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chapter 8 & 9 patho

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liver

500 different functions Has regenerative capabilities Liver is an organ that is a hub of activity Some of the liver's primary roles are vital for homeostasis and include metabolizing carbohydrates, proteins, and fats Synthesize glucose, protiens, amino acids, enzymes, cholesterol, trigylcerides and clotting factors Store glucose, fats, and micronutrients and release them when needed, detoxify the blood of potentially harmful chemicals, maintain intravascular fluid volume through the production of circulating protiens, produce bile, inactivate and prepare hormones for excretion, remove damaged or old erythrocytes from blood to recycle iron and protein,serve as blood reservoir and convert fatty acids to ketones The liver has a duel blood supply The liver is a small part of the body weight but receives 25% of the cardiac output The hepatic artery carries oxygenated blood from the genral circulation to the liver at a rate of approximately 300 ml per minute to nourish the liver The portal vein carries partially deoxygenated blood from the stomach, pancrease, spleen and gallbladder as ell as from the small and large intestines to a rate of 1000ml a minutes The liver is one of the few body organs that can regenerate, up to 75% can be removed but the liver can slowly generate into a whole liver again The liver produces bile which is necessary in emulsifying fats and fat soluable vitamins (A, D, E K) The bile flows to the gallbladder for storage or to the dueodum If the gallbladder requires surgical removal then the bile constantly flows to the small intestines The liver removes toxicins, stores nutrients, produces proteins, metabolises and beraks down nutrients, helps produce bile

infertility issues

Biological inability to contribute to reproduction Female issues: ovulation dysfunction, hormones, transport disorders, uterine defects, pelvic adhesions The most common female infertility is ovulation dysfunction Other female problems can include hormone deviation, transport disorders, uterine defects, and pelvic adhesions Normally women who ovulate have monthly menses and molimma An ovulatory cause of infertility is indicated in menses and molimina are absent or irregular Many conditions can cause olvulation dysfunction (extreme exercise, eating disorder) and can be categorized by hypothalmaci pituitary in orgin or other systemic orgins (thyroids, cushings) Disorders that can affect transport of oocyte and sperm can be caused by tubal disease and pelvic adhesion The tubual disease is usually pelvic inflammatory disease caused by STI Uterine fibroids and endometriosis can also cause infertility Diagnosis- history, physical, ovulation testing, hysterosalpingography, ovarian reserve testing to determain the quality and quantitiy of eggs, hormone analysis, genetic testing and imaging studies infertility issues we discussed male infertility issues earlier this is female infertility so it affects one in every ten women of childbearing age and it can be ovulation dysfunction or hormone imbalances ***again there can be transportation issues for the sperm, for the egg or a mixture of the two uterine defects causing the inability for the zygote implant and grow appropriately again pelvic adhesions can cause unsafe environments for fetal growth so there are many things that can play a factor into fertility treatments can include intrauterine insemination which is when they offer for the patient to come in they utilize a device to implant the sperm into where it needs to go into the uterus so it takes out the process to make it a little bit more precise to make sure that sperm is adequately getting into or where it needs to be to create a pregnancy there are many steps to this whole entire fertility process it can be a lot it can be overwhelming for patients all the hormones depend on stages of the cycle they might have to go for testing every few days to really understand the hormonal aspects of this because you have to have everything kind of balanced out before you proceed with any of the infertility treatments to see if there's any deficiencies in any areas so it's usually a long process and people get a lot of anxiety producing interventions and it's just a lot for a lot of these patients so again usually IUI would be the first step, IUD would be the next step, if IUI fails IVF is when the sperm is collected from a male and the eggs are removed from the ovaries of the female and then in the laboratory the eggs and the semen are introduced to each other and fertilized then the fertilized eggs start to grow and they form an embryo and then those embryos are transferred back into the uterus and they use surgical interventions for this whole process to hopefully be able to create a safe and healthy pregnancy

benign breast mass

Categorized based on tissue type: non-proliferative, proliferative without atypia, atypical hyperplasia Other benign breast masses Symptoms: increased size or pain before or during menstruation Characteristics of masses Diagnosis: ultrasound Treatment: largely symptomatic Often detected by palpation and or on imaging studies such as mammograms Breast masses can occur anywhere in breast tissue such as the ducts, lobeles and connective tissue While many masses are begning. Some are assossited with an increased risk of breast cancer Three different types Nonproliferative: the most common type of masses are breast cysts whch are usually fluid filled masses that can be solitary, multiple or in clusters Cysts can be classified as simple, complex and complicated Proliferative without atypia: the most common type of breast mass overall is the fibroadenoma which is a solid mass containing glandular and fibrous tissues that can be solitary or multiple Simple fibroadenoma are not associated with an increased cancer risk while complex fibroadenoma confer a sligjly icreases risk Atypical hyperplasia: these masses can be ductal or lobular and are associated with ductal carcinoma in situ or lobular carcinoma in situ There are many other that are considered benging such as limpomas, fat necrosis, galactolceles and adenomas Masses can become more promident and painful during menstration because of the fluxation in hormones Although, The exact cause is unknown the condition is thought to result from hormones Clinical manifestations: can include changes such as increased in size or pain before or during menstration The breast mass can be solitary or multiple or occur in clusters Some masses are large while other are small The mass can feel smooth and firm and often discrete The conistancy canbe rubbery, squishy, grapelike and even hard Nipple discharge is not common with beginin breast mass Any discharge that is spontaneous, persistant or blood is consitant with breast cancer Diangosis and treatment: diagnostic is a history iwht a focus on breast cancer risk and physicial examination Masses are evaluated with ultrasound which by itself is often sufficant for women < 30 A biopsy done to rull out breast cancer Mammograms are done often with older women Usually no treatment for masses that have no cancer risk When necessary treatment strategies largely symptomatic and include needle aspiration of fluid, surgical removal of cyst, anaglesics, a supportive bra, heat/cold application, supportive bra, and limit of dietary fats, avoid caffine and chocolate so this leads into the breast, so breast mass, this mass can be benign or malignant they're detected by palpation and imaging So mammography they can occur anywhere in the breast tissue and the ducts and the lobules and the connective tissue benign but they can increase the risk of breast cancer so there are different tissue types of benign breast masses so you have your nonproliferative lesions or proliferative lesions lesions with atypical hyperplasia which is more of your DCIS so DCIS is usually indicative of a potential mass so usually those lesions with hyperplagia are taken into account very seriously they can also be lipomias, fatty necroses, adenomas masses can be become more prominent and sensitive certain times of the month based upon the menstrual cycle so usually you want to encourage self-breast exams about a week or so after a menstrual cycle has started because that's when the hormones are at most at their baseline so again making sure they're doing self breast exams when a woman knows her breast tissue it's easier for her to identify when something's abnormal and then be evaluated further more quickly than not really performing self-breast exams and not knowing what normal breast tissue is for them like I said many things actually can cause the change in lumps and bumps is what we call it so you want to really make sure that you're encouraging regular self-breast exams so breast cancer risk evaluation is something that we do through the diagnosis ultrasound biopsy if needed and mammogram also treatment you would want to do if I not needle aspiration if its highly suspected, analgesics such as NSAID or acetamyinophen encourage supportive bra use, heat and cold applications can also help dietary changes so this is another thing that can in increase the lump and Bumps, caffeine chocolate and fats*** those three things can really increase on how the density of your breast tissue so limiting that you want to include vitamin B into your diet, magnesium, evening primrose can also help so these are all things that can help with benign masses

GI changes with aging

Changes begin in Oropharynx with decreased saliva & oral enzymes, & decreased dentition GI undergoes a dew changes with aging The stomach lining may shrink and become inflamed leading to atrophic gastritis Stomach acid production occasionally can decrease because of atrophic gastritis Achlorhydria can cause decreased intrinisic factor production, resulting in vitamin B12 deficiency and slow digestion Chnages in the liver associated with age include reduced blood flow, delayed drug clearance and a diminished capacity to regenerate damaged cells The small intestines absorb less calcium with advancing age so increasing calcum intake is needed to prevent bone mineral loss and osteoporosis Peristalsis also decreased with age, increasing the risk factor of constipation Have impaired neuromuscular disfunction, have dysphagia and motor movements Esophogus the spinctures relax cause secondary paraslysis Colon helps delayed the transmission of the food Collethiasis Altered drug metabolism is big in population

PCOS

Common endocrine disorder Characterized by: ovarian hyperandrogenism, oversensitivity to LH, Insulin-resistant hyperinsulinemia, contributes to obesity Menstrual & ovulatory dysfunction Increased risk: inherited traits & disorders Is considered one of the most common endocrine disorders affecting 5 million women of reproductive age The syndrome is characterized by functional ovarian hyperandrogenism and insulin resistance hyperinsulinemia leading to menstrual and ovulatory dysfunction The syndrome Is thought to begin in utero with a resulting congential dysfuction that causes a predisposition to subsequent development of PCOS The congential dysfunction effects the ovaries The syndrome of manifestation become evident during puberty and adolescence In pCOS the dysfunction ovarian theca cells are overly sensitive to LH and over secrete androgens The excessive androgens also affect the grandulosa cells as they normally reply on the theca cells coordination to start progesterone In insuin resistant hyperinsulinemia is the second most common characteristic of PCOS nad is present in approximately 50% of patients In PCOS the insulin resistance causes a compensatory excess insulin secretion In PCOS the muscle is resistant to the metabolic effects of insulin but the ovaries, fat tissue and adrenal glands remain responsive to the insulin Hyperinsulinemia contributes to obesity we discuss this not too long ago so it's characterized by functional ovarian hyperandrogenism in 90% of those with PCOS the other type is an insulin resistance or hyperinsulinemia and this leads to some menstrual and ovulatory dysfunction for PCOS there is a small fluid filled sacs along the outer edges of the ovary and these are cyst like structures and they contain immature eggs so these follicles fill to regularly release an egg so they might have menstrual and ovulatory inpredictability the cause is unknown there's many theories from anywhere from a hereditary or acquired deficiency to environmental factors, epigenetics, a mixture of everything it's usually identified in late puberty and early adolescence

dysphagia

Difficulty swallowing Obstruction, neurological, muscular, or psychiatric conditions Functional dysphagia Iatrogenic causes Difficulty swallowing usually developes secondary to a condition that causes mechanical obstruction of the esophogus Or impaired esophogeal motility May be due to a disorder in the pharanyx which is characterized by difficulty initiating swallowing or oresophagus which is characterized by difficulty swallowing after initiating a swallow Dysphagia can occur due to intrinsic or extrinsic mechanical obstruction Mechnaical obstriction includes those caused by congenital atresia, esophogeal stenosis or strincture, esophageal diverticuta, esophagitis, tumors, neurologic disorders including stroke, celebral damage, achalasia, parkensons, alzhemiers, huntington disease, celebral palsy, MS, amyotrophic lateral sclerosis, gullain- barre syndrome and muscular dystrophy Functional dysphagia is a sense of solid and or liquid food lodging, sticking, or passing abnormally through the esophogus With functional dysphagia there is no evidence of esophogeal, mucosal or structural abnormalities and the dysphagia is not attributed to other disease processes Dysphagia can have iatrogenic causes resulting from many head and neck surgeries and procedures such as endotracheal intubation and tracheostomy Usually a secondary condition causig impaired motility Functional- sense of solid or liquid food or passing through no evidence of abdormality and no other causes Usually from a head or neck surgery, intubation is isogenic Someone who has had head or neck is isogenic Can be a side effect of mediation, sedatives Some medical conditions, anxiety, panic acttacks, or something being lodged in the throat

varicocele

Dilated vein in spermatic cord (valve issue) causing blood pooling in veins Asymptomatic, mildly/extensively painful, fertility issues Scrotal support, surgical repair, embolectomy, & sclerotherapy A varicocele is a dilated vein in the spermatic cord Much like varicose veins in the leg this condition results from valve issues that allow blood flow to pool into the veins The valve issues can be caused by congenital defects or obstructions Varicoceles are common in ages 15-25 and often on left side of scrotum Unknown reasons they may cause infertility in men They are much common in the left than right testicle because the angle of the left testicular vein enters the left renal vein vein, a lack of effective antireflux valves at the left testicular and renal vein juncture and an increase in renal vein pressure Some varicoceles may be asymptomatic while some may cause mild pain that is described as dull and aching Extensive baricoceles can be tender and painful The dilated veins give the scrotum a bag of worms feeling upon palpitation and the blood pooling ay give a sense of heaviness in the scrotum The testicular heaviness is usually present when standing and lying down relieves the symptoms Dignostic procedures- similar to hydrocele, a CT of the abdomen with contrast if suspect a thrombus Treatment is usually unnecessary unless the varicocele cause discomfort, impairs semen, or if testicular atrophy occurs Treatment includes scrotal support, surgical repair, embolectomy, and sclerotherapy varicocele again kind of similar this is diluted vein in the spermatic cord it's similar to varicose vein that you find in the legs are in the lower extremities so this is a valve issue that allows blood to pull into the veins of the spermatic cord so these valve issues can be a result of congenital defects or incompetence of the valves or absence of valves or there's an obstruction from a tumor or thrombi so all of these things can play a factor into this it's usually to 15 to 25 year olds and you usually find on the left side of the scrotum more than on the right side just because of anatomy on the right side you would usually see it more because there's an obstruction somewhere like a renal vein thrombosis on the left testicular vein you might find it's because of the angle of the testicular vein and the renal vein causing the difference these are also the most common cause of low sperm counts and decreased sperm quality due to testicular ischemia if these are findings in an older male you want to have consideration for renal tumor to determine if that's the possible cause of the blocked blood flow so symptoms usually they're asymptomatic they can have some mild dull achy type of pain if they're large varicocele they can be quite tender and painful but usually they're kind of like a moderate size *****whenever you do the physical exam they actually feel like as if it's a bag of worms and present on palpation ***so that's a unique feature with this ***** again it feels like there's like a bag of worms and that's all of the varicoceles collecting together testicles can have atrophy due to increase in the scrotal temperature so something that you want to consider that can in turn cause some fertility issues especially since the highest age group is those of child bearing age you want to have a lot of consideration for that, so CT of the abdomen, contrast will be helpful treatment with scrotal support of briefs or jockstrap surgical repair if absolutely necessary would be another consideration

Anatomy and Physiology

GI Tract composed of 4 layers of walls The GI tract is split into upper and lower divisions The walls of the GI tract have 4 layers The mucosa is the inner most layer that produces mucus The mucus facilitates movement of the GI contents and protects the GI tissue from extreme PH of the GI tract, necessary for digestion The submucosa layer consist of connective tissue that includes blood vessels, nerves, lymphatics and secretory glands The muscle layer include circular and longitudinal smooth muscle layers This layer contracts in a wave like motion to propel food through the GI tract call parastalsis The serosa is the outer layer of the wall, however the outer layer of the esophogus is adventitia The perotineal cavity is the space that contains the serious fluid to decrease friction and facilitate movement Lecture: The serosa layer lubercates the outside of the GI tract The muscular is 2 layers of smooth muscle The submucosa is the next layer, blood vessles, lymph and nerves Inner most layer is the mucosa GI tract to lubercate and protect the inside of the GI tract Uppper and lower divisions

Leiomyomas

Firm, rubbery growth of smooth muscle of myometrium Symptoms r/t size, fibroid pressure, type of fibroid, & impact on fertility & pregnancy A uterine fibroid, is a firm rubbery growth of the smooth muscle of the myometrium Most common pelvic tumors in women and they are classified according to their location 25% of women have symptomatic fibroids 70% women have fibroids by the age of 50 They are most requent in blacks Other risk factors include obesity, advancing age, hypertension and nulliparity, as well as high consumption of red meat, low viramin D levels, alcohol Clinical manifestations- most are asymptomatic, CM depend on size, which can range from microscopic to weighing several pounds and location Pressure from the fibroid can cause pelvic pain, bladder dysfunction, dyspareunia and constipation Heavy menstrual bleeding can occur and passage of clots can cause dysmenorrhea The risk of infertility and pregnancy problems increase with tumor size Leiomyomas are actually uterine fibroids they are firm rubbery growth in the smooth muscle of the myometrium this is a common culptic benign tumor in women it's classified based upon location risk factors include obesity advancing age hypertension and never having a child The cause is not known most grow during menstruation due to estrogen and they actually shrink after menopause

sexually transmitted infections

Infections contracted via sexual contact Mandated CDC reporting of chlamydia, gonorrhea, & syphilis Prevalence rates varies Increasing STI rates in the US STI encompass a broad range of infections that can be contracted through sexual contact Some of these pathogens can be transmitted from mother to baby Some STI are easily irradicated with appropriate treatment where as others perisit for a lifetime Many STI go undiagnosed and not all STI are reported there for making incidences even higher Law makers mandate that 3 STI need to be reported: chalmydia, gonnorhea and syphilis STI rates have been increasing in the US despite educational efforts toward prevention so we're going to discuss a few STI this is a great table I would look at it and to go over HSV HPV chlamydia gonorrhea syphilis etc

vomitting

Involuntary/voluntary forceful ejection of chyme Significance of vomitus characteristics Diagnosis: H & P, BMP/CMP Treatment: cessation of vomiting & correction of electrolytes Vomitting or emesis, is the involuntary or voluntary forceful ejection of chyme from the stomach up through the esophogus and out through the mouth Vomitting can be a protective function or result from reverse peristalsis Increased intracranial pressure can cause sudden projectile vomititng Additionally vomiting may be assossiated with other symptoms such as severe pain ** the medulla coordinates vomiting and drugs and toxicins and chemicals can stimulate this vomiting center Steps of vomiting: deep breath is taken, the glottis closes and the soft palate rises, respirations cease to minimize risk of aspiration, the gastroesophogeal sphincter relaxes, the abdomen msucles contract and squeeze the stomach against the diaphragm forcing chyme out, reverse parstalstic waves eject chyme out of the mouth The characteristics of the contnets are signficiant and can illuminate the underlying cause of the committing envent Blood in vomit has a brown, grandular appearance, similar to coffee grounds Yellow or green color can indicate bile, this can occur due to GI obstruction A deep brown color can possibly be fecal matter due to intestional obstruction Conditions of impaired gastric emptying can cause recurrent vomiting of undigestive food Diagnosis and treatment Diagnostic procedures for vomiting foucs on identifying causative agent as well as fluid, electrolyte and PH imbalance These procedures vary and may include a history and physical and blood chemestries Treatment strategies focus on cessation of vomiting, maintaining hydration, restorying acid base balance and correcting electrolyte alterations Forecfull projection of chyme Can be due to a variety causes or condition Intense pain Meduall coordinates vomtiitng Can stimulate vomtiting center Ultailzied the glottis to close the esophgus rises the abdominal muscle contracts and forced in an upward movement Actually reqires a significant amount of work Want to check gag reflex if someone had an endoscopy Somewone who had astoke more at risk for aspiration Blood can be coffee brown emeissi Yellow/ green the is from bile Drark brown is an obstruction or impaired gastric emptying Sudden type of propelous Posiioning as well Diangosis do a metabolic panel ake sure electroyltes are stable Maintiance of hydration Antiemenis Dramaine can be over the counter Oral and electrolyte replacement

testicular cancer

Mostly germ cell tumors, seminoma or nonseminoma tumor Often asymptomatic May be hard, painless, palpable mass, testicular enlargement & discomfort, & gynecomastia Highly curable: orchiectomy, chemotherapy, & radiation Testicular cancer is an uncommon cancer Men ages 15-35 years old and white males are the highest risk for developing this Most cases of testicular cancer occur due to germ cell trumors which can be slow growing (seminoma) or less common fast growing tumors (non-seminoma) Riks for developing this is though to be increased by family history, infection, trauma, tobacco use, testicular abnormalities and cryptorchidism Is often asymptomatic whne present clinical manifestations usually include a hard, painless, palpable mass that does not transulluminate, testicular discomfort or pain, testicular enlargement and gynocomastia Dignosis- early diagnosis and treatment enhances prognosis Doing monthy testicular self exam is corner stone for early diagnosis The evaluation of a testicular mass begins with bilateral scrotal US A CT scan of the abdomen or chest x-ray or CT of chest done for metasis An orchiemtomy is advise to evaluate the tissue histology and control the tumor but chemotherapy and radiation may be used to treat the disease Semen can be persevered prior to orchiemtomy, in case of family planning so this is uncommon but when it does occur it's usually younger gentleman so I think the oldest I've ever seen testicular cancer was in the early 30s the book reports 15 to 35 years old and that's pretty spot on so mostly secondary germ cell tumors it usually effects only one testicle but both can be affected you do want to be cognizant because when one testicle is involved you want to make sure that they're checking the other testicle because there is a higher chance of recurrence so that second testicle would then be compromise potentially metastases are rare but if they do occur it's usually to the lymph nodes lungs liver bone and brain it's highly curable when it's identified early so some risk factors include a family history infection trauma tobacco use any testicular anomalies can increase the risk and then a failure from the testes to descend into the scrotum when in the younger years again usually asymptomatic if they do experience any symptoms it's usually a hard painless palpable mass usually you cannot transilluminate through because it is a mass they might experience some testicular discomfort or pain they may have some testicular enlargement and gynecomastia so diagnosis would be the use of the scrotal ultrasound you would want a little further investigative studies like a CT scan of the abdomen and pelvis potentially chest X-ray of the chest just to make sure that there's no metastasis to the lungs and then tumor markers so we would look at alpha fetoprotein which is AFT we would look at beta human chorionic-tropin or lactate dehydrogenase which is LHD so treatment would be an orchiectomy semen can be preserved for fertility purposes so if it's somebody who's younger and they do have to proceed with an orchiectomy you can involve fertility to have seen preservation chemotherapy and radiation usually that's not necessary but it can happen depending on what stage it's found and then again encourage self-exams because if it's only unilateral you can't see or experience the other testicle becoming involved at some point

