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What are the layers of the uterus
- endometrium (sheds away each month if egg not fertilized)
- Myometrium (middle muscular layer where fibroids develop)
- Perimetrium (outer layer of uterus)
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vagina
collapsible hollow tube that is vulnerable to pressure from other structures
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Cervix
bottom portion of the uterus
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what does PAP test check for?
Cervical Cancer
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PAP Test Prep
- no intercourse for 24 hours before test
- no vaginal bleeding for best results
- no douching
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if initial PAP test is positive what is done next
- Colposcopy
- which is PAP where vinegar is used to accentuate the features of the cervix and then a lighted instrument is used to look for lesions, cancerous area on the cervix
- If any identifiable lesions are found a cervical biopsy is done
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Hysteroscopy
should be done when pregnancy is least likely. 2-5 days after menses after bleeding but before ovulation
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laparoscopy
- 3 small trochars placed into abdomen
- abdomen is distended with CO2 for visualization
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semen analysis looks at....
- count
- motility
- shape
- DNA
- ability to swim
- quality of fluid (should be alkaline)
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why should semen be alkaline
to balance the female vagina is very acidic
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prostate biopy
Why is it done and how is it done
- looks for cancer cells
- done either transrectal or transurethral
- needle biopsy with multiple specimens to increase the chance of finding cancer
- Normal PSA is less than 4ng/ml
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determining ovulation
- 1st stage follicular phase can be any #of days
- Last stage Luteal Phase is always 14 days
- Ovulation triggers Luteal Phase to begin
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most patients that suffer from PMS or fibercystic breast disease have most symptoms ......
during luteal phase right after ovulation
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Ductal Ectasia
- benign breast problem of women approaching menopause
- caused by the thickening of the ducts in subareolar area
- Mass hard with irregular borders
- Greenish Brown Nipple discharge
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Intraductal Papilloma
- Benign occurs women 40-55
- bloody nipple discharge as papilloma grown it causes trauma and erosion in the duct
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Fibroadnoma
- Benign adolescence - 30
- Solid, slowly enlarging, round, firm, easily movable, nontender, usually located in the upper outer quadrant
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Fibrocystic Breast Disease
- nodularity of the breast occurs 20-30
- can increase in severity until menopause
- Cyclic in nature
- pain tenderness, cysts in breasts
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Gynomastia
- less than 1% of all breast cancer is men
- Alcoholism
- Obesity
- Liver Disease
- Hyperparathyroidism
- Androgen Deficiency
- Estrogen Excess
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What are the risk factors for developing breast cancer?
- 1st degree relative
- Obesity
- early menarche, or late menopause
- having no children, or having children late in life
- not breast feeding
- using oral contraceptives
- More estrogen the more likely you are to have breast cancer each of these thing would stop the estrogen for an amount of time
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DCIS
What is it ad how is it treated?
- Ductal Carcinoma in Situ:cancerous cells in the mammary ducts. (not dangerous in ducts)
- Usually treated very aggressively because once it leaves ducts it is very dangerous and they cannot predict if or when is will erupt for the ducts
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most common breast cancer
Ductal Carcinoma
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Lobular Carcinoma
- about 10%
- does not always form palpable lump
- harder to see on mamogram
- Only type that may present in both breasts at one time
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Colloid Carcinoma
- Occurs more frequently in older women
- Good Prognosis
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Inflammatory Carcinoma
- less tha 1%
- very dangerous
- sore, blister or lesion develops on the outer breast
- often mistaken for mastitis
- often metastasized at diagnosis
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Medulary CArcinoma
occurs more frequently in younger wmen
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Triple Negative Breast Cancer
- Poor Prognosis
- Estrogen receptor negative
- Progesterone Receptor Negative
- Does not overexpress HER2NEU gene, less ways to treat because HER2NUE is not making it grow and Estrogen/progesterone are not feeding it
- ONLY Tx IS CHEMO, RAD, & SURGERY
- we don't know why it is harder to treat and tends to reoccur quickly and is less responsive to chemo and rad
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treatment for estrogen/progesterone receptive tumor
- Tamoxifen
- or other estrogen blocking agent
- give oral pill for 1-5 years
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Treatment for cancer that overexpresses HER2NEU gene
Herceptin (IV treatment)
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lumpectomy
- removal of the tumor
- always accompanied by Radiation
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Mastectomy is only accompanied by radiation if...
the lymph nodes are found to have cancer in them
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If axillary nodes are taken what effect does this have on the patient?
