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Essentials of Human Diseases and Conditions 4th edition

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Title: Essentials of Human Diseases and Conditions 4th edition


1
Essentials of Human Diseases and Conditions 4th
edition
  • Margaret Schell Frazier
  • Jeanette Wist Drzymkowski

2
Chapter 12 Diseases and Conditions of the
Reproductive System
3
Learning Objectives
  • Identify risk factors for sexually transmitted
    diseases (STDs).
  • Explain what a silent STD is, and give an
    example.
  • Name the complications of untreated gonorrhea.
  • Recall how trichomoniasis is diagnosed.
  • Explain how genital herpes is transmitted.
  • Explain why women with genital herpes are advised
    to have regular Pap (Papanicolaou) smears.

4
Learning Objectives (contd.)
  • Describe the stages of untreated syphilis.
  • Explain why hepatitis B is classified as sexually
    transmitted.
  • List the possible causes of dyspareunia in men
    and women.
  • Name drugs that can contribute to impotence.
  • Name a common causative factor in male and female
    infertility.

5
Learning Objectives (contd.)
  • Explain the value of prostate-specific antigen
    (PSA) as a screening test.
  • Discuss the medical interventions for prostatic
    cancer.
  • Explain how varicocele may contribute to male
    infertility.
  • Explain why physicians encourage monthly
    testicular self-examinations for younger men.

6
Learning Objectives (contd.)
  • Explain what causes the dysmenorrhea associated
    with endometriosis.
  • Discuss the importance of early diagnosis and
    prompt treatment of pelvic inflammatory disease.
  • Discuss the advantages and possible risks of
    hormone replacement therapy for the
    postmenopausal woman.

7
Learning Objectives (contd.)
  • Explain how uterine prolapse, cystocele, and
    rectocele may be corrected surgically.
  • List the risk factors for cervical cancer.
  • Name the leading cause of deaths attributed to
    female reproductive system disorders.
  • List some possible causes of ectopic pregnancy.

8
Learning Objectives (contd.)
  • Explain how a pregnant woman is monitored for
    toxemia.
  • Describe abruptio placentae.
  • List the factors that place women at higher risk
    for breast cancer.

9
Chapter 12Lesson 12.1
10
The Normally Functioning Reproductive Systems
  • The human reproductive system is classified into
    two groups
  • Gonads produces germ cells and hormones
  • Testes (males)
  • Ovaries (females)
  • Ducts transport germs cells

11
The Normally Functioning Reproductive Systems
(contd.)
  • Both the male and female reproductive systems are
    vulnerable to a number of diseases or
    dysfunctions
  • The origin of these conditions may be
  • Functional
  • Structural
  • Emotional

12
Sexually Transmitted Diseases
  • More than 20 infectious diseases are spread by
    sexual contact
  • Sexually transmitted diseases (STDs) are spread
    from one person to another through bodily fluids
    (blood, semen, vaginal secretions) during
    vaginal, anal, or oral sex
  • Some spread by direct contact with infected skin

13
Sexually Transmitted Disease Risk Factors
  • A person is at greater risk for getting an
  • STD if he or she
  • Has sex without knowledge of partners history
  • Shares drug-related needles
  • Has sex with multiple partners
  • Has direct skin contact with an open wound of an
    infected person

14
Chlamydia
  • One of the most frequently reported infectious
    diseases in the U.S.
  • More common than gonorrhea and the leading cause
    of pelvic inflammatory disease and sterility in
    women
  • Sometimes called the silent STD because it often
    has no symptoms

15
Chlamydia (contd.)
  • Symptoms
  • When symptoms are present they are evidenced in
    both females and males and include
  • Females
  • Thick vaginal discharge with burning sensation
  • Itching
  • Abdominal pain
  • Pain during intercourse (dyspareunia)

16
Chlamydia (contd.)
  • Males
  • Discharge from penis with burning sensation
  • Itching
  • Burning sensation when urinating
  • Scrotum may be swollen

17
Chlamydia (contd.)
  • Treatment
  • Antibiotic therapy is given to both partners
  • Initially a single injection
  • Followed by oral antibiotics
  • Patients are encouraged to abstain from
    intercourse until both partners are cured

18
Gonorrhea
  • A common STD with symptoms similar to chlamydia
  • Additional symptoms
  • A discharge of pus from the genital tract in both
    males and females
  • Difficult or painful urination
  • Symptoms vary in severity

19
Gonorrhea (contd.)
  • Treatment
  • Antibiotic therapy for both partners
  • Because many strains of the bacteria that cause
    gonorrhea have become resistant to standard
    antibiotic therapy (tetracycline and penicillin),
    follow-up cultures are routinely ordered to
    ensure a complete cure

20
Gonorrhea (contd.)
  • Neglecting treatment can lead to the following
    complications
  • Pelvic inflammatory disease
  • Blood poisoning (septicemia)
  • Septic arthritis

