TEST1_BOOKDEF2 – Flashcards
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Cystic Fibrosis (CF)
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Inherited disorder and is transmitted as an autosomal recessive trait Workup: A family history, a pulmonary function test, radiographic chest film, and stool studies Treatment is supportive measures that help the child to lead as normal a life as possible
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Cystic Fibrosis (CF) 2
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Genetic testing can be done prenatally if parents are known to be carriers of a genetic mutation. Supportive measures include the use of a high-calorie, high-sodium chloride diet; chest physiotherapy; vitamin supplements with vitamins A, D, E, and K; increased fluid intake; and pancreatic enzyme supplementation to aid in digestion. Broad-spectrum antibiotics are used aggressively to treat infection, and drugs are given that thin the mucus. Because CF is considered a fatal disease, the long-term prognosis is not favorable.
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Phenylketonuria (PKU)
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An enzyme needed to change phenylalanine in the body into tyrosine is lacking Symptoms: A characteristic musty odor of the child's perspiration and urine, rashes, irritability, hyperactivity, personality disorders Inherited autosomal recessive trait causes defective enzymatic conversion in protein metabolism
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Phenylketonuria (PKU) 2
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Phenylketonuria (PKU) is an inborn error in the metabolism of amino acids that causes brain damage and mental retardation when not corrected. Screening of all newborns is mandatory in all states, and a positive screen indicates immediate dietary intervention. PKU is detected by mandatory screening of the newborn blood. A positive Guthrie test result indicates the presence of phenylalanine in the blood.
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TREATMENT PKU
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Place the infant on a phenylalanine-free diet that allows the infant to grow with normal brain development Patient remains on a protein-restricted diet Newborns cannot have breast milk Starchy foods are closely monitored Individuals with PKU must eat a diet low in phenylalanine for the rest of their lives. Restriction or elimination of the following foods is required: meat, chicken, fish, cheese, nuts, and dairy products. The prognosis is excellent when the infant is placed on a phenylalanine-free diet soon after birth. Close follow-up with testing for phenylalanine levels in the blood may allow some modification of the difficult dietary restrictions.
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Klinefelter Syndrome
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Presence of two X chromosomes in affected males causes abnormal development of the testes and reduced levels of testosterone Person appears normal, except for exceptionally long legs, above-average height, and reduced muscle development Rarely seen in females
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Klinefelter Syndrome 2
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Klinefelter syndrome (XXY condition) is male hypogonadism, appearing in males after puberty with at least two X chromosomes and one or more Y chromosomes. Puberty begins at the usual time and usually results in a normal-size penis, but the testes are small and body hair is scant. Alternations in the affected female are a mild delay in language acquisition and increased risk of behavioral and learning disabilities. Some affected individuals have mild to more significant intellectual impairment. The male infant appears normal at birth, and symptoms are usually not noted until puberty. The condition may be discovered during a routine sports or pre-camp physical.
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Klinefelter Syndrome 3
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Results from the presence of at least two X chromosomes, typically the 47,XXY pattern At the time of normal puberty, long-term hormone replacement with testosterone by injection or a transdermal patch is given Fertility cannot be restored No prevention known
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Klinefelter Syndrome 4
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The extra X chromosome may be of either maternal or paternal origin. The diagnostic workup includes a physical examination, serum and urine gonadotropin level determination, and semen analysis. Testosterone is necessary for the maintenance of normal sexual function, and normal muscle and bone mass. Many patients report an improvement in energy and emotional stability with hormone therapy.
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Turner Syndrome
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At birth, the ovaries are immature or absent, and the female infant appears short, with low-set ears, swollen hands and feet, and webbing of the neck They experience lack of sexual maturation along with amenorrhea, sterility, dwarfism, and cardiac and kidney defects
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Turner Syndrome 2
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Results from a loss of the second X chromosome Symptoms can be reduced by estrogen and growth hormone therapy Surgical correction may be indicated for certain anomalies Emotional support will be needed for patient
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Turner Syndrome 3
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Turner syndrome is a chromosomal disease that occurs in females with a single sex chromosome, 45,XO. Cardiac defects may include coarctation of the aorta in the infant and in adulthood aortic dissection due to cardiovascular disease. If ovaries were present at birth, they slowly begin to disappear, leaving only small amounts of tissue. Well-baby examinations may reveal signs of the disorder. The baby is referred for chromosome studies to confirm the diagnosis.
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Turner Syndrome 4
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Chromosomal smear studies show only one X chromosome instead of the normal 46,XX chromosomal pattern. There is no cure for this genetic disorder; however, the prognosis is good if the patient has no other complicating conditions, including cardiac or kidney disorders. Because Turner syndrome is a chromosomal disorder, there is no prevention.
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Reye Syndrome
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Symptoms appear in five stages Lethargy, listlessness, irritability Hyperventilation, hyperactive reflexes, hepatic dysfunction, disorientation Organ changes and coma Deeper coma and loss of cerebral function Seizures, loss of deep tendon reflexes
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Reye Syndrome 2
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Reye syndrome is a combination of brain disease and fatty invasion of the inner organs, especially the liver. This rare syndrome is an acute and often fatal illness that may affect children through 15 years of age. Children who begin vomiting 3 to 6 days after viral illness such as chickenpox are possible candidates for Reye syndrome and require immediate assessment and intervention.
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Reye Syndrome 3
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Cause is unknown Laboratory blood studies show elevated serum ammonia levels Successful management with early diagnosis involves hospitalization to stabilize the patient, to control cerebral edema, to monitor blood chemistries, and to manage seizures
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Reye Syndrome 4
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It typically follows infection with influenza A or B virus or chickenpox. The prognosis is good with prompt intervention and aggressive treatment. For prevention, the use of nonsalicylate analgesics and antipyretics, such as acetaminophen, is recommended instead of aspirin.
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Risk Factors for Sexually Transmitted Diseases (STDs)
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A person is at greater risk for getting an STD if he or she: Has sex without knowledge of partner's history Has sex at an early age and/or with multiple partners Shares drug-related needles Is a man who has sex with other men Has skin contact with an STD-infected wound
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Sexually Transmitted Diseases (STDs)
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Risk of STDs is also heightened with use of alcohol or drugs. Other risk factors include transfusion of blood or blood products, lack of education or concern about risky sexual behavior, and hemophilia.
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Sexually Transmitted Diseases (STDs) 2
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More than 20 infectious diseases are spread by sexual contact Sexually transmitted diseases (STDs) are spread from one person to another through bodily fluids (blood, semen, vaginal secretions) during vaginal, anal, or oral sex Some spread by direct contact with infected skin U.S. STD rates are among the highest in the world and growing. One in four teenagers eventually gets an STD.
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Chlamydia
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One of the most frequently reported infectious diseases in the United States Causes urethritis in men and urethritis and cervicitis in women
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Chlamydia 2
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Chlamydia sometimes is called the silent STD because it often has no symptoms and thus it is sexually transmitted unknowingly.