normal reproductive changes after menopause

Manifestations with menopause manifestations of menopause this is a great algorithm I'm not going to talk you through this this is something that I think you need to evaluate on your own I've said this before sometimes with algorithms you just have to look at it and make sure it understands you understand it if I talk you through it it can just be labor a process that like I said just evaluating making sure you understand how this works is helpful

menstrual cycle

Menstrual cycle: stages & hormonal changes The menstrual cycle is a series of monthly changes that begin in puberty and continue throughout the years The average age of onset of menstration is 13 years The menstration cycle is usually a 28 day cycle that consist of 2 phases, the proliferative/follicular phase and the secretory/luteal phase The follicular last 14-21 days and starts with menses and ends before the surge of LH The luteal phase last approximately 14 days and begins with the LH surge and ends with onset of the next menstrual cycle At the beginning of the follicular stage- estrogen and progestrogen are low causing GnRH stimulation and FSH and LH surge and ends with onset of the next menstrual cycle The small select group of follicles then secrete inhibin which starts suppression of FSH While follicles are developing estrogen is prepping the uterus by causing proliferation and leading to an increasing in stringy cervicle mucus Estradiol levels peak around one day before ovulation The high hormone levels cause a positive feedback mechanism with the increase in FSH and LH this surge marks the begin of the luteal phase About 36 hours after the LH increase, the oocyte is released from the follicle, it travels to the fallopian tube and the follicle becomes the corpus luteum, the remaining follicles are reabsorbed in the body At the end of the luteal phase the uterus is ready to receive and nourish a zygot If fertizilation doesn't occur then the LH and FSH start to decline resulting in the corpus luteum producing less estrogen and progesterone Menstration expels the unfertilized ovum and maintains a healthy uterine lining If fertilization and pregnancy occurs then the endometrium thickens After implemnation of a zygot (5-6 days after fertilization) the placenta secretes HCG (human cgroionic gonadotropin) HCG is continuously secreted until placenta is fully developed and makes their own estrogen and progestrogen, usually after 1st trimester Menstration occurs until estrogen levels decrease and become less erratic usually between 45-55 years old alright i love this picture of the menstrual cycle i think this represents it to a tee it's easier to read it's easy to understand so two things trigger menstrual cycle so one is the hypothalamus and two is the hormone increases so in the menstrual cycle it begins early like around 13 years old is when it starts and it's a monthly series of endometrial shedding through the reproductive years so each cycle is a 28 day cycle on average for some people they have less than 28 days and some people have greater than 28 day cycle for the purposes of this lecture we are going to use 28 because it's easy to understand and that's usually what we utilize when we're educating people in regards to the menses so each cycle is 28 days and it's easy to break everything down from here so there are two phases there's a proliferative phase which is also called a follicular phase and this is an estrogen dominated phase this lasts about the 1st 14 days so we count day like when somebody starts a menstrual cycle that's day 0 so from 0 to day 14 is this proliferative or follicular phase when this phase finishes around day 14 this is when we have an LH surge which is luteal phase Luteal phase is a progesterone dominated phase and that's usually the last 14 days of this Cycle so we have this LH surge which you can see on this graph and this is when about 36 hours after that LH surge this is one the Oocyte is released from the follicle so this is the highest time for somebody to be able to get pregnant so really there's only about like 24 to 36 hours in a month that someone can actually get pregnant which is pretty crazy so you have the LH surge the egg is released from the follicle and this is the start of ovulation so ovulation it goes through the fallopian tubes and it either forms a zygote which is what will then be implanted into the uterine lining and start of pregnancy or with the placenta or there is no sperm there and then the egg it continues on the fallopian tube and that's what sheds a the endometrial lining if a zygote is not implanted into the endometrium creating the placenta

leomyomia's

Most common benign pelvic tumor in women Diagnosis: H & P, pelvic & transvaginal US Treatment: monitoring, hormone therapy, surgery Daignisis and treatment: a history and physical and pelvic and transvaginal ultrasound A CBC is done to evaluate anemia Other diagnosis procedures include hystrescopy, biopsy Laproscopy and MRI Symptoms severity and childbearing intentions should be considered when choosing treatment options Treatmnet strategies include simple monitoring, hormone therapy can be used to shrink the fibroid and reduce symptoms Oral contreceptives with estrogen- prosgestin can be used to reduce fibroid development and menstrual bleeding, but the combined hormones may cause fibroid growth Other treatment include NSAIDS, surgery, myomectomy or hysterectomy, myolysis, or endometrial ablation clinical manifestations they're commonly asymptomatic but they can have manifestations if they do become larger in size as they can cause some compressive issues pressing on adjacent structures and tissues Pelvic, plain bladder dysfunctions, disperenmia, constipation so for diagnosis we want to do pelvic or transvaginal ultrasound CBC because sometimes this can contribute to anemia hysteroscopy biopsy to rule out malignancy an MRI if needed ****so treatment is first you want to determine their childbearing intentions because that will affect which intervention that is pursued ****so again you want to determine the childbearing intentions of the of the patient that will help determine how you pursue with interventions you can do simple monitoring they can do hormone therapy they can attempt oral contraceptives to help reduce the growth and help myomectomy or hysterectomy they can do endometrial ablations they can do uterine artery embolizations which send particles to obstruct blood flow decreasing the supply *** but again childbearing intentions do play a factor in which treatment plan the patient proceeds with

prostate cancer

Most common cancer among men Prognosis and risk factors Tumor growth & urethra impediment, with s/s similar to BPH, bloody semen & hematuria Diagnosis: PSA measurement Treatment: radical prostatectomy, radiation, orchiectomy, or antitestosterone drug therapy Most common cancer among men, particularly blacks The most common type is adenocarcinoma The tumors are slow growing and 80% of cases are diagnosed while the cancer is still confined to the prostate improving prognosis Prognosis improves with early diagnosis and treatment and worsens with advancing age Increased screening with PSA and prostate biopsy for those whose with elevated PSA have contributed to increasing survival rates Prostate cancer in black men occurs at a younger age Clinical Manifestations: As the tumor grows the prostate enlarges and impedes the urethra There for prostate cancer has similar CM to BPH, have urinary difficulties and erectile dysfunction Additionally may have bloody semen and hematuria Men are usually asymptomatic when diagnosed If it metastizes, it will metasize to the bone and bone pain will be present Diagnosis- usually determain a PSA level which is elevated in prostate enlargement The free PSA measurement used to calculate the ratio of free to total psa and a low ration (<15%) is suspicious for prostate cancer Prostate acid phosphate testing may be used Biopsy is necessary to make diagnosis Treatment includes combination of radical prostatectomy, radiation, and orchiectomy or antitestosterone drug therapy These treatments often impact patients quality of life due to side effects or complications which may be short or long term prostate is another common cancer in men particularly African American men they have an increased risk compared to any other ethnicity most common type is an adenocarcinoma the cause is not known but we know that it does increase risk with age the peak age is around 65 to 75 year olds ***there again is an increased risk in black men and it's younger black men is when we see it more often anyone who is a first degree relative with prostate cancer this also increases their risk a family history of other cancers such as breast ovarian and pancreatic increase the risk of prostate cancer you will see that some of the other female reproductive cancers increase the risk of prostate cancer usually there is a genetic component but unfortunately they haven't been able to identify all of the genetic components that might have cross over between men and women so there are some that increase the risks slightly but again they are seeing correlations between some of these other cancers or people might be more predisposed, however the genetic mutations have not yet been identified high fat diets are also another risk factor and then androgen hormone replacement so some tumors are androgen dependent so that can play a factor sexual transmitted infections in the past also increases the risk these are typically slow growing in about 80% are diagnosed when it's still confined to the prostate so that improves the prognosis **** again prognosis improves with early detection survival rates have improved secondary to increased screening for increased screening we utilize prostate specific antigen or PSA's since we have done more for screening purposes we have been able to identify patients who are with high PSA prior to in the past and this is obviously increase our ability to identify those patients early if they have a high PSA , it's usually checked again and if it remains high then they usually go for a biopsy after that clinical manifestations urethra compression based upon the size of the prostate they might present with similar symptoms to BPH and they might have reports of bloody semen, hematuria if somebody does a digital rectal exam they're usually identifying some nodules or asymmetry on exam usually they're often asymptomatic when they're diagnosed if metastases does occur it's usually in the bones so they may report some bone pain which is a likely complaint ***so again the diagnosis would include a PSA level a biopsy if necessary treatment would depend on the cancer stage when it's identified so you can do some active surveillance for a brief period of time you do a PSA and then you do PSA again and if it continues to be high then you want to progress further with further evaluation orchiectomy which should be removal of the testes would be another surgical consideration that we would think about and then radiation if necessary

normal female reproductive system

Ovaries: estrogen, progesterone, Oogenesis & ova The ovaries are paired, alond shaped organs located on each side of the uterus The ovaries produce hormones primarily estrogen, progestrogen and inhibin that regulate reproductive function and secondary sex characteristics Estrogen is also produced in smaller amounts by the breast and adipose tissue during pregnancy by the placenta The ovaries also produce testosterone and other androgens but the levels are much smaller in women than men There are 3 types of estrogen, eestradiol, estrone and estriol Estradoil is the most promident All estrogens are derived from androgens and their effects are systemic Estrogen is important for reproductive growth and maturation of breast, uterus, fallopian tubes and external genitallia Progestrogen- mainly secreted by the corpus luteum and in small amounts by the follicles During pregnancy the placenta secretes progesterone Progesterone is used as a contraceptive because estrogen inhibits and prevents ovulation Progestrone in pregnancy allows the uterus to thicken, prevents uterine contraction and prepares the breast for lacation The ovaries contain the precurosrs to mature eggs During oogenesis the oocytes mature into ova By the 30th week of gestation the female fetus has 7 million follciles By puberty 400,000 follicles remain Ova are not contiously produced throughout a womens life which is the key difference between spermogenosis Multiple births can occur when more than one ovum Is produced, released and fertilized these flanked uterus they're held in place by suspensory ovarian ligaments they produce hormones which is primarily estrogen progesterone inhibin some testosterone and androgens but that's very low in women remember, testosterone is more of a male dominated hormone same thing with androgens females is primarily estrogen progesterone inhibin there are three types of estrogen ****so this is important to know ***so you have estradiol estrone and estriol ****estradiol is the most potent and prevalent until menopause ****than the estrone is the more predominant estrogen after menopause *** so estradiol is before menopause **** estrone is after in the ovaries androgens are converted to estradiol and estrone ***estriol is a metabolite of estradiol and estrone ****so estriol is a metabolite of estradiol and estrone ****all estrogens are derived from androgens ***so that's important to know all estrogens are derived from androgens the effects from estrogen are systemic so in the reproductive that they are important in reproductive growth maturation of the breast uterus fallopian tubes and the external genitalia some non-reproductive effects from estrogen include lipids, reduction of osteoclastic activity the inhibition of platelet adhesiveness it increases collagen, maintenance of skin and neuroprotection memory and cognition so progesterone is secreted by the corpus luteum and slightly from follicles so during pregnancy the placenta secrets progesterone and progesterone targets the uterus blood and the brain so progesterone for contraceptive use, progesterone has anti estrogenic effects when the progesterone levels are high they create an inhibition in estrogen alternatively when progesterone is low the opposite occurs for the maintenance of pregnancy progesterone aids in uterus functioning it prevents contractions, it aids in lactation and it protects the fetus so sometimes people who have low progesterone in pregnancy they might need supplemented especially in those early weeks until the uterus is fully functioning on its own so they might actually have supplemental progesterone which is usually in form of injection from the time that they're identified as being pregnant until in the 20s, week 20 or 20 plus of their pregnancy until the uterus is fully functioning on its own ovaries also contain oocytes which are precursor to a mature egg *****so by the time a female fetus is 30 weeks' gestation they have approximately 7 million follicles ****so when they're still in you a female fetuses in utero at around 30 weeks' gestation they have approximately 7 million follicles **** when they are born they are go from 7 million follicles to 2 million follicles *** by puberty they only have about 400,000 follicles left ***so that's really important to know ****ova are not continuously produced like sperm ***ova you have the amount of follicles that you have when you're born so the eggs you do not get anymore that's all you have sperm is a continuously produced ****ova in the ovaries remain in the stage of prophase for as long as 45 years ***so ova can remain in the ovaries in that prophase for up until menopause occurs

lower GI tract

Provides "movement" of food mixture Small intestine, large intestine, & anus The lower GI tract is comprised of the small intestines (duodenum, jejunum and ileum), large intestines (cecum, colon, rectum) and anus The small intestine is the longest section of the GI tract Carbohydrates, protiens, fats, bile, vitamins and minerals are digested and absorbed in different locations of the small intestines In the small intestines, the enzymes that have been secreted into the GI tract break the large food molecules into small molecules which are then absorbed The smaller molecules are transported to the circulatory and lymphatic system Muscular rings slowly move the food mixture through the small intestines using peristaltic wave motions The small intestine also contains cells that secrete fluid to neutralize PH and enzymes to facilitate digestion After making the long journey through the small intestines, the chyme ultimately reaches the large intestines (apro. 3-5 hours) The large intestines has a large number of globlet cells and enterocytes (absorption cells) The appendix does not have much function but does have potiental to cause harm The colon has 3 different second, ascending, transverse and descending The mixture entering the colon from the small intestines includes water, unabsorbed food molecules, indigestiable food and electrolytes The colon absorbed 90% of water and electrolytes As chyme moves through the colon it changes into fecal mass Feces contains remaining undigestive or unabsorbed remants along with bacteria Feces also aids in mucus to aid in bowel movement The rectum expands when feces enters the area The receptor sends an impulse to the enteric nervous system and spinal cord to elecit defication reflex Deficiation is consciously controlled and may require assistance from abdominal muscles The valvsva manuver (taking a deep breath and then pushing) causes an intrathoratic and intra-abdominal pressure to facilitate the passage of stool The longer the feces stays in the GI tract the more water gets absorbed and the harder it is to expel out The dueofum, ileum and the jugunm- small intestine, the longest section about 20 feet long

penile cancer

Rare malignancy Commonly squamous cell carcinoma Risk ~ other penile disorders & conditions Is a rare malgnancy The most common type is squamous small cell carcinoma Its exact cause is unknown but risk is thought to be increased various penile disorders or conditions such as smegma, being uncircumcised, poor hygiene, phimosis and HPV infections Can appear thick grey white lesions (bowen lesions) or red shiny lesions (erythroplasia of queyrat) or have a painless bump Usually occurs in older men Progronosis is good when early diagnosis and treatment but penectomy may be required if the cancer is extensive or does not respond to usually cancer treatment (chemo, radiation, surgery) penile cancer Is a very rare malignancy it's the most common type is a squamous cell CA The cause is not known there's increased risk of obtaining this when there's various penile disorders so risk factors: smegma is a sebaceous secretion in the folds of the skin, which usually on or under the foreskin so those that's a high risk factor someone who is uncircumcised poor hygiene habits phimosis and HPV infections usually, this is found in older man and not younger men presentation is usually thick grey white lesion called a bowmans lesion but you can also have erythroplasia which is a red shiny legion and that's also known as a querat or a painless lump that's another identifying characteristic prognosis is good with early detection treatment you would do a penectomy which is a removal of the penis if the cancer is pretty extensive or if it doesn't respond to cancer treatments such as chemotherapy radiation and local surgical incision

erectile dysfunction

Recurring & consistent inability to attain & maintain penile erection sufficient to complete sexual intercourse Dysfunction in processes: hormonal, physiologic, neurologic, vascular Refers to the recurring or consistant inability to attain or maintain a penile erection sufficient to complete sexual intercourse Other sexual dysfunctions include diminished libido and abnormal ejaculation (premature) ED is the most common sexual disorder Most commonly occurs around age 40 and becomes more of a problem in older men Risk factors include obesity, smoking, sedentary lifestyle, and obstructive sleep apnea ED can result from psychological, neurologic, and vascular processes as well as hormonal influences Normally the brain receives perceived sensual input and signals are sent to an erection center, there is also a sacral erection center The spinal cord then sends signals to divert the blood to the corpora cavernosa Disruption in testerone will cause decreased libido and ED Pelvic trauma and prostate surgery can cause vascular and neurogologic interruption and lead to ED so erectile dysfunction is a recurring or consistent inability to attain or maintain a penile erection sufficient to complete sexual intercourse and this is the most common sexual disorder that there is and this can occur at any age but it's usually around 40 and higher when it becomes most prevalent there are many risk factors included in erectile dysfunction including obesity smoking history as sedentary lifestyle and sleep apnea and this can result from many influences so there can be a psychologic in portion to this including anxiety depression guilt stressors relationship issues it can be neurologic so somebody who had a stroke or has multiple sclerosis or possibly dementia anything that really impairs that correct signaling from the brain to the gentle urinary receptors can impair that process vascular process so anything that inhibits adequate blood flow so hyperlipidemia diabetes smoking with these are vascular dysfunction all of those things can impair the ability for someone to obtain an erection and then hormonal influences, so testosterone can cause decreased libido and that can have an impact on acquiring and maintaining an erection so other causes can be pelvic trauma someone who previously had prostate surgery or any type of surgical intervention involving the genito-urinary tract some medications including antihypertensives antidepressants antipsychotics and anti-androgens, those can all play a factor alcohol use, recreational drug substances such as cocaine and then Pyrenees disease can cause fibrotic plaques to form on the surrounding area of the corpora cavernosa and that can obviously also impede the ability to obtain an erection

peptic ulcer disease

Stomach or duodenal lesions extending through muscularis mucosae Duodenal, gastric, & stress ulcers Symptoms: GI hemorrhage, obstruction, perforation, bowel penetration, peritonitis, and other GI inflammation s/s Risk factors: NSAID use, H. pylori infections, Zollinger-Ellison syndrome Contributing factors PUD refers to stomach or duodenal lesions that extend through the muscularis mucosae The two most common risk factors are NSAIDS and H. pylori infections both are more likely with advanced age Ulcers can vary in severity and superficial erosin to complete penetration through muscle, damaging blood vessels and even eroding through the GI tract wall Dueodenal ulcers: account for 80% of stomach ulcers Most commonly assossiated with excesive gastric acid with or without H. pylori H. pylori however is in 95% of cases Typically between 20-50 year olds Allows for acid neutralization and allows for organism to survive in harsh acidic enviroments Patients typically present with epigastric pain that is relieved with the prescence of food, the pain Is more common at night Gastric ulcers: less frequent and more deadly Gastric ulcers are assossiated with NSAID use that increases with age Typically ages 50-70 H. Pylori infection is assossiated with gastric ulcers but the incident is low compaired to dueodenal Gastric cancer risk are higher in patietns with gastric ulcers Stress ulcers: developes due to physiologic stressors on the body Stress ulcers associated with burns are called curling ulcers And ulcers associated with head injurty is cushing ulcers Peptic ulcers, stomach or duodenal lesion, nsaids, and H pylori are most common cause******* Gastric tumors 80% of the cases are dueodneul ulcers 95% have h pylori Gastric is more deadly with increase risk of cancer Can have stressors Hemorrage is the first indicator Usually more acute onset and mascked by other stressors

upper GI tract

The areas that begin the digestive process Oral cavity, pharynx, esophagus, & stomach The stomach is an expandable food and liquid resevior When its empty the stomach wall shrinks forming wrinkles called rugae Prior to the arrival of food into the stomach, gastric secretions begin in preparation for the arrival of food As the stomach fills, the rugae unfold and the wall stretches to acommadate a volume up to 4 L Rugue has different cells that secrete various substances These include parietel cells that secrete hydrochloric acid, intrinis factor, and gastroferri Mucus cells secrete an alkaline mucus, chief cells secrete pepsinogen,, G cells release gastrin, D cells secrete somatostatin and entrochromaffin cells that secrete histamines Inside the stomach the hydrochloric acid and enzymes further chemically digest food and peristatic churning further mechanicially digest food into chyme For additional protection, bicarbonate is secreted to neutralize stomach acid Nutrients are not absorbed in the stomach, instead the food is simily prepared for absorption Alcohol, NSAIDS and aspirin are absorbed in the stomach Chyme leaves the stomach through the pyloric spincture Pushes food into the back of the throat Thent he pharanxy then into the esophogus, the esophpgus uses rings to aid in movement of food toward stomach As food approaches the stomach, the les aids in prevent reflux into the esophogus Stomach expands with food and liquid Directly after a meal is the chyme and then 1-2 it slowly gets smaller then 3-4 hours later then difestion starts The fundus is at the top curvature The pylorus is at the end

pancreas

The pancrease is an organ that has exocrine and endocrine functions The exocrine functions include producing enzymes, electrolyes and water necessary for digestion The duct system carries these substances to the duodenum to join the chyme The endocrine functions include producing hormones to help regulate glucose Endocrine "out" Exocrine "in" Exocrine and endocrine functioning The ilets of langerhauns The sinner cells- the pancreatic jucies help with the digestive process

