Reproductive pathophysiology

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Transcript of Reproductive pathophysiology

  • 1. REPRODUCTIVE PATHOPHYSIOLOGYJanet J. Nelson RN

2. REVIEW Ectopic pregnancy Dysmenorrhea Tubal Ligation http://www.youtube.com/watch?v=yETDInQU6lQ tubal videowith Filshie clips Accessory nipples 3. ACCESSORY NIPPLE/S 4. PID http://www.cdc.gov/std/pid/stdfact-pid.htmPID Complications of PID: Scarred f.t. with infertility Tubo-ovarian abcess Ectopic pregnancy Pelvic adhesions Chronic pelvic pain 5. WHAT DOES DIFFERENTIALDIAGNOSIS MEAN?Differential diagnosis: The process of weighing theprobability of one disease versus that of other diseasespossibly accounting for a patient's illness. The differentialdiagnosis of rhinitis (a runny nose) includes allergic rhinitis(hayfever), the abuse of nasal decongestants and, ofcourse, the common cold.SO WHAT DIFFERENTIAL DX could therebe before PID is finally decided? 6. ENDOMETRIOSIS Endometriosis is the presence of endometrial tissueoutside the uterus on structures such as the ovaries,ligaments or colon. This ectopic tissue responds to the hormonevariations and will grow, degenerate and shed withbleeding. But there is no exit for the blood, so the surroundingtissue is irritated and develops into fibrous tissue(leading to adhesions) The inflammation recurs with each cycle. 7. Endometriosis cont. Etiology: Unknown. Proposedmechanisms include migaration ofendometrial tissue up through thefallopian tubes into the pertonealcavity during menstruation. S&S: Dysmenorrhea, Constantpain and cramping abdomen, &back, dyspareunia. DX: Laparoscopic exam TX: Conservative treatment withvarious hormones is indicated foryounger patients.Totalhysterectomy with bilateralsalpingo-oophorectomy may beindicated. 8. Endometriosis Prognosis PX: Fibrous tissue maycause adhesions andobstructions ofassociated organs e.g.bladder or colon. Fallopian tubes may beblocked or the ovarycovered by fibrous tissue. The uterus may be pulledinto a retrovertedposition. Infertility may result. Endometriosis fibrous tissueon small intestine 9. TOXIC SHOCK SYNDROME Toxic shock syndrome is a rare, life-threateningbacterial infection that has been most oftenassociated with the use of superabsorbent tamponsand occasionally with the use of contraceptivesponges. (Septic bacteremia) Etiology:Toxic shock syndrome (TSS) is caused by atoxin produced by certain types of Staphylococcusbacteria. This may because of the length of time atampon is left inside, or contraceptive sponges.Surgery and skin wounds have also been associatedwith TSS.It is septic bacteremia S&S: high fever, rash, skin peeling and shocksymptoms 10. TSS continued DX: History , PE, and elevatedWBC, liver enzymes & BloodC&S TX: Antibiotics, fluidreplacement PX: Good with treatment. Iftreatment is delayed, deathmay result from shock. http://www.nlm.nih.gov/medlineplus/ency/article/000653. 11. CYSTOCELE Cystocele: is thedownwarddisplacement of theurinary bladder The bladder cannotempty completely andrecurrent cystitis iscommon. 12. UTERINE PROLAPSE Uterine Prolapse isdownward displacementof the uterus. 1ST Degree=cervix dropsinto vagina 2nd Degree=the body ofthe uterus lies in thevagina 3rd Degree=the uterusand cervix protrudethrough the vaginal os. 13. Concurrent uterine and rectal prolapse 14. RECTOCLE Rectocele: is theprotrusion of therectum into theposterior aspect ofthe vagina Interference withdefecation andfeeling of pressurein the pelvis arecommon complaints 15. Herniation/Prolapse Etiology: Pelvic floor weakening S&S: c/o bulge & pelvic pressure, stressincontinence. DX: History and exam TX: Kegels, surgical repair Marshall-Marchetti-Krantz Colporrhaphy (anterior) Posterior repair A&P repairBimanual Exam Mesh and slings have had problems in past but new arebeing used with success 16. FIBROCYSTIC BREAST DISEASE AKA: Mammary dysplasia Fibrocystic breast disease refers to benign changes in thetissues of the breast, considered normal for most women The cause is not completely understood S&S: Dense, irregular and bumpy "cobblestone"consistency in the breast tissue, breast discomfort,premenstrual tenderness and swelling. DX: Mammograms, breast US and aspirations of cysts TX: Must be aware of importance of SBE & annualmammograms PX: Women with fibrocystic breast disease do not havean increased cancer risk. 17. BREAST CANCERBreast cancer is the mostcommon cancer amongwomen in the United States,other than skin cancer. It isthe second leading cause ofcancer death in women, afterlung cancer. (Am Ca Society9/25/14)For men, the lifetime risk ofgetting breast cancer isabout 1/10th of 1% (1 in1,000). 