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Chlamydia 3
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When symptoms are present they are evidenced in both females and males and include: Females Odorless yellow vaginal discharge with burning sensation Itching Abdominal pain Pain during intercourse (dyspareunia)
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Chlamydia 4
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A high percentage of women have no symptoms before dangerous complications start. If symptoms are present, they usually begin 1 or 2 weeks after exposure and are likely to be mild. Chlamydia is a major cause of female sterility and a leading cause of pelvic inflammatory disease (PID).
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Chlamydia 5
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When symptoms are present they are evidenced in both females and males and include (cont.): Males Discharge from penis with burning sensation Itching Burning sensation when urinating Scrotum may be swollen Left untreated can result in infertility
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Chlamydia 6
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75% of males will show symptoms 1 to 3 weeks after exposure. What causes the burning sensation when urinating? (Urethritis—inflammation of the urethra caused by infection) Newborns can acquire Chlamydia from the infected mother during birth, resulting in conjunctivitis, blindness, arthritis, or overwhelming infection.
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Treatment for Chlamydia
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Antibiotic therapy is given to both partners Initially: A single injection Followed by: Oral antibiotics Severe cases may require IV antibiotics Patients are encouraged to abstain from intercourse until both partners are cured
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Treatment for Chlamydia 2
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Use standard precautions when caring for a patient with chlamydial infection. Infected patients should inform sexual contacts of their infection. Chlamydia can be cured with a complete course of antibiotics. Meticulous personal hygiene is also recommended to patients to avoid spreading the infection to the eyes.
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Symptoms of Gonorrhea
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Gonorrhea, the second most commonly reported notifiable disease in the United States, is a sexually transmitted infection of the genitourinary tract. Up to 50% of males and females are without symptoms and may unknowingly continue to spread the infection. If males do develop symptoms, it is usually after an incubation period of 3 to 6 days. The disease can also affect the eyes and throat and become systemic.
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Gonorrhea
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Common STD with symptoms similar to Chlamydia Additional symptoms A discharge of pus from the genital tract in both males and females Difficult or painful urination Symptoms vary in severity
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Gonorrhea 2
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Curative treatment is recommended for the infected individual and any sexual partners as well Many strains of Neisseria gonorrhoeae have become resistant to tetracycline, penicillin, sulfa, and quinolones
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Gonorrhea 3
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Early and complete treatment usually results in a complete cure. Abstinence from sexual contact is encouraged until treatment is complete and follow-up cultures prove negative.
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Gonorrhea 4
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Neglecting treatment can lead to the following complications: PID Septicemia Infertility Septic arthritis Salpingitis (inflammation or infection of the fallopian tube)
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Gonorrhea 5
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Emphasize the importance of complying with a complete treatment plan and follow-up testing to ensure a cure. Common bacterium N. gonorrhoeae requires specific conditions for growth and reproduction. Where can gonorrhea exist? (In the back of the throat from oral sex, in the genitals, and in the rectum)
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Trichomoniasis
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Protozoal infection of the lower genitourinary tract Infection is usually vaginal in the woman and urethral in the man Common among people who are sexually active
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Trichomoniasis 2
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When symptoms are present they are evidenced in both females and males and include: Difficult or painful urination Itching Females Profuse greenish yellow discharge from the vagina Males Thin, whitish discharge from the penis
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Diagnosis of Trichomoniasis
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Discharge from either the male or female is typically studied for the microorganism responsible Cervix may also be examined for the presence of small hemorrhages with a strawberry-like appearance How long does the incubation period last? (5 to 28 days) Urinalysis may be performed.
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Genital Herpes 2
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Incurable, recurrent infection of the skin of the genital area, with ulcerations spread by direct skin-to-skin contact, causing painful genital sores similar to cold sores Caused by herpes simplex virus type 2 (HSV-2) Large percentage of infections go unnoticed
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Genital Herpes 3
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One in six adults between the ages of 14 and 49 carries the genital HSV-2 infection. Usually transmitted by sexual contact.
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Genital Herpes 4
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One or more blister-like lesions on or around the genitals or anus Swollen glands Fever Headache Painful urination Presence of characteristic lesions on the male or female genitalia An antigen test or tissue culture may confirm the diagnosis
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Genital Herpes 6
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Polymerase chain reaction (PCR) and a rapid fluorescent test are also used to identify HSV-2. The presence of open lesions increases the risk of contracting AIDS during sexual acts between persons infected with HSV-2 and those who are positive for HIV.
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Genital Herpes 5
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No cure Prescription drugs routinely used to reduce frequency/duration of outbreaks Women with genital herpes are at increased risk for cervical cancer and are encouraged to obtain a Pap smear every 6 months for screening Unprotected exposure of health care workers to oral and genital secretions when caring for HSV-infected patients can result in an intensely painful infection of their fingers called herpetic whitlow. This is usually caused by autoinoculation or other direct contact between the HSV and a break in the skin, such as a torn cuticle. Recurrent episodes are often triggered by fatigue and stress.
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Genital Warts
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Genital infection that causes raised cauliflower-like growths in or near the vagina or rectum or along the penis Warts are caused by the human papillomavirus (HPV) and are usually transmitted through sexual contact How long is the incubation period for genital warts? (1 to 6 months) Risk factors for acquiring persistent infection with HPV are early age for initiation of sexual activity and having multiple sexual partners.
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Genital Warts 2
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Possible itching or burning Discomfort varies by size, number, and location Added risk factor: Women with HPV infection are at greater risk for cervical cancer
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Genital Warts 3
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Many types of HPV have been identified by scientists. The same types of HPV that infect the genital areas can infect the mouth and throat. Some are low risk, whereas high-risk types can cause several cancers, including head and neck cancer, which is becoming more prevalent.
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Genital Warts 4
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Topical drug therapy Surgical procedures Cryosurgery: Freezing and removing affected tissue Electrodesiccation: Removing warts using lasers Some genital warts disappear without treatment Up to 30% of genital warts go away without treatment, but the underlying virus is never completely eliminated. Although both drug and surgery treatments can remove warts, recurrence is common. Pregnancy promotes the growth and spread of the lesions.
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Syphilis
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Chronic, systemic, sexually transmitted infection that consists of four stages Syphilis is on the rise, especially in men, in the United States for the first time in many years It is important to treat syphilis in the early stage.
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Symptoms of Syphilis
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Symptom stages Presence of a painless but highly contagious local lesion called a chancre (pronounced "shang-ker") found on the genitalia In 1 to 2 months, when the primary lesion heals, the causative organism has disseminated throughout the body and multiplied, producing lesions wherever the organisms are most prevalent, including the skin, lymph nodes, cardiovascular system, brain, and spinal cord The chancre can appear on either the male or female genitalia. Without early treatment during the primary stage, it becomes a systemic, chronic disease that can involve any organ or tissue. Syphilis is caused by infection with the Treponema pallidum spirochete through sexual contact or other direct contact with infected lesions or infected body fluids. It is highly contagious when a chancre is present.
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Symptoms of Syphilis (Cont.)
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Symptom stages (cont.) Infection begins spreading systemically throughout the body and may present with: Fever Headache Aching joints Mouth sores Rashes on palms or soles of feet Then a latent period, lasting from 1 to 40 years, may follow, during which the infection is generally subclinical or asymptomatic.