Normal Female Reproductive System

Uterine changes with fertilization and pregnancy so this demonstrates this is what I was talking about a few slides ago this demonstrates the release of the follicle so the released Oocyte from the ovary heads over to the fallopian tubes you see those ferrmrated edging where at the end so that's where the Ooocyte goes in it meets the sperm, it forms a zygote then it goes through cellular replication and addition and it starts to duplicate and duplicate again and duplicate again and then it continues to go into the uterus and the uterus implants into the endometrial lining and that's what forms the placenta to start to function so this is a really nice picture that the stepwise processed this one is also uterine changes with fertilization and pregnancy so day five to six there's hatching day 6 to 7 there's apposition 7 to 8 there's adhesion and then day 8 to 9 there's invasion into that uterine endometrial lining and that's again when the placenta starts to form for the zygot

testicular torsion

•Abnormal rotation of testes on spermatic cord leading to ischemia & necrosis (frequently by trauma) •Sudden, severe testicular pain, scrotal swelling, nausea, vomiting, etc. •Diagnosis: H & P, testicular Doppler US and scrotal US Treatment: surgery Testicular torsion refers to abnormal rotation of the testes on the spermatic cord Sudden scrotal edema and pain developes as the twisting compresses the blood vessels This leads to ischemia and necrosis Immediate treatment is required to restore blood flow and minimize testicular damage After 12 hours, irreversiable ischemic damage can occur Its more common in the first year of life with another peak incidence in puberty and up until age of 18 It is most frequently caused by trauma but it can also occur after stenous exercise or spontaneously The primary manifestation is sudden severe testicular pain usually with or without a predisposing event Other manifestations include scrotal swelling, nausea, vomiting, dizziness, and hematosphemia Dignasotic procedures- history, physical exam, testicular doppler US to determaine blood flow and scrotal US which will reveal abscent blood flow to effected teste With the appendage torsion blood flow will be normal or even increased due to inflammation Surgery- will be required to treat testicular torsion and should be performed within 6 hours to prevent testicular necrosis Manual manipulation by rotating the testicle gentely away from the midline Surgery required to secure testicle and prevent recurrence this is an abnormal rotation of the testes are on the spermatic cord this is a sudden and intense pain with scrotal edema and it's actually twisting of the testes and this compresses the blood flow and decreases the arterial blood flow and venous obstruction so if this is not immediately treated an individual can have ischemia and necrosis pretty quickly ****so the time frame that we want to look at is 12 hours ****so at the 12 hour mark irreversible ischemic damage can be had so you obviously want to have something treated before then typically this is so painful they're not waiting 12 hours to go to the hospital and unless there's some like geographic issue that they can't make it to a hospital but usually the pain is pretty intense from what I've heard so usually they're at the hospital before that 12 hour mark clinical manifestations again sudden severe testicular pain it's usually unilateral it's usually not bilaterally not to say that bilateral cannot happen scrotal swelling they can have kind of like a visceral response with some nausea vomiting dizziness they might have hematospermia which is blood in semen physical findings, so testicular mass you can do a Doppler ultrasound to determine if the blood flow is absent to that area manual manipulation if you can rotate the testicle away from midline you can try but it's not always guaranteed that that is be going to work and be sufficient enough that it wouldn't recur surgical intervention if necessary within six hours to prevent further testicular necrosis

amenorrhea

•Absence of menstruation •Primary: Genetic or anatomic abnormalities as cause (Turner Syndrome) •Other Refers to the absence of menstration With this condition menstration may have never occurred or may have ceased Is considered primary if the menstration has not occurred by 16 years of age The evaluation of the disorder should be carried out earlier than 16 and if growth and sexual development are abscent Genetics or anatomic abnoramalities are usually causes of primary amenorrhea Stress, sudden weight loss, and extreme reduction in body fat (anorexia, eating disorders, athletes) are termed functional hypothalamic amenorrhea when there is not pathologic underlying cause Ovarian disorder can cause primary amenorrhea as a result of abnormal ovarian development such as in turner's syndrome Congenital abnormalities can cause vaginal disorders or can cause uterine developemental disorders A minor surgery to perforate the hymen can be performed to allow normal menstrual flow Amenorrhea is the absence of menstruation so either it has never occurred or may have stopped primary amenorrhea is when menstruation has not occurred by 16 years old or if there's any genetic or an at anatomic abnormality which is causing amenorrhea or something like Turner syndrome so Turner syndrome is a chromosomal condition it's usually identified with someone who's has short stature it's usually identified by the time someone's 5 years old but this syndrome can have a loss of ovarian function so they obviously need hormone replacement therapy to aid in more female functioning and usually they have some difficulty conceiving but might need supplemental help in in that area

pelvic inflammatory disease

•Acute infection of female reproductive system •Result of STI ascending to upper genital tract •Fever, pain, or tenderness in the pelvis, lower abdomen, or lower back, dysmenorrhea, abnormal discharge, etc. •Treatment: broad-spectrum antibiotic coverage Is a general term for an acute infection of the femal reproductive system PID occurs usually as a result of an STI that ascends into the upper genital tract and is not usually used in reference to pelvic infections due to other causes In this infection bacteria usually ascends through the reproductive tract Mycoplasma genitalium is the most common organism Risk factors for PID can include multiple sex partners, sexual intercourse with infected partner, or history of prior STIs or PID Most common women ages 15-25 Clinical manifestations can include indications of infection such as fever, chills, myalgia and leukocytes, pain and tenderness in the pelvis lower abdomen or lower back, dysmenorrhea, abnormal vaginal and cervical discharge, postcoital bleeding, intermenstrual bleeding or heavy menses, dyspareunia, urinary frequency and dysuria Diagnosis and treatment: consist of history and physicial A presumptive clinical diagnosis is a young, sexually active women with lower abdominal or pelvic pain and pelvic exams findings of cervicle motion or uterine and adnexal tenderness Can do US, CT, MRI CBC for leukocytosis Treatment: include broad-spectrum antibiotic coverage due to polymicrobial pathogens that are commonly present with PID Sexual activity should be delayed until completion of treatment, resolution of symptoms and treatment from partner If exposure was less than 60 days then partner needs to be screened and treated public inflammatory disease this is a general term for acute infection of the female reproductive tract it's usually from an STI that ascends up the upper genetial tract usually polymicrobial so the exact microbe is usually never identified so we would treat with a broad spectrum antibiotic to treat you know that does well for polymicrobial coverage so risk factors are multiple sexual partners history of STI previously or PID and it's usually the most common in 15 to 25

cervical cancer

•Advanced symptoms: anorexia, weight loss, fatigue, pelvic, back or leg pain, unilateral lower-extremity edema, HMB, etc. •Treatment: Pre-cancerous and early malignancies Loop electrosurgical excision procedure, cryotherapy, and laser therapy •Advanced cancer: chemotherapy, radiation, & surgery •Prevention ~ HPV vaccine Diagnosis and treatment: ***The pap smear remains the corner stone in early cervical cancer detection An abnormal cervical cytology indicates the need for cervicle biopsy and removal of a portion of the cervix Admininistration of the HPV vaccine may prevent this cancer Precancerous and early malignant changes can be treated with loop electrosurgical excision procedure, cryotherapy and laser therapy Advance cancer can be treated chemo, radiation and surgery Survival rates 100% when cancer treated early so with an increase in the use of pap smears and we've been able to detect dysplagia earlier still cervical cancer rates have declined actually there are more advanced procedures also so whenever we do identify dysplasia that's concerning we're able to perform interventions such as a colposcopy or ability to take some of those precancerous cells and excise them from the cervix Carcinogenic exposures can create malignant changes so it's not always guaranteed but we can at least treated in meantime almost all cervical cancer is a result of HPV infection so about 99.7% of the cervical cancers are from HPV and HPV can be detected early with a pap smear so but with that being said HPV can develop cervical cancer in anywhere from 10 to 15 years so it takes a very long time so you know people were upset over changes to the frequency of pap smears but it does take so long for those HPV cells to switch over to cancerous cells so usually we're able to identify that quite early risk factors multiple sexual partners and not practicing safe sex increases that risk for HPV

cervical cancer

cervicle cancer

•Advancements in screening •Procedures to remove precancerous cells •99.7% from HPV infection, slow-cancer •Early: continuous vaginal discharge and AUB Has been on the decline in recent years due to advancesments in screening Cervical cytology screening can now detect precancerous changes Procedures can be performed to remove these percanceroua cells limiting the likihood of these changes progressing to perment malignant changes Almost all cervical cancers are caused by the HPV infection with subtypes 16 and 18 accounting for 70% The latency period from exposure to HPV to development of cervicle cancer is 10-15 years Most risk factors include not practicing safe sex, having multiple partners, similar to how would contact HPV Early stage- is usually asymptomatic When present clinical manifestions can include continuous vaginal discharge, which is pale, watery, pink, brown, bloody foul smelling Abnormal urterine bleeding Indication of advanced cervical cancer include anorexia, weight loss, fatigue, pelvic back and leg pain, unilateral lower extremtity edema, heavy menstrual bleeding. Leaking of uterine or feces from the vagina and bone fractures so with an increase in the use of pap smears and we've been able to detect dysplagia earlier still cervical cancer rates have declined actually there are more advanced procedures also so whenever we do identify dysplasia that's concerning we're able to perform interventions such as a colposcopy or ability to take some of those precancerous cells and excise them from the cervix Carcinogenic exposures can create malignant changes so it's not always guaranteed but we can at least treated in meantime almost all cervical cancer is a result of HPV infection so about 99.7% of the cervical cancers are from HPV and HPV can be detected early with a pap smear so but with that being said HPV can develop cervical cancer in anywhere from 10 to 15 years so it takes a very long time so you know people were upset over changes to the frequency of pap smears but it does take so long for those HPV cells to switch over to cancerous cells so usually we're able to identify that quite early risk factors multiple sexual partners and not practicing safe sex increases that risk for HPV

GERD

•Back-up of chyme into esophagus •Symptoms: heartburn, nausea, food regurgitation, dry cough, laryngitis, pharyngitis, & lump sensation in throat •Influences & risk factors GERD is a condition where chyme periodically backs up from the stomach into the esophogus Occasionaly bile can back up into the esophgus The presence of the gastric secretions irritates the esophogeal mucucosa This can result from an abnormality of in the LES Various factors can contribute to LES abnormalities and development of GERD Pressure changes may orginate from many sources such as obesity, pregnancy, or other circumstances that increase intra-abdominal pressure Smoking, drinking alcohol, certain foods, and certain medications can alter the LES pressure Food that can ulter include chocolate, caffine, carbonated beverages, citrus fruit, tomatoes, spicy and fatty foods and peppermint Medications include nitrates, sedatives, beta blocker, and ect Another key indicator is the acidity of the reflux, the higher the acidity the greater the harm Clinical manifestations include heartburn (early) which is described as epigastric or retrosternal pain, usually after a meal or when recumberant And regurgitation of food which is gastric contents coming back up into the throat or mouth, has a sour taste Can have nausea, dry cough, larygnitis, pharyngitis and sensation of lump in throat GERD- primary gerd and secondary gerd Chyme backs up from stomach into the esophogus Usually orginated from the lower esophogeal spincture Pressure changes, coughing, pregnancy and obesity Smoking drinking alcohol Food that alter the lower esophogeal pressure Chocolate, citrus foods, spicy foods, pepermit Nitrates calcium channel blockers

Condylomas

•Benign growths caused by human papillomavirus (HPV) •Types 6 and 11 •Clinical manifestations •Characteristics of growths •Abnormal bleeding, discharge, or itching •Treatment •Vaccine for preventing HPV infections •Growth removal methods Are benign growths caused by HPV More than 200 different types exisit Condylomata can occur on the external genitals and vaginal wall, cervix, anus, thighs, lips, mouth and throat The genotypes that cause most genital warts are types 6 and 11 This can lead to reproductive cancer in women HPV can have an incubation period that last 6 months The immune system clears most HPV within 2 years though some infection persisit Most sexually active men and women will contact HPV as it can be contracted with just skin to skin contact Clinical manifestations: can be asymptomatic depending on location Transmission can occur without the prescence of a lesion From infection to development of lesion can be from 3 weeks to 8 months Lesions can vary in appearance Can be growths that are flat, rough, smooth, flesh colored, white, grey, pink, cauliflower like large or barely visible Additional symptoms can be abnormal bleeding, discharge or itching Diagnosis and treatment: diagnosis based on history and physicial and clinical findings While there is no treamnet of HPV itself, treatmens exist for serious conditions it can cause such as (cervicle cancer) Vaccine is recommended for both females and males Can remove growths for aesthetic purposes Sexual partners of the infected individual should be screened and treated Removal of growths will not cure the underlying condition so growths may reappear So these are benign growths that are usually occurring from HPV there's type 6 and type 11 they look like a little growth as you can see on this slide that's kind of what they look like in real life they can cause abnormal bleeding sometimes drainage or discharge and they can be a little itchy for patients they can be quite cumbersome so usually they try to excise them if possible because they can get larger again they can have some issues with abnormal bleeding so they try to excise these especially if there's multiple they will wait until there's a few and then they will try to surgically excise them all at once again you want to try to prevent these from occurring and encourage HPV vaccine for those who are at high risk for obtaining condylomas

ovarian cysts

•Benign, fluid-filled sacs on the ovary •Types: Follicular vs. corpus luteum cysts & Functional vs. dermoid cysts •Symptoms: Abdominal pain/discomfort, abnormal menstrual bleeding, & abdominal distension Are benign, fluid filled sacs on the ovary Often the cysts forms during ovulation process when a follicle or follicles are stimulated Instead of the dominant follicle releasing eggs the fluid stays in the follicle or the nondominant follicles do not ger reabsorbed or regressed creating a follicular cysts Follicular cysts are more common but corpus lutum cysts cause more symptoms Other ovarian cysts include dermoid cysts which develop from ovarian germ cells A small number can become malligant when present, abdominal pain or discomfort is the most prevelnat clnical manifestation Pain occurs when the cyst bleeds, ruptures, twists or exerts pressure on nearby structures Pain may be assossiated with bowel movement and sexual intercourse Other clinicaln manifestations can be abnormal menstrual bleeding and abdominal distenstion these are benign fluid filled sacs on the ovaries this usually forms during ovulation when a follicles or follicles are stimulated enough fluid will stay in a follicle or if non dominant follicles don't get reabsorbed into the body they create the cyst so you can have a follicular cyst, those are usually term functional cysts you could have a corpus luteum which can cause a cyst the corpus luteum produces progesterone and it makes a good environment for developing fetus but sometimes if that does not occur then it can breakdown and caused a an ovarian cyst ***the follicular cysts are more common than the corpus luteum cysts ***the corpus luteum cysts usually cause more symptoms ****so again the follicular cysts are more common but the corpus luteum cysts are more symptomatic these cysts can disappear on their own without treatment or they can rupture causing extreme discomfort they're most common in childbearing years and so you you'll see abdominal pain abdominal discomfort sometimes abdominal distension pain with cysts and bleeding, abnormal menstrual bleeding and in rare cases they can experience ovarian torsion as a result of this

spermatocele

•Benign, sperm-containing cyst : develops between testis & epididymis •Painless, soft, & small •Moveable & may transilluminate •Blockage of duct system, infection, inflammation, or trauma •May require surgical removal for large cysts A spermocele is a benign, sperm containing cyst that developes between the testis and the epidiymus If its less than 2 <2cm its called an epidiymus cyst Usually the cyst is a painless soft and small but it can grow quite large and lead to discomfort The cyst is movable and transilluminate light The exact cause of this is unknown but thought to be due to blockage in duct system, infection, inflammation and trauma Diagnostic similar to hydrocele Cyst usually does not cause problems but may require surgery if large spermatocele is a similar concept to a hydrocele but this time it's a sperm containing cysts between the testes and epididymis less than two centimeters is considered an epidemic epididymal cyst and this is usually painless soft small movable and you can usually transilluminate for this area the cause is not clear but it's thought to be caused from a blockage in the duct system treatment might be required spermatocelectomy if it becomes too large and too compressive

infertility issues

•Biological inability to contribute to reproduction •Male issues •Decreased sperm or sperm abnormalities, hormone deviations, physical impediments •Immunotherapy for males with antisperm antibodies Infertility describes the biological inability to contribute to reproduction The ability to conceive and support a fetus rquires functioning male and female reproductive systems If a couple has been unsuccessful after 1 year of trying then they should see a fertility specialist Male problems that can lead to infertility include decreased sperm count or sperm abnormalities, hormone deviations, and phsyicial impediments Hypogonadism is caused by GnRH and gonadtropin deficiencies Spermatogensis are idiopathic Multiple disorders that are genetic, congentital or acquired can effect spermogenesis Sperm transport issues can be caused by disorders effecting the structures and delivery of sperm Diagnosis- history, physicial, cultural of penile drainage if infection suspected, hormone analysis and imaging studies Genetic testing ccan be done as well Treatment- immunotherapy for males with antisperm antibodies, alpha-sympathomimetic agents for males with retrograde ejaculation, collegen injection to the bladder neck, sperm treatment to wash and concentrate sperm, antimicrobial therapy if infection is present, coenzyme Q to increase sperm count Infertility issues, so infertility can be both men and women so right now we're just going over male infertility but infertility in general is considered to be after one year of actively trying to conceive so that means unprotected sexual intercourse at least once a month for 12 consecutive months this should be considered in infertility and it needs to be investigated further with someone through fertility so fertility specialists are usually considered reproductive endocrinology so again you would want to send patient for further evaluation from males that usually includes a sperm analysis ***not every hospital facility does this it's usually a timed test meaning that they provide a specimen and the specimen is then quickly analyzed under microscope to determine motility sperm count the how the sperm looks from a morphologic standpoint **** so again if there is a wait between the time that specimen is obtained and the time a hospital that does deliveries, they usually do them for the most part ****but again it's usually time test and it's usually done in the morning actually getting a sperm analysis will be completed and they see if there's a decrease sperm count they look at sperm abnormalities motility movement the ability for it to possibly be transported to see if there's any physical impediment to getting from the penis into the female, if there are any genetic or congenital issues that might be occurring they also look at hormonal deviations from the male perspective so there's a variety of testing that can be done including genetic testing and sometimes ultrasound if needed

endometrial cancer

•Cancer of the uterus, mostly endometrioid •Unopposed estrogen a major factor •Most significant manifestation as abnormal painless vaginal bleeding •Diagnosis: endometrial biopsy •Treatment: early ~ chemotherapy, radiation, hysterectomy, and hormone therapy •Uterine sarcoma Cancer of the uterus The most common malignancy in women The exact cause is unknown but unopposed estrogen may be a major factor in its development Unoppposed estrogen is more likely in women with prolonged episodes of amenorrhea and anovulation or obesity Clinical manifestation: The most significant finding of endometrial cancer is normal painless vaginal bleeding especially after menopause After the age of 45 any menstrual disorders such as intermenstrual or heavy bleeding can be due to endometrial cancer Additional clinical manifestations that are late signs can be nonbloody vaginal discharge, pelvic pain, weight loss, palpable pelvic mass and pain during sexual intercourse Diagnosis and treatment: An endometrial biopsy is a diagnostic proceure of choice when malignancy is suspected Transvaginal US with the finding of thicken endometrium in a postmenopausal women is a suspicion for endometrial cancer If diagnosed early enough endometrial cancer can be treated successfully with chemotherapy, radiation, hysterectomy and hormone therapy Uterine sarcoma- a malignant uterine tumor not as scommon as endometrial carcinoma These tumors are rare and account for only 3% of uterine cancers and the incidence increases with aging Most common clinical manifestation is postmenopausal bleeding, AUB in premenopausal women, abdominal and pelvic pain and pressure and abdominal distension Physicial exam reveal a large uterus Diagnosis is often made during myomectomy or hysterectomy Treatment is hormone therapy, chemo, radiation and surgery The tumor arise from the myometrium or connective tissue it's the fourth most frequent cancer in women and the six leading cause of death in women the five year survival rates about 82% it's unclear if the cause but it's believed to be a hormonal cause with unopposed estrogen or an abnormal balance of estrogen and progesterone so usually risk factors are on the estrogen progesterone balance diabetes and hypertension clinical manifestations include abnormal painless vaginal bleeding any bleeding after menopause is considered abnormal so late signs include weight loss pelvic pain palpable pelvic mass and pain with sexual intercourse so diagnosis would be a pap smear pap smears don't detect cancers above the level of the cervix however sometimes pap smears you might find malignant cells and or atypical cells that came from the uterus because of the were able to come down with gravity so you might find some elements cells on a pap smear you would want to do an endometrial biopsy transvaginal ultrasound to check that the endometrial lining if that endometrial lining is thick then we suspect endometrial cancer the key is early detection it can be successful with chemotherapy and radiation after hysterectomy and then hormone therapy

chalymdia

•Caused by Chlamydia trachomatis •Most commonly reported STI in the United States •Transmission modes •Serotypes: 11, labeled from A to K •Usually, asymptomatic •Causes other infections Is caused by Chlamydia trachomatis Chlamydia is the most common reported STI in the united states Chlaymdia rates have increased by 22% since 2013 Can be transmitted from sexual contact and infects the mucosal epithelium along the urogenital tract There are 11 serotypes A-K Genotypes D-K causes urogenital, rectal, pharyngeal and conjunctive infections Can have mother to child tranmission during childbirth The incubation for sexually transmitted chalmydia is 7-14 days after infection however the period of infectivitiy is unclear in asymptomatic cases Clinical manifestations: often called silent STI and usually asymptomatic in both males and females Chalmdyia most commonly effects the cervix in women and in men most commonly effects the urethra Symptoms include mucopurulent endocervical discharge, vaginal discharge, that is purulent, mucoid or watery penile discharge, menstrual disorders, dysuria, painful sex during intercourse and rectal pain and mucopurulent discharge so chlamydia is caused by chlamydia trachomatis which is an intracellular parasitic bacterium it requires a host cell to reproduce ***this is the most common STI in the United states it's transmitted through sexual intercourse there is eleven serotypes each serotype can cause a different presentation of symptoms

