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49 Cards in this Set
- Front
- Back
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Normal function of menstrual cycle:
1. endocrine control 2. ovary: hormones 3. uterus: cycling |
1. Hypothalmus: GnRH (pulsative and timing)
Anterior Pituitary: Gonadotropins (LH and FSH) 2. Follicle: produce Estrogen Corpus Lutenum: Progesterone (when egg ovulates) 3. Menstrual lining (endometrial growth) Proliferative phase: 11 days Secretory phase: 12 days (thick and profound vesicles) implantation or menses: 5 days |
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what is feedback
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estrogen or progesterone->
FSH/ LH-> Hypothalamus |
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Primary amenorrhea
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pt has never had menstral cycles
*genetic or chromosomal abnormalites |
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secondary amenorrhea
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previously has had menstrual cycle but then stops
*syndromes or illnesses |
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Underlying conditions of Amenorrhea:
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prenancy; hypothalamic dys (exercise/stress/thyroid); pituitary dys (adenomas- b); ovary dys (pco/meno/chromo); outflow tract anomalies (Mulerian Duct Abberancies- primary/genetic)
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galactorrhea
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production of breast milk when not breast feeding
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r/o:
pituitary, ovaries |
X-ray will conclude on pituitary
give OC to see if there is a normal cycle- ovaries high FSH & LH after= ovaries weren't working low= ovaries were working |
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treatment for hypothalamic suppression
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weight gain, less exercise
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metrorrhagia
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irreg and frequent bleeding
(train/metro) |
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menorrhagia
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prolonged or excessive bleeding
(men) |
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menometrorrhagia
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irreg and frequent, prolonged or excessive bleeding
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oligomenorrhea
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infrequent menstrual flow
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dysfunctional uterine bleeding
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bleeding source is uterine/ hormone
abnormality in estrogen or progesterone levels |
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postmenopausal bleeding
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any bleeding 6 months after last period
(cancer?) |
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Polysystic ovary dis
(stein-leventhal syndrome) |
1. estrogen excess
2. cause of infertility & amenorrhea 3. Clomiphen Citrate (Clomid)-stimulate ovulation 4. hyperplasia will result of endometrial build up 5. hyperplasia may become atypical-> precancerous disease |
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PCO dis tx:
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-Progesterone (medroxyprogesterone)
-estro/pro combo (OC-if estro not high) -estro (oral or IV- with heavy blood flow) -NSAIDs (decrease bleeding-lower prostraglandins, vasoconstrict, pain) -D&C (when pharm has failed-will have to redue) -Abblation (cauterize endo-lasting effect, scaring, lowers bleeding, sterilized) |
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most common cause of second amen
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pregnancy
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uterine cancer suspected in:
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-post meno bleeding
-abnormal bleeding in middle age or older females (get a tissue specimen) - family hx -prolong estrogen increses risk |
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infertility
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unprotected intercourse, timed appropriately, for 12 months
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Male factors:
hormonal disorders Test |
androgen dis, assoc with rare tumor, thyroid dysfunction
TSH, prolactin levels |
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Male:
disorders of sperm production tx |
post traumatic, varicocele, toxins, auto-immune, infections
semen anaylsis (inital test) |
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male:
sexual dys |
impotence (meds, depression, chronic health conditions) and decresed libido
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femal problems:
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-disorder of ovulation (inital evaluation)
-cervical mucos changes -hostile endometrium -abberant tubal/uterine anatomy (scaring) |
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causes of anovulation
test: |
-PCO syndrome
-hypothyroidism -pituitary adenoma -adrenal hyperplasia -hypothalamic dysfunction -ovarian failure (menopause) *the ovaries on up** |
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hostile environments tested by:
tx: |
-serum progesterone (1 wk after ovulation)
-endometrial biopsy (less reliable may cause miscarriage) *Clomid or progesterone |
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dysmenorrhea
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recurring pain, occurs consistantly with menstrual cycle
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primary dysmenorrhea
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pain results from the normal menstrual cycle (more then normal)
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secondary dysmenorrhea
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pain results from pathologic menstrual process
** cervical stenosis, enometriosis, adenomyosis, pelvic congestion, adhesions, somatization/ depression** |
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1. scant flow?