21
Trichomoniasis
  • Infection of the lower genitourinary tract
  • Affects about 15 percent of sexually active
    people
  • Most infected men and women are without symptoms

22
Trichomoniasis (contd.)
  • Symptoms
  • When symptoms are present they are evidenced in
    both females and males and include
  • Difficult or painful urination
  • Itching
  • Women profuse greenish yellow discharge from the
    vagina

23
Trichomoniasis (contd.)
  • Diagnosis
  • Discharge from either the male or female is
    typically studied for the microorganism
    responsible.
  • Urinalysis may be performed
  • Cervix may also be examined for the presence of
    small hemorrhages with a strawberry-like
    appearance

24
Trichomoniasis (contd.)
  • Treatment
  • Anti-infective drugs are given orally or in some
    cases vaginally.
  • Follow-up examinations to ensure the infection
    has been eliminated

25
Genital Herpes
  • Infection of the skin in the genital area
    resulting in painful genital sores
  • Spread by direct skin-to-skin contact
  • Caused by herpes simplex virus type 2 (HSV-2)
  • Large percentage of infections go unnoticed

26
Genital Herpes (contd.)
  • Symptoms
  • One or more blister-like lesions on or around the
    genitals or anus
  • Swollen glands
  • Fever
  • Headache
  • Painful urination

27
Genital Herpes (contd.)
  • Diagnosis
  • Presence of characteristic lesions on the male or
    female genitalia
  • An antigen test or tissue culture may confirm the
    diagnosis.

28
Genital Herpes (contd.)
  • Treatment
  • There is no cure.
  • Prescription drugs are routinely used to reduce
    the frequency and duration of outbreaks.
  • Women with genital herpes are at increased risk
    for cervical cancer and are encouraged to obtain
    a Pap smear every six months for screening.

29
Genital Warts (Condylomata Acuminata)
  • A genital infection that causes raised
    cauliflower-like growths in or near the vagina or
    rectum or along the penis
  • Warts are caused by the human papillomavirus
    (HPV) and is usually transmitted through sexual
    contact.

30
Genital Warts (contd.)
  • Symptoms
  • Possible itching or burning
  • Discomfort varies by size, number, and location
  • Added risk factor
  • Women with HPV infection are at greater risk for
    cervical cancer

31
Genital Warts (contd.)
  • Treatment
  • Topical drug therapy
  • Surgical procedures
  • Cryosurgery freezing and removing affected
    tissue
  • Electrodesiccation removing warts using lasers
  • Some genital warts disappear without treatment

32
Syphilis
  • A chronic, sexually transmitted infection that
    can affect the entire body if left untreated

33
Syphilis (contd.)
  • Symptoms manifest in four stages
  • Presence of a painless but highly contagious
    local lesion called a chancre (pronounced
    shang-ker) found on the genitalia
  • Within one-two months, the primary lesion heals,
    but the infection spreads throughout the body and
    can cause similar lesions anywhere

34
Syphilis (contd.)
35
Syphilis (contd.)
  • Symptom stages
  • The infection begins spreading systemically
    throughout the body and may present with
  • Fever
  • Headache
  • Aching joints
  • Mouth sores
  • Rashes on palms or soles of feet

36
Syphilis (contd.)
  • Symptom stages
  • A latent period follows where the infection is
    without symptoms but can be transmitted in the
    first few years of this stage.
  • This stage can last from one to 40 years and
    varies by person.

37
Syphilis (contd.)
  • Symptom stages
  • In the final stage, lesions (called gummas)
    invade the body organs and systems and cause
    widespread damage that can be disabling and
    life-threatening.

38
Syphilis (contd.)
  • Treatment
  • Can be cured with a course of antibiotic therapy
    using penicillin G
  • Patients are monitored with follow-up blood tests
    for up to one year to ensure elimination of
    infection.

39
Chancroid
  • A bacterial infection of the genitalia that
    causes a shallow and painless lesion on the skin
    or mucous membrane that appears seven to 10 days
    after sexual contact with an infected person
  • Symptoms
  • Over time, ulcer usually deepens and oozes pus

40
Chancroid (contd.)
  • Treatment
  • Antibiotic therapy
  • Lesions must sometimes be drained surgically
  • Good personal hygiene
  • Refrain from sexual contact during treatment

41
Hepatitis B
  • An infection of the liver that is caused by a DNA
    virus
  • The disease has a long incubation and symptoms
    may become severe or chronic, causing serious
    damage to the liver

42
Hepatitis B (contd.)
  • Causes
  • Can be transmitted by
  • Contaminated blood or blood derivatives in
    transfusions
  • Sexual contact with an infected person
  • Use of contaminated needles and instruments

43
Hepatitis B (contd.)
  • Symptoms
  • Fatigue
  • Loss of appetite
  • Nausea
  • Abdominal discomfort
  • Dark urine
  • Clay-colored bowel movements
  • Yellowing of the skin and eyes (jaundice)

