-
most common cz sepsis in elderly
acute cystitis
-
-may occur along with urethritis
-most common bacterial infection in women
acute cystitis
-
-unresolved after TX due to obstructions, ATB resistant bacteria, mult bacteria strains
Chronic cystitis
-
cystitis that recurs within 2 weeks
recurrent cystitis
-
indwelling caths, comorbidities, pregnancy
complicated cystitis
-
if a 62yr old woman cam ein with vaginal bleeding what would you do?
refer for endometrial BX
-
TX for STD's
1. Chlamydia
2. Gonorrhea
3. Syphilis
- 1. Zithromax
- 2. Ciprofloxacin
- 3. PCN
-
Name all reproductive hormones (5)
- 1. estrogen
- 2. progesterone
- 3. FSH
- 4. GnRH
- 5. LH
-
LMP means what?
1st day started bleeding, not last day of period
-
sequence of menses, hormones, etc
Follicular phase (from 1st day of period to ovulation)--LH--ovulation--14 days go by--start bleeding
-
other hormones that have affect on reproductive system (3)
- prolactin (breaks cycle, common during pregnancy and after birth)
- testosterone (produced by adrenal cortex)
- TSH
-
Anovulation:
- adolescence/early cycle
- perimenopause (worry about family planning)
- hormone use
- hypothyroidism
- PCOS (metabolic syndrome)
- anorexia (low adipose)
-
Anovulation:
SX-
- sx-
- amenorrhea
- DUB
- galactorrhea
- pregnancy
-
Anovulation:
DX-
- dx-
- TSH, FSH, LH, estradiol, testosterone levels
- pelvic U/S (PCOS)
-
Dysfunctional uterine bleeding:
cz by what?
most frequent during?
- cz by dysfunction of hypothalmic-pituitary-ovarian axis, may be cz by OCP's
- frequent during menarche
-
post menopausal DUB requires:
endometrial BX
-
menorrhagia
metrorrhagia
- menorrhagia- heavy
- metrorrhagia- irregular
-
Amenorrhea:
Primary (disorder)
Secondary
- primary-
- absence of menarche by age 16; cz- outflow, ovary, anterior pituitary, hypothalamus
- secondary-
- absence of menstruation for >3months; cz- pregnancy, hormone contraception, elevated prolactin (pituitary adenoma), stress, wt loss, anorexia, menopause, hypothyroid, chronic dz, PCOS
-
Amenorrhea:
DX
progesterone challenge (10mg x10days, after 3rd dose should be bleeding by now), progesterone/estrogen challenge, pelvic U/S, labs, MRI of sella turcica
-
PCOS:
cz's
- formerly Stein-Leventhal syndrome
- hypothalamic- pituitary- ovarian axis disorder
- elevated LH
- low FSH
- elevated estrogen (constant)
- androgen overproduction
- 5-10% occurence
- usually dx w/fertility failure
-
PCOS:
sx
- anovulation leads to amenorrhea/DUB
- hirsutism
- infertility
- acne
- alopecia
- acanthosis nigricans (dark neck looks dirty)
-
PCOS:
DX
- lab testing
- pelvic U/S (may not be conclusive)
- basal body temp charting w/endometrial BX to confirm anovulation
-
PCOS:
TX
- TX-
- OCP's (if fertility not desired)
- androgen-lowering agents
- infertility hormones/surgery
-
Dysmenorrhea:
most common cz-
TX-
- cz- prostaglandin increase at onset of menses
- may indicate endometriosis, PID, fibroids, etc...
- TX-
- OTC RX analgesics (Aleve, motrin)
- OCP's
- heat
-
Endometriosis:
- proliferation of endometiral tissue on sites other than the uterine lining
- almost exclusively found on premenopausal women
- genetics
-
Endometriosis:
sx
- sx-
- dysmenorrhea
- dyspareunia
- infertility
- constant pelvic or LBP unrelated to menstrual cycle
-
Endometriosis:
DX
- DX-
- exam- normal
- exam- fixed uterus d/t adhesions, pain w/uterine movement, nodules on the posterior vaginal fornix, adnexal tenderness
- laparoscopic surgery and BX
-
mastodynia/mastalgia:
definition...
happens most commonly during...
R/O?
TX-
- painful breasts
- usually cyclic during luteal phase
- R/O CA (most cancerous lesions are nontender)
- TX-
- avoid methylxanthines (coffee, tea, chocolate, cola)
- mild diuretic
-
Mass/swelling at the introitus:
- malignancies
- infections
- benign cysts (inclusion, Gartner duct)
- varicosities
- prolapsed uterus, bladder, or rectum
- pertinent HX
-
Bartholin's gland cyst:
sx-
- common
- consider malignancy if postmenopausal
- sx-
- extremely painful mass on either side of introitus
- inflamed and fluctuant
- easily visualized
- systemic sx are rare
-
Bartholin's gland cyst:
DX
TX
- dx-
- PE
- C&S of drainage rarely done
- BX if malignancy suspected
- tx-
- I&D/word catheter
- ATB's
-
Vaginal discharge:
- infection
- pregnancy
- malignancy
- pertinent HX
-
normal vaginal microscopy:
- epithelial cells
- lactobacilli (gram + rods)
- rare WBC's
- variable RBC's
- normal vaginal pH 4-4.5
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