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Syphilis Treatment
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Can be cured with a course of antibiotic therapy using penicillin G Patients are monitored with follow-up blood tests for up to 1 year to ensure elimination of infection If the patient is allergic to penicillin, other antibiotics are used, such as doxycycline, azithromycin, and ceftriaxone. Untreated syphilis progresses to long-term severe systemic complications. Emphasize the importance of finishing the course of medication, even if symptoms improve.
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HPV and Cervical Cancer
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Many types of HPV, some of which cause cancers of the: Cervix Anus Vagina Vulva Penis No antiviral drugs currently are available to treat HPV. HPV infection is most often associated with cervical cancer. The virus may be spread not only by unprotected intercourse, but also by close physical contact with an infected area and probably through digital/anal, oral/anal, and digital/vaginal contact as well.
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Chanroid
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bacterial, painful dime sized spot that may have a grey coating
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Treatment of Chancroid
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Antibiotic therapy Lesions must sometimes be drained surgically Good personal hygiene Refrain from sexual contact during treatment Antibiotic therapy usually cures the lesions and the infection. Condoms help prevent the spread of the infection. Hepatitis B, also a known STD, is discussed in Chapter 8.
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Male and Female Infertility
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Involuntary inability to conceive With regular unprotected intercourse, about 90% of couples conceive within 1 year Of those unable, approximately 40% can be attributed to male factors, 40% more to female factors, and less than 10% unknown
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ED
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ED/impotence may also have a psychosocial basis as well that is not directly related to the mechanical functions of the penis. The most common contributing factors include depression and stress.
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ED 2
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Interventions such as psychoanalysis, discussion, behavioral modification, and sensate exercises are aimed at restoring the patient's ability to complete the entire sexual response cycle. What are some drugs used to treat ED/impotence? (Sildenafil citrate [Viagra], vardenafil [Levitra], and tadalafil [Cialis]) There is growing evidence linking ED to the eventual onset of the clinical manifestation of coronary artery disease.
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Causes of Female Infertility
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Failure to ovulate Endometriosis Scar tissue from infection, ectopic pregnancy, or surgery Blocked fallopian tubes Congenital structural or chromosomal disorders Psychological distress Other factors include: Tumors Antisperm antibodies in the female vaginal secretions Medications that compromise fertility
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Diagnosis of Female Infertility
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Charting of menstrual cycle Blood tests to assess hormone levels Visual examination of fallopian tubes and uterine cavity using radiography to determine tubal patency Laparoscopy may be necessary to rule out endometriosis
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Treatment of Male and Female Infertility
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Varies based on diagnosed problem, but commonly includes: Infection control Surgery to remove blockage Use of fertility drugs Artificial insemination Intrauterine insemination (IUI) In vitro fertilization (IVF) Many couples who seek treatment for infertility do achieve pregnancy. Some have untreatable causes or take as long as 3 years to achieve pregnancy. Much of the patient teaching involves answering questions about the complexity of the medical evaluation and the selected therapeutic approach.
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Male Reproductive Diseases
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Most commonly affected organ is the prostate gland Symptoms may include: Urinary problems (incontinence, difficulty urinating) Pain or swelling of reproductive organs Sexual dysfunction (ED/impotence)
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prostate gland
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The gland can become inflamed or enlarged as a result of bacteria and can cause urinary problems.
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Torsion of the Testicle
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Condition in which one testicle is twisted out of its normal position Primary symptom is sudden, severe pain in one testicle Scrotum becomes red, swollen, and tender The pain can be so severe that it causes nausea and vomiting, and it is usually constant. Torsion can cause the blood vessels supplying the testicle to become kinked, which in turn prevents blood flow to and from the affected testicle. This condition occurs when the testis rotates on the spermatic cord, causing a sudden, extreme twist or torsion.
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Treatment of Torsion of the Testicle
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Gentle manipulation to untwist the testicle (detorsion) Surgery (bilateral orchiopexy) is required
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Treatment of Torsion of the Testicle
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Immediate consultation with urology is required, followed by surgical intervention of both testes. Delaying surgery can result in permanent damage to the testicle. The prognosis is good if treatment is received promptly when the torsion does not correct itself.
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Varicocele
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Veins of one testicle become abnormally distended, causing swelling around the testicle that expands within the scrotal sac Symptoms Discomfort (especially in hot weather or following exercise) Possible lower sperm count It is more common on the left side due to the anatomy of the vascular supply. Why might varicocele result in a lower sperm count? (Increased venous blood raises temperature in the scrotum.) The condition often is asymptomatic. If a vein ruptures as a result of local injury, pain and swelling in the scrotum cause the patient to seek prompt medical intervention. This condition has no apparent cause and most often occurs in the 15- to 25-year-old age group.
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Varicocele
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enlarged veins of the spermatic cord
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Varicocele -
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Use of scrotal support Tight-fitting underwear Athletic supporter Surgery may be indicated to remove distended veins if fertility is threatened The patient history, physical symptoms, and an examination by the physician confirm the diagnosis. Surgical removal of veins may improve fertility.
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Prostatitis
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Acute or chronic inflammation of the prostate gland Infection (bacterial or nonbacterial) is the most likely cause Bacterial causes may include, most commonly, Escherichia coli that has caused a urinary tract infection, gonococci from a patient with gonorrhea, Staphylococcus, Streptococcus, or Pseudomonas. Inflammation of the prostate gland is more common in men older than 50 but can occur at any age.
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Benign Prostatic Hyperplasia (BPH)
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Nonmalignant, noninflammatory hypertrophy of the prostate gland Symptoms May compress urethra and cause urinary blockage Difficulty starting urination Weak urinary stream Inability to empty bladder
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Benign Prostatic Hyperplasia
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Common in men older than 50 years of age. Urinary frequency, including nocturia, and in severe cases, inflammation and symptoms of renal disease have been observed. The usual diagnosis is based on the patient history and a rectal examination for prostatic abnormalities. Routine tests include ordering urinalysis, urine culture, renal function studies, and prostate-specific antigen (PSA) serum level to screen for prostatic cancer.
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Treatment of BPH
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Watchful waiting Control fluid intake before bedtime Avoid medications that cause urinary retention (decongestants) Drug therapy (to relax tightened muscles inside the prostate or shrink enlarged prostate gland) Surgery may be performed to remove urinary tract obstruction The prognosis is good with intervention. Lack of intervention may allow infection to reach kidneys and cause cystitis and dilation of the ureter, among other complications. Best means of prevention is regular prostate examinations to detect any enlargement.
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Prostate Cancer
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Malignancy of the prostate gland Risk factors Age (most cases occur in men over age 45) Heredity (presence of certain genes) Lifestyle (diet high in animal fat, low in vegetables and selenium) Ethnicity (more common in African Americans)
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Prostate Cancer 2
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Although this is a very common cancer, it grows so slowly that only 3% of men with prostate cancer will die from it. Nonetheless, prostate cancer is the second leading cause of cancer death in men.