44
Hepatitis B (contd.)
  • Treatment
  • Some cases are self-limiting
  • Medications to control nausea and pain
  • Low-fat, high-carbohydrate diet
  • Restriction of physical activity
  • Alcohol should be avoided at all costs because of
    its potential to strain the liver
  • Antiviral therapy for chronic cases

45
Hepatitis B (contd.)
  • Prognosis
  • Acute cases prognosis is good
  • Liver heals and regenerates
  • May take several months
  • Chronic cases prognosis is poor
  • Inflammation causes destruction of liver cells
    and possible liver failure

46
Chapter 12Lesson 12.2
47
Sexual Dysfunction
  • Sexual dysfunction is the abnormal or impaired
    function of sexual behavior resulting from
    physical and/or mental imbalances in the system

48
Dyspareunia
  • Refers to recurrent painful or difficult sexual
    intercourse
  • Can occur in men and women but is more common in
    women

49
Dyspareunia (contd.)
  • Physical causes (women)
  • Intact hymen
  • Insufficient lubrication
  • Presence of an STD
  • Use of spermicide
  • Endometriosis
  • Pelvic inflammatory disease
  • Presence of cysts or tumors in pelvic region

50
Dyspareunia (contd.)
  • Psychological causes (women)
  • Past trauma
  • Sexual abuse
  • Fears (including fear of pregnancy)
  • Anxiety

51
Dyspareunia (contd.)
  • Causes (men)
  • A bowed erection
  • Tight foreskin
  • Inflammation of the prostate
  • Anxiety or guilt

52
Dyspareunia (contd.)
  • Treatment
  • Determined by cause but could include
  • Use of lubricants during intercourse
  • Gentle stretching of vaginal opening
  • Treat existing infections
  • Address psychosexual issues in counseling
  • Corrective surgery, if necessary

53
Erectile Dysfunction (ED)/Impotence
  • Description
  • The inability of a man to perform sexual
    intercourse, usually because he is unable to
    attain or maintain an erection of the penis

54
ED/Impotence (contd.)
  • Medical conditions
  • Diabetes mellitus
  • Heart disease
  • High cholesterol
  • Hypertension
  • Nerve disorders arising from
  • Prostate surgery
  • Trauma
  • Psychological causes
  • Depression
  • Unconscious guilt
  • Sexual trauma
  • Discordant relationships
  • Anxiety about sex
  • Chronic fatigue
  • Stress

55
ED/Impotence (contd.)
  • Other causes
  • Medications used to treat hypertension and
    depression
  • Alcohol
  • Recreational drugs
  • Antihistamines
  • Diuretics

56
ED/Impotence (contd.)
  • Diagnosis
  • Physical examination
  • Lab tests to rule out organic disease
  • Measurement of testosterone level
  • Medical history of patient and family
  • Any chronic disease such as diabetes,
    hypertension heart disease, renal or vascular
    problem, etc.
  • Lifestyle habits such as smoking, alcohol use,
    stress levels, and degree of sexual activity

57
ED/Impotence (contd.)
  • Treatment
  • Change or discontinue medications
  • Testosterone therapy
  • Psychological counseling
  • Penile implants/injection therapy
  • External vacuum therapy
  • Oral drug therapy

58
Frigidity
  • The lack of sexual desire or response in a woman
  • A patient may report an inability to experience
    sexual arousal, excitement, or achieve an orgasm.

59
Frigidity (contd.)
  • Causes
  • Medications
  • Chronic fatigue
  • Stress
  • Depression
  • Past trauma such as rape or sexual abuse

60
Frigidity (contd.)
  • Treatment
  • Training to enhance sensation and focus
  • Psychological counseling
  • Drug therapy (testosterone cream) to help
    increase libido

61
Premature Ejaculation
  • Ejaculation of semen that occurs prior to or
    immediately after penetration of the vagina by
    the penis
  • Problematic in that it may allow for little
    foreplay or may result in an inability to satisfy
    partner or impregnate

62
Premature Ejaculation (contd.)
  • Causes
  • Psychological guilt or anxiety
  • Relational a troubled or negative relationship
    with a sex partner
  • Diseases infections or neurological conditions

63
Premature Ejaculation (contd.)
  • Treatment
  • Address underlying psychological issues
  • Techniques for delaying ejaculation

64
Male and Female Infertility
  • The involuntary inability to conceive
  • With regular unprotected intercourse, about 90
    percent of couples conceive within one year
  • Of those unable approximately 40 percent can be
    attributed to male factors, 40 percent more to
    female factors, and less than 10 percent unknown

65
Male and Female Infertility (contd.)
  • Causes (male)
  • Insufficient number of sperm
  • Inadequate motility (movement) of sperm
  • Presence of an STD or any infection or blockage
  • Other physical conditions (genetic disorders) or
    injuries (radiation exposure, hormonal
    imbalances) that may result in sterility

