Lecture 6- Abnormal Bleeding Flashcards Preview

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Flashcards in Lecture 6- Abnormal Bleeding Deck (44):
1

Frequent menstrual bleeding (<21 days)

Polymenorrhea

2

Prolonged or excessive bleeding occuring at regular intervals (loss of 80mL or more lasting for more than 7 days).

Menorrhagia

3

Bleeding in between periods.

Metrorrhagia

4

Frequent bleeding that is excessive and irregular in amount and duration.

Menometrorrhagia

5

what is the most common cause of amenorrhea?

pregnancy

6

What levels should be measured with amenorrhea?

FSH, LH, prolactin level

7

What is primary amenorrhea?

No menstruation by age 13 w/out 2° sexual development or by age 15 with 2° sexual development.

8

What is secondary amenorrhea?

Absence of menstruation for 3 – 6 months in a previously normal menstruating woman or for three typical cycle lengths in a woman with oligomenorrhea.

9

What are some functional causes of amenorrhea?

Wt loss, excessive exercise, obesity, drug-induced, neoplastic, psychogenic, heat injury, chronic medical illness

10

When is ovarian failure considered premature?

Women under 40

11

What are the most common anomalies in primary amenorrhea?

Imperforate hypen
Absence of uterus or vagina

12

What is a syndrome that is from scarring of the uterine cavity due to D&C. Most frequent anatomic cause of secondary amenorrhea.

Asherman Syndrome (common in people with a number of abortions)

13

What is a common syndrome that causes anovulatory abnormal uterine bleeding?

PCOS

14

What are the two main types of abnormal uterine bleeding?

Anovulatory
Ovulatory

15

What causes anovulatory AUB?

Endometrium outgrows its blood supply and sloughs at irregular and unpredictable times. Bleeding can be light and infrequent or frequent and heavy (can alternate)

16

What causes ovulatory AUB?

Luteal phase defect.
Corpus luteum doesn't develop fully.
There is insufficient progesterone secretion.

17

How long does the corpus luteum live?

14 days

18

What do you measure for ovulatory AUB?

Progesterone (often at day 21)

19

What tests do you do for AUB?

Pap smear
vaginitis/ STI screening
Endometrial biopsy
Labs
Pelvic ultrasound
sonohysterogram

20

What are some risks associated with AUB?

Anemia, acute hemorrhage, endometrial hyperplasia/ CA

21

What is some treatment for AUB?

Minera IUD
Prover 10 mg 10-14 days
cyclic progesterone
OCP
high dose estrogen
OCP 4x4, 3x3, 2x2, 1 PO q day

22

If people with AUB has no reponse to medical thearpy what can be done?

D&C
Ablation of uterine lining
Hysterectomy

23

What is excess of protaglandins leading to painful uterine muscle cramping.

Primary dysmenorrhea

24

what is painful uterine muscle cramping caused by clinically identifiable causes: extrauterine, tumors, intramural, intrauterine.

Secondary dysmenorrhea

25

What is the main difference b/w chronic pelvic pain and dysmenorrhea?

Chronic pelvic pain isn't cyclical, where dysmenorrhea is

26

What are some common cause of secondary dysmneorrhea?

Endometriosis, adenomyosis, adhesions, PID, leiomyomata

27

When is secondary dysmenorrhea most common?

Later in life

28

What are common therapy for primary dysmenorrhea?

NSAIDS (prostaglandin inhibitors)
Heat
exercise
psychotherapy
reassurance
oral contraceptives

29

What is used for cases of severe pain that don't respond to conventional therapy. This disrupts the presacral nerves.

Presacral Neurectomy

30

How do you treat secondary dysmenorrhea?

Correct underlying condition when possible.
OCP can also be used

31

How long does pelvic pain need to have lastsed to be diagnosed as chronic pelvic pain?

Longer than a year

32

Is chronic pelvic pain just combined to the uterus?

No, can also involve diseases of reproductive, genitourinary, and GI tracts

33

What is a condition that can cause chronic pelvic pain and is a chronic inflammatory condition of the bladder?

Interstitial cystitis (ICS)

34

What is when there is the presence of endometrial glands and stroma in any extrauterine site

Endometriosis

35

What do you use for diagnosis of endometriosis?

Tissue biopsy

36

What are the three major theories of endometriosis?

1. Retrograde menstruation
2. Vascular and lymphatic dissemination
3. Coelomic metaplasia

37

What should you think when you see "mulberry, brown lesions, "chocolate cysts"

Endometriosis

38

What is the triad of endometriosis?

Dysmenorrhea, dyspareunia, dyschezia

39

What are the two types of surgery for endometriosis?

Conservative
Extirpative (everything removed)

40

What is medical treatment for endometriosis?

NSAIDS, continuous OCP’s, Depo-Provera, Danazol, GnRH agonists (Depo-Lupron) with add-back therapy.

41

What are benign muscular tumors or the uterus. Highest prevalence in 5th decade?

Uterine Leiomyomas (fibroids)

42

What type women have a higher prevalence of uterine fibroids?

African-American women

43

What are the three most common types of leiomyomas?

Intramural
Subserosal
Submucosal

44

What is The presence of ectopic endometrial tissue within the myometrium. Causes irregular bleeding and pain. Only treatment is hysterectomy. Commonly found at time of hysterectomy.

Adenomyosis