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Prostate Cancer 3
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Weak or interrupted urine flow Frequent urination Urinary retention Blood in urine Erectile dysfunction Prostate cancer is often without symptoms at diagnosis. When symptoms are present, many are associated with urinary obstruction.
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Prostate Cancer 4
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Digital rectal exam Blood test to determine level of prostate- specific antigen (PSA) Biopsy (indicated if PSA level is 4 ng/ml)
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Prostate Cancer 5
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A biopsy is advised if the PSA level is greater than 4 ng/ml and should be performed at lower values if clinical suspicion is high. A transrectal ultrasound-guided biopsy is usually performed. If the biopsy is negative but the PSA level remains high, a repeat biopsy is often performed several weeks to months later as prostate cancer can be missed on the initial biopsy. Analysis of the tumor histology (the Gleason score) leads to a scoring system based on the degree of glandular differentiation and structural architecture. The Gleason score and the PSA level are incorporated into the TNM stage determination as well.
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Treatment of Prostate Cancer
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Type of treatment depends on several factors The Gleason score PSA level Age Physical condition of patient Risks and benefits of each treatment
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Treatment of Prostate Cancer 2
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Options for early stage prostate cancer include radical prostatectomy, radiation therapy, brachytherapy (the direct implantation of a radiation source into the prostate), or active surveillance. For patients with metastatic prostate cancer, first-line treatment involves androgen deprivation therapy (ADT) by either surgical orchiectomy (removal of a testicle) or medical orchiectomy (use of hormones to suppress the release of testosterone). The most important predictors of disease progression are TNM stage, Gleason score of the biopsy specimen, and serum PSA level. For early-stage tumors, radiation therapy and prostatectomy offer similar 10-year survival rates.
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Prevention of Prostate Cancer 3
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Annual screening for all men 50 years of age or older, which consists of: Digital rectal exams Serum PSA test If either test is positive, transrectal ultrasound biopsy is performed
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Prostate Cancer 3
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Screening can be offered beginning at age 50 to men who have a life expectancy of at least 10 years. Men considered at high risk for prostate cancer (African-American males and men with two or more first-degree relatives with prostate cancer) can begin screening at age 40 to 45. Screening is generally not beneficial if the patient's life expectancy is less than 10 years. Eating a healthy diet is recommended, although no dietary supplement has a known definite link to prostate cancer prevention at this time
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Symptoms of Testicular Cancer
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Nodule on or swelling of one testicle Dull ache or heavy sensation in abdomen Advanced disease symptoms Lower extremity swelling Enlarged lymph nodes Anorexia Bone pain
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Testicular Cancer
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Testicular cancer is one of the most curable solid neoplasms, but it still has a significant effect on the physical and emotional status of the young population it usually affects. Nearly all testicular tumors are germ cell tumors (GCTs), equally distributed between two main types: seminomas and all others, termed nonseminomatous germ cell tumors (NSGCTs). Other symptoms of advanced disease include: Dyspnea or cough Anorexia Bone pain
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Testicular Cancer
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Family history of testicular cancer A testicle that has not descended into the scrotum Previous GCT(s) Infertility HIV infection Testicular neoplasms are most common in males between the ages of 15 and 45. Those with Down and Klinefelter syndromes may be at greater risk for developing testicular cancer. Children with cryptorchidism are at a higher risk for developing the disease, even if the testicle is brought to its anatomic position in the scrotum.
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Risk Factors of Testicular Cancer
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Family history of testicular cancer A testicle that has not descended into the scrotum Previous GCT(s) Infertility HIV infection Testicular neoplasms are most common in males between the ages of 15 and 45. Those with Down and Klinefelter syndromes may be at greater risk for developing testicular cancer. Children with cryptorchidism are at a higher risk for developing the disease, even if the testicle is brought to its anatomic position in the scrotum.
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Diagnosis of Testicular Cancer
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Physical examination of the testes to detect possible nodes Suspected testicular cancer may be followed by: Scrotal ultrasound Computed tomography (CT) scan of abdomen and pelvis Chest x-ray Measurement of serum tumor markers
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Diagnosis of Testicular Cancer 2
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Any firm, hard area in the affected testis is cause for concern. Biopsy is not usually attempted because of the risk of spreading the tumor. In young men for whom future fertility is an issue, efforts should be made to perform a baseline sperm count and sperm banking before radiographic procedures so that radiation does not damage the sperm.
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Treatment of Testicular Cancer
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For men with elevated levels of a serum tumor marker, monitoring the level throughout treatment often produces the best indicator of treatment effectiveness. As a result of the high cure rate for testicular cancer, posttreatment follow-up is an important part of the care for these patients. Patients with good (60% of GCTs), intermediate (26% of GCTs), and poor (14% of GCTs) prognosis are defined by the stage groupings. Routine screening with testicular self-examination or measurement of tumor markers is not recommended since the risks of screening do not outweigh potential benefit of early detection given the good prognosis even with advanced disease. Chemotherapy Surgical resection Radiation therapy
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PMS
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Constellation of physical and emotional symptoms that may appear shortly after ovulation and subside with the onset of menstruation or shortly thereafter PMS is related to fluctuations in the levels of estrogen and progesterone and their subsequent impact on levels of neurotransmitters, such as dopamine, serotonin, and norepinephrine in the brain and other parts of the body. There are also alterations in other compounds in the body leading to sodium and fluid retention.
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PMS 2
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During the menstrual cycle, fluctuating hormone levels alter mood, sexual desire, and energy levels and may affect physical functioning. Some women experience edema (swelling related to fluid retention), bloating, and abdominal pain as well. When these cyclic symptoms become severe and fit certain psychological criteria, the diagnosis shifts from PMS to premenstrual dysphoric disorder (PMDD). Anxiety Anger Sadness Food cravings Fatigue Breast tenderness Irritability
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Treatment of PMS
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Directed toward the relief of symptoms Reduce dietary intake of sodium Moderate exercise Mild analgesics Diuretics Emotional support Antidepressant medication or hormone therapy, especially for PMDD Increase calcium intake In addition, some women notice less breast tenderness when they eliminate caffeine from their diet. Other therapies include using extended cycle birth control pills. These contraceptives are packaged so that the woman will have only four periods per year compared to a normal 12 per year.
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Amenorrhea
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The absence of menstrual periods Two classifications Primary: If menstruation has not occurred by age 16 Secondary: No menses after a woman has been having menstrual cycles Amenorrhea can be temporary or permanent. It has no symptoms and the only sign is lack of cyclic bleeding. A medical examination is indicated for either primary or secondary amenorrhea.
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Causes of Primary Amenorrhea
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Late onset of puberty Abnormalities of the reproductive system Hormonal imbalances These conditions usually are not suspected unless the girl has reached 16 years of age and is still not having periods. Obstruction of the uterus or vagina or chromosomal/developmental/endocrine abnormalities are ruled out as a cause of primary amenorrhea.
