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29 Cards in this Set
- Front
- Back
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How does NOS then NO work
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– 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 |
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The signal to increase blood flow in pelvic vascular bed
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– from Thoraco-lumbar Erection Center in T-11 to L-2
– this center is under the influence of higher CNS cortical input |
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Tactile stimulation of penis and genital area can reflex erections via what?
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– sacral reflex arc at S-2 to S-4
– the Sacral Erection Center |
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PDE 5 inhibitors
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– PDE 5 breaks down cGMP
– PDE 5 inhibition increases cGMP -> corporeal SM relaxation which allows blood to be trapped |
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Apomorphine
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– suglingual
– Non-selective dopamine agonist that works in mild ED – Causes nausea and rarely vaso-vagal (bradycardia/syncope) |
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Yohimbine
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Peripheral and central acting a-blocker w/ low evidence of efficacy in mild ED
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Alprostadil
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– 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 |
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Papaverine
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– Increases cAMP
– for ED |
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Pudendal Nerve
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Ventral divisions of S2, S3, and S4 in sacral plexus
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Pelvic Nerve
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Direct branches off S3 and S4 motor roots
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Endopelvic “Fascia”
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– 3 Levels of Support
– Uterosacral Ligaments – Arcus Tendineus Fascia Pelvis – Rectovaginal Septum & Perineal Body |
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Internal Iliac Arteries
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Majority of blood flow to pelvis; collateral circulation impressive
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Perineal Planes
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– Important regarding rapidity with which infection from perineal sources can spread
- especially in immunocompromised patients |
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Tx of hot flashes
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– Phytoestrogens
– Clonidine (patch or pill) – Megestrol – SSRI/SNRI |
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Menopausal Metabolic Syndrome
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– 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 |
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Etidronate
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Bisphosphonate
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Alendronate
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Bisphosphonate
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Tx for UI
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– Bladder training
– Pessary – Surgery – Estrogen Replacement |
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Tx for prolapse
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– Kegel exercises
- Pessaries - Surgery |
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Pyometra Endometritis
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2o to cervical stenosis
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Adenomyosis
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– Downgrowth of endometrial basalis deep into myometrium
– markedly thickened but not nodular wall w/ multiple tiny hemorrhagic cysts |
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Endometrial polyp
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– benign focal hyperplasia of basalis
- ab bleeding - large vessels in stroma |
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Type 1 Endometrial adenocarcinoma
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– 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 |
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Type 2 Endometrial adenocarcinoma
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– post menopausal w/ atrophy
– high grade w/ deep myometrial invasion and progressive behavior – the subtypes are serious and clear cell – p53 is the gene |
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Childhood causes of abnormal uterine bleeding
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- Iatrogenic (trauma, FB, infection)
- Precocious puberty - Vaginal neoplasms |
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Adolescent causes of abnormal uterine bleeding
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- DUB
- Complications of pregnancy |
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Perimenopause causes of abnormal uterine bleeding
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– DUB
- Organic lesions (Polyps, Hyperplasia, Carcinoma) |
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Postmenopause causes of abnormal uterine bleeding
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- Atrophy
- Organic lesions (Carcinoma, Hyperplasia, Polyps) |
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Reproductive years causes of abnormal uterine bleeding
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- Complications of pregnancy
- Organic lesions (Endometritis, Leiomyomas, Polyps, Hyperplasia, Carcinoma) - DUB |
