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35 Cards in this Set

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this is a condition that has painful menstruation and primary is between 17-22 whereas secondary condition of this dz is MC with age
dysmenorrhea
what is the difference between primary and secondary dysmenorrhea
1- absence of pelvic pathology
2- dt identifiable organic diseases
this usu starts 1-2 days before menses and lasts over 12-72 hours., improves with advancing age and after childbirth
primary dysmenorrhea
what are some sx of primary dysmenorrhea
crampy
ha
diarrhea
nausea and vomiting
normal pelvic exam
suprapubic or lower abdominal area
what has the pathophysiology of dysmenorrhea been a/w?
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
what are some tx of primary dysmenorrhea
`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
what has been shown to be more effective than the pill in treating primary dysmenorrhea
transdermal patch, nuvaring, IUD
what about for resistant cases? what is the tx?
tocolytic agents (analgesics)
salbutomol, nifedipine

progestogens (medroxyprogesterone)
what is the path of secondary dysmenorrhea
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
what are some common causes
endometriosis
adenomyosis
leiomyoma
PID
ovarian cysts
pelvic congestion
what type of cyst releases chocolate like materal
ovarian endometrioma --> endometriosis (presence of uterine cells/endometrial glands in other parts of the body)
what is adenomyosis
endometrium are in the myometrium causeing hypertrophy and hyperplasia of surrouding myometrium

***BOGGY and GLOBULAR uterus ***
pelvic congestion is typical of what demographic
multiparous women who have pelvic vein varicosities.

gets worse with fatigue, standing, and sex
what are benign monoclonal tumors arising from smooth muscle cells of the myometrium called
leiomyomata
where can leiomyomatas occur
subserous, sumucoal, intra mural, intracavitary, pedunculated
this type of cyst has teeth, hair, and sebum. usu occurs in younger pts
dermoids
what are some features of secondary dysmenorrhea
heavy /irregular menses
infertility
dyspareunia
vaginal discharge
where can you can growth of endometrial tissue with endometriosis?
pelvic cavity
ovaries
uterosacral ligaments
pouch of douglas
what is endometriosis a.w
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
what is the demographic that endometriosis usu hit
tall thin non blacks and non asians
~30 yo nulliparous and infertile
what are some RF for endometriosis
late menarche >14 yo
extended itnervals of lactation
nulliparous/multiparous
early menarche/late menopause
short menstrual cycles
prolonged menses
what is the classic triad of endometriosis
dyspareunia (pain with sex)
dysmenorrhea (recurrent painful periods)
dyschezia (painful defecation)

you can also have chronic LBP, pelvic pain, adnexal masses, subfertility
what are some thoughts on the pathogenesis of endometriosis
retrograde metaplasia
lymphatic spread
coelomic metaplasia
which path of endometriosis implants it into the pelvic strucutres via fallopian tubes
retrograde metaplasia
this allows it to go to pelvic sites where tissues grow ectopically and done via lymphatic draining of the uterus
lymphatic spread

20% of endometrial tissue has been found in pelvic lymphatics
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.
coelomic metaplasia
T OR F, endometriosis is a/w genetic component
true 7% increase with immediate first relatives
what are some things you may find on PE of endometriosis
tenderness of adnexal masses/pouch of douglass/uterosacral ligaments

palpable tender noduels
tender enalrged adnexal mass
thickening and induration of uterosacral ligaments
what are the diff stages of endometriosis
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
what is the ONLY DX TEST that can reliably rule out endometriosis. this is GOLD STANDARD
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
what are some markers of endometriosis
serum ca 125
not sensitive though
best seen with stage 3 or 4 dz
what are things you must consider when tx endometriosis
severity of sx
extent of dz
desire for future fertility
age of pt
threat to GI and urinary tract or both
what are some pharmacologic tx
OCP
progestins
danazol
gnrh analogues (suppress ovarian activity and menses and cause atrophy of endometriotic implants
NSAIDS
surgical tx of endometriosis?
laparoscopy or open abd procedures
hysterectomy or bilateral oophorectomy
laser/thermal ablation
what is amenable to only surgical resection as far as endometriosis goes
large endometriomas >3 cm