GU-1

• -Most common cystic lesion of vulva
• -Located below epidermis
• -Caused by occlusion of sebacious gland in labia majora or minora
• -Usually no Sx
• -Usually don't need to Tx, but can incise and drain or excise if troublesome

• -Caused by chronic inflammation or trauma resulting in occlusion of Bartholin's duct
• -Sx: Usually asymptomatic
• -Tx: If Sx, marsupialization and insert Word catheter
• -Excision if malignant, esp. important in menopausal women

• -White, flaky, onion-like skin on labia; usually in older women
• -Sx: pruritus, burning, introital stenosis, dyspurenia in menopausal women; labia min. gets lost, labia maj. flattens, clitoris inverted
• -Complications: has 4-6% chance of developing SCC
• -Tx: Topical steroids (clobetasol), Intralesional steroid injection in refractory cases, Oral antihistamine for pruritis

• -Subserosal: under serosa (outermost layer); palpable on pelvic exam
• -Intramural: within wall of uterus (middle layer); palpable
• -Submucosal: under endometrium (innermost layer); causes abnormal uterine bleeding
• -Pedunculated: attached to stalk; torsion and necrosis can occur, can parasitically use blood supply of omentum

• 1. Fatty degeneration
• 2. Cystic, calcified
• 3. Red or carneous degeneration during pregnancy from bleeding into tumor
• 4. Sarcomas - rare and after menopause

• -Sx: mostly asymptomatic; 35-50% have Sx (uterine bleeding, long heavy menses, pelvic mass, pelvic pressure, pedunculated one going through cervix/vagina, infertility & spontaneous abortion)
•        *leads to anemia, pain w/ torsion, frequent urination, pressure, bloating, GI symptoms

-Tx: menorrhagia managed w/ hormones, GnRH (effects only last as long as it's taken; only used 6 months or less), myomectomy after GnRH, hysterectomy, embolization

• -Most common cyst of ovary; seen in reproductive years
• -Sx: none or pain w/ rupture, mentrual changes, dyspareunia
• -PE: unilateral tenderness, mobile, cystic adnexal mass
• -Dx: bimanual exam, US
• -Tx: Observation cus most disappear in 60 days; OC to suppress gonadotropin; cystectomy if needed

• -Sx: pelvic pain, menstrual irregularities; hemmorrage and torsion may ocur
• -PE: lage, tender cystic or solid adnexal mass
• -Dx: bimanual exam, pelvic US, 
• -Tx: OC for 2-3 cycles to speed up resolution of cysts; surgery if medical therapy not successful

• -Occurs during pregnancy or with gonadotropic stim. (hydatidoform mole or choriocarcinoma)
• -Usually bilaterally filled with straw colored fluid
• -Can become large
• -regaress following treatment of causative condition'
• -Sx: pelvic heaviness, aching; regresses when gonadotropic levels fall
• -Tx: Observation. Surgery if complications (torsion, hemorrhage)

• -Sx: bleeding in 1st half of preganancy; vomiting; passage of vesicles; preeclampsia before 24 weeks
• -Dx: US, high hCG
• -Tx: Evacuation

• -Malignant transformation of trophoblastic tissue; may follow molar, normal, or ectopic pregnancy
• -Sx: enlarged uterus and ovaries, vaginal bleeding, high hCG
• -Dx: CT scan
• -Tx: methotrexate

• -Most common ovarian neoplasm
• -Contains a bunch of weird shit inside
• -Dx: transvaginal US or Ct
• -TX: cystectomy with pervation of ovarian tissue
• -Cx: torsion due to weight of tumor, chemical peritonitis if ruptured

• -Persistent anovulation
• -Sx: hirsutism (female hairyness), menstrual irregularities, acne, inferitility, obesity, ovaries have multiple small follical cysts
•       *high LH, androgen, and estrogen levels, you get fucked up
• -Dx: US of ovaries, eval of hyperinsulinism, lipid studies, HDL, LDL, androgen levels, LH, FSH
• -Tx: suppress LH w/ OC, hair removal, weight loss

• -Benign condition where endometrial tissue is present outside uterine cavity; typical case is woman in 30's who is nulliparous and infertile
• -Theories:
• 1. Retrograde Menstruation Theory of Sampson - endometrial fragments travel through fallopian during during menturation and implant and grow in weird places; does not explain lesions in distant areas (lung, axilla)
• 2. Coelomic Metaplasia Theory of Meyer - endometriosis is from metaplastic transformation of peritoneal mesothelium into endometrium cus of some stimulus
• 3. Lymphatic Spread Theory of Halban - endometrial tissue is taken up by lymphatics with drain uterus and go to various pelvic sites where tissue continues to grow

It is most likely from the 3 theories, immunologic factors, and genetics

• -Sx: triad = dysmenorrhea (painful menstruation), dyspareunia (hard to sex), and dyschesia (hard to shit)
• *pelvic pain
• *infertility more frequent
• *may be asymptomatic
• No clear correlation between extent of disease and severity of pain
• *tender nodularity in culdesac; pelvic pain; firm fixed tender adnexal mass
• *gotta use laparotomy or laparoscopy

-Expectant Mgmt = no med or surgical therapy in patients with mild disease

• -Surgical mgmt = when bowel or bladder involved, adhesions, endometrioma > 3 cm, distortion of pelvin organs
• *Conservative surgical mgmt = excision, cauterization, laser, or electrocoagulation ablation
• *Definitive surgical mgmt = hysterectomy, salpingo-oophorectomy, destruction of all implants and adhesions

• -Medical mgmt =
• 1. Danazol (inhibits LH and FSH which lowers estrogen, induces pseudomenopause)
• 2. GnRH agonists

-Extension of uterine glands and stroma into uterine musculature. Uterus is diffusely enlarged with thickened myometrium. 

• Sx: dysmenorrhea, menorrhagia
• Tx: NSAIDS, OC's, hormone patches, hysterectomy