Term
|
Definition
| >80cc (>1 pad every 3 hrs) |
|
|
Term
|
Definition
| Dimished bleeding (Spotting) |
|
|
Term
|
Definition
| Bleeding at intervals <21 days apart |
|
|
Term
|
Definition
| Bleeding at intervals >35 days apart |
|
|
Term
|
Definition
| Profuse bleeding at regular intervals between 21-35 days apart |
|
|
Term
|
Definition
| Bleeding at very irregular periods but not excessive in amount |
|
|
Term
|
Definition
| Bleeding that is excessive in amount and at very irregular periods |
|
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Term
|
Definition
-Dysfxnal uterine bleeding
-AUB without organic causes
-Dx of exclusion
-Menometrorrhagia
-Usually occurs with anovulation and lack of progesterone in adolescents and perimenopausal women
-Endometrial hyperplasia (endometrium outgrows the blood supply and sloughs off)
-Chronic endometrial hyperplasia in perimenopausal women cal lead to carcinoma transformation |
|
|
Term
|
Definition
-Extension of the endometrial glands into the myometrium of the uterus
-Birth trauma to uterus is proposed cause
-Uterus is enlarged soft, tender
-Dysmenorrhea and menorrhagia
-DX: Pelvic US or MRI
-TX: Anti-prostaglandins for MILD cases; Hysterectomy for SEVERE cases |
|
|
Term
|
Definition
-Presence of endometrial tissue outside the uterine cavity
-Ectopic locations include pelvic peritoneum, ovary, cul-de-sac, sigmoid colon and fallopian tube
-PE shows nodularity and fixed/retroverted, painful uterus
-DX: Lap
-TX: continuous OCP or Provera for MILD; Danazol or Lupron for SEVERE; hysterectomy for EXTREME |
|
|
Term
| Uterine Leiomyoma (Fibroids) |
|
Definition
-Benign, smooth muscle tumors of the uterus
-Rare transformation into leiomyosarcoma
-PE shows nontender, enlarged uterus with protrusions
-DX: Pelvic US
-TX: none for asymptomatic; Provera, Lupron or Danazol for LARGE; UAE, myomectomy or hysterectomy for SEVERE |
|
|
Term
|
Definition
-Rare tumor that develops from fetal trophoblast (placenta)
-Most common form is Hydatidiform mole
-Molar pregnancies show: (+) pregnancy test, rapidly enlarging uterus, vaginal bleeds, High hCG levels, HTN, N/V
-DX: US with snowstorm appearance from grape clusters
-TX: D&C; hysterectomy and chemo if malignant |
|
|
Term
|
Definition
BASELINE
-Pregnancy test
-H&H
-Pap
-STD
SECONDARY
-Coags
-TSH, Free T4
-FSH, LH, Prolactin
-Androgen levels
-ACTH, Cortisol, GH
-Pelvic/vaginal US, hysteroscopy
-CT/MRI is suspect pituitary tumor |
|
|
Term
|
Definition
-Women >35 -- Refer for Bx
-Hypothyroid Related -- Tx with Synthroid
-Hyperthyroid Related -- Refer for evaluation & Tx
-Benign tumor -- Surgical eval
-1st Tri Threatened Abortion -- Place on bed rest
-2nd Tri Threatened Abortion -- Refer to OB/GYN
-Ectopic Pregnancy -- Refer for Sx or Methotrexate Tx
-Pelvic Infxn -- Tx with appropriate ABXs and re-evaluate
-Suspected malignancy, pituitary Dz or adenomyosis -- Refer |
|
|
Term
|
Definition
-DUB with small bleeding -- 1/50 OCP QID
-DUB with heavy bleeding but no anemia -- Tx with Premarin 2.5mg QID
-DUB with heavy bleeding and anemia (Hct <25%) -- Hospitalize and Tx with IV estrogen 25mg Q4 til bleeding stops |
|
|
Term
| Causes of Primary Amenorrhea |
|
Definition
-Congenital Abnormalities
-Chromosomal Abnormalities
-Hypothalamic/Pituitary Abnormalities
-POC |
|
|
Term
| Causes of Secondary Amenorrhea |
|
Definition
-Pregnancy & Lactation
-Hypothalamic/Pituitary Dysfxn
-Hyperprolactinemia
-Contraceptives
-Menopause/Perimenopause
-Outflow obstruction
-Asherman's Syndrome
-Sheehan's Syndrome
-Premature Ovarian failure |
|
|
Term
|
Definition
-Short stature, shield chest, lymphedema at birth, skeletal abnormalities, coarctation of aorta
-Absence of ovaries and secondary sex characteristics |
|
|
Term
|
Definition
