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29 Cards in this Set

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How does NOS then NO work
– w/ NADHP and O2, converts arginine into citruline and NO
– NO promotes the generation of cGMP
– Type 5 cGMP PDI will metabolize cGMP and prevent or deflate the erection
The signal to increase blood flow in pelvic vascular bed
– from Thoraco-lumbar Erection Center in T-11 to L-2
– this center is under the influence of higher CNS cortical input
Tactile stimulation of penis and genital area can reflex erections via what?
– sacral reflex arc at S-2 to S-4
– the Sacral Erection Center
PDE 5 inhibitors
– PDE 5 breaks down cGMP
– PDE 5 inhibition increases cGMP -> corporeal SM relaxation which allows blood to be trapped
Apomorphine
– suglingual
– Non-selective dopamine agonist that works in mild ED
– Causes nausea and rarely vaso-vagal (bradycardia/syncope)
Yohimbine
Peripheral and central acting a-blocker w/ low evidence of efficacy in mild ED
Alprostadil
– prostagladin E1
– Increases SM relaxation by increasing cAMP
– Inject drug into corpus cavernosum (one side only)
– it also can be used intraurethrally
– Can cause pain, and rarely priapism or fibrosis
Papaverine
– Increases cAMP
– for ED
Pudendal Nerve
Ventral divisions of S2, S3, and S4 in sacral plexus
Pelvic Nerve
Direct branches off S3 and S4 motor roots
Endopelvic “Fascia”
– 3 Levels of Support
– Uterosacral Ligaments
– Arcus Tendineus Fascia Pelvis
– Rectovaginal Septum & Perineal Body
Internal Iliac Arteries
Majority of blood flow to pelvis; collateral circulation impressive
Perineal Planes
– Important regarding rapidity with which infection from perineal sources can spread
- especially in immunocompromised patients
Tx of hot flashes
– Phytoestrogens
– Clonidine (patch or pill)
– Megestrol
– SSRI/SNRI
Menopausal Metabolic Syndrome
– 1) Lipid Triad – Hypertriglyceridemia, LDL up
– 2) Insulin resistance, insulin elimination and secretion down, Hyperinsulinemia
– 3) Other Factors – Endothelial dysfunction, more visceral fat and uric acid
Etidronate
Bisphosphonate
Alendronate
Bisphosphonate
Tx for UI
– Bladder training
– Pessary
– Surgery
– Estrogen Replacement
Tx for prolapse
– Kegel exercises
- Pessaries
- Surgery
Pyometra Endometritis
2o to cervical stenosis
Adenomyosis
– Downgrowth of endometrial basalis deep into myometrium
– markedly thickened but not nodular wall w/ multiple tiny hemorrhagic cysts
Endometrial polyp
– benign focal hyperplasia of basalis
- ab bleeding
- large vessels in stroma
Type 1 Endometrial adenocarcinoma
– Unopposed estrogen in pre and peri menopausal
– hyperplasia
– low grade w/ minimal myometrial invasion and stable behavior
– the subtypes are endometriod – MSI, ras, and PTEN are the genes
Type 2 Endometrial adenocarcinoma
– post menopausal w/ atrophy
– high grade w/ deep myometrial invasion and progressive behavior
– the subtypes are serious and clear cell – p53 is the gene
Childhood causes of abnormal uterine bleeding
- Iatrogenic (trauma, FB, infection)
- Precocious puberty
- Vaginal neoplasms
Adolescent causes of abnormal uterine bleeding
- DUB
- Complications of pregnancy
Perimenopause causes of abnormal uterine bleeding
– DUB
- Organic lesions (Polyps, Hyperplasia, Carcinoma)
Postmenopause causes of abnormal uterine bleeding
- Atrophy
- Organic lesions (Carcinoma, Hyperplasia, Polyps)
Reproductive years causes of abnormal uterine bleeding
- Complications of pregnancy
- Organic lesions (Endometritis, Leiomyomas, Polyps, Hyperplasia, Carcinoma)
- DUB