Gonorrhea

•Caused by Neisseria gonorrhoeae •Attaches to epithelial mucosa of vagina, mouth, or anus •Sexual or mother-child transmission •Asymptomatic or symptoms similar to chlamydia •Complications Refered to the clap Casued by N gonorrhoeae Attaches to the epithelial mucosa of the urethra, cervix, mouth and anus and causes irritation and inflammation Can adapt to the fenital tracts, change its surface structure and multiply in various forms and avoid the immune system Gonorrhea is transmissible through sexual contact and from mother to child and usually results in neonatal conjunctivitis Clinical manifestations: usually asymptomatic If they do occur usually do not appear until 2-10 days after infection exposure and incubation period usually 2-5 days for men Most commonly effects the cervix causing cervicitis but the urethra is also often coinfected in women as opposed to chlamydia In men the most common site of infection is the urethra Men are more likely than women to experience symptoms Syptoms include mucopurulent endocervical discharge, vaginal discharge that is purulent or mucopurulent, mucoid mucopurulent or watery penile discharge, menstrual disorders, dysuria, and painful sexual intercourse Complications of untreated gonorrhea include pelvic inflammatory disease, which can then lead to infertility and chroninc pain as I said it's usually Co infected with chlamydia usually when you screen for one you screen for both this attaches to the epithelial mucosa in the urethra cervix mouth or anus this is like a chameleon so it will adapt to anywhere it changes the surface structure and multiplies in various forms and it tries to avoid the immune system so but like I said it's a chameleon it kind of adapts to wherever it lands up is transmitted through sexual contact and it can also be spread from mom to baby clinical manifestations it's usually asymptomatic usually symptoms don't present until 2 to 10 days after exposure the incubate incubation period is 2 to five days from men in men it can cause epididymitis usually there's mucopurulent drainage more copious than in chlamydia again cervical friability vaginal discharge watery penile discharge post coital bleeding painful intercourse if left untreated again it can cause infertility and chronic pain

Heavy menstrual bleeding (HMB)

•Causes •PALM-COEIN system •Structural disorders (PALM) •Nonstructural disorders (COEIN) •AUB during perimenopause and menopause Is one of the most common types of AUB And the terms are often used interchangeably even though amenirrhea is included in the AUB definition The most common cause of HMB and IMB vary depending on whther the women is pregnant, of reproductive age or experiencing perimenopause or menopause The cause of HMB and IMB in non pregnant females cam be categorized by the PALM_COEIN PALM- is structural disorders COEIN- is non structural disorders Polyps, Adenomyosis, Leiomyoma, Malginancy, Coagulopathy, Ovulatatory, Endometrial disorder Iatrogenic disorders Not yet classified During perimenopause the menstratual cycle changes due to normal physiologic reduction in ovarian hormone secretion that occurs with aging Can also occur due to underlying pathology and the most likely causes is structural disorders such as fibrois, polyps, and adenomyosis Menopause- is considered abnormal The causes often include endometrial polyps and malignant disorders so this is a nice classification nation it's called PALM-COEIN this is an acronym so PALM is more of the structural causes of heavy menstrual bleeding and then COEIN is the non-structural causes of heavy menstrual bleeding so the structural causes would be polyps adomyosis, leomyomias, malignancy or sometimes hyperplasia then the C for coein would be Coagulopathy, ovulatory dysfunction, endometrial causes such as primary disorders of the endometrium or androgenic disorders and then medication possibly IUD and then the N is not classified yet so those are some classification that we can use to further classify abnormal uterine bleeding

gastritis

•Causes: internal & external irritants as well as severe stress •Diagnosis: EGD, H. pylori testing, CBC, & stool analysis •Treatment: Acute gastritis ~ self-resolving with management to limit complications for chronic gastritis Clinical manifestations include indigestion, heartburn, epigastric pain, nausea and vomiting, anorexia and malaise The presence of hematemesis and dark tarry stools can indicate ulcertation and bleeding Chronic gastritis can develop gradually and last months to years Accompanied by epigastric pain and sensation of fullness after minimal intake, nausea and vomiting may occur Diagnosis and treatment Usually with a history and physical along with a diagnostic test to evaluate for the cuase Imaging test such a s an EGD to evaluate the muscosal lining and H pylori testing Active H pylori infection is evlauted with the urea breath test or H pylori stool antigen Additional test can be a CBC stool analysis Treatment strategies depend on etiology For instance bacterial infections such as H pylori require antibiotics Chronic disease management is important to limit complications assossiated with inflammation May include PPI and mucosal barriers Endoscopy can be CBC or occult blood Can last a few days for acute and wont have to do too much Can avoid irritatants Can do antibiotic therapy H 2 blockers

Cryptorchidism

•Common genitourinary tract congenital condition •Undescended testes remaining in abdomen prior to birth •Risk factors •Diagnostic procedures (US) •Treatment by 6 months May include manual manipulation, hormonal therapy, surgical repair, etc Is a common congenital geninturinary tract condition in which one or both of the testes do not descend from the abdomen to the scrotum prior to birth This can also include abscent testes The absecent testes occur because the testes never developed or they atrophied Risk factors include prematurity (birth before 37 weeks gestation), low birth weight, small size for gestational age, multiple fetus, family history for crytrochidism or other problems of genetial development, maternal estrogen exposure during the first trimester, maternal alchol use during pregnancy, maternal cigarette smoking or secondhand smoke exposure during pregnancy, maternal diabetes, and parental exposure to some pesticides Diagnostic- include history, physicial, self testicular exam abdominal ultrasound, MRI, laparoscopy, and open abdomenial exploratory surgeries Additional hormone levels and genetic therapies are distinguished potiental causes and complications Treatment - most cases the testes descend by 9 months of age without treatment, however cryptorchidism treatment should be done by 6 months of age because the testes are unlikely to descend after this time Early treatment prevents perment damage Treatment strategies include manual manipulation, hormone therapy, surgical repair, orchiectomy, testicle implants, hormone replacement OK cryptorchidism is a condition of one or both testes not descending from the abdomen into the scrotum prior to birth this can also be an absent testes or that they never formally developed and they could have experienced atrophy so about 2 to 5% of full term males are born with one or two undescended testicles it's rare for both to be undescended it's usually you know a-laterally but it can occur with both being undescended the risk factors are premature birth so before 37 weeks a low birth weight small size for gestational age multiple fetuses (so anything greater than twins) maternal estrogen exposure during pregnancy primarily the first trimester alcohol use and cigarette use, maternal diabetes that includes type one type 2 gestational and then prenatal exposures to pesticides so diagnosis obviously a history and physical assault testicular exam abdominal ultrasounds MRI sometimes laparoscopy if we have to determine further why this is where the testicles might have gone to, a method's not really able to be identified and have to proceed with some type of surgical intervention to see, explore a little bit and see where they are you might want to check some hormone levels and then genetic testing or genetic studies treatment it's important to note that the most causes of undescended testes usually occur it corrects itself within the first nine months but if it's around six months you need to start looking to see if you able to feel them at all are they in lower pelvis or in the lower abdomen abdominal area it's around six months research really investigate a little further by nine months if it hasn't corrected itself it definitely needs to be treated the earlier the treatment the less permanent damage that will be had you can attempt manual manipulation but this doesn't mean that it will be successful and it might not last, they might reset recede and go back up pharmacologic aides sometimes some hormonal therapy specifically with testosterone may help *****again surgical repair if necessary

esophogeal atrisa

•Congenital malformation of esophagus with two separate esophageal sections with or without tracheoesophageal fistula (TEF) •Types A, B, C, D •Symptoms occur immediately after birth with drooling, choking, & difficulty breathing Is a result of a congenital formation of the esophogus The malformation leads to 2 sperate esophogeal sections the lower and upper section There are 4 types A, B, C, D With 2 sperate sections and most cases are assossiated with tracheal- esophogeal fistulas Most of the cases of esophageal atresia with TEF involve the lower half of the esophogus connecting with the trachea The risk of esophogeal atresia increases with the fathers age increases and if the mother used assistive reproductive technology to become pregnant Clincial maniestations Prenatally, esopogeal atresia should be suspected when there is polyhydramminos (excessive aminoic fluids) however many cases are not detected prenatally Clinical manifestations are dependent on whether a TEF is present of abscent Manifestations can occur immediately after birth The infant will start drooling, choking and have difficulty breathing The infant may choke with feeding as he or she is unable to swallow during feeding If no TEF the infant may have scaphoid shaped abdomen with no gas because food and liquids are not going through the esophogus to the stomach The abdomen can become distending causing breathing diffuclties The gastric contents can also cause reflux through the fistula and lead to aspiration pneumonia which is assossiated with higher incident of death Leads into 2 separate esophogeal sections, upper and lower and not connected Different types of variations that can occur Abcd Most common is type C TEF Those at highest risk, fathers at increase age and mothers who need reproductive services to be pregnant

premenstrual syndrome (PMS)

•Criteria •Diagnosis: H & P Treatment: hormone therapy, diuretics, antidepressants, etc The pathogenesis of PMS is poorly understood but during the luteal phase of the menstrual cycle estrogen and progesterone levels ae normal but abnormal response to neurotransmitters Diagnositc- is a history and physical exam Treatment- often include hormone therapy, such as oral contreceptives, diuretics, antidepressants, anaglesics and life style modifications Can also include dietary changes( sugar and sodium reduction, eating small frequent meals) criteria for PMDD is the same as above but we use five symptoms a week before the onset of menses and this usually improves a few days after the onset of the menstrual cycle so treatment is usually hormone therapy so we're looking oral contraceptives sometimes diuretics, anti-depressants especially SSRI need to help and says lifestyle measures such as stress reduction regular exercise dietary changes and supplements with the vitamins there was a big study demonstrating that especially PMDD calcium magnesium primrose oil there's a lot of speculation in some studies like I said, but there's it lacks like true data to determine efficacy but sometimes you just you know it pays to see if it helps

GERD

•Diagnosis: H & P and EGD (for concerning presentations) •Treatment: balance pressures & reduce acid GERD can result in esophogeal and nonesophogeal complications such as espophogitis, barretts esophogus, strinctures, ulcerations, esophogeal cancer, asthma exacerbations and chronic laryngitis GERD is one of the top 3 reasons for chronic cough Risk fo barrett esophous considered a precursor t adenocarcinoma of the esophogus is higher long standing gerd > 5 years and smoking and obesity GERD complications such as gastrointestinal malignancy, should be suspected in individuals with symptoms of heart burn and regurgitation, other concerning features are vomiting, GI Bleeds, new onset dyspepsia after age 60, anorexia and first degree relative with GI cancer Diangosis and treatment: made based on history and physicial in those with heart burn and regurgitation Diagnostic testing is not necessary, testing can indicate a prescence of symptoms other than heart burn and regurgitation if there is a concern for complications of GERD suc as berrett esophogus Treatment strategies include eating small frequent meals and avoid eating 2-3 hours before bedtime, assume high fowlers position for 2-3 hours after meals, elvate the head of the bed approximately 6 inches, losing weight, avoiding triggers, avoiding medication that cause gastric irritation, avoid clothing that is restrictive around the waist, taking certain medication and herbal remities such as PPI, antiacids, mucsual barriers, and having surgery H2 blockers History and physicial, when have you noticed this and for how long Biopsy and make sure everything looks okay Dysphagia

cleft palate and cleft lip

•Diagnosis: H & P and prenatal US •Temporary treatment: special nipples or dental appliances •Surgical procedures in stages Diagnosis; consisit of history and physicial and prenatal US Treatment is often temporary measure such as special nipples and dental appliances until surgical procedures are recommended Surgical repar is necessary to close the gap Cleft lip repair is recommended before age 3 months and cleft palate repair is recommended by 18 months Treatment can spand over 20 years And cosmetic surgery may be neeed to improve appearance of defect Lecture: may be unilateral or bilateral depeding on the lips Maxillary and utero folds in utero Creates an opening between the oral and nasal cavities The sucking can cause nutrition deficiencies And will have aspirtation risk Can idneify history and physical if not diagnosed with prenatal US Recommended to be repaired before 3 months of age Cleft palate recommended 18 months of age Might require a few extra surgeries Can do surgery on pregnant women Speech therapy and speech helps with feeding interventions Might need audiologist, pediatritian GI surgical team

prostitis

•Diagnosis: H & P, UA, and C & S •Treatment: long-term antibiotics, analgesics, antipyretics, hydration, & sitz bath Diagnostic and procedure- history, physical, and urine gram stain and culture The digital rectal exam should be preformed gentaly as a vigerous exam can result in bacteremia Treatment strategies include long term antibiotics, and hospitalization may be necessary Abcess should be expected when treatment is delayed or when symptoms do not improve with antibiotic therapy Diagnostic test for chronic prostastis include urine and prostatic fluid samples The prostate fluid sample culture will be positive for pathogens in chronic bateria prostitis Treatment- strategies for chornic bacterial prostitis include antibiotic therapy, anagesics, antipyretics, adequet hydration, and sitz bath Other treatment include treatment of urinary sysmptoms, and acupuncture and extra corporeal therapy to help chronic pelvic pain Diagnostic and treatment you want to do a urine culture and sensitivity on these patients long term antibiotics are the way to go you analgesics, anti-pyrectics, **hydration that's a big one** and then sitz bath for comfort

pyloric stensiosi

•Diagnosis: H & P, abdominal US, BMP/CMP, CBC •Treatment: bilirubin & liver enzymes for jaundice, pyloromyotomy, balloon dilation, and correction of fluid, electrolyte, and pH imbalances Diagnosis and treatment include history and physical and abdominal US as well as blood chemestries and a complete blood count A test of bilirubin and liver enzymes, AST and ALT is performed when an infant has jaundice Surgical repairment called pyloromyotomy Is recommended to open the sphincter but ballon dilation may be used in high surgical risk infants Signs and symptoms may resolve within 24 hours of surgical repair Want to check metabolic panel, check CBC Surgical repair if needed Usually if they have surgery they can start eating 8 hours after surgery Correct any fluid or electrolyte imbalances

ovarian cysts

•Diagnosis: H & P, imaging, evaluation for tumors •Treatment: often resolve, OCPs, ovarian cystectomy Diagnosis and treatment- is a history and physicial HCG should be performed to assess for pregnancy, specificially atopic pregnancy A pelvic and transvaginal US or an MRI may be necessary CBC can evaluate anemia bleeding CA-125 serum biomarker for ovarian cancer treatment includes evaluation for enlargement Most cysts resolve without treatment Oral conteceptives can reduce incidence Of cysts developememt so history and physical you want to make sure you want check HCG to assess for pregnancy make sure they don't have an atopic pregnancy that this is truly assessed and not atopic pregnancy you would further evaluate with the pelvic or transvaginal ultrasound possibly an MRI maybe a biopsy if necessary CA-125 levels to make sure that this is truly assessed and not cancer CBC to check for anemia sometimes you can have some hemorrhage if these break and rupture so I'm checking CBC and make sure that the patient is adequate cereal evaluation to see if there's any changes sometimes oral contraceptives will help reduce the incidence Reduce the incidence so sometimes they do have to have an ovarian cystectomy which is removal of the cyst from the ovary or an infrectomy which is removal of the ovary itself

Genetial Herpes

•Infection causing blisters on the genitals and in the reproductive tract •Characterized by recurrent episodes of lesions •HSV type 1 vs. HSV type 2 •Genital herpes and pregnancy An infection that causes blistering vesicles on the genitals and in the reproductive tract Genital herpes is caused by herpes simplex virus HSV has two forms- HSV type 1 and HSV type 2 HSV1 infection most commonly manifest as a cold sore Generally HSV 1 is above the waist and HSV 2 is below the waist HSV2 infections can spread below the waist and HSV 1 infections can spread below the waist through oral-genital sexual contact HSV 2 is also tranmissable through direct skin to skin contact Contracting genital herpes during pregnancy creates a great risk for the fetus causing spontaneous abortion If lesions are present at the time of birth than cessarian birth should be performed to minimize risk Both HSV infections are characterized by recurrent episodes of the lesions The virus causes an initial infection at the entry site but then it will travel along the dermatone to the nerve root where it remains protective and dorment until the next outbreak The lesion first appear as a vesicle surrounded by erythema When the vesicles rupture they leave behind painful ulcerative lesions with watery excudate it's infection causing blisters on the genitals and in the reproductive tracks so there's an herpes simplex virus one herpes simplex virus 2 the way I remember this is HSV one is usually cold sores it's oral herpes but both viruses can be the cause for oral or genital herpes that HSV one is usually found on the face you only have one face HSV 2 is usually found in the genital area and you have two legs so that's how you remember one you only have one face that's usually identified as a cold sore HSV 2 you have two legs it's usually found in the genital area you can have recurrent episodes of these lesions so you might have them treat them they go away and then usually during times of high stress or when your immune system is compromised in some way that's usually when they rear their ugly head and you might have a resurgence so usually people might have valtrex daily or at least valtrex that's used in groupings for times during stress to decrease how many are presented if they do have a recurrence or if they're in a stressful time, they know they might have a recurrence so then they prophylactically treat with valtrex or acyclovir during those times just to decrease the chance of them actually recurring

erectile dysfunction

•Diagnosis: H & P, nocturnal penile tumescence • •Treatment strategies: psychological counseling, testosterone replacement, phosphodiesterase-5 inhibitors, other Diagnosis: consist of history and physical, if the ED began sudden and abrupt the cause is usually psychogenic unless there is trauma or surgery assossiated with ED If the man has ED but has nocturnal erections, a vascular and neurologic cause are more likely In comparison to psychogenic cause Can do labatory values, beginning with identifying the common cause Can do glucose and hormone testing Can do hormone analysis Nocuturnal penile tumescence can be done to evaluate psychogenic vs physiologic ED This can be done with monitoring in their own home while patient is asleep Cavernosgraphy may be necessary and involve x-ray with contrast die injected into penile blood vessels Treatment: psychological counseling, testosterone replacement, PD5 inhibitors, other medications, herbal remideies, prostaglandin E injections, penis pump or vaccume devices, surgical penile implants and vascular surgery so diagnostics and history and physical, you want to ask a lot of questions about when they are noticing this, is it all the time, is it certain times because there's all clear factor into what might be causing it like is it a psychological issue, is it a stressor issue there might be some a lot of things playing a part of why this is happening so if it's a sudden or abrupt onset and it's not from trauma or surgery it's usually psychologic in nature if there is erectile dysfunction but this person has nocturnal erections then it's usually like a vascular or neurologic cause that's more likely to be causing it if it's anxiety after penetration that's usually obviously a psychologic component and then you want to check any underlying disorders for vascular you want to make sure that they don't have diabetes or hyperlipidemia any thyroid or testosterone deficiencies any metabolic issues that might be playing a factor on hormone levels you want to check ultrasound X-ray make sure that there's no other underlying cause that needs resolved treatment psychological counseling testosterone replacement if necessary medications like cialis and levitra can also help usually androgenic antagonists, herbal remedies, herbal remedies are not quite clear but some people might find benefit from at least attempting them so those are some things that you want to be considered for erectile dysfunction