-Congenital absence of uterus, fallopian tubes, upper vagina
-Normal ovaries and normal secondary sex characteristics |
|
|
Term
|
Definition
-Disruption of normal embryologic processes of the mullerian ducts results in various congenital anomalies of the female reproductive tract
-Mullerian aplasia or Vaginal Agenesis results form hypoplasia of the mullerian duct system |
|
|
Term
|
Definition
-Mullerian Agenesis
-Vaginal Agenesis
-Congenital absence of the uterus and vagina (CAUV)
-Mullerian Aplasia (MU)
-Genital Renal Ear Syndrome (GRES)
-WNT4 gene suppresses male sexual differentiation and ovarian androgen production
-25-50% have urologic anomalies
-Normal 2* sexual characteristics but primary amenorrhea
-TX: NonSx: Self-Dilation; Sx: McIndoe Vaginoplasty |
|
|
Term
| Polycystic Ovary Syndrome (POC) |
|
Definition
-LAB: elevated serum estrogen, testosterone, LH; elevated serum glucose from insulin insensitivity
-Enlarged and cystic ovaries on US
-Obesity, hirsutism, acne, irregular menses
-TX: Wt loss and progesterone; Clomiphene, Dexamethasone, Spironolactone |
|
|
Term
|
Definition
-Presents with amenorrhea, or abnormal uterine bleeding
-Hirsutism
-TX: Adrenal Sx; androgen suppression with Dex, Spir, E/P |
|
|
Term
| Abnormalities of Outflow Tract |
|
Definition
-Uterus, cervix, vagina, imperforate hymen
-DX: H&P
-Imperforate hymen can be opened in office |
|
|
Term
|
Definition
-Destruction of endometrium either by infxn or overly aggressive curettage during a D&C
-DX: H&P or hysteroscopy
-TX: D&C, ABX X 10 days, OCPs |
|
|
Term
|
Definition
-Benign monoclonal smooth muscle tumors that are hormonally sensitive
-RISK: Nulliparity, obesity, early menarche, AA
-S&S: bleeding, pelvic pain, urinary symptoms, recurrent pregnancy loss, infertility, pregnancy complications, DUB
-Classes: Subserosal, Intramural, submucosal
-DX: PE, US, SIS, hysteroscopy
-TX: hysterectomy vs myomectomy; Hormonal modulation; UAE |
|
|
Term
|
Definition
-Peaks at 40-50 but most common cause of post-menopausal bleeds
-S&S: intermenstrual bleeding/menometrorrhagia, infertility
-DX: US, SIS, HSG, hyertscopy, D&C |
|
|
Term
|
Definition
-Most common GYN malignancy in US
-RISK: Hyperplasia with atypia, unopposed estrogen exposure, Tamoxifen, Obesity, DM
-Protective factors: OCPs >12 mths
-S&S: avg age 60; postmenopausal bleeding (90%), abnormal vaginal discharge, pelvic pain/pressure
-DX: Endometrial Bx; D&C (gold standard)
-TX: Staging Sx (TAH, BSO, LND, OMX) XLAP with vertical incision; XRT reserved for advanced stage or recurrence |
|
|
Term
|
Definition
-Dz of menopausal women
-Highest fatality rate of GYN malignancy
-90% from ovarian epithelium
-RISK: Low parity, delayed childbearing, infertility, family Hx
-Protective factors: OCPs and breastfeeding
-Most is sporadic
-S&S: usually asymptomatic; may have vague abdominal symptoms (nausea, bloating, early satiety, wt gain)
-DX: No dependable screening test; XLAP
-Sx MGMT: Omentectomy, TAH, BSO, Pelvic Paraaortic Lymphadenectomy; Goal is optimal debulking (<1cm)
-TX: None for early; Combo chemo after cytoreductive Sx for all others; CA-125 followed for Tx efficacy |
|
|
Term
|
Definition
-Avg age 51
-Arises in areas of cervical dysplasia
-RISK: HPV!!, Cigarettes, immunosuppression
-S&S: Post-coital bleeding, pain and pressure, D/C
-DX: Pap smear, colposcopy, cervical Bx, LEEP
-TX: Based on stage; Sx Therapy: 1a1, 1a2-small, 1b2; Chemo with XRT for Stage 2-4 |
|
|
Term
|
Definition
-Avg age 70
-Often multifocal
-Think "older lady with husky voice and bad smell"
-RISK: HPV, vulvar intraepithelial neoplasia, smoking, chronic steroids
-S&S: vulvar mass or lesion, pruritus, bleeding, ulcerations, 50% asymptomatic
-DX: Pap, PE (inguinal canal), colposcopy, Punch Bx
