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35 Cards in this Set
- Front
- Back
this is a condition that has painful menstruation and primary is between 17-22 whereas secondary condition of this dz is MC with age
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dysmenorrhea
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what is the difference between primary and secondary dysmenorrhea
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1- absence of pelvic pathology
2- dt identifiable organic diseases |
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this usu starts 1-2 days before menses and lasts over 12-72 hours., improves with advancing age and after childbirth
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primary dysmenorrhea
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what are some sx of primary dysmenorrhea
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crampy
ha diarrhea nausea and vomiting normal pelvic exam suprapubic or lower abdominal area |
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what has the pathophysiology of dysmenorrhea been a/w?
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uterine contractions with ischemia
sloughing of endometrial cells release PGF2/PGE2 --> uterine ischemia via myometiral contraction and vasoconstriction elevated levels of prostaglandins have been noted |
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what are some tx of primary dysmenorrhea
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`heat
exercise acupuncture behavioral itnervention NSAIDS highly effective becaseu they decrease PG production via enzyme inhibition cox inhibitors now being theorized to use can also use OCP - reduce menstrual flow, inhibit ovulation and less AA which is the substrate for most PG synthesis |
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what has been shown to be more effective than the pill in treating primary dysmenorrhea
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transdermal patch, nuvaring, IUD
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what about for resistant cases? what is the tx?
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tocolytic agents (analgesics)
salbutomol, nifedipine progestogens (medroxyprogesterone) |
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what is the path of secondary dysmenorrhea
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presents after menarche
MC around a woman's 20's or 30's elevated PG can be a cause not limited to sx only at time of menses. can occur othertimes pelvic path can be present |
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what are some common causes
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endometriosis
adenomyosis leiomyoma PID ovarian cysts pelvic congestion |
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what type of cyst releases chocolate like materal
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ovarian endometrioma --> endometriosis (presence of uterine cells/endometrial glands in other parts of the body)
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what is adenomyosis
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endometrium are in the myometrium causeing hypertrophy and hyperplasia of surrouding myometrium
***BOGGY and GLOBULAR uterus *** |
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pelvic congestion is typical of what demographic
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multiparous women who have pelvic vein varicosities.
gets worse with fatigue, standing, and sex |
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what are benign monoclonal tumors arising from smooth muscle cells of the myometrium called
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leiomyomata
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where can leiomyomatas occur
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subserous, sumucoal, intra mural, intracavitary, pedunculated
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this type of cyst has teeth, hair, and sebum. usu occurs in younger pts
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dermoids
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what are some features of secondary dysmenorrhea
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heavy /irregular menses
infertility dyspareunia vaginal discharge |
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where can you can growth of endometrial tissue with endometriosis?
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pelvic cavity
ovaries uterosacral ligaments pouch of douglas |
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what is endometriosis a.w
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20-30% women with subfertility
50% of teens going through laproscopy for chronic pelvic pain 12-32% of women of reproductive age undergoing pelvic pain |
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what is the demographic that endometriosis usu hit
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tall thin non blacks and non asians
~30 yo nulliparous and infertile |
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what are some RF for endometriosis
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late menarche >14 yo
extended itnervals of lactation nulliparous/multiparous early menarche/late menopause short menstrual cycles prolonged menses |
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what is the classic triad of endometriosis
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dyspareunia (pain with sex)
dysmenorrhea (recurrent painful periods) dyschezia (painful defecation) you can also have chronic LBP, pelvic pain, adnexal masses, subfertility |
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what are some thoughts on the pathogenesis of endometriosis
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retrograde metaplasia
lymphatic spread coelomic metaplasia |
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which path of endometriosis implants it into the pelvic strucutres via fallopian tubes
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retrograde metaplasia
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this allows it to go to pelvic sites where tissues grow ectopically and done via lymphatic draining of the uterus
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lymphatic spread
20% of endometrial tissue has been found in pelvic lymphatics |
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certain cells when stimulated can differentiate into diff types of cells. the peritoneal cavity has cells capable fo dedifferentiating into endometrial tissue with unidentified stimuli.
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coelomic metaplasia
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T OR F, endometriosis is a/w genetic component
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true 7% increase with immediate first relatives
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what are some things you may find on PE of endometriosis
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tenderness of adnexal masses/pouch of douglass/uterosacral ligaments
palpable tender noduels tender enalrged adnexal mass thickening and induration of uterosacral ligaments |
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what are the diff stages of endometriosis
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minimal- isoalted impalnts no adhesions
mild- superficial implants <5 cm scattered on peritoneum and ovaries , no adhesions moderated - multiple implants, superficial and invasive, peritubal and periovarian adhesions may be evident severe- multipel superficial and deep implants, filmy and dense adhesions are usually present |
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what is the ONLY DX TEST that can reliably rule out endometriosis. this is GOLD STANDARD
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laparoscopy
looks like powder burn or gun shot lesions on the ovaries, serosal surfaces, and peritoneum lesions are black, dark, bluish puckered lesions, old hemorrhea surrounded by variable extent of fibrosis |
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what are some markers of endometriosis
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serum ca 125
not sensitive though best seen with stage 3 or 4 dz |
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what are things you must consider when tx endometriosis
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severity of sx
extent of dz desire for future fertility age of pt threat to GI and urinary tract or both |
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what are some pharmacologic tx
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OCP
progestins danazol gnrh analogues (suppress ovarian activity and menses and cause atrophy of endometriotic implants NSAIDS |
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surgical tx of endometriosis?
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laparoscopy or open abd procedures
hysterectomy or bilateral oophorectomy laser/thermal ablation |
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what is amenable to only surgical resection as far as endometriosis goes
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large endometriomas >3 cm
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