fibroids by inducing a temporary menopause-like environment
Leuprolide [Lupron] or other gonadotropin-releasing hormones (GnRH) side effects
vaginal dryness
hot flashes
Long term side effects of Lupron or GnRH
vasomotor symptoms and loss of bone density
Mifepristone (RU-486, Mifeprex)
a progesterone antagonist used to treat uterine fibroids
Fibrocystic disease of the breast
over growths of fibrous tissue in the area of the ducts forming small cysts that develop and disappear quickly
Risk factors for Fibrocystic disease of the breast
Ages 30-50
Signs and Symptoms of Fibrocystic disease of the breast
Occasional shooting sensation or dull ache
Fibrocystic disease of the breast Diagnosis
ultrasound
Fibrocystic disease of the breast treatment
aspiration of fluid

Medications: danocrine and analgesics
Colon Polyps
a small clump of cells that form on the lining of the colon. Mostly harmless, may become cancerous over time.
3 major types of colon polyps
1. Adenometaous polyps
2. Hyperplastic polyps
3. Inflammatory polyps
Adenometaous polyps
rarely become cancerous and consist of 2/3 of all polyps
Hyperplastic polyps
Occur most often in the left (descending) colon and rectum. Usually less than .5 cm or 5mm in size. They're very rarely malignant.
Inflammatory polyps
Follow a bout of ulcerative colitis or Crohn’s disease of the colon. Not a significant threat themselves, but the presence of ulcerative colitis or Crohn’s disease increase the overall risk of colon cancer.
Colon polyps Signs and Symptoms
Rectal bleeding (bright red blood); blood in stool (red streaks or black); constipation; diarrhea; narrowing of the stool; pain or obstruction; abdominal pain; and change in bowel habits that last longer than a week.
Complications of colon polyps
may turn into colon cancer.
Risk factors for colon polyps
age 50+, overweight, smoker, eat a high-fat or low fiber diet, history of colon polyps or cancer, African American, Ashkenazi Jew, or Eastern European decent
Colon polyp diagnosis
fecal occult (hidden) blood test; fexible sigmoidoscopy; barium enema; colonoscopy; computurized colongraphy (CTC); stool DNA testing; genetic testing (determines risk).
Colon polyp treatment
snare; surgery; endoscopic mucosal resection; colon and rectum removal; dietary changes; limit alcohol; smoking cessation; physically active and healthy body weight; medication therapy- ASA or hormone therapy
Prostatic hyperplasia
a normal, aging related, enlargement of the prostate gland that causes urinary outlet obstruction.
Prostatic hyperplasia signs and symptoms
reduce stream force and caliber of urine, a feeling of not emptying the bladder, urinary retention.
Prostatic hyperplasia diagnosis
rectal digital exam of the prostate, iv pyelogrpahy, elevated BUN and creatinine levels, ua and urine culture.
Prostatic hyperplasia Treatment
prostate massage, fluid restriction, sitz bath, regular sexual intercourse, TURP, and continuous irrigation.
TURP (Transurethral Resection of the Prostate)
an instrument is inserted up the urethra to remove the section of the prostate that is blocking urine flow
TURP Post-op
1-2 days hospitalizaiton; catherer to remove blood or blood clots in the bladder.
Avoid for 6 weeks post-op of a TURP
strenuous activity, constipation, and sexual activity
IV pyelography
shows the kidneys, ureter, and bladder via x-ray imaging as the dye moves through the upper and then lower urinary system.
Normal BUN
10-20mg/dL
Normal Serum Creatinine
~0.7-1.4mg/dL

*increases as renal function decreases*
Dietary alterations for colon polyps
Adequate amounts of calcium; plenty of fruits, vegetables, and whole grains; watch fat intake.
Colon and rectum removal creates an
Ileal pouch-anal anastomosis
Ileal pouch-anal anastomosis
a pouch is constructed from the end of the small intestine ileum that attaches directly under the anus. Allowing for normal waste expellation, through several watery bowel movements in a day.
Endoscopic mucosal resection (EMR)
Removal of larger polyps with a colonoscope. Liquid, such as saline, is injected under the polyp to elevate and isolate the poly from surrounding tissue making it easier to remove (avoids complications), higher rate of complications.
Snare polyp removal
removal of smaller polyps during a colonoscopy or sigmoidoscopy by snaring them with a wire loop that simultaneously cuts the stalk of the polyp and cauterizes it to prevent bleeding.

Risk for bleeding and perforation of the colon.
Laparoscopic snare polyp removal
A laproscopic removal of large snares which provides for a faster and less painful recovery.
Once the section of the colon is removed, the polyp can't recur at that area but can.....
... develop in other areas of the colon in the future.
Flexible sigmoidoscopy
a slender lighted tube that is used to exam the rectum and sigmoid- approximately the last 2 feet of the colon. Where nearly half of all colon cancers are found.

Slight risk for colon perforation, but less than the colonoscopy.
Barium enema and Colon polyps
A barium enema is given and x-rays to diagnose colon polyps.
Carries slight risk for colon perforation.
No chance for doctor to perform a biopsy.
Colonoscopy
a long, slender tube attached to a video camera and monitor allowing for a view of the entire colon and rectum.

Carries risk for colon perforation.
Computerized tomography colongraphy (CTC)
an x-ray style virtual colonoscopy that does not require you to go inside of the body.

Pt will need colonoscopy if a biopsy is needed.