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Flashcards in Female- Reproduction Deck (52)
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What is PID?

What areas might be affected?

Pelvic Inflammatory Disease

Inflm of reproductive tract beyond the cervix (excludes vagina)
• Uterus (endometritis)
• Tubes (salpingitis)
• Ovary (oophoritis)


Describe Etiology of PID?

• Polymicrobial

Examples: Chlamydia, gonococci, staphylococci, streptococci
• Often related to untreated infect (sexual transmission)
o 10% d/t untreated gonorrhea
o 20% d/t untreated chlamydia
o E. coli also sometimes implicated possible d/t proximity of anus


What is pyogenic?

Pyogenic- Pus producing bacteria

Relates to most microbes of PID


Basic Pathology of PID

• Microbes enter cervix -> endometrium -> tubes
• Rapid proliferation as endometrium sloughs
• Ascending infections
• Common complication: pelvic abscess (often (Often Leading to peritonitis)


When do PID infections often gain entry to body?

When cervix is dialated during menstruation

Flow impedes a bit, but all the slough of the endometrium provides nutrients for bacteria
• Rapid proliferation as endometrium sloughs
• Ascending infections
• Common complication: pelvic abscess (leading to peritonitis)


What is Parametritis?

Parametritis refers inflm of ligaments around uterus



• Lower abd pain
• Heavy, purulent vaginal discharge
• Dyspareunia (pain during sexual intercourse)
• Adnexal tenderness (around uterus)
• Fever
• Occasional vaginal bleeding
• Infertility (common if PID goes untreated)
• Leukocytosis


Dx of PID

• Presentation (i.e the MNFTS above)
• Inc ESR (erythrocyte sedimentation rate)
o Indicates Inflm
• Inc CRP
• Laparoscopy


Tx of PID

• Multiple broad spectrum Abx (90% success)
• Evaluate and treat partner
• Occasionally may need Sx (laparotomy)


Describe the basics of Breast CA

Incidence, Location,

• Most common CA in Women (~1 in 8)
• Major cause of CA death
• Rarely in men

Locations: Upper outer quandrant (axillary region) most likely location, then nipple... region


Basics of Etiology of Breast CA?

• Mutated genes (as with all CA)
• Aging (but can occur in younger women
• Genetic predisposition
• Hereditary Type (5-10%)
• Hormonal factors


Describe the hereditary Type of Breast CA

Include Genes/Chr involved

Hereditary is a specific form of Breast CA
o Of these 75% have know defective gene
• BRCA 1 – Chr 17
• BRCA 2 gene on chr 13
o The rest are unknown genes


Describe the hormonal factors that influence Breast CA

o Estrogen admin post menopause
• This is E without progesterone (exogenous estrogen)
• Given to limit effects of menoapuse
o Early menarche (more estrogen exposure starting early)
o Late menopause (same longer E exposure)
o Nulliparity (without pregnancy)


What are the two major types of breast CA

(Other types in Text day 1577 take a look)

Ductal carcinoma in situ

Infiltrating ductal Carcinoma

(Other types in Text day 1577 take a look)


Ductal Carcinoma

• Ductal carcinoma in situ
o ~20% of all breast cancer
o Intraductal
• Non invasive
o Stage 0 (tumor is there, if not treated it will change inform to the next


Describe infiltrating ductal carcinoma

o Most common (~75%)
o Ductal in origin (solid irreg mass)
o Invasive
o Proximal metastasis (to axillary lymph node)
o Distal metastasis (eg liver, bone, brain)


MNFTS of Breast CA

• Unilateral
• Fixed, irregular, Painless mass
• Usually upper outer quadrant
• Late Presentation: discharge, retraction & edema in breast


Dx of Breast CA

• Mammography
• Biopsy (to determine benign or malignant)
• E & P receptors (In Biopsy, reveals hormone support)
•Tumor Markers CEA eg (Carcinoembryonic Antigen)
• Most detected by patient

o Proteins that marks for breast CA (though not exclusively- i.e colorectal CA)
o Protein present in breast tissue r/t to cell adhesion


Basic Tx of Breast CA

• SX, Radiation, Chemo (Triad) + hormones
• If E/P receptors High = Hormone therapy (hormones never used on their own)


Describe Hormone Tx in Breast CA

Hormone therapy
o Estrogen- Sometimes treat with high does of hormone
• Goal being “down regulating” the receptor
• Reducing the # of receptors
o Tamoxifen (antiE) non steroidal Tx
o Androgens- (caution- complications with male sex hormone)
o Progestins


What is an important factor relating to progression that impacts Breast CA prognosis

Lymph node involvement is most important

Tumour size may also have an impact


Describe the "ectomy's " of breast CA

• Mass and surrounding tissue
• Quadrant removal
• Breast


How are Radiation and Chemo used in breast CA

• Limited to breast and axillary lymph nodes
• Pre or post Surgery


What is the prognosis of ovarian CA and what is this related to ?

• Most Lethal Female reproductive CA
• Differential Dx
o 75% metastasized at Dx


Describe Etiology and risk of Ovarian CA

• Aging 64-84 (cumulative exposure to potential carcinogens)
o r/t Ovulatory Aging (oocytes have been there from birth)

• Autosomal Dominant in some forms
• Family Hx in others
• Other Factors
o Nulliparity, infertility, dysmenorrhea (low risk)


What are three cells that may be become malignant in Ovarian CA

Epithelial (90%), Stromal (structural), Germ cell (give rise to Gametes)


Describe the spread of Ovarian CA

• Silent growth and spread
o Extension/invasion- tubes, uterus, and ligaments, other ovary
o Seeding- bowel surfaces, liver other organs
• (through body cavity- not always falling)
• Pressure on adj organs or abdm distension
o Metastasis- via blood and lymph
• Pressure on abd organs


Describe MNFTS and Dx of Ovarian CA

• Early non specific GI disturbances
o Difficult to detect
• Abdm distension
• Pain, Urinary and bowel obstruction
• Ascites with dyspnea (fluid shift relating to exudate from tumour spread)
• Pelvic mass usually 1rst finding (but late)
o US and Exploratory Sx (help stage the CA), but still a differential DX


Describe Tx for Ovarian CA

• Determined by exploratory Sx
• Aggressive Surgery
o Excise uterus, tubes, ovaries, omentum, etc
• Then Chemo (intermediate and Advanced disease)
• 6-24months later laparotomy to explore for growth
• Though poor prognosis... some recover fully


What is Uterine CA also known as?
Why does this make sense for CA?
What group is at risk?

Uterine (Endometrial) CA
• Most common pelvic CA in Women
• Usually between 55-65 yr
• (endometrium is regenerating constantly)