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CHAPTER 2 GYN

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FOR HORMONE REGULATION WHAT DO THE ENDOMETRIUM AND OVARIES RESPOND TO?
ESTROGEN AND PROGESTERONE LEVELS IN THE BLOOD.
THE ESTROGEN AND PROGESTERONE LEVELS IN THE BLOOD ARE DETERMINED BY A FEEDBACK MECHANISM BETWEEN WHAT?
THE OVARIES AND THE HYPOTHALAMUS/PITUITARY COMPLEX.
WHAT DOES A TROPIC HORMONE DO?
SIGNALS ANOTHER ORGAN TO FUNCTION OR SECRETE.
WHEN SERUM ESTRODIOL LEVELS FALL BELOW A GIVEN CONCENTRATION THE HYPOTHALAMUS PRODUCES WHAT HORMONE?
GONADATROPIC RELEASING HORMONE(GnRH)
THE GnRH IN TURN SIGNALS THE ? TO SECRETE THE ?
1.)ANTERIIOR PITUITARY GLAND
THE PITUITARY GONADOTROPINS ARE WHAT 2 HORMONES?
FSH AND LH
WHAT DOES FSH DO?
STIMULATES THE GROWTH AND DEVELOPMENT OF OVARIAN FOLLICLES.
WHAT DO THE THECA CELLS WITHIN THE FOLLICLES PRODUCE?
ESTROGEN WHICH STIMULATES ENDOMETRIAL GROWTH
AS FOLLICLES GROW INCREASING ESTRADOIL LEVELS WITHIN THE FOLLICLES HELP THEM RESPOND TO ? W/ EVENTUAL OVULATION.
LH
WHAT DOES LH DO?
1.)STIMULATES MATURATION OF THE FOLLICLES AND IS RESPONSIBLE FOR GRAFFIAN FOLLICULAR RUPTURE CAUSING OVULATION.
WHEN THE FERTILIZED OVUM IMPLANTS INTO THE ENDO WHAT SIGNALS THE CORPUS LUTEUM TO CONTIMUE SECREATING PROGESTERONE TO PREVENT THE SHEDDING OF THE ENDOMETRIAL LINING?
HCG PRODUCTION!
WHEN IMPLANTATION DOESNT OCCUR, WHAT PERMITS SLOUGHING OF THE UTERUS LINING?
DECREASING PROGESTERONE LEVELS
WHAT IS MENARCHE?
THE ONSET OF MENSES USUALLY OCCURING BTWN 11-14YRS OF AGE.
WHAT IS MENOPAUSE?
TERMINATION OF REGULAR MENES USUALLY OCCURING BTWN 45-55YRS OF AGE.
WHAT IS PREMATURE MENOPAUSE?
TERMINATION OF REGULAR MENSES PRIOR TO AGE 40.
WHAT ARE OVARIAN PHASES UNDER THE INFLUENCE OF?
FSH AND LH
WHAT ARE THE 3 SPECIFIC PHASES THAT OVARIES GO THROUGH DURING A NORMAL CYCLE?
1.)FOLLICULAR PHASE (DYS 1-14)
2.)OVULATION (DAY 14)
3.)LUTEAL PHASE (DYS 15-28)
WHAT IS THE FOLLICULAR PHASE (DAYS 1-14) STIMULATED BY?
FSH
WHAT HAPPENS DURING THE FOLLICULAR PHASE?
DORMANT EGG CELLS ARE SURROUNDED BY FLUID FILLED FOLLICLE WHICH EXPANDS RAPPIDLY AND MOVES TO THE OVARIAN SURFACE. SEVERAL FOLLICLES DEVELOPE EACH MONTH.
BY ABOUT WHAT DAY MAY THE DOMINANT FOLLICLE BE IDENTIFIED BY AND WHAT SHOULD IT MEASURE?
BY DAY 8 AND IT MESURES AROUND 10MM.
WHAT ARE THE OTHER SONOGRAPHIC CONSIDERATIONS OF A DOMINANT FOLLICLE?
1.)ANY FOLLICLE MEASURING GREATER THAN 11MM WILL MOST LIKELY OVULATE.