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Causes of Secondary Amenorrhea
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Hormone-related issues such as: Pregnancy Emotional factors Illness (anorexia, malnutrition, sudden weight gain or loss) Pituitary tumors Thyroid disease Excessive athletic training What does the term post-pill amenorrhea refer to? (Failure to resume menses within 3 months of discontinuation of oral contraception)
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Diagnosis of Amenorrhea
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Pelvic exam (rules out physical abnormalities and pregnancy) Blood tests (detects hormone problems) Urine samples (detects hormone problems) Radiographic studies (detects tumors) Premature ovarian failure should be ruled out in women under the age of 40.
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Treatment of Amenorrhea
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Treat underlying condition if possible Contraceptive hormones or cyclic progesterone The prognosis of amenorrhea is excellent when the underlying cause is corrected or if cyclic hormones are used to produce menses. Reinforce any medical regimen as prescribed, and review any adverse effects of hormonal therapy that should be reported to the physician.
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Ovarian Cysts
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Fluid-filled semisolid or solid masses that originate within ovaries Two types Physiologic cysts: Those caused by normal functioning of the ovary Neoplastic cysts: Benign or malignant and not related to normal functioning
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Ovarian Cysts 2
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Follicles that occur during a normal menstrual cycle are often called cysts during radiologic evaluation, but it is best to think of them as follicles unless they are outside the physiologic norm in size or appearance. Most ovarian cysts are physiologic, resulting from ovarian follicle growth or a corpus luteum that persists too long. Cysts that occur in a postmenopausal woman and those more than 10 cm in size are more concerning for malignancy. The cause of malignant or benign ovarian tumors is not certain.
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Ovarian Cysts
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Most are small and unnoticed by the patient Large cysts can cause urinary retention If cyst produces hormones various symptoms result Cysts may twist on themselves causing pain, nausea, and vomiting The size at which a cyst becomes symptomatic depends on many factors, including how quickly it develops, size, underlying cause, and association with adjacent structures or other intrapelvic pathology. Larger cysts can undergo a process known as torsion or twisting that can cause pain, nausea, and vomiting. Diagnosis may include an ultrasound and/or a laparoscopy.
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Treatment of Ovarian Cysts
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Small cysts are common and seldom require treatment Large cysts can be drained or removed Cysts that are drained are more likely to recur than those that are removed Small physiologic cysts usually disappear spontaneously. Birth control pills were once believed to help cysts resolve; however, their effectiveness has recently been called into question. Cysts that are cancerous require surgery, often requiring removal of the uterus, omentum, appendix, and lymph nodes.
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Endometriosis
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Chronic condition characterized by extrauterine endometrial tissue The implants of endometrium are found most commonly in the pelvis, but may occur in distant sites When a patient has progressively painful menstruation, she should be scheduled for a pelvic examination. Infertility may be the only complaint in some patients. Where is the endometrial tissue originally located? (Mucous membrane that lines the uterus) Endometriosis is considered a benign condition but can be very painful and chronic.
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Endometriosis
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A condition in which the tissue that lines the uterus grows somewhere else
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Endometriosis
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Secondary dysmenorrhea is a classic symptom Constant pain and cramping in lower abdomen beginning before and lasting several days after menstruation Infertility Pelvic pain during intercourse Pain during defecation The cyclical inflammation and scarring eventually can lead to symptoms even when a woman is not menstruating. Complications include infertility, ectopic pregnancy, pelvic scarring, and adhesion formation
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Risk Factors of Endometriosis
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Family history of the disease Menstrual cycles shorter than 28 days Uterine structural abnormalities Periods lasting longer than a week Retrograde menstruation is believed to be the most likely cause for most cases of this condition. When functioning endometrial tissue grows outside the uterine cavity, it responds to the ovarian hormones as the endometrium (lining of the uterus) does during the normal menstrual cycle. This cyclic swelling, inflammation, bleeding, and subsequent scarring are what cause pain. Fibroids and diseases of the immune system, such as lupus, have also been associated with an increased incidence of endometriosis.
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Diagnosis of Endometriosis
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Pelvic examination to look for: Tender areas Nodules Thickened scar tissue Patient history and ultrasound (predict the presence of advanced endometriosis) Laparoscopy (confirms the diagnosis and helps stage the extent of the disease)
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Treatment of Endometriosis
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Hormone treatment for younger patients Pregnancy, nursing, and menopause usually bring a remission of symptoms Surgery to remove or destroy endometrial growth Total hysterectomy with bilateral salpingo-oophorectomy may be indicated in severe cases Blocking estrogen may prevent the endometriosis from growing. Hormone treatment is considered a more conservative approach to increase the possibility of remaining fertile. Although no cure for endometriosis is known, a variety of treatment options are available. Generally, the prognosis is good.
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Pelvic Inflammatory Disease (PID) 2
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Infection of a women's pelvis Is self-limiting to life-threatening Symptoms Fever Chills Malaise Foul-smelling vaginal discharge Backache Painful, tender abdomen The infection is most common in young sexually active women, especially those with more than one partner. Often, even walking is painful, and the patient may walk with a shuffling gait. If an abscess has developed, a soft, tender pelvic mass may be palpated.
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Pelvic Inflammatory Disease (PID) 3
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Pelvic examination (demonstrates tenderness) Ultrasound to rule out abscess Signs include elevated WBC count and fever Laparoscopy is helpful to confirm diagnosis The initial infection is usually started by an STD (e.g., gonorrhea, chlamydia), but then the infection becomes multibacterial with both aerobic and anaerobic organisms. Cervical cultures may or may not be positive for an STD.
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Pelvic Inflammatory Disease (PID) 4
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Aggressive antibiotic therapy to treat disease and help prevent complications Analgesics Without effective treatment, serious and life-threatening complications can develop Early diagnosis and prompt treatment lessens damage to the reproductive system. Inflammation can cause scarring and adhesions that can cause infertility and increase the risk of ectopic pregnancy. Peritonitis can spread the infection throughout the abdominal cavity, or if the infection becomes blood-borne, septicemia and even death may result.
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Pelvic Inflammatory Disease
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infection of the upper female genital tract-the cervix, uterus, fallopian tubes, and ovaries
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Laparoscopy
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inspection of the abdominal or pelvic cavity with a laparoscope, which is an endoscope used to examine the abdominal and pelvic regions
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Uterine Leiomyomas (Fibroids)
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Noncancerous (benign) tumors of the smooth muscle within the uterus They may vary in number, size, and location within the uterus. They are the most common tumors of the female reproductive tract and can be found in up to 40% of women before menopause.
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Uterine Leiomyomas
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Most do not cause any symptoms If present, they often include: Heavy and prolonged periods Pelvic pain and pressure Constipation Frequent urination Abnormal bleeding The severity of symptoms is related to the number, size, and location of the tumors. The cause of leiomyomas is unknown. Their development is stimulated by estrogen; they occur only in premenopausal women and some postmenopausal women on hormone replacement therapy.
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Fibroids
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Depends on: Severity of symptom Age of patient Desire to bear children Treatment options Surgery to remove tumors (childbearing age) Hysterectomy (if bleeding continues) Ultrasound ablation Uterine artery embolization In the woman who does not want children, magnetic resonance imaging (MRI)-guided high-frequency ultrasound ablation may be useful. In general, fibroids do not need to be removed. The rate of malignancy within a fibroid is about 0.27%. In cases where they are removed, there is a 10% to 50% recurrence rate. The chance of recurrence is greater when there are multiple fibroids present. With uterine removal, there is essentially no chance of recurrence.
