week 8 Flashcards
(78 cards)
Breast disease
A. Common symptoms (not specific for cancer, fibrotic growths, cysts; however, the older the patient, the greater the likelihood that it is malignant)
• Pain
• Palbable masses
• Nipple discharge
Mammography
• Start screening at ~40 yrs because younger women have denser breast tissue making it difficult to identify a mass
- It detects density
- Can show architectural distortions
- Identifies calcification
- Changes over time and these changes can indication pathologies such as cancers
- ~10% of breast cancers that are not detected by mammography, can be detected by palpitation
- Can use imaging to help guide biopsy needle in order to sample a growth.
- 85-90% predictive
Acute mastitis
- Can cause breast abscesses and necrosis
- Typically associated with women who are breast feeding.
- Can be caused by plugged ducts
- Can be infectious or non-infectious
Fat necrosis
• Usually associated with trauma (from a seat belt during an accident)
Breast cysts
- Fibrolytic changes
- Higher risk of breast cancer
- Occurs 20-40 years old
- Doesn’t typically occur after menopause
- Can calcify
- Can look like cancer on mammogram
Benign neoplasm
- Fibroadenomas are the most common
- Mostly connective tissue
- Well circumscribed
- Don’t typically remove unless uncomfortable
Breast carcinoma
• Rarely occurs
Cervical Cancers
• HPV (human papillomavirus)- associated squamous cell neoplasm represents most cervical cancers -use pap smear to detect early • Risk factors -multiple sex partners -Immunosuppression -early age of first sexual contact -oral contraception for >5 years -nicotine use
Polyps
Endometirum. 1. Causes:
• Hypertension
• Obesity
• Late menopause
Endometrial cancer (adenocarcinoma
1. Risks • Obesity • Diabetes • Hypertension 2. Treatment • Hysterectomy-treatment of choice • Radiation/chemotherapy adjunctive
Endometritis (infections)
cause is often IUDs (intrauterine devices)
Endometrial hyperplasia
can progress to a cancer • Exaggerated responses due to excessive estrogen (e.g., excessive ovarian activity) • Treatment: Progesterone Hysterectomy
Ovarian masses
A. Types: • Non-neoplastic cysts (e.g., follicular) • Neoplastic: e.g., endometroioid Most are sporadic Contraceptives can decrease risk Treatment: -total hysterectomy + removal of surrounding tissue + chemotherapy B. Symptoms: • Pelvic pain • Pelvic mass • Abdominal bleeding C. Unlike cervical cancer, there is no effective screening for ovarian cancer
HORMONE REPLACEMENT TREATMENT/PHARMACOLOGY
. Natural estrogens are steroid hormones—synthesized estrogens may be non-steroidal
2. They cross cell membranes and activate estrogen receptors inside cell—modulate expression of genes
3. The menstrual cycle:
• Menstrual stage—menses
• Follicular stage—proliferative
• Luteal stage—secretory
4. As populations age, they spend more time in menopause (females) or andropause (males
Estrogens
. Natural
• Estrone (predominant during menopause)- E1
• Estradiol (predominant during productive years)—E2
• Estratriol (predominant during pregnancy)—E3
b. Synthetic:
• Steroidal: ethinyl estradiol
• Non-steroidal: diethylstilbesterol
c. Physiological functions
• Sexual maturity
• Increased CNS excitability (seizure inducing?)