gonorrhea

•Diagnosis: Screening & NAAT testing, testing of sexual partners •Treatment: Ceftriaxone & azithromycin, some antibiotic resistance of gonorrhea Diangosis and treatment: diagnosis is made with a history and physicial and several other testing options Can do urinary and swabs of the genitourinary tract- vaginal, endocervicial or urethral As with chlyamidia, the gold standard test and most accurate is the NAAT testing NAAT can be done and provide results in 90 minutes Treatment: usually antibitoics with ceftriaxone in one dose and azithromycin in one dose Chlaymdia often occurs as a coinfection but already cover with the usual treatment of azithromycin for gonorrhea Sexual partners within 60 days of infection should be screened and treated Pregnant women are retested and should avoid having a vaginal birth and have cecessarian birth instead Patients should avoid sexual intercourse for 7 days after treatment again you can do the Nat test for this antibiotics for gonorrhea would be ceftriaxone plus azithromycin treatment of sexual partners in the past 60 days cure testing is not necessary for this again you should not repeat in that test within two weeks after the infection because it might still be positive so if you do want to do it cure test this should be done at least seven days after therapy is totally completed pregnant women would need retested because you want to make sure that the baby is OK and again avoiding intercourse until 7 days posts therapy completion

esophogeal atrsia

•Diagnosis: atresia evaluation with catheter, EKG, renal sonogram, & x-ray •Initial treatment: continuous suction of the esophagus •Treatment: surgical repair Daignosis and treatment Usually made at birth The atresia is evaluated by attempting to pass a catheter into the stomach and an inability to do so is suspicious for atresia The catheter location is assessed with an x-ray and the catheter will be curled up in the upper esophogeal pouch with an atresia TEF will be evident on x-ray and the GI tract will be filled with gas May do an echocardiogram. Renal sonogram and x-ray of the spine and limbs Initial treatment will include contious suctioning of the esophogus to prevent complications Surgical repair of the esophogeal defects and tef is the mainstay of treatment Surgery will need to be performed in stages Such as when the gap between the upper and lower pouch of the esophogus is too large Mom whose have polyhydramous- too much ambionic fluid, can happen in Gest DM Can make baby big Can have problems with breathing with TEF Scaphoid abdomen if not TEF Usually diagnosis at birth, they pass a catheter into the stomach, an inability to pass a catherter into the stomach then thats high suspicion Nothing is going through Abdomen with gas Check and echo and renal us Surgicla intervention occur in stages, and before proceeding with surgical intervention they might need for baby to grow before surgery

hiatal hernia

•Diagnosis: barium swallow, upper GI X-rays, manometry, EGD •Treatment: healing mucosa & relieving inflammation The symptoms improve when standing up as organs return to usually position A soft upper adominal mass may be present especially when pt is laughing, coughing or straining Diagnosis and treatment: can do history and physical, barium swallow, upper GI tract X-ray Manometry and EGD Treatment strategies focus on relieving inflammation by decreasing regurgitation of chyme and healing mucosa Stratgies can include eating small, frequent meals (6 small meals a day), avoiding alcohol, assuming high fowlers position after meals and sleeping with head elevated at least 6 inches, smoking cessation, weight loss, taking ant-acids and PPI Surgical repair may be necessary if not relieved by other strategies Can have dysphagia, chest pain, may symptoms may occur afte reating,, in recumberant positon or when leaning forward Retching type of feeling Barium swallow, an endoscopy Eat smaller meals 6 small melas High fowlers after eating 2-3 Elevate the head of the bed higher than the feet Smoking sessation and weight loss and can do surgery (for paraesophogeal)

disorders of the pelvic floor

•Dorsal lithotomy position: prolapsed organ severity graded using Pelvic Organ Prolapse Quantification (POPQ) •Treatment: Kegel exercises, avoidance of straining, vaginal pessary devices, & incontinence interventions When conducting physical exam for pelvic organ prolapse, a women usually in dorsal lithotomy position The prolapse may be evident immediately upon visulazation of the introitus or may be seen while the women performs valsva manuver The prolapse may be evident in a supine position The simple pelvic organ prolapse quantification can be used by general clinicialsn to grade the severity of ht eorgan prolapse This system involves measurement along antomic points in the vagina Digagnosis and treatment- is usually made on finding from physicial and history Can evaluate the bowel and bladder and evaluate for dysfunction In asymptomatic women treatment is not necessary Treatment can include kegel exercises, and avoidance of straining A vaginal pessary device may be necessary A pessary must be removed and cleaned routinely this is a staging criteria for the pelvic support and issues that might be occurring so I want you to evaluate that on your own

normal male reproductive system

•Duct system: epididymis, vas deferens, spermatic cord, ejaculatory duct, and urethra •Accessory glands: facilitate ejaculation The male reproductive system contrains a complex tube structure to deliver sperm from the testes to the female reproductive system The duct system includes the epididymis, vas deferens, spermatic cord, ejaculatory duct and urethra Once they are mature, sperm leaves the epididymis and travel to the vas deferens The vas deferens widens at the prostate, forming a pouch called the ampulla The ampulla joins the seminal vesicles to form the ejeculary duct The sperm and the ejaculary fluid join in the vesciles to form semen The semen flows from the ejaculatory duct to the urethra where it is propelled from the penis during intercourse The primary function of the accessory glands is to facilitate ejaculation Sexual stimulation inititates the ejaculatory process When a male is sexually stimulated, his sperm travels from the epididiums to the vas deferens to the semicale vesicle and ejaculatory duct During ejecculation a valve in the bladder closes to prevent urine from entering the urethra and killing the sperm The male reproductive system consists of a duct type of system and this system creates the semen so this is a tube structure that delivers sperm from the testes to the female reproductive system this duck system includes the epididymis vas deferens spermatic cord ejaculatory duct and the urethra sperm mature and leave the epididymis and travel to the vast deference around the vast deference is the testicular artery venous plexus lymph vessels nerves connective tissues cremaster muscle and together all of these items form the spermatic cord next, the spermatic cord suspends the testes vast deference widens at the prostate and this forms the ampulla which joins the Seminole vesicles to form the ejaculatory duct ***** the sperm and the ejaculatory fluid and the vesicles form semen or ejaculate **** the accessory glands aid in the facilitation of ejaculation **** so these are two facilitate ****again the duct system is more of the creating side of the system the accessory glands are more of the facilitation ******so again the duct system creates, excessive accessory glands facility so these work in combination together to facilitate the ejaculation process sexual stimulation initiates the ejaculation process so when sexual stimulation occurs the sperm travel from the epididymis to the vast deference to the Seminole vesicles and the ejaculatory duct fluid from the prostate gland plus sperm plus secretions from Seminole vesicles all combined and the prostate fluid helps in a few ways so the prostate fluid helps decrease acidity of the ejaculate it also helps increase the motility of the sperm and it prolongs the sperm life and then additionally it helps balance the pH balance with the vaginal secretions the vaginal secretions in itself if it didn't have this condition of the prostate fluid the vaginal secretions would otherwise kill sperm so it helps the prostate fluid helps balance out the pH of everything to make a better environment for sperm to live and prolong through the process so we have the copra glands these are two pea size glands adjacent to the urethra they also aid in neutralizing the acidity as well and these are also considered accessory glands ****so they aid in the secretion and lubrication of the penis during sexual intercourse and then this secretion can also contain sperm from a previous ejaculation therefore this can also cause pregnancy ****so again the copra gland aids in the neutralization of acidity and they are also glands that aid in the secretion lubrication during sexual intercourse but this secretion can also contain sperm from a previous ejaculation therefore this secretion can cause pregnancy **** so in a new encounter or a new sexual encounter in which there is new ejaculation if there is a pull out prior to the ejaculation ***somebody can still get pregnant from their previous ejaculation if that makes sense so you have to be careful

normal male reproductive system

•Erection & ejaculation •Nitric oxide •Motor neurons & ejaculation •Composition of ejaculate Erections start in urtero and continue throughout the life of a man Penentraton of the penis during sexual intercourse is accomplished due to the ability of the penis to become erect Erection occurs from the parasympathetic nervous impulses in the spinal cord to release nitrix oxide; simultaneously sympathetic nerve fibers which cause constriction are inhibited The release of nitrix oxide leads to arterial dilation and blood fills in the corpra cavernosa and to a lesser degree the spongiosum of the penis shaft The erection is maintained due to compression and constriction of the veins which prevent outward blood flow The expulsion of semen is a result of motor neurons stimulating muscular contraction of the gland and ducts of the reproductive system During ejaculation a valve in the bladder closes to prevent urine from entering the urethra and killing the sperm Composition of semen: ejaculated semen contains sperm and secretions from the seminal vesicles, prostate and cowper glands One ejeaculation contains 300 million semen when a male is in utero, so they start as early as in utero and they continue throughout the life of a man and the reaction can occur with stimulation which results in a parasympathetic nerve impulse in the spinal cord to release nitric oxide the sympathetic nerve fibers that cause constriction are inhibited the nitric oxide leads to arteriolar dilation blood fills in the corporate cavernosa and penal shaft the filling of this tissue with blood then causes expansion of the erectile tissue the penis enlarges it elongates and then this is what we know as an erection so ejaculate occurs due to the motor neurons stimulating the muscular contractions of the glands and the ducts so that would be the ampulla the Seminole vesicles and the bulb cavernosus muscle ejaculated semen contains sperm and secretions and this equates to about 2 milliliters to 6 milliliters in each ejaculate within that two to six milliliters there is approximately 300 million sperm in one ejaculate there's about 300 sperm

Epispadias

•Exposure of urethral meatus inner lining •Occurs on dorsal surface of penis •Increased risk for UTIs •Occurs with urinary defects •Bladder exstrophy and EEC •Diagnosis: physical exam •Treatment: surgical repair Refers to the condition in which the urethral meatus inner lining is exposed and occurs on the dorsal surface of the penis instead of the end The urethral opening may extend entire length of the penis Additionally the penis may be shorter and wider or have abnormal curve Men with this have trouble propelling semen adequetly during ejaculation Both males and females with this have an increased risk for UTI Urinary defects such as bladder exstrophy, often occurs with this type of congenital condition Along with exstrophy, other organ systems such as the reproductive tract, digestive system, pelvic bone, and muscles are often exposed Exstrophy-epispadias complex refers to a spectrum of congenital abnormalities and occurs due to rupture of fetal tissue, leading to embryonic defect in abdomen wall development Diagnosis is typically made through physical exam Other procedures may be done to identify associated condition and determine the severity of this with an IV pylelogram, pelvic x-ray, CT, MRI and US of urinary system and genetial structures In males surgical procedures may use the foreskin to repair defect Urinary incontinence is common in post o patients Surgical repair of EEC may also include closure of the abdomen wall and urinary or intestinal diverson so we have the epispadias, this is a condition when the urethral meatus inner lining is exposed on the dorsal surface of the penis and not the end of the penis so again you can see in the picture up at the top it's on the dorsal surface the penis not the end of the penis so this opening might be the entire length of the penis shaft this can also occur in females and it's usually on the mediator on the clitorus this can is usually considered a congenital condition it does not cause infertility however because of the condition, semens, you have difficulty propelling during ejaculation so it can inhibit the ability or facilitate the ability for sperm to get where they need to be this also increases the risk for UTI in both men and women it can cause bladder exstrophy which is when all or part are outside of the body and it can also happen to other organs such as other portions of the reproductive tract the digestive system and you can even see pelvic bones and muscles that can occur with this condition so risk factors include parental history of epispadias or exstrophy maternal risk factors are young age of pregnancy high parity and smoking diagnosis: you'd want to do physical exam obviously intravenous pyelogram to see the flow up X-rays including pelvic X-ray KUB also CT scan MRI ultrasound of the urinary system and this can even be identified prenatally on ultrasound this is something for consideration treatment: they can have surgery with use of foreskin to repair the defect so urinary incontinence can result from this surgery so something that you want to make sure that it is discussed and possible options the goal is to protect the external structures the surgery may also incorporate the intestinal diversions and you might need multiple procedures to be cosmetically satisfied for the patient or aesthetically appealing so those are all considerations whenever you need to discuss further care with these patients

normal female reproductive system

•Fallopian tubes •Uterus: endometrium, myometrium, & perimetrium •Vagina structures The fallopian tubes are two cylindrical structrures that extend from the fundus to the uterus to near the ovaries The end of the tubes near the ovaries are fimbrated t capture the ovumn after ovulation The tubes use a ciliary and muscular action to move the ovum toward the uterus as well as assist sperm in moving from the utuerus toward to ovum that is likely still In one of the tubes Occasionally the zygot does not reach the uterus but becomes inplanted outside the uterus called an eptopic pregnancy Most common site for this is the fallopian tubes Uterus- the uterus is usually tilted forward anteverted over the bladder but it is tilted backward retroverted in 20% of women Usually can have symptoms of pain with intercourse or menstrual discomfort There are 3 layers The endometrium: the inner mucosal lining of the uterus which undergoes hormonal changes to facilitate and maintain pregnancy During pregnancy the placenta develops to nourish the fetus Myometrium: the middle layer of the uterus, consist of smooth muscle, and vascular system, during child birth the myometrium contracts to push the fetus out through the vaginal canal After child birth or abortion this layer constricts blood vessels to control bleeding Perimetrium: outer layer serous layer that covers the fundus and parts of the corpus but non of the cervix The incomplete coverage of this layer allows surgical access into the uterus without requiring incision into the peritoneum Mucus protects organism taveling up the urinary tract structure and mucus changes during ovulation and becomes more clear ans slippery and can be stretched between fingers Fallopian tubes these are two cylinder structures that extend from the uterus to near the ovaries they don't attached to the ovaries they're just to the end near the ovaries so at the end of the tube frimbiated or fringe like structure this fringe like structure aids and the acquisition of the ovum after ovulation so it helps take that ova and with the use of ciliary and muscular action it moves that ovum over to the fallopian tube if there is sperm there when that ova gets into the fallopian tube, it will mean a sperm and then carry down the rest of the fallopian tube and implant into the uterus but the fallopian tubes play a very large portion of the reproductive process the uterus is a pear shaped organ it's usually tilted forward or anti averted and it extends over the bladder about 20% of women they have a retroverted uterus meaning that it's tilted backwards there's three layers of the uterus there's an endometrium the myometrium and the perimetrium so the endometrium is the innermost layer and it undergoes hormonal changes to facility and maintain pregnancy so this is where the placenta attaches during pregnancy the myometrium is that middle layer to smooth muscle layer it's a vascular area and it usually is what contracts during childbirth so myometrium contracts and it helps push the baby out the perimetrium is the outer layer and it's more of a serious layer

hydrocele

•Fluid between tunica vaginalis layers or along spermatic cord ~ scrotal enlargement •Congenital (baby) or idiopathic (adult men) •Diagnosis: H & P, transillumination and US •Treatment: fluid reabsorption, scrotal elevation, Sitz baths, & heat/cold application A hydrocele is an accumulation of fluid between the layers of the tunica vaginalis or along the spermatic cord This condition effects one or both testes. A hydrocele often occurs as a congenital defect, affecting approxiametly 10% of new borns A congenital hydrocele usually disappears without treatment by 1 year of age In adults hydroceles are commonly idiopathic An acquired hydrocele occurs because of inflammation, infection, trauma and tumors Usually painless but scrottum feels heavy Fluid accumulation can be small or large, sometimes liters Daignosis: usually a history, physical exam (tranlumination light through tissue) and US In most cases hydrocelel resolves without any action other than treating the underlying cause Strategies can include reabsorption of fluid by a rolled towel, a sitze bath and heat/cold application Large amounts of fluid can require aspiration Surgical intervention occur when recurrent large amounts of fluid with aspiration hydrocele so this is accumulation of fluid between the layers of the tunica vaginalis which is a membrane over the testes and along the spermatic cord so this can affect one or both testes ***it's usually congenital defect that affects about 10% of newborns the vast deference doesn't close properly and the testes therefore descend into the scrotum and peritoneal fluid follows that whenever they descend ****so again this is usually congenital cause usually self resolves by about one years old an acquired hydrocele can be secondary to inflammation infection trauma and tumors and these are usually painless but they can have a feeling of heaviness in pressure from the amount of fluid accumulation and it can worsen over the day so if they're standing up frequently through the day all of that pressure can just kind of hang there and cause a lot of discomfort but a good way to check for diagnostic purposes it's the use of transillumination so you'll carry reference transillumination a few times through this lecture and what that is ***** if you take an otoscope to the scrotal area and you are able to see using the light see through the scrotum and then that means there's fluid in there ***if you shine the light on the scrotal area and it's just dark that means that's a tumor that's a dense area ****so again if you can see through it that means there's fluid in there so that's more reassuring ****if you're using the otoscope look in the scrotum and it's dark and that that means that it's more indicative of a tumor being in there more solid type of mass so you can use transillumination for a variety of things including like your sinus cavity I talked about that a few weeks ago when we addressed the respiratory system but this is helpful in determining what is fluid versus a tumor so other things that you want to do or consider would be an ultrasound and treat underlying causes so scrotal elevation you can roll a towel and put it in under the scrotum that's going to help take some pressure and heaviness off of that area you want to encourage kids baths which are warm water treatments that can help the rotation of heat and cold applications and then for large amounts that are extremely uncomfortable you want to consider aspiration of that fluid

PCOS

•In adults vs. adolescents •Symptoms reflect excess androgens •Diagnosis: H & P, hormone levels •Treatment: weight loss, hormonal therapy, additions to oral contraceptives There are 4 different types criterias in adults Phenotypes (classic PCOS) hyperandrogenism, polycystic ovary Pehnotype 2 - hyperandrogism with oligoanulation Pehnotype 3- hyperandrogenism with polycystic ovary but without ovulatory dysfunction Phenotype 4- oligo-anovulation The severity of hyperandrogenism, menstration disorders and symptoms decrease from phenotype 1 to phenotype 4 The criteria for adolescence: abnormal uterine bleeding pattern that is not explained by other disorders and is abnormal gynecologic development (symptoms persists greater than a year) Evidence of hyperandrogenism- persistant testosterone elevation moderate to severe hirishms and moderate to severe inflammatory acne Clinical manifestations: Skin maninifestations- hirishms, acne, and male pattern baldness, menstration disorders- infrequent menses, episodes of heavy bleeding, obesity, ovarian cysts usually multiple Diangosis and treatment: history and physical and hormone level A transvaginal US may reveal cysts An absence of cysts does not rule out PCOS Can do glucose and lipid abnormalitiy tests Treatment: weight loss with diet, exercise may improve symptoms and ovulation, hormone therapy, spironolactone- to lower androgen levels Metform to help with insulin restistancy risk factors include abnormal ovarian morphology elevated testosterone levels metabolic syndrome, insulin resistance and obesity, maternal history of PCOS clinical manifestation so that they usually have an increase in acne or facial hair body hair growth obesity, again abnormal menses ovarian cysts there are four different phenotypes to diagnose PCOS you have phenotype classic PCOS, phenotype 2, phenotype 3 and four you want to look at lipid panels A1C's check some hormonal levels like testosterone hormone FSH and estradiol to see where they stand hormonally so treatment would be Weight Loss Diet exercise hormone therapy fastest spironolactone can help lower not androgen so take that into consideration we utilize metformin a lot to help improve insulin resistance, that seems to help significantly and any other treatments that would have manifestations of this disorder

mastitis

•Inflammation of breast tissue: may be a/w infection & lactation •Symptoms: breast lumps, pain while breastfeeding, flu-like symptoms, nipple discharge, enlarged axillary lymph nodes •Diagnosis: H & P, cultures •Treatment: antibiotic therapy, adequate hydration, rest, analgesics, supportive bra Refers to an inflammation of the breast tissue that can be assossiated with infection and lactation This condition usually developes within 6 weeks of childhood and in most cases a staphyloccoal or streptococcal bacterium is introduced to the nipple through the breast feeding process Mastistis can occur through absence of lactation or breastfeeding Impaired nipple or skin integrity increases the likelihood of mastitis developing The infection usually invades the breast fatty tissue triggering an inflammatory response Clinical manifestations include breast tenderness, breast lumps, pain or burning sensation continuing or while breast feeding, flulike symptoms, nipple discharge, enlarged nearby axillary lymph nodes Diagnostic procedures for mastitis include history and physical and cultures of the drainage and or breastmilk Treatment strategies include antibiotic therapy, adequet hydration, rest, anaglesics, supportive bra, heat/cold application, needle aspiration Breast feeding is encouraged and safe during mastitis mastitis is an inflammation of the breast tissue from infection and or lactation for lactation purposes is usually within the first six weeks of having a child it's usually from staphtococcol or streptococcal species and this can be from impaired nipple and or skin integrity microorganisms invade the breast tissue whenever there is an impaired skin integrity it creates an inflammatory response so they have erythema warmth, that areas are edemous and painful they can have systemic symptoms if it gets bad enough so flu like symptoms nipple drainage, enlarged lymph nodes in the axillary areas so diagnosis it's usually clinical manifestations and physical examination you can do cultures but usually it's pretty promptly because they feel so lousy and most of the time they have newborn at home so they feel really lousy treatment hydration rest Tylenol ibuprofen supportive bra heat and cold compresses there's a bunch of old wives tale things that work for mastitis but we'll just leave these treatments to the textbook for right now scheduled milk expression and breastfeeding are strongly suggested that's going to help you get to regular rhythm and decrease some of those clogged milk ducts that might come along with this

