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Flashcards in Female- Reproduction Deck (52)
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1

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)

2

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

3

What is pyogenic?

Pyogenic- Pus producing bacteria

Relates to most microbes of PID

4

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)

5

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)

6

What is Parametritis?

Parametritis refers inflm of ligaments around uterus

7

MNFTS of PID

• 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

8

Dx of PID

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

9

Tx of PID

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

10

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

11

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

12

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

13

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)

14

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)

15

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

16

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)

17

MNFTS of Breast CA

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

18

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

NOTE:
CEA
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

19

Basic Tx of Breast CA

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



20

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

21

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

22

Describe the "ectomy's " of breast CA

Lumpectomy
• Mass and surrounding tissue
Quadrantectomy
• Quadrant removal
Mastectomy
• Breast

23

How are Radiation and Chemo used in breast CA

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

24

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

25

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)

26

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

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

27

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

28

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

29

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

30

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)