-TX: Emphasis on performing the most conservative operation with highest chance for cure; primary lesion and groin nodes managed independently |
|
|
Term
|
Definition
-Avg age 65
-Suspected HPV/VAIN
-80% of lesions actually metastasis from cervix or uterus
-RISK: HPV, Intraepithelial lesion, previous anogenital malignancy, previous radiation
-S&S: Painless vaginal bleeding, especially postcoital, D/C, 80% asymptamatic
-DX: Pap smear, Bx
-TX: maintenance of a fxnal vagina is KEY; young pts require radiation; advanced need exenterative procedure; XRT tx of choice in most cases |
|
|
Term
|
Definition
-Complete: absence of fetal parts
-Incomplete: normal or abnormal fetal parts
-TX: D&C |
|
|
Term
|
Definition
-Benign tumor
-Extension of mole into myometrium
-DX: persistent pregnancy hormone
-TX: chemo (methotrexate)
-95% success |
|
|
Term
|
Definition
-Malignant Dz
-Often vascular spread
-25% follow abortion/ectopic
-25% follow full term pregnancy
-50% progress from Hydatidiform mole |
|
|
Term
| GTD: Placental-Site Trophoblastic Tumor |
|
Definition
-Rare
-Entirely placental related
-Resistant to chemo
-Usually benign |
|
|
Term
|
Definition
-Low Risk: 6, 11
-High Risk: 16, 18
-16: more common in squamous lesions
-18: more common in endocervical lesions |
|
|
Term
|
Definition
| -Lesion in which part of the epithelium is replaced by cells showing varying degrees of atypia |
|
|
Term
|
Definition
-Age of 1st intercourse
-Multiple partners
-STD
-HPV
-High risk HPV
-Immunosuppression
-Smoking
-High risk partner |
|
|
Term
| Mistakes made with Pap Smear |
|
Definition
-Do not use lube to place speculum
-Do pap smear before STD testing
-Do not perform pap smear during heavy menses
-Slide should be fixed immediately |
|
|
Term
|
Definition
-Begin at 21
-Yearly (conv Pap) or 2y (Thin-Prep)
-Low risk - every 2-3 yrs after age 30 fi 3 normals in a row
-Stop at 70 if no abnormal test in last 10 yrs
-Stop after hysterectomy if no Hx of CIN2/3
ACOG
Same but: HPV test for >30
-No upper age limit
-Continue annuals |
|
|
Term
| Squamous Epithelial Cell Abnormalities |
|
Definition
-Atypical Squamous cells (ASC)
-of undetermined significance (ASC-US)
-cannot exclude HSIL (ASC-H)
-Low grade squamous intraepithelial lesions (LSIL)
-High grade squamous intraepithelial lesion (HSIL)
-Squamous cell carcinoma |
|
|
Term
| MGMT of Atypical Pap Smear |
|
Definition
-Normal, Reactive changes --> Routine follow up
-Infxn --> Tx
-ACS-US --> Reflex HPV testing (Positive --> Colpo; Negative --> Routine follow up)
-ACS-H, LSIL, HSIL, SCCA --> Colposcopy
-AGC --> Colpo, ECC, Endometrial Bx |
|
|
Term
| Colposcopic Warning Signs of Invasion |
|
Definition
-Friable epithelium with contact bleeding
-Irregular surface contour
-Surface ulceration
-Atypical blood vessels
-Extremely abnormal punctation and mosaicism
-High grade lesions in 3 or 4 quadrants
-High grade lesions extending into canal either >5mm or beyond view |
|
|
Term
| Cervical Intraepithelial Neoplasia Class |
|
Definition
-CIN 1: Mild dysplasia
-CIN 2: Moderate dysplasia
-CIN 3: Moderate dysplasia
-CIN 4: Severe dysplasia, Carcinoma in situ
-Carcinoma |
|
|
Term
|
Definition
-Expectant mgmt if colpo satisfactory
-Consider ablative or excisional procedure if persistent
-Follow up:
-Repeat Pap 6 mths or HPV test at 12mths
-Refer back to colpo for >ASC-US |
|
|
Term
|
Definition
-Excision or Ablation
-Observation NOT acceptable (except adolescent/pregnant)
-Repeat Pap 6mths or HPV at 12mths
-Require therapy
-Ablative technique
-Excisional technique |
|
|
Term
| Chronic Pelvic Pain (CPP) |
|
Definition
| -Noncyclic pain of 6 or more months duration that localizes to the anatomic pelvis, anterior abdominal wall at or below the umbilicus, the lumbosacral back, or the buttocks and is of sufficient severity to cause fxnal disability or lead to medical attention. |