2.)GROWS LINEARLY(APPROX. 2-3MM/DAY)
3.)MAX DIA. VARIES BTWN 15-30MM
4.)LINE OF DECREASED REFLECTIVITY AROUND FOLLICLE SUGGESTING OVULATION WILL OCCUR WITHING 24HRS.
5.)PRESENCE OF CUMULUS OOPHORUS(MURAL NODULE WITHIN FOLLICLE) SUGGESTS OVULATION WILL OCCUR WITHIN 36HRS.
WHAT HAPPENS ON ON OVULATION(DAY 14)?
A SURGE OF LH SECREATION CAUSES RUPTURE OF FOLLICULAR MEMBRANE, USUALLY WITHIN 24-36HRS AFTER THE SURGE.
WHAT ARE THE SONOGRAPHIC FINDINGS THAT INDICATE THAT OVULATION HAS OCCURED?
1.)SUDDEN DECREASE IN FOLLICULAR SIZE
2.)FREE FLUID IN POSTERIOR CUL-DE-SAC.
WHAT HAPPENS IN THE LUTEAL PHASE?
THE CRATER LEFT BY THE EXPULSION OF THE OVUM BECOMES FILLED W/ A FATTY YELLOWISH CELL TYPE BECOMING THE CORPUS LUTEUM.
WHAT DOES THE CORPUS LUTEUM DO?
1.)IT MANUFACTURES AND SECRETES PROGESTERONE TO PREPARE AND MAINTAIN THE ENDO FOR IMPLANTATION.
2.)IN THE ABSENCE OF HCG, THE CORPUS LUTEUM REGRESSES AND ATROPHIES.
WHAT ARE THE SONOGRAPHIC FINDINGS IN THE LUTEAL PHASE?
1.)REPLACEMENT OF DOMINANT CYSTIC FOLLICLE W/ AN ECHOGENIC STRUCTURE REPRESENTING THROMBUS.
2.)SM. IRREGUALR CYSTIC MASS W/THICK BORDERS AND LOW LEVEL ECHOES.
3.)DOPPLER FINDINGS OF A HYPERVASCULAR CORPUS LUTEUM W/LOW RESISTANCE FLOW.
WHAT ARE THE 3 UTERINE PHASES?
1.)MENSTRUAL PHASE (DYS 1-5)
2.)PROLIFERATIVE PHASE (DYS 6-14)
3.)SECRETORY PHASE (DYS 15-28)
WHAT HAPPENS DURING THE MENSTRUAL PHASE(DYS 1-5)?
1.)DURING THE FINAL 2-3DYS OF SECRETORY PHASE THE ENDOMETRIAL INTRACELLULAR EDEMA IS RESORBED.
2.)DESQAMATION AND SLOUGHING OF THE SUPERFICIAL LAYER OF ENDO TISSUE & BLOOD CELLS OCCURS AND IS EXPELLED I THE FORM OF MENSES.
3.)TYPICALLY 12-24HRS HEAVY FLOW THEN 4-7DYS SCANTY FLOW.
WHAT HAPPENS DURING THE PROLIFERATIVE PHASE(DYS 6-14)?
1.)THE REGENERATION AND PROLIFERATION OF THE ENDO IS STIMULATED BY ESTROGEN SECREATED BY THE DEVELOPING FOLLICLES.
2.)THE PHASE BEGINS ON THE 4TH OR 5TH DAY AFTER MENSES(BEGINS?). IT LASTS ABOUT 10DYS AND ENDS AT OVULATION.
WHAT ARE THE SONOGRAPHIC FIDINGS DURING THE PROLIFERATIVE PHASE (DYS 6-14)?
1.)HYPOECHOIC AREA AROUND PROMINANT MIDLINE ECHO (EARLY PHASE)
2.)THICKEND ISOECHOIC ENDO (LATE PHASE)
WHAT HAPPENS DURING THE SECRETORY PHASE (DYS 15-28)?
1.)BEGINING AT OVULATION THE ENDO PREPARES FOR THE POSSIBLE IMPLANTATION OF A FERTILIZED OVUM.
2.)UNDER THE INFLUENCE OF PROGESTERONE THE ENDO BECOMES GROSSLY EDEMATOUS AND SPONGY REACHING IT'S MAX THICKNESS.