- Increased risk of lymphedema
- lymph nodes draw excess fluid from the body
- doesn't have good filtering system
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patient teaching for patients with ALND (axillary lymph node removal)
- no lab sticks, IV, Blood draws or injections in affected extremity for 25 years
- Keep arm elevated at night when possible
- watch for S/S infection in extremity and report asap
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Adjuvant treatment for breast cancer
- Chemo (IV Tx for prevention or to slow the growth of DISTANT metastasis)
- Radiation (local external bream Tx to prevent LOCAL RECURRENCE)
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Primary Amenorrhea
- 16 yr old with no menses
- look for S/S of puberty
- Anatomical anomalies
- ask family about family history
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Secondary Amenorrhea
causes and treatment
- Preg, Menopause, breast feeding, hysterectomy,
- less obvious causes: anorexia, strenuous exercise, some antidepressants, stress and anxiety
- Tx oral contraceptives, treat causes
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PMS
- involves cognitive, physical and emotional symptoms
- begins with ovulation
- have pt make symptom chart to know what to expect
- may use oral contraceptives or NSAID for relief
- will increase in severity until menopause
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Meonpause
- 12 months have passes with no menses
- 45-55
- Hot flashes, Headaches, Anxiety, depression, insomnia, vaginal dryness, stress incontinence, decreased libido
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why is hormone therapy no longer used to treat menopausal women?
- It increases risk of
- breast cancer
- ovarian cancer
- risk of heart disease and stroke
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endometriosis
what is it
what are symptoms
- growth of endometrial tissue outside of the uterus
- may grow on bowel, ovary, diaphragm
- pain, dyspareunia, constipation, backache, pressure lower abdomen
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how to Dx Endometriosis
Laparascopy (has to be visualized to Dx)
- Tx Danocrine, Danozol, Lupron (causes medical menopause)
- only use for 6-8 months
- then allow pt to try conceive symptoms will reappear after childbirth and regress at menopause
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Endometrial cancer
- Disease of postmenopausal women
- Good Prognosis if treated early
- ALWAYS follow up on postmenopausal BLEEDING
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If bleeding is not endometrial cancer evaluate for
- Atrophic Vaginitis (due to dry Mucosa)
- Cervical Polyps
- Endometrial Hyperplasia
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endometrial hyperplasia
endometrial layers build up and breaks down intermittently and erratically due to lack of estrogen
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cervical polys
painless benign lump on cervix that bleed very easily
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cervical cancer
- is almost always caused by HPV
- Usually No Symptoms (sometimes painless vaginal bleeding)
- Is a disease of progression, takes years to progress to invasive disease
- vaccine is Gardisil
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Ovarian Cancer
- is the most deadly GYN cancer
- symptoms are very vague (indigestion, backache, constipation, dyspepsia)
- Biopsy must be done by Laparoscopy because ovaries difficult to reach and not palpable until very large
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Toxic Shock Syndrome
- still monitored by CDC
- wash hands before and after
- tampons dry out vaginal mucosa and cause fissures and microabrasion. Staph bacteria are rapidly absorbed to blood stream causing sepsis and often death
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Uterine Prolapse and causes
- 3 grades of uterine prolapse
- uterus drops caused by child birth
- multiple pregnancies
- weakening of pelvis support due to lack of estrogen
- age and gravity
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Cystocele
protrusion of bladder through the vaginal wall due to weakened pelvic structures
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rectocele
protrusion of rectum through a weakened vaginal wall
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endometrial ablation
- burning or freezing uterine layer away to destroy it as an alternative to hysterectomy for various gyn problems
- Pt should not get pregnant as supportive endometrium is gone
- If successful not more periods
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