66
Male and Female Infertility (contd.)
  • Causes (female)
  • STD or infection of the reproductive system
  • Failure to ovulate
  • Endometriosis
  • Blocked fallopian tubes
  • Congenital structural or chromosomal disorders
  • Scar tissue from infection, ectopic pregnancy, or
    surgery
  • Psychological distress

67
Male and Female Infertility (contd.)
  • Diagnosis
  • Men
  • Medical history with special attention to
    childhood diseases
  • Thorough physical exam
  • Semen analysis

68
Male and Female Infertility (contd.)
  • Diagnosis
  • Women
  • Charting of menstrual cycle
  • Blood tests to asses hormone levels
  • Visual examination of fallopian tubes and uterine
    cavity using radiography to determine tubal
    patency
  • Laparoscopy may be necessary to rule out
    endometriosis

69
Male and Female Infertility (contd.)
  • Treatment
  • Varies based on diagnosed problem, but commonly
    includes
  • Infection control
  • Surgery to remove blockage
  • Use of fertility drugs
  • Artificial insemination
  • Intrauterine insemination (IUI)
  • In vitro fertilization (IVF)

70
Male Reproductive Diseases
  • Most commonly affected organ is the prostate
    gland
  • The gland can become inflamed or enlarged as a
    result of bacteria and cause urinary problems.
  • Symptoms may include
  • Urinary problems (incontinence, difficulty
    urinating)
  • Pain or swelling of reproductive organs
  • Sexual dysfunction (ED/impotence)

71
Epididymitis
  • The inflammation of the epididymis, which is a
    long convoluted tube in the sperm duct system
    located in the testes

72
Epididymitis (contd.)
  • Symptoms Signs
  • Fever
  • Dysuria
  • Malaise
  • Groin or scrotal tenderness/pain
  • Difficulty walking
  • Epididymis may become enlarged, tender, or hard
  • Prehns sign

73
Epididymitis (contd.)
  • Causes
  • STDs (gonorrhea and syphilis)
  • Urinary tract infection
  • Inflamed prostate (prostatitis)

74
Epididymitis (contd.)
  • Diagnosis
  • Physical examination
  • Urinalysis
  • Urine cultures

75
Epididymitis (contd.)
  • Treatment
  • Antibiotic therapy
  • Analgesics (pain relief)
  • Anti-inflammatories
  • Rest
  • Avoidance of alcohol and spicy foods
  • Scrotum support elevation

76
Orchitis
  • Orchitis is an infection of the testis causing
  • Swelling
  • Tenderness
  • Acute pain
  • Fever
  • Chills
  • Nausea/vomiting
  • General malaise

77
Orchitis (contd.)
  • Causes
  • May be an infection from the mumps virus
  • Can also be attributed to other viruses and
    bacteria
  • May follow epididymitis
  • May accompany the presence of an STD

78
Orchitis (contd.)
  • Treatment
  • Antibiotic therapy (if infection is bacterial)
  • Mumps virus has no specific treatment besides
  • Bed rest
  • Adrenal steroid drugs (reduces fever and swelling
    in severe cases)
  • Scrotum support

79
Torsion of the Testicle
  • A condition where one testicle is twisted out of
    its normal position, causing a reduction in blood
    flow to the affected testicle
  • The primary symptom is sudden, severe pain in one
    testicle
  • The scrotum becomes red, swollen, and tender
  • Fever and urinary frequency may occur

80
Torsion of the Testicle (contd.)
81
Torsion of the Testicle (contd.)
  • Diagnosis
  • Patient history
  • Gentle physical examination
  • Ultrasound may be necessary to distinguish
    torsion from epididymitis

82
Torsion of the Testicle (contd.)
  • Treatment
  • Gentle manipulation to untwist the testicle
  • Surgery may be necessary if the above fails to
    correct problem

83
Varicocele
  • The veins of one testicle become abnormally
    distended, causing swelling around the testicle
  • Symptoms include
  • Discomfort (especially in hot weather or
    following exercise)
  • Possible lower sperm count

84
Varicocele (contd.)
  • Treatment
  • Use of scrotal support
  • Surgery may be indicated to remove distended
    veins if fertility is threatened

85
Prostatitis
  • Acute or chronic inflammation of the prostate
    gland
  • Infection (bacterial or nonbacterial) is the most
    likely cause

86
Prostatitis (contd.)
  • Symptoms
  • Pain or burning sensation during urination
  • Low back pain
  • Fever
  • Muscular pain and tenderness
  • Frequent urination
  • Blood in urine possible

87
Prostatitis (contd.)
  • Treatment
  • Antimicrobial penicillin and other antibiotics
  • Sitz baths
  • Rest
  • Increase fluid intake
  • Analgesics (for pain)

88
Benign Prostatic Hyperplasia (BPH)
  • A nonmalignant, noninflammatory enlargement of
    the prostate gland
  • Symptoms
  • May compress urethra and cause urinary blockage
  • Difficulty starting urination
  • Weak urinary stream
  • Inability to empty bladder

