pathophysiology
Terms
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- ⬢ Primary amenorrhea
- o Lack of menstruation and failure to menarche by age 14
- ⬢ Secondary amenorrhea
- o Absence of menstruation for a time period of 3 or more cycles o Elevated prolactin levels (not associated with pregnancy) also can cause unusual hariness and infertility
- ⬢ Dysfunctional uterine bleeding
- o 69% of GYN use o Cause-age, stress, and endocrine disorders  Pathophysiology o No progesterone secretion (corpus luteum) but continuous estrogen o Unopposed estrogen produces atypical hyperplasia and CARCINOMA
- ⬢ Polycystic ovarian syndrome
- o Ovulation inhibited by production of androgens and convert to estrogen o Cause-persistent anovulation endometrial polyps and breast cancer
- what out of what women PMS
- 8 out of ten
- 1 pattern of PMS
-  5-7 days before onset of period and stop when period begins
- pattern of pms
-  Starts ovulation and lasts for 2 weeks until period (2 weeks total)
- PMS-A
- anxiety, tension, irritability and mood swings
- PMS-H
- (Hyper hydration) – water retention, abdominal bloating, breast tenderness, weight gain, swelling of feet and hands
- PMS-C
- for sweets, chocolates, headaches, fainting, heart palpations
- PMS-D
- (Depression) – depression, confusion, fatigue, crying, forgetfulness, and insomnia
- PMDD
- premenstrual dysphoric syndrome MAIN DIFFERENCE FROM PMS  Clinical depression short cycle duration. Seen after age 25
- PMDD CAUSE
- imbalance of estrogen and progesterone. Even though they must be present to trigger PMS the hormone itself doesn’t cause the disorder
- PMDD Susceptibility
-  Genetic differences  Sensitivity of receptors and messenger systems for signals to cell  History of other mood disorders or serotonin function
- TREATMENT FOR PMDD
-  Healthy diet  Regular exercise plan  Vitamins – B6, A, Zinc, folic acid  Progesterone replacement
- DIFFERENT THERAPIES OF PMDD
-  Thyme leaf, passion flowers, wild milky seed, rosemary leaf, st. john’s worth  Prostaglandin – oil of evening primrose  Serotonergic drugs- Prozac  Oral contraceptives  Surgery
- ⬢ Pelvic Inflammatory Disease (PID)
- o Infection involving the uterus, fallopian tubes, or ovaries o Clinical – severe abdominal pain with fever seen during or after menstruation
- Vulvitis CAUSES
- o Irritation by soaps, lotions, hygienic sprays, etc.
- Bartholintis
- o Inflammation of ducts leading from vaginal opening caused by strept/staph infection
- Cystocele CAUSED BY
- CAUSED BY – women with prolonged labor and push for a long duration
- Urethrocele
- – pressure from fetal head
- Uterine prolapsed things that help
- o Pessary – a mechanical device to hold uterus in place o Kegel exercise helps
- ⬢ Benign ovarian cyst o Two types
- follicular cyst and corpus luteum cyst
- Endometrial polyps
- o Mass of endo tissue attached to uterine lining by a pedicle
- ⬢ Leiomyomas what is it and treatments
- o Uterine fibroids o Clinical signs – abnormal uterine bleeding, pressure on related structures o Treatment – reduction with progesterone or GNRH
- cervical cancer- it is very invansive cased by HPV. o Human papillomavirus
- it can be increased by smoking
- what is a pap smear (test)
-  Cells are scrapped or brushed of the cervix and prepared on a slide.
