Abnormalities of the Breast, Ovaries, Uterus, Cervix, and Vagina (part 3) [done]

what is a treatment option that does not work for adenomyosis?

*Not responsive to OCP or hormonal tx*

H & P adenomyosis? [4]

-Dysmenorrhea -Menorrhagia -Pelvic pressure from enlarged, globular uterus -Mildly tender to palpation

H & P and presentation findings of endometrial hyperplasia?

-H/o oligo. or amenorrhea followed by irregular or excessive bleeding -Occ. obese, acanthosis, acne, hirsutism -Pelvic exam normal

s/s of cervical fibroids? [3]

-Intermenstrual bleeding -dyspareunia -pregnancy complications

s/s of benign epithelial disorders of the vulva and vagina?

-Itching, irritation, burning, dysuria, dyspareunia, -c/o vulva bumpy, tender, or thickened

examples of congenital anomalies of vulva and vagina lesions?

-labial fusion -imperforate hymen -transverse vaginal septum -vaginal atresia -vaginal atresia

how often does imperforate hymen occur and s/s?

1 in 1,000 births Primary amenorrhea and pelvic pain

what do other women have with adenomyosis also have?

15-20% also have endometriosis and 50-60% have fibroids in conjunction with adeno.

what is endometrial hyperplasia a common cause of?

AUB

what is vaginal agenesis?

Absence of vagina and absence or hypoplasia of cervix, uterus, and fallopian tubes

describe the adenomyosis appearance

Adenomyoma, well circumscribed area of adeno. but no pseudocapsule like fibroids

where does cervical polyps come from? symptoms?

Arise anywhere on cervix, usually asymptomatic

where does cervical fibroids arise?

Arise in cervix or prolapse from endometrial cavity

symptoms of cervical stenosis?

Asymptomatic unless completely obstructed

does adenomyosis undergo changes?

Does not undergo secretory and proliferative changes because it goes through the basalis layer into the myometrium

how does a skene's gland cysts occur?

Paraurethral glands become blocked

dx of endometrial hyperplasia? [2]

Pelvic U/S show thickened EMS EMB or D&C

s/s of transverse vaginal septum?

Primary amenorrhea, pelvic pain

s/s of vaginal atresia?

Primary amenorrhea, pelvic pain

how often does double cervix result and what usually causes it?

RARE, congenital anomaly, usually from DES exposure

how does gartner's duct cysts occur?

Remnants of mesonephric ducts

what are nabothian cysts?

Retention cysts caused by blockage of endocervical gland

with a double cervix, what is a risk?

Risk for incompetent cervix in pregnancy

how does a sebaceous cysts occur and type of treatment needed?

Sebaceous gland becomes blocked Superinfection may need I&D

tx of bartholin's cysts/abscess?

Sitz bath, I&D if painful or large (need to remove because an increased risk for cancer in that area) Do gc/chl cultures Word Catheter sometimes placed

when does endometrial hyperplasia typically occur?

Typically occurs in menopausal or perimenopausal, but also occurs in obese females with oligo.

diagnosis of endometrial polyps? [2]

U/S or sonohysterogram Women >35 with AUB need EMB

what causes endometrial hyperplasia?

Unopposed estrogen causes increased endometrial proliferation → can to endometrial carcinoma

symptoms and treatment of gartner's duct cysts?

Usually asymptomatic, surgery to remove

s/s of epidermal inclusion cysts?

Usually small and asymptomatic, if infected→ I&D

treatment of congenital anomalies of vulva and vagina?

all require surgery

symptoms of nabothian cysts?

asymptomatic

what is a complete hysterectomy?

removal of the uterus and cervix

what is the most common tumor on the vulva?

Epidermal Inclusion Cyst

what is adenomyosis?

Extension of endometrial tissue into myometrium

treatment of apocrine sweat gland cyst? [2]

I&D, ABX +/-

how often does adenomyosis occur and what age group?

Incidence 15% 30-40s, parous

what are some examples of benign epithelial disorders of the vulva and vagina?

Lichen Sclerosis Squamous Cell hyperplasia (Atopic Eczema) Lichen Simplex Chronicus Lichen Planus Vulvar psoriasis Vaginal Adenosis

what are some other benign epithelial disorders of the vulva and vagina? [3] treatment?

Lipomas Hemangiomas Urethral carbuncles Treat as needed

what is vaginal atresia?

Lower vagina fails to develop, everything else normal

how to diagnosis adenomyosis? [2]

MRI Pelvic U/S and EMB >35

what to do if the bartholin's cysts is persistent?

Marsupilization if persistent

treatment of cervical stenosis?

May need cervical dilation

H & P/Presentation of endometrial polyps?

Metrorrhagia, menorrhagia, menometrorrhagia

what are bartholin's cyst/abscess and where are they located?

Mucus secreting glands, 4 and 8:00 Open just external to hymenal ring

treatment of adenomyosis? [4]

NSAIDs ?OCPs Hysterectomy

treatment options of endometrial hyperplasia?

Based on degree of atypia (when the cells begin to look atypical) Progestin therapy Mirena D&C Hysterectomy

what are endometrial polyps?

Benign overgrowths of endometrial glands and stroma

what is a apocrine sweat gland cysts?

Blockage of sweat glands, Hirdradenitis suppurativa

treatment of benign epithelial disorders of vulva and vagina?

Bx and steroids (up to 12 wk for sclerosis)

when does labial fusion occur?

CAH, ambiguous genitalia

what can cervical polyps case? treatment?

Can cause intermenstrual bleeding, post coital bleed. Remove in office

what is the cause of adenomyosis?

Cause unknown, usually occurs in parous women

risk factors for endometrial hyperplasia?

Chronic anovulation Obesity Nulliparity Late menopause Exogenous estrogen DM HTN Tamoxifen

who are endometrial polyps common in? [2]

Common in 40-50 y/o and women on Tamoxifen

what is cervical stenosis caused by?

Congenital, infection, atrophy, or scarring

treatment of endometrial polyps?

D&C for symptomatic or >1cm in size