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Menopause
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Represents the cessation of menstrual periods Menstruation discontinues due to ovaries producing less estrogen, which inhibits ovulation Changes in pituitary hormone levels bring physical and psychological changes The average age of menopause is between 50 and 51, and it is not considered premature unless it occurs under the age of 40. Schedule the patient for a medical examination and consultation with the physician. Inform the patient that a pelvic examination may be required.
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Symptoms of Menopause
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Fluctuation in menstrual cycle Periods become lighter and less frequent Hot flashes/night sweats Vaginal dryness/skin changes Many women experience transient to troublesome psychological symptoms, including depression, poor memory, anxiety, sleep disorders, and loss of interest in sex. An accurate diagnosis can be made with blood tests to measure whether certain hormones are high and estrogen levels are low.
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menopause
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Consists of management of symptoms Hormone treatment Patient should be part of the final decision about whether or not to use hormones due to the great risk of cancer Vaginal changes can be managed with local estrogen products and lubricants or a newer selective estrogen-receptor modulator product ospemifene
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menopause
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Hot flashes and other changes related to estrogen withdrawal may be managed with estrogen products or a low dose serotonin-specific reuptake inhibitor (SSRI) (paroxetine mesylate [Brisdelle]). Weight-bearing exercise and dietary calcium, or calcium supplementation with adequate vitamin D3 can also help to reduce the rate of bone loss in sedentary patients or those with poor calcium intake and low vitamin D levels. Menopause is a normal condition with a variable course. Cigarette smokers experience menopause about 2 years earlier than nonsmokers.
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Uterine Prolapse
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Prolapse of the uterus is a downward displacement of the uterus from its normal location in the body The uterus becomes prolapsed when the pelvic floor muscles and ligaments become extremely overstretched or weakened
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Uterine Prolapse
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Pelvic floor muscles often weaken as a result of childbirth, old age, or genetic factors. The weakening of these supports allows the uterus to move down the vaginal canal, pulling the vagina where the cervix is attached along with it. When the uterus is completely outside the vagina it is termed complete procidentia. The prolapse is usually visible upon pelvic examination.
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Treatment of Uterine Prolapse
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Exercises that strengthen the muscles of the pelvic floor after childbirth Weight loss High-fiber diet Insertion of supportive uterine device (pessary) Surgery (for serious prolapse) In women who no longer need their uterus, a hysterectomy is commonly performed with or without reattaching the vaginal apex to the sacrum or to the sacrospinous ligaments. Prognosis is good, even with surgery. Cessation of smoking to reduce coughing and high fiber diets with adequate fluid intake to reduce constipation can help.
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Squamous cell carcinomas
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Arise in the transitional zone between the different epithelial types of the uterus corpus and the vagina Adenocarcinoma The cervix is the lower part of the uterus, extending from the uterine isthmus into the vagina. It functions to allow sperm into the uterine cavity and the infant to pass into the birth canal.
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Symptoms of Cervical Cancer
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Watery, bloody, or purulent vaginal discharge Bleeding between menstrual periods and/or after intercourse or after menopause Abnormal Pap smear test result Advanced symptoms Pelvic/lower back pain Hematuria Dysuria Rectal bleeding Vaginal discharge may be heavy and foul-smelling. The appearance of the cervical lesion varies, but it is often a mass or an ulcer on the surface of the cervix.
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Risk Factors of Cervical Cancer
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Not having routine Pap smears Exposure to HPV, most often through unprotected sexual contact Smoking Immunosuppression Low socioeconomic status The most common age for diagnosis is 45 to 55 years, but it is also a significant problem in women over age 65, who are less likely to get a Pap smear. The premalignant lesion for cervical cancer is called cervical intraepithelial neoplasia (CIN), and it involves dysplasia or atypical changes in the cervical epithelium. HPV infection is common in individuals who have had early and frequent unprotected sex with multiple partners. HPV DNA is detected in nearly of cervical cancers.
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Treatment of Cervical Cancer
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Early stage Loop electrosurgical excision procedure Laser therapy Cryoablation Later stage Radiation therapy, plus treatments mentioned above The Pap smear test was developed specifically to detect cervical cancer. The diagnosis of cancer is then confirmed through colposcopy and directed biopsy of the cervical lesion. Radical hysterectomy (removal of the uterus, cervix, and upper vagina) is usually performed to treat early invasive stages. Patients should be followed up with periodic physical examination and a Pap smear to detect recurrences.
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Prevention of Cervical Cancer
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Primary prevention is vaccination against HPV Sexually active women should obtain annual Pap smear and pelvic examination After three consecutive normal Pap smears, screening can be less frequent as determined by doctor
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Prevention of Cervical Cancer
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HPV testing can be performed at the same time as the Pap smear to look for infection with high-risk subtypes of HPV. Women with a Pap smear suggesting CIN should be evaluated with colposcopy and a biopsy of any lesion detected. Stage is the most important determinant of prognosis, followed by lymph node status, tumor volume, and depth of tumor invasion. The 5-year survival rate ranges from 98% for women with stage IA1 cancer to 9% for those with stage IVB neoplasms.
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Endometrial Cancer
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Malignancy of the lining of the uterus Most common gynecologic malignancy Two types High cumulative exposure to estrogen (usually presents as a low-grade adenocarcinoma) High-grade papillary serous or clear cell carcinoma (poorer prognosis) Any uterine bleeding in postmenopausal women should prompt evaluation for malignancy. Excess estrogen may come from sources, such as estrogen replacement therapy for postmenopausal women, tamoxifen therapy for breast cancer, obesity, early onset of menarche, late menopause, never having children, and chronic anovulation.
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Endometrial Cancer 3
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Endometrial cancer causes ulcerations in the uterus. As blood vessels erode, vaginal spotting or bleeding occurs. The disease may be revealed by atypical endometrial cells on a routine Pap smear. Abnormal uterine bleeding at the onset of or following menopause Abdominal pain (in advanced stage)
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Endometrial Cancer 2
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Endometrial biopsy Dilation and curettage (D&C) (usually performed when biopsy is inconclusive) Transvaginal ultrasound Endometrial biopsy is usually performed on all women with abnormal uterine bleeding or abnormal endometrial cells on a Pap smear. Staging requires a total hysterectomy with bilateral salpingo-oophorectomy and lymph node dissection to fully evaluate the extent of disease.
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Treatment of Endometrial Cancer
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Early stage Surgery Advanced stage Radiation therapy with or without chemotherapy A radioactive implant can be inserted into the vagina and left in place for the duration of treatment while the patient is in the hospital The risk of recurrent disease is greatest within the first 3 years of diagnosis. Follow-up physical examination, including pelvic exam, should be done initially every 3 to 6 months to detect recurrence. The prognosis is determined by the stage of the disease and the tumor grade. The 5-year survival rate ranges from 20% to 90%, depending on the stage at diagnosis.