2. pain worse at night or standing 3. dyspareunia 4. hx of infertility 5. worse with stress 6. accompanying mood swings |
1. cervical stenosis
2. pelvic congestion 3. adhesions/ endometriosis 4. adhesions 5. somatization 6. depression |
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Pelvic exam and testing:
1. uterus mobile or fixed 2. os sounded 3. recto-vaginal exam 4. mental status exam 5. hysterosalpingogram 6. laparoscopy |
1. endometriosis/ adhesions
2. cervical stenosis 3. nodules/ endo 4. somatization/ dep 5. cervical stenosis 6. endo, adhesions, pelvic veins or dilation |
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usually made as a diagnosis of exclusion
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primary dysmenorrhea, starts shorly after menarche, within the first three to six cycles
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symptoms of dysmenorrhea made by:
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sloughing of endometrial tissue, progesterone levels, prod of prostoglandins (inflamation)
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tx of dysmenorrhea
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decreasing prostaglandins sythesis (NSAIDs)
or reducing amount of progesterone and endometrial tissue sloughed (OC) |
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Physical signs of a uterine fibroid:
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-diagnosis made by abd and pelvic exam
-finding of a firm mass or irreg, nodualr uterus -if lg or uncertain, do a SONOGRAM to r/o enlarged ovaries |
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symptoms:
most are.. and the rest |
-asymptomatic (picked up on exam)
*prob b/c: symetrical enlargement= pregnancy or diff to distinguish from ovarian pathology -bleeding (menorrhagia) -pressure (urinary & constipation) -pain/tenderness (degeneration, gradual, severe- fever & leuko) -distortion of abd (lg fibroid) -infertility |
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TX for uterine fibroids
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-observation and reassurance
*most don't need therapy- esp asymp *examine often- rate of growth&symp *no size limits to fibroids -surgical (myomectomy-4 childbearing) *20% reaccurance *adhesions (likely) *more blood loss -hysterectomy -arterial embolization (UAE) |
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medical management of uterine fibroids:
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Lupron (GnRH antagonist)
-reduce the size 40-60% -return back to original size in 3months after stopping -used to DEC. SIZE for VAGINAL HYSTERECTOMY -correct anemia b4 surgery if iron only doesn't work |
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uterine fibroids:
benign/malignant symp/ asympto symptoms based on... most common treatment |
-benign
-asymptomatic -size and degeneration (severe deg=fever and leuko)....abnormal bleeding -surgical removal (hysto or myomectomy) |
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cervical dysplasia
or cerv. intraepithelial neoplasia or CIN |
-dysplasia: abnormal maturation
cellular changes *immaturity *disorganization *nuclear abnormalities *increased mitotic activity |
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cytology classification:
squamous epithelia cell abnormailities |
Atypical squamous cells
-ASCUS (unditermined significance) -ASC-H (can't exclude HSIL) Sqamous intraepithelial lesion -LOW grade (HPV, koilocytosis CINI -LGSIL) -HIGH " (CIN II, III - HGSIL) Squamous CEll Cancer |
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cytology:
Glandular Cell abnormalities |
Atypical glandular cells (AGC)
-endocervical, endometrial, NOS AGC, favor neoplastic -endocervical or NOS Endocervial Adenocarcinoma in situ AIS Adenocarcinoma |
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cytology:
Other |
Endometrial cells
-in women >40 y/o |
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observation follow-up
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-CIN I only
-high likelyhood it will revert back to normal 90% -repeat pap 6-12 months HPV testing 12 months |
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ABlative Techniques:
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-cryocautery (good for CIN i-but now use observation)
-laser vaporization (historical now; used with lg transformation zones) |
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ecisional tech
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Leep
Leep cone cold knife conization (CKC) -used for diagnostic purposes as well as therapy for dysplasia |
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LEEP
most are using this procedure |
loop electrical excision procedure
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tx for AIS
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CKC
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Hysterectomy
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-radical tx for dysplasia
-multiple recurrences -poor follow up -other GYN issues |
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pap smears done to detect...
colposcopy done to determine... tx by ablating or excising the transformation zone will... |
detect dysplasia
high grade or low lesion lower chance of lesion progressing into CA |
