Chapter 74 Gynecological Disorders

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Chapter 74 Gynecological Disorders
2014-02-05 23:33:10
Chap 74
Gyn Disorders Chapter 74
Chapter 74 Gyn Disorders
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  1. Primary Dysmenorrhea
    • one of the most common gyno problems
    • occurring in teens and early 20s
    • Occurs when Ovulation is established
  2. Primary Dysmenorrhea
    • Painful Uterine cramping with spasmodic lower abdominal pain that begins with the onset of menstrual flow and lasts 12-48 hours
    • The pain radiates to the lower back and thighs
    • N/V, fatigue and nervousness may occur with the pain.
  3. Primary Dysmenorrhea
    • Postaglandin synthetase inhibitors
    •      ibuprofen, (NSAIDS), naproxen
    • Oral Contraceptives (suppress ovulation)
    • Complementary and alternative therapy
    •       Acupressure, aerobic exercise, swimming, application of heat or cold, massage, biofeedback and relaxation
  4. Premenstrual Syndrome
    • A collections of symptoms that are cyclic in nature
    • Affects women 30-40
    • Severity increases with aging until menopause
  5. Premenstrual Syndrome
    • Emotional Sypmtoms: irritability, easily precipitated crying spells, low self esteem, anxiety and depression
    • Physical Manifestations: breast tenderness, bloating, fluid retention, increased appetite and food cravings, insomnia, fatigue, hot flashes, headaches and musculoskeletal discomfort
    • Cognitive Problems: short-term memory problems, difficulty concentrating and unclear thinking
  6. Premenstrual Syndrome
    • most effective assessment is to have women keep a menstrual chart
    • instruct to keep for 3 months, showing length of cycle, duration of bleeding and occurrence of symptoms
    • If woman has PMS symptoms will occur during the luteal phase (ovulation to menstruation). Symptom free period is at least 7 days.
  7. Premenstrual Syndrome
    Management is focused on eliminating the pts own unique symptoms
  8. Premenstrual Syndrome
    NSAIDS, antidepressants, oral contraceptives, decreased caffeine in the diet
  9. when are women with Premenstrual Syndrome usually symptom free?
    end on menses until the ovulation
  10. What is Amenorrhea?
    Absence of menstrual periods
  11. What is primary Amenorrhea?
    menstruation that has failed to occur by age 16

    Relatively uncommon and is associated with congenital factors caused by ovarian, endometrial functions, and anatomy
  12. Primary Amenorrhea
    How to tell if structural or Hormonal?
    If there are no other signs of puberty, the primary amenorrhea could be Hormonal

    If pt has gone through puberty in every other way she may have a structural anomaly.
  13. What is Secondary Amenorrhea
    menstruation that started but has stopped and has not returned for at least 3 months
  14. What are the most common causes of Secondary Amenorrhea
    • Pregnancy
    • Lactation
    • Menopause
  15. What is the Assessment for Secondary Amenorrhea?
    thorough medical and ob history as well as surgery history (Hysterectomy?)
  16. What are causes of Secondary Amenorrhea?
    • stress, strenuous exercise or anorexia (low body fat), some meds (antidepressants)
    • pregnancy, breast feeding, menopause
  17. What is the Treatment for Secondary Amenorrhea?
    based on the causes
  18. Postmenopausal Bleeding
    • Manifestation not disease
    • vaginal bleeding that occurs after 12 month cessation of menses after the onset of menopause
    • Gynecologic Cancers occur in 20-40% of these women
    • Never Normal to Have Postmenopausal Bleeding!!
  19. What are the 3 most common causes of noncancerous post menopausal bleeding?
    • Atrophic Vaginitis
    • Cervical Polyps
    • Endometrial Hyperplasia
  20. Atrophic Vaginitis
    vaginal mucosa is thin and dry and easily traumatized by intercourse and infection causing spotting
  21. Cervical Polyps
    usually soft, red, oval tissue masses that appear within the cervical canal.