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Conditions and Complications of Pregnancy
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Complications in pregnancy can arise at any point in the gestational period This further emphasizes the need for early and continual prenatal care and patient education Complications ranging from worrisome or annoying conditions to life-threatening conditions affecting the mother or the fetus occasionally occur.
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Conditions and Complications of Pregnancy (Cont.)
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Prenatal diagnostic tests that can identify fetal genetic or chromosomal abnormalities and detect complications Amniocentesis Chorionic villus sampling (CVS) Maternal serum fetal free DNA analysis Doppler ultrasonography In amniocentesis, a small amount of amniotic fluid is extracted for laboratory analysis. CVS is a biopsy procedure to excise placental tissue for laboratory analysis. Doppler ultrasonography is a noninvasive real-time, three-dimensional (3D) fetal imaging procedure.
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amniocentesis
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In amniocentesis, a syringe is used to collect amniotic fluid. Ultrasound imaging is used to guide the tip of the syringe needle to prevent damage to the placenta and fetus. Fetal cells in the collected amniotic fluid can then be chemically tested or used to produce a karyotype of the developing baby.
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Ultrasonography
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Pelvic ultrasonography is specific for the lower abdominal tissue, including the uterus, adnexa, and fetus. This noninvasive, non-radiating, painless technique helps in diagnosing fetal anomalies, fetal age and size, fetal position, the condition and placement of the placenta, and many other conditions of the female reproductive system. A more recent advance is 3D prenatal ultrasound, which produces 3D, crystal-clear images of the baby that are as detailed as a photograph. A technique in which high-frequency intermittent sound waves are reflected off tissue and read by scanners The various densities of the tissue then are displayed on a screen, and still pictures can be taken to record the real-time image
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Ectopic Pregnancy
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Occurs when the fertilized ovum implants and grows outside the endometrial canal, most often the fallopian tube Any fertilized egg that cannot make it into the uterus and is able to implant and grow will become ectopic. The cause of most ectopic pregnancies is generally unknown. Pelvic adhesions, the presence of damaged fallopian tubes, progesterone contraception, previous tubal ligation, previous pelvic infection, prior pelvic surgery, and intrauterine devices (IUDs) are all associated with an increased incidence of ectopic pregnancy.
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Symptoms of Ectopic Pregnancy
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Sudden onset of severe lower abdominal pain Evidence of vaginal bleeding No pain or pain on one side Positive pregnancy test Possible shock and death There may be no pain and the urine test can be negative for pregnancy. A level of the serum -hCG greater than 1500 to 2500 units with an empty uterus on transvaginal ultrasound is suspicious for ectopic pregnancy. An abnormal rise in the level of -hCG over 48 hours can also be an early sign of an ectopic pregnancy.
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Diagnosis of Ectopic Pregnancy
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If it is not ruptured and not causing pain, then serial ultrasounds with serial blood pregnancy tests may help make the diagnosis Transvaginal ultrasound is the mainstay in diagnostic imaging Culdocentesis (placing a needle into the space behind the uterus) can likewise be used in some unusual cases where the diagnosis is uncertain In areas where the diagnosis remains unclear or ultrasound is not available, then a frozen D&C may be performed to look for evidence of intrauterine gestational tissue. If the diagnosis still remains in question, then laparoscopy may be performed to directly visualize the pelvis and fallopian tubes.
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Treatment of Ectopic Pregnancy
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Laparoscopic surgery to terminate the pregnancy and remove the fetus and placenta Replace lost blood Methotrexate (instead of surgery) may be used to terminate ectopic pregnancy that has not ruptured If the tube is unruptured, then tubal conservation may be possible. In many cases, the tube is sacrificed but rarely does one need to remove the ovary. Even when there has been internal bleeding, surgery can still be accomplished through the laparoscope. Prognosis is good with prompt medical attention.
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Premature Labor
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Contractions leading to cervical change occurring before 37 completed weeks of pregnancy Symptoms Contractions with cervical change Increased vaginal discharge Vaginal examination may reveal cervical changes as mentioned previously. Ultrasound can also be used to assess cervical length and can demonstrate dynamic changes in this length with abdominal pressure or contractions.
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Causes of Premature Labor
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Maternal infection Uterine abnormalities Uterine fibroids Maternal age Gum disease Infection No prenatal care Other possible contributing factors include smoking, stress, and domestic violence.
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Treatment of Premature Labor
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No effective treatment Medical management includes drug therapy Monitoring Patient Fetal heart Fetal movement The only clear treatment for women with a prior history of preterm birth is the use of weekly intramuscular progesterone injections The diagnosis is made by demonstrating cervical change in the presence of uterine contractions. Most studies show that true preterm labor can at best be delayed by 48 to 72 hours. The outcome for the baby depends on the age it is born, underlying presence of infection, birth defects, and cause of the labor. The earlier the gestational age, the more guarded the prognosis.
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Abruptio Placentae
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Premature detachment of a normally positioned placenta during pregnancy When the placenta separates from the uterine wall too early during pregnancy, it can cause hemorrhage, abdominal pain, fetal distress, or even fetal death Abruptio placentae is a medical emergency for both mother and fetus. In many cases, the cause is unknown; however, hypertension, preeclampsia, trauma, maternal vascular disease, infection, drug use (cocaine), and multiple gestation all predispose a woman to placental abruption.
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Placenta Previa
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When the placenta covers the opening to the cervix Caused by low implantation of the blastocyst in the uterine cavity Usually occurs in the first or second trimester A partial previa describes a condition where the majority of the placenta is away from the opening (os) and a complete or central previa is where the more central portion of the placenta covers the os. A prior cesarean delivery increases the risk of previa as does previous childbirth or multiple gestation.
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Placenta Previa
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Painless, bright vaginal bleeding Abdomen is soft and not tender Vital signs may indicate shock Fetal blood supply may be compromised The onset of bright red vaginal bleeding during pregnancy requires immediate attention, close observation, and diagnostic evaluation. The diagnosis is based on a pelvic ultrasonogram that shows the placenta implanted over the cervical os. As the cervix begins to dilate, the vessels tear loose and the placenta bleeds.
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Treatment of Placenta Previa
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Many times in a known previa, the woman may continue daily activities if no bleeding If bleeding is significant, close observation and monitoring in a hospital setting may be required Immediate cesarean section is warranted with massive hemorrhage or fetal or maternal compromise Even with a viable fetus, vaginal delivery is not allowed in placenta previa Exercise or intercourse are avoided if bleeding. In most cases of previa, the outcomes are excellent. Clearly the prognosis becomes more guarded if there is excessive blood loss and fetal compromise requiring immediate delivery, especially if the infant is premature.
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Hydatidiform Mole
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An abnormal proliferation of the placental tissue that can take on characteristics of a malignancy The placenta has a "cluster of grapes" type of appearance on ultrasound or the diagnosis may come from pathologic evaluation after a miscarriage or pregnancy termination.
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Hydatidiform
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The cause of a molar pregnancy is due to a genetic anomaly during fertilization. The placenta develops abnormally as a mass of clear grapelike vesicles
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Symptoms of Hydatidiform Mole
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Nausea and vomiting Vaginal bleeding Abnormalities noted on ultrasound Uterus increases in size disproportionately to gestational age Greatly elevated hCG levels If a pregnant woman reports vaginal bleeding, an ultrasound appointment is scheduled to evaluate the uterus. An incomplete mole exists with a living fetus. In a complete mole, no fetus is present.