• Increased endometrial and uterine growth
• Maintain skin elasticity
• Reduce bone adsorption
• Increase blood coagulability
d. Clinical uses
• Primary hypogonadism
• Postmenopausal
(1) Guidelines for use
Always use the smallest dose for the shortest period of time possible
Sometimes local creams are preferred to minimize exposure
e. Adverse effects
• Postmenopausal bleeding
• Nausea, breast tenderness
• Migraines
• Hypertension
• Hyperpigmentation (especially around eyes)
• Increases some cancers (e.g.. breast and endometrial)
f. contraindicated:
• Liver disease (slows metabolism)
• Breast/endometrial cancers
• Thrombolytic disorders
Progestins
• Made from cholesterol
• Present in males, but less than females
a. Progesterone (natural)—most important progestin in human
• Precursor to estrogen, androgen and adrenalcortical steroids (e.g., cortisol)
• Also precursor to testosterone and estradiol
b. Synthetic progestins
c. Half life= 5 min. (very short acting)
d. Effects:
• Increase fat deposition
• Decrease CNS excitability (e.g., antiseizure—opposite of estrogen)
• Increase aldosterone—increase Na+ retention—increase BP—increase water retention and blood volume
• Increase body temperature
e. Clinical uses:
• Replacement therapy
• Oral contraception
• Long-term ovarian suppression (e.g., dysmenorrhea or endometriosis)—in contrast to estrogens, no problem with bleeding or clotting
• Contraindications:
Breast cancer is a risk
Severe hypertension or heart disease is risk
Contraception
Combination ( progesterone + estrogen)
• Decreases ovulation (approaching 100%)
• Decreases conception and implantation
b. Progestin only (less effective, ~80-90%)
• Decreases ovulation 50-80%
• Thickens mucus and reduces sperm penetration
• Impairs implantation
c. Delivery forms
• Combinations:
Monophasics- constant doses of both estrogen and progesterone
Biphasic- dosage of one or both change one time during cycle
Triphasic-dosages change 2 times
• Progestin only—referred to as the “minipill” (no estrogen); fewer side effects, but less effective
• Implantable
• Injections (i.m., sustained effects)
• Intravaginal rings
• IUDs with and without estrogen/progestin
• Transdermal combinations
d. Side effects of combinations
• Reduced ovarian functions and size
• Increased breast size and tenderness
• Increased thrombolytic events
• Increased heart rate and BP
• Hyperpigmentation, especially around the eye
• Mild nausea, breakthrough bleeding, headaches
• May interact with antibiotics that disrupt G.I. normal flora (e.g., wide spectrum antibiotics such as amoxicillin)—normal absorption of contraceptives from GI system is dependent on these flora
f. Uses
• Oral contraception
• Menstrual disorders, irregularity, heavy discharge
• Acne
8. Antagonists
• Tamoxifen—blocks actions of estrogen in breast-used to treat breast cancers
• Mifepristone- morning after contraceptive: blocks progesterone and glucocorticoid receptors
• Danazol—suppresses ovarian function (has a masculinizing effect)
9. Ovulation-inducing; for promoting fertilization and pregnancy (increased risk of multiple births—e.g., twins)
• Clomiphene (Clomid)
• Tamoxifen
antagonist- blocks actions of estrogen in breast-used to treat breast cancers
• Mifepristone
antagonist- morning after contraceptive: blocks progesterone and glucocorticoid receptors
• Danazol
antagonist-suppresses ovarian function (has a masculinizing effect)
• Clomiphene (Clomid
Ovulation-inducing; for promoting fertilization and pregnancy (increased risk of multiple births—e.g., twins)
testosterone
causes male puberty
• Converts to estradiol
• Replacement therapy for males
• Gynecological disorders—reduces breast size (gynecomastia)
• Has protein anabolic effects—helps replace muscle loss
• Growth stimulation—can prematurely close growth plates in growing adolescents
• Counter some age-related loss of muscle mass
• Adverse effects in women especially—masculinization
• Testosterone analogs abused for muscle and strength building—can cause acne, aggressiveness and “roid rage”, although this I controversial
BONE AND JOINT
- 99% Calcium stored in bones
- In adult, the bones are the primary site of hematopoeises
- Constantly remodeling
- Medullary bone resists compression forces, Cortical bone is thick and resists bending forces
- Periosteum is tough fibrous membrane—covers bone surfaces except at joints—well innervated
Osteogenesis imperfecta
a. Deficient or defective type 1 collagen—too little bone
b. Generalized osteopenia
• Multiple fractures and bone deformities
• Malformed teeth (dentin deficiency)