89
Benign Prostatic Hyperplasia (contd.)
  • Treatment
  • Watchful waiting
  • Control fluid intake before bedtime
  • Avoid medications that cause urinary retention
    (decongestants)
  • Drug therapy (to relax tightened muscles inside
    the prostate or shrink enlarged prostate gland)
  • Surgery may be performed to remove urinary tract
    obstruction

90
Prostate Cancer
  • Malignancy of the prostate gland
  • Risk factors
  • Age (most cases occur in men over age 45)
  • Heredity (presence of certain genes)
  • Lifestyle (diet high in animal fat, low in
    vegetables and selenium)
  • Ethnicity (more common in African-Americans)

91
Prostate Cancer (contd.)
  • Symptoms
  • Weak or interrupted urine flow
  • Frequent urination
  • Difficulty starting or stopping urination
  • Urinary retention
  • Blood in urine
  • Erectile dysfunction

92
Prostate Cancer (contd.)
  • Diagnosis
  • Digital rectal exam
  • Blood test to determine level of prostate
    specific antigen (PSA)
  • Biopsy (indicated if PSA level is 10ng/ml)

93
Prostate Cancer (contd.)
  • Treatment
  • Type of treatment depends on several factors
  • PSA level
  • Age
  • Stage of disease
  • Physical condition of patient

94
Prostate Cancer (contd.)
  • Treatment options
  • Radical resection of the prostate (TURP)
  • Hormone therapy (for metastatic prostate cancer)
  • Radiation therapy
  • No intervention (for men 70 years or older or who
    have other co-existing illnesses)

95
Prostate Cancer (contd.)
  • Prevention
  • Annual screening for all men 50 years of age or
    older, which consists of
  • Digital rectal exams
  • Serum PSA test
  • If either test is positive transrectal ultrasound
    biopsy is performed

96
Testicular Cancer
  • Malignant tumor of the testis
  • Symptoms
  • Nodule on or swelling of one testicle
  • Dull ache or heavy sensation in abdomen
  • Advanced disease symptoms
  • Lower extremity swelling
  • Anorexia
  • Bone pain

97
Testicular Cancer (contd.)
  • Risk factors
  • Family history of testicular cancer
  • A testicle that has not descended into the
    scrotum
  • Infertility
  • HIV infection

98
Testicular Cancer (contd.)
  • Diagnosis
  • Physical examination of the testes to detect
    possible nodes
  • Suspected testicular cancer may be followed by
  • Scrotal ultrasound
  • CT scan of abdomen and pelvis
  • Chest x-ray
  • Blood tests

99
Testicular Cancer (contd.)
  • Treatment
  • Chemotherapy
  • Surgical resection
  • Radiation therapy

100
Testicular Cancer (contd.)
  • Prevention
  • Monthly testicular self-exam is the most reliable
    screening method
  • Enhances body awareness (allows males to assess
    the normal size and shape of testicles)
  • Enables early detection of abnormalities

101
Chapter 12Lesson 12.3
102
Female Reproductive Diseases
  • The female reproductive organs are susceptible to
    disease in two distinct ways
  • Microorganisms can invade the organs, allowing
    infections to develop
  • Tumors (both benign and malignant) and cysts can
    develop

103
Premenstrual Syndrome
  • A cluster of physical and emotional symptoms that
    appear shortly after ovulation and subside with
    the onset of menstruation or shortly thereafter.

104
Premenstrual Syndrome (contd.)
  • Common symptoms
  • Anxiety
  • Anger
  • Sadness
  • Food cravings
  • Fatigue
  • Breast tenderness
  • Irritability
  • Some women also
  • experience
  • Edema
  • Bloated feeling
  • Abdominal pain

105
Premenstrual Syndrome (contd.)
  • Treatment
  • Directed toward the relief of symptoms
  • Reduce dietary intake of sodium
  • Moderate exercise
  • Mild analgesics
  • Diuretics
  • Emotional support
  • Antidepressant medication or hormone therapy
    especially for PMDD
  • Increase calcium intake

106
Amenorrhea
  • The absence of menstrual periods
  • Two classifications
  • Primary if menstruation has not occurred by age
    16
  • Secondary no menses after a woman has been
    having menstrual cycles

107
Amenorrhea (contd.)
  • Causes of Primary Amenorrhea
  • Late onset of puberty
  • Abnormalities of the reproductive system
  • Hormonal imbalances

108
Amenorrhea (contd.)
  • Causes of Secondary Amenorrhea
  • Hormone-related issues such as
  • Pregnancy
  • Emotional factors
  • Illness (anorexia, malnutrition, sudden weight
    gain or loss)
  • Pituitary tumors
  • Thyroid disease
  • Excessive athletic training

109
Amenorrhea (contd.)
  • Diagnosis
  • Physical examination that includes
  • Pelvic exam (rules out physical abnormalities and
    pregnancy)
  • Blood tests (detects hormone problems)
  • Urine samples (detects hormone problems)
  • Radiographic studies (detects tumors)

110
Amenorrhea (contd.)
  • Treatment of Primary or Secondary
  • Treat underlying condition if possible
  • Contraceptive hormones or cyclic progesterone
  • May require long-term hormone therapy

111
Dysmenorrhea
  • Pain associated with menstruation
  • Two classifications for cause
  • Primary
  • Results from normal hormonal changes (not
    considered a pathologic disorder)
  • Secondary
  • Usually caused by underlying disorder or disease
    (pelvic infections, fibroids, endometriosis, etc.)