|
|
Term
|
Definition
CENTRALIZATION
-Chronic signals lead to a permanent change in the SC
-Results in a continuous signal to the brain even in the absence of peripheral nociception
WIND-UP
-Occurs when multiple peripheral low-level stimuli result in increased responses
-Associated more often with acute pain syndromes |
|
|
Term
|
Definition
-Endometrial glands and stroma located outside of the endometrial cavity
-Classic Triad: Dysmenorrhea, Dyschezia, Dyspareunia
-Hx: Significant for severe dysmenorrhea in adolescence worsening as an adult
-PE: cul-de-sac nodularity, fixed or retroverted, nodularity along uterosacral ligaments, enlarged ovaries/pelvic masses
-DX: Lap with Bxs
-TX: removal of endometriomas, cautery of endometriosis implants, hormonal therapy post-op, NSAIDs |
|
|
Term
| Pelvic Inflammatory Dz (PID) |
|
Definition
-Adhesions
-IV ABX vs Outpt meds |
|
|
Term
| Pelvic Adhesions Dz (PAD) |
|
Definition
-Usually preceded by Sx or pelvic infxn
-Hx for non-specific, generalized pain, possibly related to defecation and intercourse
-Exam and radiographic studies unremarkable
-TX: Adhesiolysis at time of Sx; Adhesions reform 1-2 wks later; pain follows in 2-3 months |
|
|
Term
|
Definition
-Hx: Significant for cyclic, midline pain
-Exam luteal phase reveals tender, "boggy" uterus 1.5 X normal
-DX: Hysterectomy
-TX: Hysterectomy or hormonal suppression of menstrual cycle |
|
|
Term
|
Definition
-Dilation of pelvic vessels
-Increased pain throughout day, especially with standing and relieved by lying
-Accompanying dyspareunia
-DX: Venography
-TX: Progestins and psych |
|
|
Term
| Irritable Bowel Syndrome (IBS) |
|
Definition
-Pain relieved by defecation or associated with a change in frequency or consistency of stools
-Need at least two in the Rome II Criteria
-Chronic relapsing pattern of abdominopelvic pain and bowel dysfxn with constipation and dairrhea
-TX: 1st line therapy is dietary changes with increased fiber and H2O, anticholinergics and Kytril |
|
|
Term
|
Definition
-Consider if pain began with pregnancy or post-partum
-Poor posture
LEVATOR ANI SPASM
-"Pelvic falling out"
-Relieved by falling down or with defecation
-DX: tenderness over muscle
-TX: ROM, heat, local massage, NSAIDs |
|
|
Term
|
Definition
ANATOMIC
-Urethral diverticulum
-Cystocele
INFLAMMATORY
-Chronic UTI: DX with U/A, Culture; TX: ABXs
-Bacterial Urethritis: <100K CFU on culture; TX: long-term ABXs
FXNAL
-Bladder Spasms: Suprapubic pain and urge symptoms; DX: cystometrics; TX: antispasmodics and bladder training |
|
|
Term
|
Definition
-Cystoscopy with hydrodistension
-Bx is essential
-TX: hydrodistension, oral antispasmodics, inravesical therapy |
|
|
Term
| Rare and Miscellaneous CPP |
|
Definition
-Ovarian remnant
-Vaginal cuff cellulitis
-Post-hysterectomy cuff granulation tenderness
-Pelvic organ entrapment
-Pelvic neuropathy
-Traumatic neuromas |
|
|
Term
| Mammography Screening Guidelines |
|
Definition
-1-2 yr intervals from age 40-49
-Annually for women >50
-<40 in some circumstances: 25y or 10yrs younger than 1st degree relative; 8yrs after completion of irradiation; 25-35 if BRCA1/2 (+) |
|
|
Term
| Interpreting Mammography Report |
|
Definition
0: Needs additional Imaging
1: Negative
2: Benign Finding
3: Probably benign; short interval follow-up
4: Suspicious; Bx
5: Highly suggestive of malignancy
6: Bx proven malignancy |
|
|
Term
| Absolute Indications for Open Breast Bx |
|
Definition
-Clinically suspicious mass that persists through a menstrual cycle, regardless of mammographic findings; if FNA is unequivocally (+), most surgeons proceed to definitive Tx
-Cystic mass that does not completely collapse on aspiration, or contains body fluid