3.)IN THE ABSCENCE OF FERTILIZATION, IMPLANTATION AND HCG, THE ENDO GLANDS FRAGMENT AND UNDERGO AUTOLYSIS AND START CYCLE AGAIN.
WHAT ARE THE SONOGRAPHIC FINDINGS DURING THE SECRETORY PHASE (DYS 15-28)?
HYPERECHOIC ENDO W/ OBSCURED MIDLINE ECHO, OFTEN W/POSTERIOR ACOUSTIC ENHANCEMENT. MAX A.P. DIA.=18MM.
ABNORMAL MENSTRUAL PATTERNS CAN BE CATEGORIZED AS WHAT?
ABNORMALITIES OF VOLUME OR FREQUENCY.
WHAT IS HYPERMENORRHEA?
AKA MENORRHAGIA?
EXCESSIVE VOLUME DURING CYCLIC MENSTRUAL BLEEDING.
WHAT IS HYPOMENORRHEA?
AN ABNORMALLY SMALL AMOUNT OF MENSTRUAL BLEEDING.
WHAT IS POLYMENORRHEA?
FREQUENT MENSTRUAL BLEEDING OCCURING LESS THAN 21 DYS APART.
WHAT IS OLIGOMENORRHEA?
MENSTRUAL BLEEDING OCCURING MORE THAN 35 DYS APART.
WHAT IS METRORRHAGIA?
IRREGULAR FREQUENT BLEEDING.
WAHT IS MENOMETRORRHAGIA?
BLEEDING THAT IS IRREGULAR IN BOTH FREQUENCY AND VOLUME.
WHAT IS DYSMENORRHEA?
PAINFUL BLEEDING
WHAT IS AMENORRHEA?
THE ABSENCE OF MENSTRUAL FLOW.
WHAT IS PRIMARY AMENORRHEA?
PT HAS NEVER HAD A PERIOD.
WHAT IS SECONDARY AMENHORRHEA?
PT HAD PERIODS BUT THEY STOPPED.
WHAT IS DUB (DYSFUNCTIONAL UTERINE BLEEDING)?
VAGINAL BLEEDING THAT IS NOT RELATED TO MENSES OR ENDOMETRIAL PATHOLOGY.

*CAUSES MAY BE FUNCTIONAL OR ORGANIC AND INCLUDE:ENDOCRINE DISORDERS, ENDO DISORDERS, AND MANY MORE.
HOW LONG HAVE IUD'S BEEN USED FOR?
APPROX 40YRS.
WHAT ARE THE 4 MOST COMMON TYPES OF IUD'S?
1.)COPPER-COATED(ie, PARAGARD, COPPER-T)
2.)SAF-T-COIL
3.)LIPPES LOOP
4.)HORMONAL (ie, PROGESTASERT, MIRENA)
WHAT ARE 3 SONOGRAPHIC APPEARANCES OF IUD'S?
1.)HYPERECHOIC TO THE ENDO ALTHOUGH MAY APPEAR ISOECHOIC TO ENDO.
2.)POSTERIOR ACOUSTIC SHADOW OR OTHER ARTIFACT.
3.)POSITIONED IN FUNDUS OR MID PORTION OF UTERINE BODY.
WHAT DOES OCP'S STAND FOR?
ORAL CONTRACEPTIVE PILLS

*THEY ARE SYNTHETIC AGENTS SIMILAR TO NATURAL FEMALE SEX HORMONES THAT PREVENT CONCEPTION BY INHIBITING OVULATION.
WHAT IS THE MOST COMMON REGIMEN IN THE U.S.?
PILLS CONTAINING BOTH ESTROGEN AND PROGESTERONE WHICH ARE TAKEN EVERY DAY FOR 20-21 DYS.
WILL PATIENTS ON OCP'S DEVELOPE A DOMINANT FOLLICLE & OVULATE?
NO!!
IF A TRANSVAGINAL U/S WAS DONE ON A PT TAKING OCP'S WHAT MAY THE IMAGE REVEAL?
SMALLER FOLLICLES MEASURING BTWN 5-19MM.
WHAT IS U/S VERY VALUABLE FOR IN OB/GYN?
1.)FOR BASELINE EVAL TO DOCUMENT PRE-EXISTING CONDITIONS
2.)ALSO IN IN-VITRO FERTILIZATION PROGRAMS.