112
Dysmenorrhea (contd.)
  • Symptoms
  • Pain or cramping shortly before or after
    the onset of menstrual flow
  • Pain in the uterine area, lower pelvis that may
    radiate to thighs and buttocks
  • Painful bowel or bladder function
  • Symptoms usually abate by the end of menstruation

113
Dysmenorrhea (contd.)
  • Treatment
  • Non-steroidal anti-inflammatory drugs
    (prescription or OTC) for pain relief
  • Heating pad for abdominal pain
  • Hormonal therapy or surgery may be necessary if
    endometriosis, fibroids, or if cervical
    abnormalities are present

114
Ovarian Cysts
  • Fluid-filled semi-solid or solid masses that
    originate within ovaries
  • Two types
  • Physiologic cysts (those caused by normal
    functioning of the ovary)
  • Neoplastic cysts (benign or malignant and not
    related to normal functioning)

115
Ovarian Cysts (contd.)
  • Symptoms
  • Most are small and unnoticed by the patient
  • Large cysts can cause urinary retention
  • If cyst produces hormones various symptoms result
  • Cysts may twist on themselves causing pain,
    nausea and vomiting

116
Ovarian Cysts (contd.)
  • Treatment
  • Small cysts are common and seldom require
    treatment
  • Large cysts
  • Can be drained or removed

117
Endometriosis
  • A condition in which the endometrial tissue
    implants outside the uterus in the pelvic cavity
    or in other distant sites

118
Endometriosis (contd.)
  • Symptoms
  • Secondary dysmenorrhea is a classic symptom
  • Constant pain and cramping in lower abdomen
    beginning before and lasting several days after
    menstruation
  • Infertility
  • Pelvic pain during intercourse
  • Pain during defecation

119
Endometriosis (contd.)
  • The thickening and bleeding in these unnatural
    areas (and the resulting cysts, scar tissue, and
    adhesions) are the cause of pain and discomfort.
  • Risk factors include family history of the
    disease, menstrual cycles shorter than 28 days,
    uterine structural abnormalities and periods
    lasting longer than a week.

120
Endometriosis (contd.)
  • Treatment
  • Hormone treatment for younger patients
  • Pregnancy, nursing, and menopause usually bring a
    remission of symptoms
  • Surgery to remove or destroy endometrial growth
  • Total hysterectomy with bilateral
    salpingo-oophorectomy may be indicated in severe
    cases

121
Pelvic Inflammatory Disease (PID)
  • An infection of a womens pelvis
  • Is self limiting to life-threatening

122
Pelvic Inflammatory Disease (contd.)
  • Symptoms
  • Fever
  • Chills
  • Malaise
  • Foul-smelling vaginal discharge
  • Backache
  • Painful, tender abdomen

123
Pelvic Inflammatory Disease (contd.)
  • Diagnosis
  • There is tenderness during vaginal exam
  • Signs include elevated WBC and fever
  • Ultrasonography may be used to identify abcess
    formation
  • Laparoscopy is helpful to confirm diagnosis

124
Pelvic Inflammatory Disease (contd.)
  • Treatment
  • Aggressive antibiotic therapy to treat disease
    and help prevent complications
  • Analgesics
  • Bed rest
  • Without effective treatment, serious and
    life-threatening complications can develop

125
Leiomyomas (fibroids)
  • Leiomyomas are benign tumors of the smooth muscle
    within the uterus

126
Leiomyomas (fibroids) (contd.)
  • Symptoms
  • Most do not cause any symptoms
  • If present, they often include
  • Heavy and prolonged periods
  • Pelvic pain and pressure
  • Constipation
  • Frequent urination
  • Abnormal bleeding

127
Leiomyomas (fibroids) (contd.)
  • Treatment
  • Depends on
  • Severity of symptom
  • Age of patient
  • Desire to bear children
  • Treatment options
  • Surgery to remove tumors (childbearing age)
  • Hysterectomy (if bleeding continues)
  • Ultrasound ablation
  • Uterine artery embolization

128
Vaginitis
  • The inflammation and/or infection of the vaginal
    tissues
  • Fungal infection most common cause or may be
    bacterial or protozoan
  • Cervical infections may be mistaken for vaginitis
  • Postmenopausal women are also at greater risk