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Treatment of Hydatidiform Mole
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Surgical intervention (D&C) Observation for hemorrhage If mole is found to be cancerous, patient may receive chemotherapy On occasion persistent trophoblastic tissue that does not respond to chemotherapy may require that a hysterectomy be performed. Prognosis is good with early treatment.
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Diseases of the Breast
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Ranging from mild to fatal, diseases of the breast necessitate age appropriate screening, with routine mammograms as prescribed by the physician Although diseases of the breast are most common in women, men do experience diseases of the breast Any changes in the breast tissue, such as lumps, indentations, nipple crusting, or leaking, should be cause for concern and investigation.
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Fibrocystic Breast Condition
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Common, benign breast disorder The most common female breast disease Symptoms Lumps and cysts, single or multiple, smooth and rounded, can be palpated in one or both breasts The breasts are tender on palpation Shooting pains in the breast tissue The female patient with mammary fibroplasia experiences an uncomfortable feeling in the breasts. Tenderness is usually more intense prior to start of menstrual cycle. Becomes less of a problem after menopause.
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Diagnosis of Fibrocystic Breast Condition
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Palpation Mammogram Ultrasonography may be used to determine whether lump is hollow or solid Cause is unknown. Usually occurs between the ages of 30 and 50 years. Possibly related to normal hormonal variation.
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Treatment of Fibrocystic Breast Condition
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The goal of treatment is to relieve breast pain and correct menstrual irregularity Some physicians remove fluid (aspirate) from the cysts with a needle Other recommendations Wearing a firm, supporting bra Avoiding caffeine The condition is benign, and most fibrocystic breast conditions never result in malignancy; however, microscopic findings that show atypical cells or hyperplasia are associated with an increased risk for breast cancer. No universal means of prevention is known, although some women notice improvement with caffeine restriction. The patient must be taught the importance of breast self-examination and of annual mammograms.
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Mastitis
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Inflammation of one or more mammary glands of the breast Often caused by a strep or staph infection that invades the milk ducts and creates inflammation and blockage Milk stagnates due to blockage and produces a dull pain The baby, the nursing staff, or even the mother's own body may be the source of the infection.
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Symptoms of Mastitis
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Sudden pain Redness Sensation of heat (at either beginning or end of lactation period) Breasts feel hot, doughy, and tough Discharge from nipple Other symptoms are fever and malaise.
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Treatment of Mastitis
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Firm, supportive bra Heat applied to the painful area Progesterone cream Antibiotics Rest Analgesics Warm soaks The diagnosis is based on the clinical picture. Breast-feeding need not cease if patient improves. Prognosis is good with treatment.
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Fibroadenoma of the Breast
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A nontender benign tumor of the breast Occurs often in adolescence and young women, with the peak incidence at 30 to 35 years of age Patient feels a firm, round, encapsulated, movable mass in the breast Experiences no pain or slight tenderness Cause is not known. Fibroadenomas are hormonally responsive, growing in size during the late phases of the menstrual cycle or during pregnancy. The diagnosis is based on palpation, the clinical picture, and mammogram.
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Cancer of the Breast
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Usually arises from the terminal ductal lobular unit of the breast, the functional unit of the breast tissue, which is very hormonally responsive The most common cancer and the second leading cause of cancer death among women Highest mortality in those younger than 35 (aggressive tumor) and older than 75 (immune system less able to fight cancer and handle treatment side effects).
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Symptoms of Cancer of the Breast
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Lump Swelling Tenderness of breast Irritation or dimpling of breast skin Pain, ulceration, or retraction of nipple Asymmetric appearance The earliest sign, however, is an abnormality on a mammogram, which usually appears before the woman or her physician can feel a lump. In advanced stages of untreated lesions, the nodule becomes fixed to the chest wall, and axillary masses and ulceration develop. Breast pain is not a common factor in early breast cancer.
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Risk Factors of Cancer of the Breast
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Increased age Female Prolonged exposure to endogenous estrogen Long-term use (>5 years) of estrogen/ progesterone hormone replacement therapy Prior history of breast cancer Alcohol usage Breast cancer is 100 times more common in women than men. What are sources of endogenous estrogen? (Younger age at start of period, older age at first full-term pregnancy, even older age at menopause) Why is the risk of breast cancer so much lower in males? (Less sensitive to hormonal influences; male breast does not have lobules.) Risk factors for male breast cancer are Klinefelter syndrome, gynecomastia, testicular dysfunction, and BRCA2 gene mutation.
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Diagnosis of Cancer of the Breast
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90% of cases are diagnosed through abnormal mammogram findings Remainder detected by physical examination A biopsy should be taken of all suspicious lumps for a definitive diagnosis Ultrasound is used to differentiate solid from cystic masses and to determine whether malignant features are present. If advanced stage is expected, a CT scan of the chest and/or abdomen and pelvis, and bone scan should be performed, depending on the patient's symptoms. Tumor estrogen receptor and progesterone receptor status, and expression of the oncogene c-erbB-2 and its protein product HER2/neu should be measured, because they have predictive and prognostic value.
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Treatment of Cancer of the Breast
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Lumpectomy (removal of tumor and some surrounding tissue) Mastectomy (removal of breast and nearby lymph modes) Radiation therapy Hormone therapy Chemotherapy Patients with hormone receptor positive tumors may benefit from treatment with an aromatase inhibitor. Close follow-up after completion of treatment is necessary to assess for disease recurrence. Prognosis is good if cancer has not spread to surrounding lymph nodes. Localized breast cancer has a 5-year survival rate of nearly 100%.
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Prevention of Cancer of the Breast
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Women should report any changes in their breasts to their health care provider. Mammogram screening guidelines per the American Cancer Society: that women 40 years and older have a mammogram every 1 to 2 years and a clinical breast examination, preferably before the mammogram; women 20 to 39 years of age have a clinical breast exam every 3 years; high-risk patients have breast mammography and an annual MRI.
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Paget Disease of the Breast
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A characteristic breast lesion that signifies the presence of malignant adenocarcinoma cells Advanced disease symptoms include: Crusting, serum, or bloody discharge from the nipple Nipple retraction Underlying carcinoma of the breast is present in up to 90% of cases. It accounts for up to 3% of new breast cancers. The skin of the nipple develops an erythematous, eczematous, scaly, or ulcerated lesion. Some patients may only present with pain or itching of the nipple. Peak age at onset is 50 to 60 years.
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Treatment of Paget Disease of the Breast
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Past conventional treatment has been a simple mastectomy, but breast-saving procedures are used with Paget disease Whole-breast irradiation may be performed in addition to surgery The diagnosis can be established by means of a biopsy or by nipple scrape cytology. Mammogram or MRI can be used to detect an associated breast mass. Prognosis for women with a palpable mass is 20% to 60% for 5-year survival; those without a mass have a 90% to 100% survival rate.