18. PLEASE STAND AND COUNT OFF 1-8. Breast cancer is the most commontype of cancer among womenawoman born in the U.S. today isestimated to have a one in eightchance of developing breast cancer. Per Healthline.com update July 1 2014 19. Risk Factors to Breast CA Gender Age Genetics (first degreerelative with BRCA1 or 2) BRCA1 ANDBRCA 2 History Race (White highest) Menarche/menopause DiethylstibestrolExposure BCP Hormone ReplacementTherapy Breast feeding Alcohol Obesity Physical Activity Nongravida 20. DIAGNOSIS Mammogram:Age40 &>annual Clinical Breast Exam annual BSE-monthly MRI and Mammogram annually withhigh risk 21. BSE http://www.womenshealthmag.com/health/breast- 22. Treatment Lumpectomy vs. Partial Mastectomyvs. Total Mastectomy vs. RadicalMastectomy 23. Surgery with or withoutreconstruction 24. Other treatments Radiation Brachytherapy Chemotherapy Hormone therapy(Tamoxifen)Brachytherapy uses multiple thincatheters inserted directly in and aroundthe tissue that harbored the originalcancer.Prognosis: Generally theearlier the cancer is found thebetter the prognosis 25. SBE video http://www.breastselfexams.org/self-exams/women- 26. CERVICAL CANCER Cervical cancer was once one of the most commoncauses of cancer death for American women. Thecervical cancer death rate declined by 74% between1955 and 1992. The main reason for this change isthe increased use of the Pap test. The most important risk factor is HPV. (vaccineavailable for some of viruses) S&S: Abnormal vaginal bleeding, abnormaldischarge (often with odor) and pain with intercourse. TX: Surgery (complete hysterectomy =uterus,ovariesand tubes), radiation and/or chemotherapy. PX: excellent if detected early. 27. American Cancer Society Pap SmearReccomendations http://www.youtube.com/watch?v=bU85vvVNleY 28. UTERINE CANCER Most uterine cancers are of the endometrium. In the majority of cases the woman is postmenopausaland c/o vaginal bleeding. Risk factors: excessive estrogen (related to medication,oral contraceptives, women who have no children, beginmenstruation at a very young age, or enter menopauselate in life). Obesity and HTN. DX: No prophylactic tests are available. Biopsy andtransvaginal ultrasound are preformed with symptoms. TX: Hysterectomy with or without oophorectomy.Radiation before or after surgery. PX: Good with the 5-year cure rate at around 90% 29. OVARIAN CYST http://www.nlm.nih.gov/medlineplus/ency/article/ovarian cyst 30. OVARIAN CANCER Cancer of the ovaries is difficult to detect in its earlystage, only about 20 percent of ovarian cancers arefound before tumor growth has spread into adjacenttissues and organs beyond the ovaries. Most of thetime, the disease has already advanced before it'sdiagnosed. Symptoms do not appear until the disease isadvance and may include: abdominal pressure,fullness, swelling or bloating,urinary urgency,pelvicdiscomfort or pain Etiology: The causes of ovarian cancer remainunknown 31. Ovarian Cancer cont. DX: Pelvic Exam andpelvic ultrasound TX: Bilateral oophorectomyand salpingectomy.Hysterectomy may beneeded if lymph glands areinvolved. Chemotherapy.Blood test C-125 PX: Varies if the tumor hasmetastasized. 32. REVIEW MALE PATHO Inguinal Hernia Cryptorchidism 33. MALE REPRODUCTIVE DISEASES REVIEW HYDROCELE http://www.mayoclinic.com/health/hydrocele/DS00617 34. TESTICULAR CANCER Testicular cancer is the most common form ofcancer in men between the ages of 15 and 34 and ismost common in white men. Risk factors: Undescended testicle (cryptorchidism):. Congenital abnormalities: Men born with abnormalitiesof the testicles, penis, or kidneys, as well as those withinguinal hernia History of testicular cancer Family history of testicular cancer: 35. Testicular CA S&S: a painless lump or swelling in a testicle pain or discomfort in a testicle or in the scrotum any enlargement of a testicle or change in the way it feels a feeling of heaviness in the scrotum a dull ache in the lower abdomen, back, or groin a sudden collection of fluid in the scrotum DX: Exam, US, Biopsy TX: 95% cure rate if dx early. Orchidectomy, chemo andradiation PX Good with EARLY treatmentindicating the need forTSE 36. TSE video http://medical-diagonosis.wonderhowto.com/how-to/give-testicular-self-exam-146839/ 37. BPH Common as men age with urinary bladderobstruction. S&S reflect the obstruction Dx: digital exam, PSA, US, cystoscopy Complication include urinary retention, renalinsufficiency, recurrent UTI, bladder calculi Tx: medication to reduce size of prostate and/orreduce symptoms, TURP, or laser or microwave(heat) using scope. Px: age/other conditions of patient interferes withtreatment options 38. BPH 39. Prostate Cancer Is an adenocarcinoma that usually grows slowly. Per 2013 statistics Prostate cancer is the leadingcause of cancer in the US Risk factors for prostate cancer (gender of course) Age Race FH Diet Obesity Exercise (or not) Infection (prostatitis) 40. Prostate CA cont. SX: nocturia, urinary frequency, urinaryretention after urination DX: PSA, DRE,TRUS, biopsy, TX: Most common excision is a radicalretropubic prostatectomy, Or laparoscopic radicalprostatectomy or TURP PX Survival rate: If local 100% If regional 100% If distant 31% 41. HYPOSPADIAS & EPISPADIAS A congenital defect of the malepenis can result in the urethralocated