129
Vaginitis (contd.)
  • Symptoms
  • Vaginal discharge
  • Itching/burning sensation of the vulva
  • Fever may be present

130
Vaginitis (contd.)
  • Treatment
  • Hormone therapy
  • Antibiotic therapy
  • Vaginal antifungal/steroid cream
  • If vaginitis is contracted by sexual contact,
    both partners must be treated

131
Toxic Shock Syndrome
  • An acute, systemic infection that has been
    associated with menstruating females who use
    vaginal tampons

132
Toxic Shock Syndrome (contd.)
  • Cause
  • Fibers of super-absorbent tampon create an ideal
    environment for bacteria to produce toxins
  • Staphylococcal infection is responsible for TSS
  • Can also occur in women using contraceptive
    sponges or diaphragms

133
Toxic Shock Syndrome (contd.)
  • Symptoms
  • Sudden onset of high fever
  • Headache
  • Sore throat
  • Rash
  • Low blood pressure (hypotension)
  • Shock

134
Toxic Shock Syndrome (contd.)
  • Treatment
  • Replacement of fluids to counteract shock
  • Antibiotic therapy
  • Without prompt treatment, condition can result in
    neurological, renal, and respiratory
    complications and death

135
Menopause
  • Represents the cessation of menstrual periods
  • Menstruation discontinues due to ovaries
    producing less estrogen, which inhibits ovulation
  • Changes in pituitary hormone levels bring
    physical and psychological changes

136
Menopause (contd.)
  • Symptoms
  • Fluctuations in menstrual cycle
  • Periods become lighter and less frequent
  • Hot flashes/night sweats
  • Vaginal dryness/skin changes

137
Menopause (contd.)
  • Treatment
  • Consists of management of symptoms
  • Recent research links HRT with increased rates
    of
  • Breast cancer
  • Heart disease
  • Stroke
  • Blood clots

138
Menopause (contd.)
  • Alternate symptom management is suggested
  • Consumption of soy products to replace missing
    hormones (high in isoflavones)
  • Medications to strengthen bones, lower
    cholesterol, and help relieve vaginal dryness

139
Uterine Prolapse
  • Prolapse of the uterus is a downward displacement
    of the uterus from its normal location in the
    body
  • The uterus becomes prolapsed when the pelvic
    floor muscles and ligaments become extremely
    overstretched or weakened

140
Uterine Prolapse (contd.)
141
Uterine Prolapse (contd.)
  • Treatment
  • Kegel exercise to strengthen the pelvic floor
    muscles
  • Weight loss
  • High-fiber diet
  • Insertion of supportive uterine device (pessary)
  • Surgery (for serious prolapse)

142
Rectocele
  • Protrusion of the rectum into the posterior
    portion of the vagina
  • Occurs when the posterior wall of the vagina is
    weakened
  • Could result from trauma to the area during
    childbirth

143
Rectocele (contd.)
  • Symptoms
  • A bearing-down feeling
  • Constipation
  • Incontinence of gas/feces
  • Difficulty with eliminating feces

144
Rectocele (contd.)
  • Treatment
  • Surgical repair of the posterior wall of the
    vagina
  • Prognosis is good with surgical repair

145
Chapter 12Lesson 12.4
146
Cervical Cancer
  • Malignant cell growth that is located in the
    cervix region
  • Most cervical cancers are squamous cell
    carcinomas and occur in the area between the
    uterus and vagina.

147
Cervical Cancer (contd.)
  • Symptoms
  • Abnormal Pap smear test result
  • Watery, bloody vaginal discharge
  • Bleeding between menstrual periods and/or after
    intercourse or after menopause

148
Cervical Cancer (contd.)
  • Advanced stage symptoms include
  • Pelvic and lower back pain
  • Blood in urine
  • Painful urination
  • Rectal bleeding

149
Cervical Cancer (contd.)
  • Risk factors
  • Not having routine Pap smears
  • Exposure to human papilloma virus (HPV) most
    often through unprotected sexual contact
  • Smoking
  • Low socioeconomic status

150
Cervical Cancer (contd.)
  • Treatment
  • Early stage
  • Laser therapy
  • Cryoablation (removal by freezing)
  • Electrocoagulation (high-frequency electric
    current that destroys tissue)
  • Later stage
  • The above plus radiation therapy and chemotherapy

151
Cervical Cancer (contd.)
  • Prevention
  • Sexually active women should obtain annual Pap
    smear and pelvic examination
  • After three consecutive normal Pap smears,
    screening can be less frequent as determined by
    doctor
  • Screening can cease at age 65-70 for women with
    no risk factors

152
Vaginal Cancer
  • Malignancy found typically on the vaginal wall
  • Vaginal cancer is rare and thought to be related
    to
  • HPV infection
  • Prior history of gynecological malignancy
  • Advanced age
  • Multiple lifetime sexual partners
  • Early age at first intercourse
  • Cigarette smoking