- is vaginal cancer common
- no..very rare
- most common Endometrial cancer
- Adenocarcinoma
- ovarian cancer is reduced by two ways what is it
- pregancy and childbirth
- two types of ovarain cancer
-  Epithelium ovarian neoplasm  Germ cell neoplasm
- o Sexual anorexia
- libido and decrease sexual drive caused by beta blockers
- Vaginismus
- muscle spasms caused by trauma such as rape
- Anorgasmisa
- inability to achieve orgasm
- Dyspareunia
- – painful intercourse caused by antihistamine (drying effect)
- ⬢Endometriosis
- o Cells similar to those which form inside the uterus are found outside the uterus o Attach to tissue and become “implants†o Generally benign o Respond to hormones of the menstrual cycle o Implants bleed internally causing tissue inflammation and scarring
- causes of endomeriosis
-  Unknown  Retrograde menstruation  Hereditary and immune system  Transported by circulatory system  Embryonic tissue  Lymphatic distribution
- what are some symptoms of endometriosis
-  Usually no symptoms  Pain and infertility  Painful intercourse  Pelvic pain during or just before menstruation  Frequent infection  Backaches  Cramping with bowel movements or urination  Inflammation and scarring causes distortion of female reproductive organs causing infertility  Lower abdominal pain  Diarrhea/constipation  Irregular/heavy menstrual bleeding
- stages of endometriosis---stage 1
- minimal (superficial endometriosis and filmy adhesions)
- o Endometriosis Stage 2
- mild (superficial and deep endometriosis and filmy adhesions)
- o Endometriosis Stage III
- moderate ( superficial and deep endometriosis and filmy and dense adhesions)
- Endometriosis stage 4
- – severe (superficial and deep endometriosis and dense adhesions)
- what methods used in diagnosing enometriosis
-  Nodules (implants) palpated  Direct visual inspection
- treatments of endometriosis
-  Pain relief- non-steroidal anti-inflammatory drugs  Motrin or Naprosyn  Dec estrogen levels  GnRH analogs – prevents natural releasing hormones from secretion  Nafarelin (Synarel) – nasal spray for 6 months  Low estrogen cause bone thinning  Leuprolide (Lupron)
- Galactorrhea
- o Excessive prolactin in blood o Menstrual abdnormalities
- ⬢ Benign breast disease information
- o Fibrocystic disease o Fluctuate during menstrual cycle
- Breast cancer how many women 1 out of get it
- o 1 in every 7 women in the US will develop breast cancer. Risk of dying from breast cancer is much lower at 1 in 28
- breast cancer is the leading cause of death in the US? true or false
- no it is the second...lung cancer is the first
- what are risk factors of breast cancer
- genetic, age, nutrional, and hormonal
- what can cause a slight increat is getting breast cancer
- o Early menstrual cycles, delayed menopause and 1st pregnancy after age 30 – slight inc risk..o not breastfeeding, drinking 2-5 alcoholic drinks a day, being overweight (esp after menopause), and not exercising o High fat diets
- process of diagnosing breast cancer
-  Mammography and breast exam  85-90% of all cancers are detected by mammography  Breast exam- during routine checkup and monthly self exam 3 days after menstrual period has stopped  Ultrasound - Biopsy
- ⬢ Lobular carcinoma in Situ (LCIS) (kind of breast cancer
- o Incidental finding in biopsy Stage 0 o Precancerous condition o No symptoms or characteristic features o 38% may not develop invasive cancer until more than 20 years after initial diagnosis
- ⬢ Ductal carcinoma in Situ (DCIS)
- o Pre-invasive form of cancer- Stage 0 o No lump associated with cancer o Multifocal in nature o 40% will ultimately develop invasive breast cancer
- ⬢ Infiltrating Ductal Carcinoma
- o 65-85% most common o Found as an irregular mass or small white irregular microcalcifications o Lump feeling harder or firmer than benign mass o Begins in milk duct and penetrates outside of the wall
- o Inflammatory carcinoma
-  Subtype of infiltrating ductal carcinoma  Signs – red, swollen, warm and thicken skin  Rapid growth of cancer  Spread to lymph nodes  Poor prognosis
- ⬢ Infiltrating Lobular Carcinoma
- o 5-10% of cases o No hard mass present upon palpation just vague thickening of breast tissue o May occur in more than one site o Begins in glands as opposed to the duct
- • Paget’s Disease
- o 1-4% of cases o Crusting and scaling of nipple o Usually in only 1 breast
- ⬢ Cystosarcoma Phyllodes
- o Firm tumor o Spreads via bloodstream o Women over 50
- treatments of breast cancer
- o Local – includes surgery and or radiation  Modified radical mastectomy – removal of breast and axially lymph nodes  Simple mastectomy – removal of breast  Lumpectomy – removal of only a portion o Systemic Therapy  Used to eradicate microscopic deposits of breast cancer cells present in other areas of the body  Chemotherapy- cyclophosphamide (Cytoxan), methotrexate, and 5-flourouracil (CMF), or Adriamycin  Six cycles over 6 months o Hormonal therapy  Anti-estrogen agent-tamoxifen  Can cause inc risk of uterine cancer  Best chance of eliminating breast cancer is prevention  A women should have a baseline mammogram between the ages of 35-40  40-50 years – one every other year  50+ - yearly