-Spontaneous serous or serosanguinous nipple D/C; in absence of a mass, "trigger point" should be demonstrable
-Suspicious mammographic abnormalities in absence of a dominant nodule or discrete thickening |
|
|
Term
| Relative Indications for Open Breast Bx |
|
Definition
-Clinically benign mass but a positive family Hx or personal Hx or breast cancer
-Hx of atypical hyperplasia |
|
|
Term
| Classification of Nipple D/C |
|
Definition
PHYSIOLOGIC
-Occurs with stimulation
-Bilateral
-Non-bloody, milky
-Multiple ducts
NON-PHYSIOLOGIC
-Spontaneous
-Unilateral
-Single duct
-Color or bloody |
|
|
Term
| Fibrocystic Breast Dz (Mammary Dysplasia) |
|
Definition
-Multiple tender palpable masses that fluctuate with menses
-Goal is to exclude malignancy
-Histology highly variable
-Concern if hyperplastic/atypical/proliferative
-TX: limit caffeine, primrose, provera, tamoxifen, danazol, bromocriptine, goserelin |
|
|
Term
|
Definition
-Composed of both fibrous and glandular tissue
-Most common breast tumor
-Discreet, nontender mobile nodules
-Enlarge with pregnancy
-Age <30
-ONly require removal if large, rapidly growing, or pt concern |
|
|
Term
|
Definition
-Benign papillary growths within ducts
-Most common just before or during menopause
-Rarely palpable
-Bloody or serous nipple D/C
-Excisional Bx |
|
|
Term
|
Definition
-Characterized by dilatation of ducts, breast D/C, and chronic intraductal and periductal inflammation
-5th decade
-Breast pain, cheezy D/C, +/- mass, +/- nipple retraction, axillary node enlargement
-Dx with Bx
-TX: None unless pt discomfort |
|
|
Term
|
Definition
-Uncommon cystic dilatation of a duct that is filled with thick, milky fluid
-Painless swelling in the breast after lactation
-Smooth, mobile
-TX: Needle aspiration
-If fluid is bloody or mass does not completely resolve, excisional Bx is required |
|
|
Term
|
Definition
-Chronic inflammation that often follows trauma
-May mimic malignancy or cyst (firm, fixed mass with skin changes, nipple retraction)
-Common in elderly
-TX: variable; FNA vs Excision |
|
|
Term
|
Definition
LACTATIONAL
-Either early in breast feeding or while weaning
-Acutely painful, red, swollen breast
-S. Aureus
-TX: Dicloxacillin, feeding/pumping drainage for abscess
NONLACTATIONAL
-Older women
-Sudden onset pain, redness, induration of mass
-TX: drainage |
|
|
Term
|
Definition
-RISK: age, genetics, nulliparity, late/early menarche, no breast feeding, high fat diet, irradiation, atypical hyperplasia, LCIS
-Types: Infiltrating Ductal carcinomas, Infiltrating lobular carcinomas, Inflammatory carcinoma |
|
|
Term
|
Definition
-Intraductal carcinoma arising in the main excretory ducts
-Involves the skin of the nipple and areola producing an eczematoid appearance
-Underlying carcinoma is palpable only in 2/3 of pts |
|
|
Term
| Inflammatory Breast Cancer |
|
Definition
-Often seen in pregnancy
-Characterized by warmth, redness of the overlying skin and associated induration
-Bx of the erythematous areas reveal malignant cells in subdermal lymphatics
-Obstructive lymphangitis
-Most are advanced |
|
|
Term
| Breast Cancer in Pregnancy |
|
Definition
-Essentially the same as for non-pregnant pts except that lumpectomy with nodal dissection followed by post-op radiation would not be appropriate with a continuing pregnancy
-For pts with nodal mets, abortion is advisable in 1st trimester due to teratogenic risks of chemo
-3rd trimester, chemo should be delayed until delivery, but Sx should occur promptly after Dx
-Stage for Stage, prognosis is similar to non-pregnant pts
-No indication that survivors without evidence of recurrence should be advised against subsequent pregnancy |
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