Epididymis

•Inflammation of epididymis usually from ascending bacterial infections or STIs •Testicular tenderness, Prehn's sign (pain when lifting scrotum, penile discharge, infection s/s •Treatments include antibiotic therapy, analgesics, bed rest Described as inflammation of the epididymis, the duct connecting the testes to the vas deferens It is common cause of scrotal pain in adults Ascending bacterial infections or sexually transmitted infections usually initiate the inflammation process Bacteria most commonly assossiated with it is ecoli and pseudomonas aeruginosa Urinary tract infections particularly from obstructions due to benign prostatic hypertrophy or other urethral strictures are the most requent etiology in men >35 years of age Gohorrhea and claymdia can cause this Risk factors include- being uncircumcised, recent surgery or history of structural problems in urinary tract, urinary catherezation, sexual intercourse with more than one partner and failure to use a condom Clinical manifestation- indicators of infection (fever, malaise), testicular tenderness and edema; can develop scrotal wall erythema and fluid accumulation, prehn sign (elevating scrotum to relieve pain), penile discharge, bloody semen, painful ejeaculation, dysuria, and groin pain Diagnostic- do history and physical, urinarylysis, cultures (of urine and penile discharge) and STI testing for gonorrhea and chlamydia Treatment: antbitoic therapy, anaglesics, bed rest, scrotal support (wearing brief instread of boxers) and elevation, cold application and screening and treamnet of sexual partners epididymitis is an inflammation of the epididymis this is usually from ascending bacterial infections or STI so bacterial infections that go up the penal shaft, testicular tenderness, and a prehn's sign ***so a prehn's sign is pain when lifting the scrotum they can have penile discharge and any other systemic signs and symptoms of infection so nausea vomiting malaise fatigue you know feeling lousy and like I said any other signs and symptoms of a systemic infection again antibiotic therapy bed rest analgesics

gastritis

•Inflammation of mucosal lining of stomach •Acute gastritis: infections or autoimmune conditions •Chronic gastritis: a/w lymphocytes, plasma cells, & macrophages with process proceeding through phases to gastric atrophy •Type A or Type B, H. pylori •Symptoms: indigestion, heartburn, epigastric pain, nausea, vomiting, anorexia, malaise Refers to an inflmamtion of the stomach mucosal lining The inflammation can involve the entire stomach or a region Acute mucosal injurty can aos occur with minimal or no inflammation Gastritis can be either acute or chronic each type has its own presentation Acute gastritis is commonly caused by infection or autoimmune condition, the infections are due to H. pylori Most H. pylori exposure occurs in childhood and most infections are asymptomatic Neutrophil infiltration characterizes acute gastritis can be caused by internal or external irritantents Can be caused by alcohol, cocaine, other medication, stress, traumatic injurty burns Chronic gastritis: assossiated with lymphocytes, plasma cells, and macrophages, typically goes through phases Typically starts superficial, then inflammation extends deeper, and then glands are effected The final stage is gastric atrophy- during which glandular structures are lost Type A effects the fundus and the body of the stomach while sparing the antrum, and this is assossiated with autoimmune disorders Type B is usually result of H. pylori infection, inconstrast to A the stomach antrum is affected but he fundus and body can also be infected H. Pylori embeds the mucosal layer, activating toxicins, and enzymes that cause inflammation Long term use of NSAIDS can contrinbute to chronic gastritis by reducing cyclooxygenase a key substance that preserves the mucosal lining Can involve all or protion of stomach Can cause no inflammation Or it can be common It is often a result of H. pylori Transmitted through the fecal oral route Ecoli, streptococci and streptococcus Medication such as N said or stress from surgery Neutrophilic inflammation Chronic is suallly deper into the mucosal surface Grandular- the cells of atrophy flatting out Indigestion ,heart burn, malaise

Prostitis

•Inflammation of prostate: Acute vs. chronic •Categories: bacterial (acute/chronic), chronic pelvic pain, asymptomatic •Clinical manifestations include Dysuria, difficulty urinating, nocturia, painful ejaculation, others Refers to inflammation of the prostate which can be either acute or chronic May occur in a variety of conditions such as bacteria, sperm, trauma, stress and urinary catheterization that trigger the inflammatory process Normally the prostate has protective mechanism to prevent infection The most common pathogen that causes this is gram negative E. Coli Prostatitis occurs in younger and middle age men and those in immunocompromised states Classified into 4 categories Category 1- acute bacterial prostatitis usually in younger men, less common and due to sexually transmitted disease or UTI (e coli) Category 2- chronic bacterial prostatitis- usually a result from recurrent urinary tract infection, persist longer than 3 months Category 3-chronic prostatitis/ chronic pelvic bladder, no clear etiology, no bacteria present, most common and least understood, last longer than 3 months, can appear or reappear without warning Category 4- asymptomatic inflammatory prostitis, no bacteria present, may be assossiated with infertility Clinical manifestations- dysuria, difficulty urinarting such as dribbling, hesitancy, urinary frequency and urgency, nocturia, pain in the abdomen groin lower back, painful ejeaculation, indiciations of an infection (fever, chills) and recurrent urinary tract infection prostatitis so this can be acute or chronic it can be bacterial or it can be a chronic prostatitis sometimes they're symptomatic sometimes they have symptoms similar to that of urinary tract infection if you have a male who has symptoms of urinary tract infection and they're not really fitting the bill for a lot of things, this is one of the considerations that you want you think about There is a categorization, one through 4 typically clinical manifestations are similar to that of a UTI so you're having dysuria and difficulty urinating ***sometimes nocturia, painful ejaculation those are some of the biggest clinical manifestations

normal female reproductive system

•Intertwined with physiologic functions of structures in female pelvis The femal reproductive system is intimately intertwined with the physiologic functions of nearby structures in the female pelvis The female pelvis contains organs of the urinary and gastrointestinal systems along with organs for the reproductive system thus the female pelvis is the site for urination, deficiation, menstration, ovulation, copulation and parturition

endometriosis

•Lesion growth & formation from endometrium tissue outside uterus •Risk factors •Manifestations depend on severity with dysmenorrhea, low back pain, bowel dysfunction, others •Treatment: analgesics, hormone therapy, & surgical repair The endometrium tissues begins growing and froming lesions in the areas outside the uterus The endometrial lesions can be superficial or deep and are made of stromal and endometrial glands The abnormal endometrial tissues contrinues to act like normal endometrial tissue would during menstration- thickening, breaking down and bleeding- even though it is outside of the uterus Pain, cysts, scarring and adhesions develop because of the inflammation With the scarring and adhesion resulting in altered ovarian function, impaired fertilization and implamentation Risk factors include- early onset of menstration, late onset of menopause, nulliparity, short menses cycles (< 27 days), heavy menstrual bleeding, low body mass index, being tall, severe physical and sexual abuse during childhood or adolescence and disorders that obstruct menstrual flow Clinicla manifestations- dysmenorrhea- dull and crampy pelvic pain or pressure that begins before menses, last through menses, and can persist for a few days agter the end of menses, low back pain, bowel dysfunction, pain during or after sexual intercourse, infertility, adnexal mass, pain during vaginal exams, uterus and cervic immobility Diagnosis and treatment- made with history and physical and pelvic us A laparoscopy confirms the diagnosis Treatment is minimizing discomforting and focusing on childbearing potiential such as anaglesics, hormone therapy, surgical repair *** this is endometrial tissue that grows and forms lesions in areas outside of the uterus **so again these are explants of endometrial tissue outside of the uterus the most common places that we find this are in the fallopian tubes, ovaries, perineum it can be found elsewhere but those are the most common places and these lesions are estrogen dependent and they usually resist progesterone so as these areas continue to bleed outside of the uterus the blood becomes trapped and it irritates the surrounding tissues and that can cause increased pain it can cause increased cyst formation scarring that in itself can actually cause adhesions so all of these manifestations can occur later in ovarian function and can actually cause some infertility so there's many theories of why this is happening no one actually knows exactly why but genes and anatomy, immune response and parental influences all of these things are thought to contribute to it so risk factors one includes early onset of menstruation, late onset menopause, never being pregnant or nulliparity, a short menstrual cycle so less than 27 days, heavy menstrual bleeding low BMI all of these things are thought to play a factor clinical manifestations this usually happens between 25 and 35 years old as endometriosis increase it usually worsens so that's something for consideration they might have dysmenorrhea, low back pain, bowel changes, urinary changes, pain with intercourse again infertility adnexal masses pain during vaginal exam and uterus or cervical immobility or displacement on pelvic exam

infertility treatment

•Lifestyle modifications •Endocrinopathies •Metformin •Intrauterine insemination •In vitro fertilization Treatment for infertility include, life style modifications (weight loss, stress reduction, and smoking), endocrinopathies (HCG, GnRH, testosterone, estrogen), estrogen recptor blockers , dopamine agonist, gonadotropins, metformin making ovulation more likely to occur, intrauterine insemination, tubual and uterine tumors/adhesivation, and in virtro fertilization

mammory glands

•Mammary glands: role in sexual arousal & nourishing newborn, prolactin Mammary glands are in the breast Each breast contains 15-20 clusters of milk-secreting mammary glands that open into the nipple Prolactin from the anterior pitutuay prompts milk production so mammory glands, they're specialized Organ they present pairs so one on the left breast, one on the right breast they are in the anterior chest wall and their primary function is secretion of milk

Candidiasis

•Men: white curd-like exudate, pruritis, erythematous small papules or white patches on the penis & foreskin •Diagnosis: in-office microscopy •Treatment: antifungal agents, perineum care, prevention strategies •Conditions for more complicated infection men have similar symptoms such as white curd like exudate, purities and erythematous small papules or white patches on the penis and foreskin Diagnosis and treatment: diagnosis most often made clinically but is best evaluated with in office vaginal microscopy The vaginal discharge is placed on a slide and KOH is added to the slide, the KOH destroys cellular elements so that candida infection can be visualized A culture of the discharge can be performed Treatment focuses on restablishing normal flora balance and miniminizing tissue irritation as well as increasing comfort Treatment can include antifungal agents, perineum care (cleaning from front to back), avoidance of douching, resisting the urge to scratch Practice safe sex, avoidance of feminine hygine sprays, wearing cotton underwear, avoiding nylon underwear, controlling blood glucose, and eating yogurt with live cultures or probiotic tablets Symtoms in healthy non pregnant indviduals can be treated at home but should not be managed at home if more severe symptoms, fever pelvic pain, patient has a negative history of candidiasis, pregnancy, immunosuppression or uncontrolled diabetes mellitus, vaginal infections, patient has reoccurent infections so usually we see a thick white vaginal discharge it can be considered curd like and it's usually not odorous the vulva seems to be erythemdous and edemodous there's sometimes white patches on the vaginal wall they might experience dysteria or painful sexual intercourse so you'll see a lot in Women's Health and in gyne offices they use a lot of microscopic evaluation because it gives them a very quick specimen collection through a gynecologic exam then they usually take that over for the amount of wet slide we're able to look at that growth under a microscope and that helps them identify what species they're dealing with treatment is usually antifungal through oral or topical usage you want to encourage perineal care avoid douching you want to decrease any itching or scratching you would encourage safe sex, avoid feminine sprays, fragrances powders or lotions to that area you want to avoid tight fitting clothing and you want to promote the use of cotton underwear should control blood glucose of somebody diabetic and increasing your yogurt uptake will actually help build that normal flora backup

abnormal uterine bleeding

•Menstrual bleeding abnormality in: frequency, blood volume, duration •New & revised terminology •Chronic/acute AUB •Heavy menstrual bleeding (HMB) •Intermenstrual bleeding (IMB) •Amenorrhea Abnromal uterine bleeding is defined by a menstrual bleeding abnormalility in the requency of a cycle, volume of blood loss, or duration of flow Aub- also inclues precocious puberty- menstrual bleeding prior to the usually start of menses AUB is generally present as vaginal bleeding and refers to the uterus as the source of bleeding The new terms replaced commonly used terms such as menorrhagia, metrorrhagia, polymenorrhea and hypermenorrhea which lacked clear definitions and lead to confusion pertaining to diagnosis and treatment Menstrual bleeding key classification include Chronic AUB- uterine bleeding that has abnroaml in requency, regularity, duration and or volume for at least the majority of the past 6 months Acute AUB- a single episode of the uterine bleeding that is of sufficient quanity to require immediate intervention to prevent further blood loss Heavy menstrual bleeding (HMB)- increased menstrual volume as described by the women and that interferes with various aspects of her life Intermenstural bleeding (IMB)- menstrual bleeding that occurs between regular, well defined cyclical menses Amenorrhea- abscnece of menses abnormal uterine bleeding we started using some new terminology to describe abnormal uterine bleeding previous terminology that we used to use, we no longer use because it's outdated it was difficult to really understand why patient was having abnormal uterine bleeding so the terms you like hyper amenorrhea, dysfunctional uterine bleeding all of these terms are no longer used and we use abnormal uterine bleeding or AUB we also have heavy menstrual bleeding which is HMB and intermenstrual bleeding which is IMB and then again we still use amenorrhea as well so chronic AUB is uterine bleeding that is abnormal and frequency for six months acute AUB is a single episode of uterine bleeding in someone who is not pregnant but of reproductive age and this requires immediate intervention for cessation of blood loss we have menstrual bleeding which is increased menstrual volume either daily or total volume for the month and this interferes with many aspects of life you have intermenstrual bleeding which is bleeding that occurs between regular defines cyclical menses and this can be random or predictable amenorrhea which is absence of menses

cleft lip and palate

•Most common congenital craniofacial malformation apparent at birth •May be unilaterally or bilaterally •May influence development with feeding, hearing, & speech difficulties Cleft lip and cleft palate are the most common types of congenital craniofacial malformations that appear at birth Such defects are assossiated with genetic mutations, maternal diabetes, drugs, toxicins, viruses, vitamin deficiencies, alcohol consumption and cigarette smoking Males are twice as likely than females to have cleft lip but females are twices as likely as males to have cleft palate Cleft lip and cleft palate can effect individuals face and may lead to feeding issues, speech problems, ear infections and hearing problems Clinical manifestations include, may appear unilaterally or bilaterally The defect can result from failure of the maxillary process and nasal elevation or upper lip to fuse during development Cleft palate results from failure of the hard and soft palate to fuse in development creating an opening between the oral and nasal cavities In addition to lip and palate defomrities, teeth and nose malformations may be present An infant with cleft lip or cleft palate is at high risk for aspiration and also impaired speech development Cleft lip occurs 1 in every 26 births And palate is 1 in eveyr 44 births Usually around 4-9 weeks of gestation is when this occurs Is with maternal diabetes and genetic factors Different viruses Vitamin deficiencies and maternal smoking Effects facial appearances Feeding issues and speech problems, ear infections and hearing

breast cancer

•Most common malignancy in women •Risk factors: FH & genetic predisposition •Clonal disease & hormonally dependent Most common malignancy in women and the second leading cause of cancer death in women While breast cancer can occur In men, its highest rates are in women Risk factors for breast cancer include early menarche, late menopause, nulliparity or pregnancy after 30, and no history of breast feeding A family history and genetic predisposition of breast cancer can increase the risk Obesity and alcohol consumption Exogenous estrogen exposure, oral contreceptives, hormone replacement, may increase risk for breast cancer Breast cancer is a clonal disease- cells reproduce due to combination of an inhereited germline cell variation that causes suspectability to breast cancer development and somatic cell mutation, along with environmental causes that can cause cancer to reproduce Breast cancer is a hormonal dependent disorder- inherited defective genes particular BRAC1 mutation can cause breast cancer in up to 80% of women and ovarian cancer in 33% of women so breast cancer is the most common malignancy in women and the second leading cause of cancer death in women it can it can actually occur men and women it increases with age it's usually those over 50 but there are many who experience breast cancer and there are twenties 30s sometimes 40s so abnormal cells reproduce due to a combination of inherited cell variations and susceptibilities along with environmental factors Brac 1 can cause breast cancer in up to 80% and ovarian cancer in up to 33% those who are positive for brca one are almost always negative for receptors of estrogen progesterone and human epidermal receptor 2 or HER 2 this would be considered a triple negative cancer which is extremely aggressive so risk factors include early menarche which is an early menses, late menopause multiparity which is a pregnancy after 30 years old or actually never having a child, never have breastfed a child increases your risk a little bit chest wall radiation from some other cause previously a family history of inherited breast cancer so brac one and two positive obesity excessive alcohol excessive alcohol is quantified as one to two drinks a day, exogenous estrogen exposure so oral contraceptives and then some breast cancers there's just no identifiable cause

chlyamdia

•Mucopurulent endocervical discharge, cervical friability, purulent vaginal discharge, penile discharge •Complications •Diagnosis: screening & Nucleic acid amplification testing (NAAT) Treatment: antibiotics Complication of untreated chlaymid can include pelvic inflammatory disease which can lead to infertility and chronic pelvic pain Diagnosis and treatment; because of STI high prevalence and potiential to cause neonatal complications, it is recommended that all pregnant women be screened for chlamydia and be screened if found to be positive Diagnosis is made with history and physicial examination, the source can be accomplished by urine swabs or swabs of the genitourinary tract- vaginal, endocervicle, or urethral Diagnostic technique that is most accurate and considered gold standard is the NAAT testing (Nucleic acid amplification testing (NAAT)) Treatment can consist of antibiotics such as azithromycin or doxyclycine Erythromycin or quinolones are alternative choices Gonorrhea often coincides with chlamydia Sexual partners usually those within 60 days prior to infection should be screened and treated usually they're asymptomatic in both females and males it commonly infects the cervix causing cervicitis in men it's usually the urethra that has the chlamydia in it and is coming only sexually transmitted through the epididymitis or prostatitis it's associated with public inflammatory disease in women usually there's market mucopurulent endocervical discharge cervix friability bleeds easily there was a patient once I had and was doing a gyne exam on her and as soon as I put the speculum in and saw her cervix, it looked raw and it just started bleeding as soon as we put the speculum in it was terrible I'll never forget that but it's completely cervix friability usually looks pretty raw red irritated they'll have post coital bleeding usually dysteria painful intercourse rectal pain sometimes from the pressure you can actually do urine sample or swab for the Gu tract ***gold standard for chlamydia is a nucleic acid amplification testing or a Nat through urine vaginal or endocervical specimens you would not check antibodies with this because antibodies can take several weeks to become positive treatment if left untreated it can cause PID which can also affect infertility you can have a reactive arthritis or writer syndrome especially in men it's a triad of symptoms like urethritis arthritis and uveitis (which is of the iris and your eye) antibiotics it would be azithromycin, doxycycline erythromycin any of the quinolones you should avoid sexual intercourse until seven days after the completion of antibiotic therapy usually there's a Co infection with gonorrhea with this any sexual partner within the last 60 days should also be screened and treated cure testing is not necessary after treatment unless somebody's pregnant when someone is pregnant usually they check a bunch of items and it's anyone who's pregnant not just any specific high group or high risk group so anyone who's pregnant usually gets and tested for chlamydia and gonorrhea in addition to you know blood type CBC and whatnot but usually this is included in the prenatal screening