WHY IS U/S IMPORTANT IN IN-VITRO FERTILIZATION PROGRAMS?
1.)ESTABLISH NORMAL UTERINE ANANTOMY AND EVALUATE ENDOCRINE INDICATORS, SUCH AS THICKNESS AND TEXTURE OF THE ENDO, & PRESENCE OF INTRACTIVITY LESIONS OR FLUID.
2.)MONITOR THE DEVELOPMENT AND GROWTH OF FOLLICLES AND DETERMINE TIMING OF INJECTION OF LH TO TRIGGER OVULATION.
CONTINUED FROM WHY U/S IS IMPORTANT IN IN-VITRO FERTILIZATION PROGRAMS.
3.)CONFIRM OVARIAN RESPONSE TO VARIOUS DRUGS(ie, CLOMID, PERGONAL) OR IDENTIFY HYPERSTIMULATED OVARIES.
4.)GUIDE OOCYTE RETRIEVAL FROM OVARIES.
NAME 4 DRUGS THAT HELP WITH OVULATION AND INCREASE THE CHANCES OF FERTILZATION:
1.)CLOMIPHENE CITRATE-(SUCH AS CLOMID, SEROPHENE)
2.)GONADOTROPINS-(SUCH AS REPRONEX, FOLLISTIM, PERGONAL, BRAVELLE, GONAL-F)
3.)GLUCOPHAGE- (SUCH AS METFORMIN)
4.)PARLODEL
WHAT IS CLOMIPHENE CITRATE(CLOMID, SEROPHENE)?
COMES IN TABLET FORM AND IS USED FOR WOMEN WHO HAVE INFREQUENT PERIODS OR LONG MENSTRUAL CYCLES.
DECRIBE GONADOTROPINS (REPRONEX, FOLLISTIM, PERGONAL, BRAVELLE, GONADAL-F):
INJECTABLE AND IS USED TO INDUCE THE REALEASE OF THE EGG ONCE THE FOLLICLES ARE DEVELOPED AND THE EGGS ARE MATURE.
DECRIBE GLUCOPHAGE (METFORMIN):
IS GIVEN TO PATIENTS AS AN INSULIN LOWERING MEDICATION. MOST COMMONLY USED IN PATIENTS W/PCOS AND HAS BEEN SHOWN TO REVERSE THE ENDOCRINE ABNORMALITIES SEEN W/PCOS WITHIN 2-3 MONTHS.
DECRIBE PARLODEL:
IS A MEDICATION USED TO LOWER PROLACTIN LEVELS AND WILL ALSO REDUCE PITUITARY TUMOR SIZE, SHOULD ONE BE PRESENT. PARLODEL HAS FEW SIDE EFFECTS AND IS INEXPENSIVE.
WHAT IS THE IVF SONOGRAPHIC PROTOCOL?
1.)BASELINE TRANSABDOMINAL SONOGRAM.
2.)PRELIMINARY TV EVALUATION OF FOLLICLES.
3.)DAILY TV TO MONITOR DOMINANT FOLLICLE.
FOLLICLES ARE TYPICALLY ASPIRATED FOR IVF WHEN THEY MEASURE WHAT?
18-24MM
NAME 4 ASSISTED REPRODUCTIVE TECHNOLOGIES:
1.)IVF
WHAT IS OHSS?
OVARIAN HYPERSTIMULATION SYNDROME
WHAT IS OVARIAN HYPER STIMULATION SYNDROME(OHSS)?
A CONDITION RESULTING FROM EXCESSIVE STIMULATION OF THE OVARIES. IT MOST COMMONLY OCCURS IN WOMEN TAKING FERTILITY DRUGS.
*MILD CASES USUALLY RESOLVE SPONTAINEOUSLY FOLLOWING THE NEXT MENSTRUAL CYCLE.
*MORE SEVERE CASES ARE ASSOC. W/HIGH MORTALITY RATE UP TO 50 PERCENT AND MAY REQUIRE HOSPITALIZATION FOR CORRECTION OF FLUID & EOECTROLYTE IMBALANCE.
*OHSS TENDS TO BE MORE SEVERE IN PATIENTS WHO CONCIEVE.
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