    Benign but bleed very easy, Need to be removed
  22. Endometrial Hyperplasia
    • tissue overgrowth
    • bleeding caused by declining ovarian function that leads to prolonged estrogen stimulation producing the hyperplasia that eventually breaks down and bleeds
  23. What is the Assessment for Postmenopausal Bleeding
    • assess risk factors
    • menstrual history and family hx
    • clients age at menopause
    • frequency and amount of bleeding
    • previous bleeding episodes
    • GI or GU symptoms
    • H&H, urine and stool samples
    • Start with things like R/O rectal Bleed
  24. Postmenopausal Bleeding
    Treatment  for Atrophic Vaginitis
    managed by the use of Estrogen via the vagina evaluate for HRT
  25. what is the treatment for Atypical hyperplasia
  26. Endometriosis
    • usually a benign problem of endometrial tissue implantation outside the uterine cavity.
    • Manifestations include pain, dyspareunia, painful defecation, sacral backache, hypermenorrhea and infertility
    • most common: pain before the onset of menstrual flow
  27. Chocolate Cyst?
    endometriosis that implants and grows around the ovary
  28. endometriosis causes:
    scarring and adhesions that exacerbates the problem
  29. endometriosis regresses during
    pregnancy and menopause
  30. what are the most common symptoms of endometriosis
    pain and infertility
  31. endometriosis pain id worse when
    it is on the bowel and under the diaphragm
  32. what is the key to diagnosing Endometriosis?
  33. what drug therapy should be used with endometriosis
    • Mild analgesics and NSAIDS for pain relief
    • Hormonal therapies to suppress ovulation (Danocrine, Cyclome, Lupron) DO NOT TAKE FOR LONGER THAN 8 MONTHS
  34. what are some complementary and alternative treatments for endometriosis
    • application of heating pad to the abdomen or sacrum
    • relaxation techniques
    • yoga
    • biofeedback
  35. Surgical Management for Endometriosis
    • Laparoscopic removal of the endometriosis and adhesions
    • Removal of the uterus if fertility is not an issue
  36. Dysfunctional Uterine Bleeding
    • Nonspecific term used to describe bleeding that is excessive or abnormal in amount or frequency without predisposing anatomic or systemic conditions (>80ml per menstrual cycle)
    • Usually around 30 very heavy bleeding w/o specific Dx
  37. what are the signs and symptoms of menopause?
    • hot flashes
    • headache
    • night sweats
    • insomnia
    • anxiety
    • short term memory loss
    • decreased concentration
    • osteoporosis
    • depression
  38. what is endometrial ablation
    • freeze or burn the endometrium
    • saves the uterus but not the fertility
    • Patient wont have periods uterus could not stand pregnancy
    • (if spot is missed, can have spotty bleeding irregular times)
  39. treatments for DUB dysfunctional uterine bleeding
    • Dilation and Curettage (not as commonly used these days)
    • Endometrial Ablation
    • Hysterectomy
  40. menopause cannot be Dx until......
    pt goes 12 consecutive months without a period
  41. simple vaginitis
    inflammation of the lower genital tract which results when there is a disturbance of the balance of hormones and bacterial interaction in the vagina.
  42. cause of simple vaginitis
    • result of menopause
    • Trichomonas vaginalis (treat Abx)
    • Yeast
    • changes in normal flora (good bacteria)
    • foreign bodies
    • chemical irritants
    • diabetes
  43. treatments for simple vaginitis
    • topical hydrocortisone to treat the itching
    • assess for irritants
    • treat with Abx if infection is cause
    • laser therapy if severe
  44. Toxic Shock Syndrome
    • caused by microabrasions related to tampon use
    • Staph produces toxin
    • abrupt onset of high fever, fever, headache, sore throat, vomiting, diarrhea, generalized rash, and hypotension
  45. TSS is treated with...
    • Vancomycin
    • PCN
    • Teach good hand washing
    • Change tampon frequently
    • avoid super absorbent
    • CDC reportable disease
  46. uterine prolapse
    stages of uterine prolapse are described by the degree of decent
  47. treatments for uterine prolapse
    • Kegel Exercises (may prevent)
    • Pessaries (simple ring inserted in vagina
    • Surgery (hysterectomy with the repair of the vagina and surrounding tissue)
  48. Symptoms of uterine prolapse
    • dyspareunia
    • backache
    • pressure in the pelvis
    • bowel or bladder problems
  49. causes of uterine prlapse
    • child birth large babies
    • obesity
    • multiple pregnancies
    • weakening of pelvic support due to lack of estrogen
    • age-gravity
  50. cystocele
    • protrusion of the bladder through the vaginal wall due to weakened pelvic structures
    • difficulty empting bladder
    • urinary frequency and urgency
    • Stress urinary incontinence
  51. Diagnosing Cystocele
    • pelvic scan
    • post void residual (most accurate)
    • bladder scan
  52. rectocele
    protrusion of rectum through a weakened vaginal wall
  53. uterine leiomyomas
    • Myomast (fibroids) that are benign
    • They develop in the Myometrium
    • risk increases with age
    • Etiology not really known
    • Usually no pain only seek help because the heavy bleeding
  54. treatment for uterine leimyomas
    • assess for anemia
    • uterine artery embolization
    • Myomectomy
    • hysterectomy (leimyomas are the most common reason for hysterectomy)
    • If not too large physician may watch if patient wants to become pregnant
  55. Cervical polyps
    • pedunculated tumors on stalks arising fro the mucosa and extending to the opening of the cervix
    • removal is simple office procedure
    • blled very easy if touched
  56. endometrial cancer
    • reproductive cancer (most common GYN cancer)
    • main symptom is postmenopausal bleeding
    • usually Dx in women  and older
    • Growth typically slow
  57. Dx of endometrial cancer
    • Transvaginal US
    • endometrial biopsy
    • once Dx is made testing for metastasis is done
  58. surgical management foe endometrial cancer
    • total abdominal hysterectomy
    • stage II Radical Hysterectomy with bilateral pelvic lymph node dissection remove appendix and check bowel
    • radiation may be scheduled for stage I or II
    • Will have NG to wall suction
  59. cervical cancer
    • client often asymptomatic
    • classic symptom painless bleeding
    • leg pain, flank pain
    • later unexplained weight loss, pelvic pain, dysuria, hematuria
  60. cervical cancer is caused by...
    HPV causes most cervical cancers
  61. pap comes back abnormal
    what next?
    • repeat pap
    • colposcopy
    • endocervical curettage biopsy
  62. non surgical management for cervical cancer
    • LEEP
    • local ablation using Loop Electrosurgical Excision Procedure
  63. over time cervical cancer can spread into the uterus, what is the treatment
    radiation or chemo
  64. ovarian cancer
    • most are epithelial tumors that grow on the surface of the ovaries
    •  grow rapidly and spread quick
    • more people die from this than any other reproductive cancer