genetial herpes

•Multiple painful vesicular lesions followed by a period of herpes genitalis antibody formation •Recurrent herpes genitalis: reactivation of virus & blister at same site •Triggering factors •Diagnosis: viral cultures for vesicle fluid •Treatment: stress reduction strategies, avoid sex during outbreaks, & prevention Clinical manifestations are dependent on whether the lesions occur shortly after being infected for the first time, whether the lesions occur for the first time after antibodies have developed or whether the lesions are due to recurrent infection Primary herpes genitals begins at the actual time of infection and antibody development The exposure ranges from 2-12 days Usually painful, mildly painful or completely asymptomatic cases Usually see 1-2mm vesicles that can be prurlitic and accompany malaise, low grade fever and groin lymph node enlargement Viral shedding happens during first stage making transmission more likely There is a phase where antibodies form- they make recurrent episodes less severe The individual is asymptomatic while the virus is dorment Recurrent herpes is characterized by reactivation of the virus and clinical manifestations The virus travels back down the nerve root at the same site of the first stage Duration of lesions is usually shorter viral shedding happens in 5 days Diagnosis and treatment: diagnsosi is based on history and physicial, and confirmation of labatory testing If lesions present than vescular fluid should be sent for viral culture Treatment options include antivral medications that suppress the number of outbreaks as well as minimize the severity of the diration Should avoid triggers such as stress, implement stress reduction strategies Sexual activitiy should be avoided during outbreaks of lesion because highly transmissible Prevention strategies include safe sex such as limiting sexual partners and putting on condoms So this is what it looks like this is also what shingles looks like So shingles resembles this this is it's painful, they're quite painful actually and they're little vesicles that form you want to make sure that those don't break open because that does increase the risk of them spreading you want to treat with stress reduction avoid sex during outbreak times and you want to try to prevent as much as humanly possible

pyloric stenosis

•Narrowing & obstruction of pyloric sphincter •Within several weeks of birth: hard, olive-shaped mass in abdomen a/w vomiting, persistent hunger, regurgitation, belching, FTT, other s/s Pyloric stenosis is also known as infantile hypetrophic pyloric stenosis Is the naorrowing and obstruction of the pyloric sphincter Th epyloric sphincter muscle fibers become thick and stiff making it difficult for the stomach to empty food into the small intestines The condition can present at birth or it may develop later in life Most cases present at approximately 3 weeks of life Clinical manifestations of pyloric stenosis is usually appears in 3-6 weeks after birth In the congential form the hypertrophied pyloric muscle can be palpated as a hard olive shape mass in the abdomen The patient will also have vomiting often projectile after feeding and is usually the first noted symptom Additional manifestations include persistant hunger, regurgitation, belching, abdominal pain, failure to gain weight and wavelike stomach contractions that result from the sincreasd peristalstic effects to pass food through the narrowed areas Pyloric stenosis is narrowing, can appear up to 6 months of age, usually 3 weeks old Causes is unknown mother use of azithromycin might contriute to this Usually by 3-6 weeks old Can plapate a hard olive shape mass in the abdomen Projectile vomiting, it is far vomit Persistant hunger because they are not eating a whole not Appear to be pretty uncomfortable Fialure to gain weight Hear abdomen without stethoscope Bili might be high Not producing wet tears or dipers

ovarian cancer

•No reliable screening test, difficult to treat, & often metastasized at diagnosis •Mostly form in epithelial cells •Risk factors: genetic predispositions, advancing age, infertility or nulligravida, excessive estrogen exposure, obesity, & androgen hormone therapy Realtively common cancer in women according to the American cancer society Ovarian cancer incidence rates have declined but remain the 5th leading cause of cancer death in women Ovarian cancer causes a concern because there is no reliable screening test for this disease, it is often difficult to treat and it has often metasized at the time of diagnosis Advancements in treatments are improving the survival rates Most ovarian cancers form from epithelial cells and a remainder are from other cells Risk factors include genetic predisposition (defects on BRAC 1 and BRAC2 genes), advancing age, infertility or nulligravid, excessive estrogen exposure, obesity, ad androgen hormone therapy rates have declined but it continues to remain the fifth leading cause of cancer death in women there's no reliable screening for ovarian cancer at this time so it's difficult to treat because by the time it's usually identified there's already metastases so some risk factors are someone who is positive for BRAC 1 and 2 you wanna take into consideration usually we will get BRAC 1 and 2 for breast cancer but there is strong correlation between someone who is BRAC 1 and 2 positive and there they have a significant increased risk for ovarian cancer as well not just the breast cancer so other risk factors including advancing age infertility Nula gravity which is someone has never been pregnant, excessive estrogen exposures obesity androgen hormone therapy as well ***clinical manifestations bloating like a chronic abdominal distension or bloating is one of the key clinical manifestations eating disturbances urinary changes bowel changes malaise menstrual changes so diagnosis would usually be on pelvic and transvaginal ultrasounds CA-125 so CA-125 is a protein that is produced in response to several conditions and ovarian cancer is one of those ***several conditions that we use the C125 level with that being said it it's not specific to ovarian cancer so if it's high is it ovarian cancer causing it to be high or is it some other unidentifiable issue in addition to that it can be increased for non-cancerous causes so if there's an inflammatory process going that can also raise the CA 125 *** so again we utilize CA 125 a lot actually but it's not specific to ovarian cancer but with that being said whenever someone is has proceeded with treatment for ovarian cancer we do use the CA 125 to evaluate for a favorable response to their treatment plan **so again when the CA 125 level declines during treatment for ovarian cancer this demonstrates to us as providers that there is a favorable response so again pelvic and transvaginal ultrasounds biopsies if we can surgical intervention-so this would include felengetomy, oophorectomy so that would be a removal of the fallopian tubes plus ovaries and usually the hysterectomy as well so there is some indication that some of the ovarian cancer actually starts in the fallopian tubes but it's rarely identified that early so that's still a determined but that's part of the reason why they usually take the fallopian tubes as well because they it seems to be that there is a chance that these ovarian cancers actually start from the fallopian tubes **** so again tubes ovaries and history in addition to that chemotherapy as well if needed

Normal Male reproductive system

•Organs involved in generation & transportation of sperm •Penis, Scrotum, Testes The male reproductive system includes organs involved in the generation and transportation of sperm These organs include the penis, testes, scrotum testes, duct system and accessory glands In addition to producing sperm, the male reproductive system produces sex hormones that give male distinct features such as facial hair, muscle mass low pitch voice Parts of the male reproductive system work with the urinary system to aid in urinary elimination Penis: the part of the male external genitalia, and contains erectile tissue that fills with blood during sexual arousal The penis deposits sperm into the female reproductive system during sexual intercourse The penis structure includes the root, shaft and glans Average is 2-5 inches when flacid and 4-7 when erect A Sheath of loose skin, called the foreskin cover the glans penis at birth The foreskin is often removed surgically for hygenic, cultureal and religious reasons If foreskin not removed than can become fully retactable by age 3 Smegma is an oily secretion from the glans that forms a cheesy substance Scrotum- fibromuscular sac of skin below the penis that contains the testes, epididimus and lower spermatic cords The scrotum maintains the proper testicular temperature for spermatogenesis by contracting and drawing the testes closer to the body to warm them and drop the testes further from the body to cool them Testes- produce sperm and the sex hormones testosterone and androgen Spermogenois developes in most males by 16 The Sertoli cells are what produces sperm, usually takes about 70-80 days to develop The sperm then travels to a figure like projection on a posterior portion of the testes called the epididymis Male reproductive system includes the testes epididymis faceprint sex accessory glands urethra penis and testes and scrotum the male reproductive system includes organs involved in the generation and transportation of sperm

normal female anatomy

•Organs involved in: generation & transport of eggs for fertilization, support of fetal development, birth of fetus, & feeding of offspring The female reproductive tract is a complex system that includes organs to manage and generate eggs, transportation of eggs for fertilization, support of fetal development, birth of the fetus and feeding of the offspring through lactation To accomplish all these the female reproductive system requires a delicate hormone balance and operational organs These organs include ovaries, fallopian tubes, uterus, vagina, external genitalia and mammory glands The hormones produced by the female reproductive system gives females their distinct characteristics so this includes ovaries fallopian tubes the uterus vagina external genitalia mammary glands and hormones specifically estrogen and progesterone so in the men we focus more testosterone in women it's more estrogen and progesterone

dysmenorrhea

•Painful menstruation •Primary vs. secondary •Effects of excessive prostaglandin secretion •Diagnosis: H & P, pelvic US, laparoscopy, & hysteroscopy •Treatment: analgesics, oral contraceptives, & heat application Is pain during menstration Most women experience mid to lower abdominal cramping during menstration but with this the cramping and pain impairs usual daily activities Primary dysmenorrhea may appear in early maenarche and often has no known epitology It also appears later in life secondary to a number of conditions such as endometriosis, or reproductive cancer In many cases, the condition resolves following childbirth an decreases with age The pathogenesis of dysmenorrhea particularly primary is excessive prostaglandin secretion which produces strong uterine muscle contraction and blood vessel constriction intensifying uterine ischemia assossiated with mesntration Clinical manifestation: can have abdominal pain that radiates to the back and legs and perineum, can have strong intermitten back pain, nausea, vmitting, headache, diarrhea and dizziness Daignosis procedure- a history and physicial, pelvic US, laproscopy and hysteroscopy Treatment involves focusing on relieaving the discomfort and resolving the underlying eptiology Can give NSAIDS< because they inhibit prostaglandin secretion, oral contreceptives and warm bath and heat application dysmenorrhea is painful menstruation it's cramping pain that affects daily living it usually starts at the conclusion of ovulation so from around 14 continuing up until menstruation so from day 14 to day 28 some people have this dysmenorrhea and there's no known cause usually tends to decrease or resolve after someone has experienced childbirth and it usually decreases with age but that's not in all cases so they believe that it has something to do with excessive prostaglandin secretion which increases uterine contraction and that's what's promoting these painful cramping and abdominal pain episodes it can be secondary to other conditions such as endometriosis or reproductive cancers you want to do a pelvic ultrasound sometimes laparoscopy or hysteroscopy to determine if there are any other identifiable causes that are causing this treatment is usually trying to aid in the relief and the discomfort and NSAIDS work really well because they affect the gyne-receptors they inhibit prostaglandin secretion so NSAIDS work very well oral contraceptives will help prohibit ovulation so you can stop that the ovulation through an oral contraceptive which would in turn help decrease the pain associated with ovulation and then again heat and warm baths will also help

Phimosis & Paraphimosis

•Phimosis: foreskin cannot be retracted from the glans penis •Paraphimosis: foreskin is retracted & cannot be returned over glans penis •Manual reduction or surgeries for paraphimosis •Circumcision, topical steroid cream, & foreskin stretching for phimosis Occurs when the foreskin cannot be retracted from the glans penis Physiological phimosis- not being able to retract the foreskin- is common in the first 3 years of age but the foreskin should retract as the child grows Pathologic phimosis can result from poor hygiene, infections, and inflammation Elderly men are at risk due to loss of skin elasticity and infrequent erections Can lead to urinary obstruction and pain Paraphimosis refers to condition in which the foreskin is forcefully retracted or when the patient or caregiver does not replace the foreskin during hygiene The penis becomes restricted and the gland becomes edemdous If not resolved there can be a lack of blood flow and can lead to local skin necrosis and rarely infarction and gangrene making it a medical emergency Treatment: includes manual reduction which requires pain control and swelling reduction or surgeries such as emergency circumcision and dorsal slit reduction which involves cutting a slit band on foreskin Elective circumcision can be considered after treatment of paraphimosis Phimosis can be treated with topical steroid cream, foreskin stretching and circumcision So phimosis and paraphimosis phimosis is foreskin cannot be retracted from the penis so during the first three years of life this is very common but it should become retractable as a child grows so some causes include poor hygiene infections inflammation some who are at increased risk for this occurring or elderly man due to loss of elasticity and more infrequent erections as time goes in life and this can also cause urinary obstruction and sometimes be painful for them so treatment considerations would be circumcision if they are not circumcised which is usually the case some topical steroid creams and utilizing some foreskin stretching might be helpful in this situation so paraphimosis is foreskin is retracted but they're not able to return it over the penis so the penis becomes constricted and therefore creating it to become swollen because there's so much construction so if it's not resolved this can lead to decreased blood flow even chemically lead to local necrosis, infarction, gangrene this would be considered a medical emergency that needs further intervention so you try to do manual reduction but it's not always helpful so therefore you would want to try an elective circumcision with the dorsal slit to help reduce some of that some of that swelling that's caused

premenstrual syndrome (PMS)

•Physical & emotional symptoms affecting women during menstrual cycle •Clinical manifestations: irritability, depression, fatigue Premenstrual syndrome refers to a group of physicial and emotional symptoms that affect women during the menstrual cycle Most women experience symptoms similar to PMS Criteria for PMS is prescence of one or more symptoms that can cause dysfunction 5 days before menstrauation and is present for three consecutive menstrual cycles PMS occurs in women in their late 20's to early 40's who have at least one child, a personal or family history of major depressive disorder and a history of post partum depression or effective mood disorder Clinical manifestations- include irritability, depression, mood swings, fatigue, heafahce, abdominal bloating, changes in bowel pattern, joint pain, breast tenderness, weight gain, and sleep distrurbances this is a group of physical and emotional symptoms during menstrual cycles primarily incidents is around 20 to 40 years old unclear reason why this happens some of the clinical manifestations include irritability depression mood swings fatigue headaches abdominal bloating joint pain breast pain weight gain sleep disturbances a more severe form of PMS, PMDD or premenstrual dysphoric syndrome and this is severe depression, severe tension, a lot of irritability which can happen so for diagnostic purposes, you do you know history and physical criteria for PMS is at least one symptom about five days before menstruation and present for three consecutive menstrual cycles

normal male reproductive system

•Production of sex hormones •Testes •LH, FSH, and inhibin •Testosterone The male sex and reproductive hormones are controlled by the hypothalamus, pituitary and other negative feed back systems Neurotransmitters such as noroepi stimulate gonadotropin releasing hormones from the hypothalamus The hypothalamus secretes Neurotransmitters serotonin and dopamine inhibit the gonadotropin releasing hormones The testes produce hormone sin their Leydig cells GnRH stimulates in a pulsatile fashion which cause the production of luteinizing hormone (LH) and follicle stimulating hormone LSH LH- stimulate Leydig cells to produce and secrete testosterone (about 5-7mg a day) FSH- stimulate Sertoli cells and promotes spermatogenesis Inhibin: secretes seteroli cells causes inhibition of FSH, which leads to reduction in spermatogonia Testosterone is one of the main male sex hormones Others is DHT and estradoil hormones that regulate LH secretion Testosterone and DHT directly inhibit LH secretions from the pituitary gland while estradoil inhibits LH but does so by inhibiting GnRH from the hypothalamus The process of testosterone synthesis in the Leydig cells occur in multiple steps Testosterone in plasma is mostly bound by sex hormone binding globulin (SHBG) and albumin SHBG has a stronger bind to testosterone than albumin Serum SHBG increases with age and there fore less testosterone is available as males age Testosterone and metabolites give males there secondary sex charactersitics and sexual function Testosterone also regulates metabolism and protein anabolism, promotes potassium escretion and renal sodium reabsorption the male reproductive process includes producing sperm and sex hormones which is mostly testosterone and this gives men their characteristics such as facial hair muscle mass and low pitch voice they also have luteinizing hormone with the secular stimulating hormone inhibin but those are mostly female hormones with the men were primarily looking at the testosterone

Priapism

•Prolonged, painful erection: Nonischemic or ischemic •Blood, circulatory, & nervous dysfunction •Diagnostic procedures to identify priapism Is prolonged painful erection The unwanted, unrelented erection is not a result of sexual stimulation Priapsm usually results from too much blood shunting within the corpus cavernosum Nonischemic- is usually caused by penile or perineal trauma The more common type of pripasm is due to blood becoming trapped in the penis In ischemic- the smooth muscles relaxation is impaired causing a compartment syndrome Nitroxic oxide dysfunction may be a mechanism for some priapism disorders Priapism occurs in conjunction with variety of blood, circulatory, and nervous dysfunction such as sickle cell, leukemia and other hematologic disorders, trauma, tumors, diabetes, spinal cord injuries, neurologic disease, medication (such as PD5 Inhibitors), alchol and illicit drugs and poisonous venom Diagnostic- include history and physicial, penile arterial blood gas, CBC, and toxicology test With ischemic- a doppler US to show minimal or abscent blood flow Other test can include CT and MRI for tumors An erection lasting longer than 5 hours is a medical emergency Treatment focuses on management Strategies for ishcemica include needle blood aspiration, injection of medication directly into penis and surgical placemtn of shunt Treatment for non ischemic include cold application, lower abdominal pressure and surgical repair of trauma Interventions for both include analgesics, sedation, hydration and urinary catheterization priapism is a prolonged and painful erection it's usually something that's lasting greater than 4 hours, it's not always from sexual stimulation but more of an issue with the blood shunting within the corpus cavernosum so some sometimes people refer to this as non-ischemic or high flow prior prism and this is usually from a penal or perineal trauma the most common cause is blood becoming trapped in the penis which is like a compartment syndrome so if you think about compartment syndrome there's an increased pressure in a confined space this is exactly what that is so you usually see this in older but younger children so like 5 to 10 year olds and then you'll see it kind of lay low for a little bit and usually again around 20 to 50 year olds as well there are some processes that involve the blood or circulatory system and sometimes the nervous system that makes this a little bit more likely for these patients and that includes those who have sickle cell anemia leukemia some who have urologic procedures in the past people who are competitive bikers with them sitting in that biking seat that can really cause a lot of issues with the genito-urinary and perineal areas so you can see a lot of issues that stem from those prolonged bike rides on a hard surface that can really play a factor for those competitors tumors diabetes spinal cord injuries those with neurologic diseases such as strokes and multiple sclerosis like we talked about earlier some medications like anticoagulants and anxiety medications can increase the risk for this alcohol and drug use and then also poisonous venom diagnosis so history and physical you want to check a CBC on them just to make sure that there's nothing else

amenorrhea

•Secondary •Normal causes ~ pregnancy •Pathological causes ~ PCOS Secondary causes- defined as absence of menses for more than 3 months in a female who had a irregular menstrual cycle before Oligomenorrhea is defined as fewer than nine menstrual cycles per year or a cycle length longer than 35 days The most common cause of secondary amenorrhea is pregnancy during reproductive age and menopause (average onset 51) Lacation will also cause amnorrhea Pathologic causes of secondary amenorrhea include hypothalamus, pituitary, ovarian, or other genital tract disorders Hypothalmic and pituitary disorders could be due to tumors and infiltrative diseases Functional hypothalamic amenorrhea due to the same causes as in primary amenorrhea can cause secondary amenorrhea **polycystic ovarian syndrome is a complex disorder with multiple hormone alterantion and can be a cause of secondary amenorrhea secondary amenorrhea is the absence of menses for more than three months and a female who has had regular menstrual cycles or absence of menses for six months in a female who has had irregular Menses So things that you need to discuss and talk about with your patients is the specifics of their menstrual cycle make sure they're tracking things appropriately that helps us be able to identify where some issues may lie PCOS is polycystic ovarian syndrome this is a disorder and it has a lot of hormonal influences but that can also be the cause of secondary amenorrhea

hiatal hernia

•Stomach section protrusion through diaphragm into thoracic cavity •Types: Sliding hernia (type I) and Paraoesophageal (types II, III, IV) •Symptoms: inflammation of esophagus & stomach especially then in recumbent position, eating, bending over, & coughing •Influencing factors: congenital malformation, trauma, age, smoking, & other iatrogenic factors Occurs when a section of the stomach protrudes upward through an opening in the diaphragm into the thoratic cavity There are two categories of hiatal hernia Sliding hiernia (type 1) and paraesophogeal hernia (types II, III, and IV) A sliding hernia is the most common and accounts for 95% of the cases With a sliding hernia the GE junction is displaced above the diaphragm, the stomach remains asligned and the stomach fundus remains below the GE junction With paraesophogeal hernias the GE junction remains below the diaphragm and the stomach fundus herniates throught the hiatus These type of hernias can result in both the GE junction and the fundus herniating When there is large opening the stomach and organs can herniate The causes of hernias are not clear, however they are more likely to occur as a result of laxity of the ligamnets that hold the stomach in place Factors that contribute to sliding hiatal hernias include increased intrathoracic pressure such as coughing vomiting or straining or increased intra-abdominal pressure (pregnancy or obesity) Clincial manifestations include of a sliding hernia are inflammation of the esophogus and stomach due to reflux, these manifestations can be indigestion, heartburn, frequent belching, nausea, chest pain, stricutres and dysphagia Manifestations worsen with recumbent positioning, eating, bending over and coughing Sliding hiatal hernia Parasophogeeal has 3 different types Sliding is the most common type The gastroesophogeal junction is disrupted Sometime sthey have no symptoms at all Can be having clinical manifestations that are progressive such as hard time breathing Straining to deficate pegnancy and pbestity can cause hernias Trauma and smoking Some are small and can go undetected some can be large and cause a lot of irritation Can hev strangulation with painadngoinf to er for surgery

