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AUB
Abnormal Uterine Bleeding
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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
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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)
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DUB
- Dysfunctional Uterine Bleeding
- NOT ovulating - NO cycles, just bleeding
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Dysfunctional Uterine Bleeding
About
- More adolescents and perimenopausal women
- Tx: medical then surgical (DNC = remove lining)
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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
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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
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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)
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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
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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
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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
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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.
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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
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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)
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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
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Hysterectomy
Surgical removal of uterus
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Salpingectomy
Surgical removal of fallopian tubes
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Oophorectomy
Surgical removal of ovary
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Colposcopy
- Direct visualization of cervix
- Bright light, magnifying microscope
- Apply 3% acetic acid
- Abnormal cells turn white
- ID for biopsy
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