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Reproductive System

Part II

QuestionAnswer
absence of menses who has no menarche by 16 amenorrhea
imperforated hymen, transverse vaginal septum, tesicular feminization, ovaries, gonadal agenesis (no growth during fetal), gonadal agenesis hypothalmic, pituitary primary amenorrhea Three varieties (outflow obstructed, end-organ, central regulatory
absence of menses for 3 cycles or 6 months in women who had them. DON"T FORGET LEADING CAUSE pregnancy! Secondary amenorrhea
asherman, cervical stenosis, polycystic ovarian, premature ovarian failure, hypothyroid, meds, STRESS, WT LOSS, anorexia secondary reasons for amenorrhea
amenorrhea and no uterus, no breasts = what is the work up? karyotype, testosterone, FSH. Consider congenital, (if no breasts: gonadal failure, hypothalamus dys)
amenorrhea and uterus, yes breasts - what dx? testicular feminizaiton, mullerian agenesis
amenorrhea workup? pregnancy test. TSH, prolactin (hypohtyroid/hyperprolactin)
if amenorrhea, TSH normal, not pregnant and prolactin normal, what should you check next? progesterone (especially for withdrawal bleeding (OC), estrogen ok, patent cervix)
adminster estrogen to effect breast development and prevent osteoporosis tx for primary amenorrhea (no uterus)
+ progesterone challenge test treatment (amenorrhia secondary) OC - prevents endometrial hyperplasia
progresterone challenge test (rarely used) administer progresterone for amenorrhea Provera. withdrawal bleeding = anovulation (estrogen works/uterus lining works/cervix works). no withdrawal bleeding = (estrogen doesn't work, signals for estrogen doesn't work, cervix doesn't work)
pain, cramping during menses - interpheres with daily life. (no obvious cause - high level prostaglandins), (2nd: fibroids, cervical stenosis, pelvic adhesion, endometriosis) dysmenorrhea (1 and 2)
pain occurs on first or second day of menstration, HA, N/V, tender on pelvis/abd, dysmenorrhea priamry
scant menses, severe cramping, pain relieveed with increased menstrual flow (scared external os) cervical stenosis
hx of pelvic infection, prior pelvic sugery pelvic adhesion
tx for dysmenorrhea (uncomfortable menses) NSAIDS and OC - treatment of choice
treatment for cervical stenosis cervical dilation
pelvic adhesions treatmnet? NSAIDS, OC, surgery to lyse adhesion
occurs during second half of the menstrual cycle with somatic(breast swelling, bloating, HA, fatigue, constipation), emotional (frustrated, depressed, anxious, libido changes) behavioral (food, concentration low, sensitive to noise) PMS
dx for PMS pt have symptom free follicular phase for 1 week. PMS occurs during luteal phase... two weeks before your period. progesterone is high, FSH, LH is low, estrogen is constant.
Antidepressant, NSAIDS, oC PMS
denoted by final menstruation and marks the end of reproduction. ages 48-52. diminished estrogen that leads to increased FSH, LH. menopause
SE of menopause lipid profile, vascular endothelium, INCREASED risk of CVA, loss of bone resorption (osteopenia, osteoporosis), Flushing, sweats, mood changes, depressoin, decreased breasts, vaginal atrophy, elevated FSH
TX for menopause estrogen/progestorone combo tx. (SE: estrogen neoplasm, emoblic events, vaginal bleeds) progesterone reduces endometrial ca.
PID infectious agents chlamdia and gonnorhea
risk of PID infertile, ectopic pregnancy (15-19) STI very risky. (IUDs, cigarettes, unmarried, nonwhite), Contraceptives help
abdominal pelvic pain, b/l or u/l - burning, cramping, stabbing. vaginal discharge, abn bleeding, dyspareunia, GI or UT sx. with FEVER. PID
cervical motoin tenderness (Chandelier's sign) and purulent discharge PID
Labs: elevated WBC count, US not helpful, laparoscopy definite diagnosis. cultures obtained. clue cells noted on wet mount (potential for other bacteria) PID
PID treatment hospital, borad-spectrum cephalosporin (cefoxitin, doxycycline) Clindamycin, gentamicn if allergic to Cephalosporins
Created by: jamieseals