Female Reproductive Problems

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Female Reproductive Problems
2012-01-28 17:28:39
Maternal child female reproductive problems

Female Reproductive Problems
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  1. AUB
    Abnormal Uterine Bleeding
  2. Abnormal Uterine Bleeding (AUB)
    • Lining (endometrium) & hormones not in sync.
    • Causes:
    • Syst dis - thyroid, diabetic, etc.
    • Infection
    • Hormone imbal
    • Treatment:
    • Control bldg & anemia
    • Prevent endometrial cancer
    • Oral contraceptives
    • Other hormonal options
  3. Abnormal bleeding (2 types)
    • Menorrhagia:
    • Excessive bleeding during regular menses
    • May have clots
    • Blood loss >80ml/cycle (normal 2-3oz/cycle)
    • Tests: CBC, platelets, blood counts
    • Metrorrhagia: Bldg @ irregular schedules
    • Polymenorrhea: Frequent menses (22 days)
  4. DUB
    • Dysfunctional Uterine Bleeding
    • NOT ovulating - NO cycles, just bleeding
  5. Dysfunctional Uterine Bleeding
    • More adolescents and perimenopausal women
    • Tx: medical then surgical (DNC = remove lining)
  6. Endometriosis
    • Endo-like tissue found outside uterus
    • Abd area / pelvic cavity
    • Chocolate cysts
    • Etiology UK. S/s assoc w/menses.
    • Leading cause of infertility - don't delay pregnancy
    • Rare in women > one child
    • Irregular menses
    • Pain: abd, back, rectal, vaginal, w/cycles
    • Estrogen influenced: swelling/inflammed, adhesions
    • N/Dia/urinary complaints/fatigue
    • Dx: Hx/phys, Lapro
    • Confirmation: biopsy
  7. Tx Endometriosis
    • Control pain
    • Slow endomet. tissue growth (control prog of dz)
    • Restore fertility
    • Strategies: Remove growths, hormones (control progression)
    • Hormones: Lupron or Danazol - suppress ovulation, cause amenorrhea
    • OCP's: if pg not desired - stops ovulation/pain
    • NSAIDS: Ibu
    • Hysterectomy: last resort
  8. Pelvic floor relaxation
    • Support structures don't hold organs where they should be
    • Causes: aging, chronic coughing, constipation, childbirth (multiple)
    • Sx: urinary and bowel incont., sexual dysfunction
    • Tx: Kegel exercises (pubocoxygeal muscles
    • Pessaries
    • Surgical (last option)
    • May occur: Cystocele (ant. bulge - descended bladder), Rectocele (post. bulge - wkness in wall b/t rectum/vagina)
  9. TSS
    Toxic Shock Syndrome
    • R/t bact growth: Staph Aureus - usually
    • Superabsorbent tampons / diaphragm or cervical cap during menses
    • Chg q3-6h, NOT overnight, NOT till 6-8wk postpartum
    • Once TSS - never tampons, again!
    • Syndrome: multi-system involved. Myalgia, n/v fever, pain
    • Labs: Elev. BUN, AST, ALT, Bili levls; Decr. platelets (r/t >bldg)
    • TX: IVs/vasopressors to >BP, vent support, renal dialysis, Abx - until septicemia ruled out
  10. PID - Pelvic Inflammatory Disease
    • Syndrome s/t STI w/or w/o abscess
    • Salphingitis - fallopian tubes
    • Oophoritis - ovaries
    • Peritonitis - peritoneum
    • HR group: non-white adolesc, low $, unemployed, low educ, smoker, multi sex ptnrs, early sexual activ, IUD user.
    • Leading contrib to infertility (tubal damage)
    • Causes: chlamydia, GC
    • SX: pain, fev 102, chills, dischg, malaise, n/v
    • DX: exam, tender/chandelier, cultures
    • Labs: CBC, UA, r/o syphilis & HIV, Elev ESR & CRP (w/inflammation)
    • Sono (eval mass), lapro (scope to look)
    • TX: mult ABX (parent/oral rocephin), tx partner, follow-up
    • TEACH: preventative measures: handwashing, urination post coitus, underwear
  11. Cervical dysplasia
    • Abn chgs in cells of cervix
    • Precancerous
    • Early detection w/pap to prevent Cx
    • Asymptomatic
    • Carcinoma in situ = severe dysplasia (untreated) - likely to become cancerous
    • TX: conization, cautery, cryo, laser, LEEP to remove abn cells
    • MUST: follow-up to prevent recurrence
  12. Uterine Fibroids (Leiomyomas)
    • Estrogen dependent
    • Most common benign growth in uterus
    • During repro yrs; atrophy @ menopause; rarely malig
    • >women of color, obesity
    • SX: Bldg, bowel/bladder sx
    • DX: exam, sono, hysteroscopy, biopsy
    • TX: myomectomy, uterine artery ablation, hysterectomy, hormones, herbs, iron (anemia)
    • MAY complicate pg.
  13. Endometrial Cx (uterine)
    • Cx in uterine lining
    • Most common gyn cancer (55-70 yrs)
    • DX early - progn fav
    • Risk factors: obesity, hi fat, infertility, nulliparity, DM, early menarche, delayed menopause (longer menses)
    • SX: abn post-menopausal bldg d/t endometrial hyperplasia
    • DX: Uterine ultrasound, biopsy
    • TX: Radical hyst, radiation, oncology consult
  14. Ovarian Masses
    • Found @ palpation
    • Usually benign, vague sx or pain
    • 1/2 are functional cysts d/t hormone production
    • Rare with OCPs
    • If in ovary, follicle >2cm=cycst
    • Dermoid cyst: cystic teratomas 10%. (Contain genetic material)
    • Endometriomas (chocolate cysts)
  15. Ovarian CX
    • Most fatal of female cancers r/t diagnosed LATE.
    • 5th leading cancer in women in US
    • Strongest risk factor: fam hx
    • Difficult to DX, dx late w/metastasis
    • Presence of BRCA1 or BRCA2 genes
    • SX: abd swelling, fat, pain, constip, uri freq, n/v, wt loss, abn vag bldg, SOA; VAGUE sx lead to late DX
    • DX: hx, exam, pelv ultrasound, Cancer markers (CA-125), MRI, lapro w/Bx; NO good screening tools (unlike cervical CX (pap))
    • TX: radical hyster w/chemo &/or radiation
  16. Hysterectomy
    Surgical removal of uterus
  17. Salpingectomy
    Surgical removal of fallopian tubes
  18. Oophorectomy
    Surgical removal of ovary
  19. Colposcopy
    • Direct visualization of cervix
    • Bright light, magnifying microscope
    • Apply 3% acetic acid
    • Abnormal cells turn white
    • ID for biopsy