introduction

•Structures responsible for consumption, digestion, and elimination of food • •Alimentary canal: food is passed through • •Accessory organs: aid in digestion The Gi tract or digestive system consists of structures responsible for consumption, digestion and elimination of food The processes provide the essential nutrients, water, and electrolytes required for the body's physcolgic activities Structures include alimentary canal through which food passes and accessory organs that aid digestion Alimentary canal incudes the oral cavity, pharnx, esophogus, stomach, small intestines and anus The accessory organs include the salivary glands, liver, gallbladder, bile ducts and pancreas Lecture: Consists of structures fo consumption, digestion and eleimation of food Include the alamentry canal and this includes the oral cavituy, esophogus, stomach, small and large intestines and the anus Accessory organs include the salivary, the liver the galbladde and the pancreas It does not eleaberate too much Anatomy and phys Compose of 4 layers

disorders of the pelvic floor

•Supportive structures: muscles, ligaments, & fascia weaken with age, excessive stretching, obesity, & trauma •Categories of pelvic organ prolapse •Symptoms: asymptomatic or r/t prolapse organs •Vaginal, urinary, defecatory, and sexual dysfunction muscles, ligamnets, and fascia normally support he bladder, uterus and rectum in female pelvis These supportive structures weaken with age, excessive stretching, obesity and trauma Decreasing hormone levels at the onset of menopause can further atrophy these structures With weakened support the organs can shift out of normal position causes pelvic organ prolapse There are 3 categories Anterior compartment prolapse- usually assosicted with cystocele Posterior compartment prolapse- usually assossiated with rectocele Apical compartment prolapse- usually assossited with uterine and cervical prolapse or the vaginal vault after hysterectomy Clinical manifestations- women can be asymptomatic or have symptoms relating to the prolapse organs Pelvic organ prolapse can often cause vaginal, urnary defecatory and sexual dysfunction Most women complain of vaginal or pelvic pressure and report a sensation of something coming out of their vagina The urinary symptoms are result of the organ kinking the urethra Due to variable obstruction symptoms, changing positon or splinting may improve uterine flow Stress incontinence and overactive bladder can occur so supportive structures are at the basis of the pelvic area and these structures weaken as one ages so this combined with stretching from other factors like childbirth, carrying the large child, chronic Constipation, obesity, trauma, just age in general all of these things create weaker pelvic muscles and as one goes through menopause there's increase in hormone levels which also can contribute to atrophy of all of these structures so the areas of these structures include the rectum, the vagina and then the urinary area so when these pelvic muscles weaken organs then shift from their normal position into a different position than that can create some issues so there are prolapses so you have an anterior compartment prolapse which just think about these from an anatomical perspective don't make these any harder than what they need to be so an anterior compartment prolapse would be what's interior of the body of the pelvic area the bladder so that would be a bladder prolapse a posterior compartment prolapse would be rectal prolapse because the rectum is in the back apical compartment prolapse is uterine and cervical prolapse or vaginal vault after hysterectomy clinical manifestations so they can include a variety of symptoms including vaginal urinary issues, defecation issues, feeling a vaginal or pelvic pressure, urinary stream changes because of the change in the anatomy, bowel movement changes so there's a variety of changes that they might see you want to do Kegel exercises physical therapy has some Women's Health specific physical therapy another treatment option would be a vaginal pessary device so this is inserted into the vagina and actually acts as like a holder to support the bladder the only downfall with these are they need to be cleaned and they need to be cleaned off and so that may be a you know deter for patients you want to encourage bowel and bladder training as well

ovarian cancer

•Symptoms: abdominal distension, pelvic or abdominal pain, eating disturbances, urinary frequency or urgency •Diagnosis: examination of CA-125, imaging studies, & biopsy •Preferred treatment: surgery & chemotherapy Early clinical manifestations of ovarian cancer can be vague and the more common symptoms include abdominal distention, pelvic or abdominal pain, eating distrurbances (feeling full too quickly) and urinary frequency and urgency Additioal symptoms are not as specific and can include bowl pattern changes, GI discomfort, pain duing sexual intercourse, malaise and menstruation changes Diagnosis: CA-125 can be produced in response to several different conditions but often examined as part of the diagnosis process Because it is produced due to different things, it is not the definitive diagnosis and imaging studies and biopsys are needed During treatment a declining CA-125 is considered a favorable response surgery and chemotherapy are perfered treatment strategies rates have declined but it continues to remain the fifth leading cause of cancer death in women there's no reliable screening for ovarian cancer at this time so it's difficult to treat because by the time it's usually identified there's already metastases so some risk factors are someone who is positive for BRAC 1 and 2 you wanna take into consideration usually we will get BRAC 1 and 2 for breast cancer but there is strong correlation between someone who is BRAC 1 and 2 positive and there they have a significant increased risk for ovarian cancer as well not just the breast cancer so other risk factors including advancing age infertility Nula gravity which is someone has never been pregnant, excessive estrogen exposures obesity androgen hormone therapy as well ***clinical manifestations bloating like a chronic abdominal distension or bloating is one of the key clinical manifestations eating disturbances urinary changes bowel changes malaise menstrual changes so diagnosis would usually be on pelvic and transvaginal ultrasounds CA-125 so CA-125 is a protein that is produced in response to several conditions and ovarian cancer is one of those ***several conditions that we use the C125 level with that being said it it's not specific to ovarian cancer so if it's high is it ovarian cancer causing it to be high or is it some other unidentifiable issue in addition to that it can be increased for non-cancerous causes so if there's an inflammatory process going that can also raise the CA 125 *** so again we utilize CA 125 a lot actually but it's not specific to ovarian cancer but with that being said whenever someone is has proceeded with treatment for ovarian cancer we do use the CA 125 to evaluate for a favorable response to their treatment plan **so again when the CA 125 level declines during treatment for ovarian cancer this demonstrates to us as providers that there is a favorable response so again pelvic and transvaginal ultrasounds biopsies if we can surgical intervention-so this would include felengetomy, oophorectomy so that would be a removal of the fallopian tubes plus ovaries and usually the hysterectomy as well so there is some indication that some of the ovarian cancer actually starts in the fallopian tubes but it's rarely identified that early so that's still a determined but that's part of the reason why they usually take the fallopian tubes as well because they it seems to be that there is a chance that these ovarian cancers actually start from the fallopian tubes **** so again tubes ovaries and history in addition to that chemotherapy as well if needed

dysphagia

•Symptoms: sensation of "food stuck" in throat, choking, coughing, "pocketing" food in cheeks, etc. •Diagnosis: H & P, barium swallow, X-rays, esophageal pH •Treatment: surgery, botulinum toxin injection, nutritional interventions Clinical manifestations include a sensation of food being stuck in the throat, choking, coughing, pocketing food in the cheeks, diffuclty forming a food bolus, delayed swallowing and or painful swallowing Dysphagia may occur with solid, liquid or both types of foods and a distinction is important to determain the probably underlying disorder Can be intermitten or progressive Diagnosis procedures focus on identifying the underlying cayse and consist of a history, physical, barium swallow, chest and neck x-ray, esophogeal PH measure, esophogeal manometry, upper endoscopy, flexable endoscopic evaluation of swallowing with sensory testing, videofluroscopic swallow study and an EGD Treatment strageies are specific for the causativecondition and can include surgery, an endoscopic balloon or botulinum toxin injection to allow the muscle to relax and facilitate swallowing Pocking food in their checks and delayed swallowing and something that has tougher texture then they are having for diffulcty Barium swallow, they are at high risk for aspiration A videoflorascopy

upper GI tract

•The areas that begin the digestive process •Oral cavity, pharynx, esophagus, & stomach The upper GI tract includes the oral cavity, the pharynx, esophogus, and stomach Food enters the GI tract through the mouth where chemical and mechanical digestion begin Issues with the mouth can create a need to bypass the mouth and introduce food directly too the stomach, for example through G/J tube Chewing or mastication, pulverizes food into small pieces and saliva from the salivary glands moistens and further breaks down food Saliva contains enzymes amalyse which start the process of carbohydrate digestion and antibodies that kill and neutralize bacteria The tounge pushes semi solid food malls or the bolus to the back of the throat where it is swallowed All activities up to bolus are under voluntary control Trigemetal, glossopharyngeal and vagus stimulate the swallowing reflex which is an involuntary action The swallowing centers coordinate the movement of food through the esophogus and this orchestrated movement prevents food from entering the nearby trachea and lungs As food nears the stomach the normally closed lower esophogus spincture (LES) releaxes to allow food to enter the stomach Food enters the mouth Mastication with salvia and chewing The salivia with amalyse to break down food These areas beging the digestive process

trichamonias

•Trichomonas vaginalis •Commonly coinfects with BV and STIs •Usually, asymptomatic •Copious, odorous, frothy, thin vaginal discharge, small petechiae, itching, painful intercourse, dysuria •Complications during pregnancy •Diagnosis: vaginal microscopy and NAAT •Treatment: metronidazole Is caused by trichmonas vaginalis This extracellular parasite can burrow under the muscosal lining In men the organism reside in the urethra In women organism reside in the vagina coinfection with bacterial vaginosis and STI is common Trichmonas can cause complications in women and can be assossiated with prostiatitis and epididymitis in men Clinical manifestations" up to 75% are asymptomatic In men infection is often transient and resolves in a few weeks without treatment If symptoms are present they are similar to infections causing urethritis In women the primary clinical manifestations are copious amounts of ordous frothy, thin, white, yellow green vaginal discharge The cervix can develop can develop petechie and appear like a strawberry Diagnosis and treatment: is history and physicial exam Vaginal microscopy can evaluate vaginal discharge On a wet mount slide mobile trichmonads can be seen Daignositic test include NAAT and trichomas RNA Rapid test can evaluate for antigen or DNA Treatment: easily treated with metronidazole an antibiotic that treats bacteria and parasitic infections Sexual partners should be treated to prevent infection Untreated prolong infections can cause increase risk of cervical cancers and HIV infections trick, it's a one cell anaerobic Organism ***in men it's usually found in the urethra and have no symptoms ***in women it's usually found the vagina and they're usually symptomatic ***so men usually not symptomatic in the urethra ***women it's usually found in the vagina and they're usually symptomatic this cannot survive in the mouth or in the rectal area so it's usually found again in the penis or in the urethra specifically or in the vagina 75% are asymptomatic in men it's often transient and usually results in a few weeks without treatment in women they have copious amounts of oderous, frothy, thin, white yellow or green vaginal discharge they can have the strawberry cervix or cervical petechie diagnosis would be vaginal microscopy wet slide and the office if you are able to have a woman's health rotation and be able to identify trichomonas it's pretty neat looking you can actually see it swimming around the slide it's kind of wild but I was able to see that a few times during my clinical rotation I have not seen it sence but it is pretty neat when you do look at it under microscope we would be on metronidazole or flagyl and you want to do follow-up testing due to the high risk of RE-infection

breast cancer

•Types: infiltrating ductal & lobular carcinoma •Classic mass: dominant, hard, immovable mass with irregular borders •Erythema, dimpling, or puckering skin changes •Metastasis indications •Screening recommendations •Aggressive, multimethod treatment There are many types and each type has a different pathology, genetic basis and clinical manifestation Most breast cancers orgininate from the epithelial lining of the duct system, breast cancer are mainly androenomas Infiltrating ductal- the second most common histrologic type Lobular carcinomas- in situ malginant cells and confined in the lobules Considered a cancer precursor even though cancer may never develop Clinical manifestation- the tumor can infiltrate the surrounding tissue and adhere to skin causing dimping In early stages the tumor moves freely but becomes fixed as cancer progresses Most classic breast masses will be one dominant, hard immovable mass with irregular boarders Upper quadrent is the majority of where breast cancers are found As disease progresses skin changes can include erythema, dimpling, or puckering that looks like an peel of an orange The nipple can be laterally displaced or retracted with sponateous discharge Metasis can occur early due to the type of breast cancer, most cases several nodes are effected at time of diagnosis, can metasis to lungs, bones and liver Daingosis and treatment: Early diagnosis and treatment are crucial to positive outcomes Regular breast self exams allow women to become more familiar with their breasts and particularly important for women at increased risk current screening guiflines vary depending on recommendations Screening should begin around 40-45 in women with an average risk As women get older (50-55) should increase from annually to biannually Women in high risk grups should get screening around age 30 Recent advancements in breast cacner treatment have increased survival rates Treatment strategies include chemo, radiation, surgery and hormone therapy Those with evidence of breast cancer can be offered prophylactic therapies and hormone therapy or surgery So there are different types there's in infiltrating ductal and lobular carcinoma and manifestations vary based upon what type and where it infiltrates if it's fixed or hard or immovable mass those are things that we look at masses less than one centimeter are usually very difficult to palpate so we rely on monography for those axillary lymph nodes become enlarged and palpable and widespread metastases is usually to the lungs bone liver and you can see some edema in the upper extremities from compressive symptoms so diagnosis we want to do early diagnosis with mammograms if we can treatment encourage regular self-breast exams like we discussed already regular mammography there are organizations who provide recommendations on screening guidelines for mammography so institution might be different on which organization they use for their screening guidelines but it's usually they start around 40 years old ***after 75 it's undetermined if mammograms are beneficial because of life expectancy it might not prolong life expectancy ***so again over 75 mammograms are it's questionable if they're necessary or not It would be a patient's decision and discussion that you would have to have MRI's for more definitive confirmation after a suspicious area and then men who are at high risk they're usually high risk after 35 years old

syphillis

•Ulcerative infection with Treponema pallidum •Transmission methods •Stages: primary syphilis, secondary syphilis, & latent or tertiary syphilis •Diagnosis: nontreponemal and treponemal serologic tests •Treatment: penicillin, doxycycline, or tetracycline Infection caused by treponema pallidum, bacteria needs a warm, moist environment to survive Syphillus is transmitted through skin or mucosa membranes contact with infected, ulcerative lesions, Additionally the bacterium can cross the mother baby barrier There are 3 different stages to syphillus Primary syphillus is the first stage, painless chancres form at the site of infection about 2-3 weeks after the initial infection is acquired Along with lymphadenopathy The chancres often go unnoticed and disappear about 4-6 weeks later even without treatment Chancres begin as palpable then ulcerative, then hard and then rasied edges usually about 2 cm in size The bacteria is domient and no other symptoms are present Secondary syphillus- occurs 2-8 weeks after the first chancres form Approximately 33% of individuals infected who do not receive treatment in primary progress to secondary Characterized by nonpruritic, brown-red rah Most common rash is on trunk and extremities and palms and soles Lantent or tertiary syphillus- is the final stage of syphillus This phase can start after 1 year and can last for years During latency there are no symptoms Tertiary is a symptomatic syphlilis phase and manifestations occur in cardio vascular system or grandulomatous nodular lesions can develop normally on skin and bones Teritary symptoms can occur as late as 30 years after infection Diagnosis and treatment Usually a history and physical Diagnostic testing includes nontreponemal tests and treponemal tests Nontreponemal tests testbiomarkers and IgG and IgM antibodies Treponemal tests measures antibodies directed against specific treponemal antigens Treatment is usually antibiotics such as penicillin (preferred) doxycycline or tetracycline so syphilis is an ulcerative infection it requires a warm environment to survive and it usually causes an infection wherever the pathogen is introduced if it's introduced in the mouth it's in the mouth genitals or the breast tissue this also provides an opportunity for transmission to acquiring other STIs so this is transmitted through skin or mucous membrane contact with infected ulcerative lesions it can cross from mother to fetus after the 4th month of gestation and this would be termed congenital syphilis once the bacteria begins to replicate it can spread throughout the body through the lymph system you can have the primary syphilis or secondary syphilis or even a late or tertiary syphilis diagnosis you have your non treponemal and treponemal serologic testing tests are reported as reactive or non-reactive antibiotics would be the use of penicillin or doxy or tetracycline as well

Hypospadias

•Urethral meatus on ventral surface of penis •Common congenital defect •Disruption in androgen stimulation during development •Combination of factors environmental & genetic •Diagnosis: PE, US •Treatment: surgical repair Refers to a condition in which the urethral meatus is on the ventral surface of the penis instead of the end Hypospadias can vary in severity and the opening can extend along the length of the penis or located on the scrotum or perineum Males can also have a downward curvature of the penis called chordee and becomes apparent during erection Exact cause unknown but its though to result from disruption in androgen stimulation during development of the male external genetalia Combination of environmental and genetic factors Risk of this increase with maternal age of 35, obesity, use of fertility treatments and hormone therapy during pregancy Diagnosis is made through physicial exam, imaging, tests, may be performed to identify other congenital defects Surgical repair can improve the penis appearance as well as sexual and urinary function so we have hypospadias and this is the urethral meatus is on the ventral surface of the penis instead of on the end so this can vary in severity and it can extend along the length of the pennis it's usually associated with a downward curvature of the penis and this can occur usually from a congenital anomaly so you can see bifid scrotum or crypto or cryptotorchidism along with the hypospadias the cause is not known it's thought to be gestational stimulation during fetal development so the risk factors include a mother with advanced maternal age so that's usually mother greater than 35 years old during pregnancy obesity fertility treatments for pregnancy can also predispose somebody to this in addition to hormone therapy before or during pregnancy so obviously we would do physical examination you can do imaging such as MRI CT scan X-rays and ultrasound and that might help further identify any other reproductive anomalies that may have occurred as well so the treatment would be multi stage surgical intervention you can proceed with surgical intervention as small as four months old but you want to initiate surgery prior to 18 months old ****so the age again that ballpark of ages after four months but before 18 months

bacterial vaginosis

•Vaginal discharge due to a reduction in vaginal flora & increase in other bacterial species & aerobes •Usually, asymptomatic •Amsel criteria •Antibiotic treatments Common cause of vaginal discharge Occurs as a result of reduction in vaginal flora, lactobacillus, with increase in a variety of bacterial species and anaerobes The prevalence is higher in women of reproductive age BV is not an STI, however, only occurs in sexually active women and an increase risk with multiple sexual partners Clinical manifestations: most women are asymptomatic But if manifestations present include increase in vaginal discharge that is off white/grey, thin with unpleasant fishy order smell that worsens after intercourse or menses Other symptoms such as dysuria and dysoareunia can occur Diagnosis and treatment: made on history, physicial exam and the presence of at least three amsel criteria 1.characteristic vaginal discharge 2.Elevated PH 3.Clue cells 4.Fishy odor Vaginal microscopy is recommended to evaluated for the presence of clue cells Can do a positive whiff test or positive amine test Treatment: can resolve without treatment however treatment is usually initiated to relieve symptoms and prevent getting other STI Treatment of antibitoics can include clindamyocin or metronidazole These medication can be taken intravaginally or taken orally BV bacterial vaginosis so this is common cause of vaginal discharge and it's a reduction in the vaginal flora this usually occurs in women of childbearing age so this is not a sexually transmitted infection but it occurs only in sexually active women so page 372 in the book describes that a little bit more but the risk of BV increases within the number of sexual partners ***but again this is not considered to be a sexually transmitted infection so here they have vaginal discharge it's usually off white or Gray and they can have a fishy odorous smell that worsens after sexual intercourse or after menses it's considered a risk factor for the development of an STI but again it's not an STI so diagnosis again we would use a microscope you would see clue cells a picture of clue cells are on this slide treatment can resolve spontaneously or you can use flagyl or Clindamycin for antibiotic coverage the recurrence of BV within a year is high and might need you to reinfection or treatment failure

canidiadis

•Yeast infection caused by Candida albicans •Occurs most frequently in vulva & vagina •Balanitis or balanoposthitis in men •Women: thick, white vaginal discharge, vulvular erythema & edema, vaginal & labial pruritus Is a yeast infection caused by the common fungus candida albicans This condiiton usually occurs as an opportunistic infection that can arise anywhere in the body Candiidiasis most requently occurs in the vulva and vagina and common cause of vaginitis Candidiasis is more common in those with increased estrogen level and increased glucose in the vaginal secretions which can occur due to pregnancy, oral contraceptives, diabetes and obesity Baths and feminine products can also alter the delicate PH balance Synthetic and Tight fitting clothes will cause an increase risk of candidiasis Clinical manifestations include: A thick white vaginal discharge that is curdlike and nonordous, vulvar erythema and edema, vaginal and labial pruritus and burning, white patches on the vaginal wall, dysuria (burning when urine touches the vulva) and painful sexual intercourse at times discharge can be thin, loose and water as opposed to thick white discharge Caused by candida albicans, it's an opportunistic infection can occur anywhere in the body but for the purposes of the reproductive system it usually occurs in the vulva and vagina candida is actually part of our normal flora in the vagina however when the pH level changes or it increases this can lead to yeast overgrowth so other contributing factors that cause this imbalance are decreased immune response so steroids use or HIV diagnosis and those with increase estrogen levels increased glucose and vaginal secretions so pregnancy oral contraceptives diabetes and obesity can increase glucose in the vaginal secretions making it a glucose rich environment for promotion of that candida bubble baths also increase the risk the use of feminine products and then synthetic or tight fitting clothes can also increase the risk

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