153
Vaginal Cancer (contd.)
  • Symptoms
  • Vaginal bleeding following sex or postmenopausal
  • Foul-smelling or watery vaginal discharge
  • Painful urination
  • Constipation
  • Black, tarry stool
  • Vaginal mass

154
Vaginal Cancer (contd.)
  • Treatment
  • Surgery usually includes
  • Hysterectomy
  • Partial or complete removal of vagina
  • Partial or complete removal of lymph glands in
    the pelvic region
  • Radiotherapy (may be used with surgery or may be
    sufficient alone to treat early-stage vaginal
    cancers)

155
Vaginal Cancer (contd.)
  • Prevention
  • Regular Pap smears
  • Using barrier contraceptives
  • Limiting the number of sexual partners

156
Labial or Vulvar Cancer
  • Malignancy of the area external to the female
    genitalia (vulva) which includes the labium (any
    of four folds of tissue on the outer portion)

157
Labial or Vulvar Cancer (contd.)
  • Symptoms
  • Presence of a nodule or ulcer on
  • Labia major and/or labia minor
  • Clitoris
  • Vulvar bleeding
  • Discharge
  • Painful urination
  • Enlarged lymph node in the groin

158
Labial or Vulvar Cancer (contd.)
  • Risk factors
  • Cigarette smoking
  • Presence of HPV, HIV, or herpes simplex virus
    type 2
  • Prior history of cervical, endometrial, or breast
    cancer
  • Northern European ancestry

159
Labial or Vulvar Cancer (contd.)
  • Diagnosis
  • Requires excision biopsy of lesion
  • Examination of regional lymph nodes is mandatory
    to determine whether tumor has metastasized and
    may also include other tests to examine related
    areas

160
Labial or Vulvar Cancer (contd.)
  • Treatment
  • Surgical removal of the growth and surrounding
    skin or complete or partial removal of the vulva
    itself (vulvectomy)
  • Radiation and chemotherapy may be used in
    combination with surgery for advanced-stage cancer

161
Ovarian Cancer
  • Malignancy of one or both ovaries
  • Ovarian cancer accounts for more deaths than any
    other gynecological malignancy, because ovaries
    are located deep within the pelvis and disease is
    often asymptomatic until the advanced stage

162
Ovarian Cancer (contd.)
  • Symptoms
  • Enlargement of abdomen caused by accumulated
    fluid
  • Lower abdominal discomfort
  • Lower back pain
  • Irregular menstrual cycles
  • Frequent urination
  • Painful intercourse
  • Persistent, vague digestive disturbance

163
Ovarian Cancer (contd.)
  • Risk factors
  • Age (most diagnosed between ages of 40 and 65)
  • History of breast or ovarian cancer
  • Factors that may reduce risk
  • Pregnancy
  • Breast feeding
  • Prolonged use of oral contraceptives
  • Tubal ligation

164
Ovarian Cancer (contd.)
  • Diagnosis
  • Sometimes, but rarely, mass is discovered during
    routine pelvic exam
  • Laparotomy is indicated once mass is found to
    confirm diagnosis
  • Abdominal or pelvic CT scans may be used to
    identify degree of metastasis

165
Ovarian Cancer (contd.)
  • Treatment
  • Early stage
  • Removal of the ovaries, fallopian tubes, and
    uterus
  • Advanced stage
  • Removal of the above organs in combination with
    chemotherapy

166
Endometrial Cancer
  • Malignancy of the lining of the uterus
  • It is the most common gynecological malignancy

167
Endometrial Cancer (contd.)
  • Symptoms
  • Abnormal uterine bleeding at the onset of or
    following menopause
  • Abdominal pain (in advanced stage)

168
Endometrial Cancer (contd.)
  • Diagnosis
  • Endometrial biopsy
  • Dilation and curettage (usually performed when
    biopsy is inconclusive)

169
Endometrial Cancer (contd.)
  • Treatment
  • Early stage
  • Surgery
  • Advanced stage
  • Radiation therapy in combination with surgery

170
Condition and Complications of Pregnancy
  • Complications in pregnancy can arise at any point
    in the gestational period
  • This further emphasizes the need for early and
    continual prenatal care and patient education

171
Morning Sickness
  • Temporary nausea and vomiting experienced with
    the onset of pregnancy through the12th to 16th
    week
  • Generally occurs during the day

172
Morning Sickness (contd.)
  • Cause
  • Elevated
  • Estrogen
  • hCG levels (hormone produced early in pregnancy
    by the placenta)
  • Emotions may also trigger episodes

173
Morning Sickness (contd.)
  • Treatment
  • Eating smaller amounts of food and simple
    hydration
  • Rest, ginger, wrist bands, and vitamins B6 B1
    may help

174
Hyperemesis Gravidarum
  • Severe nausea and excessive vomiting that cause
    starvation during pregnancy
  • The severity of episodes causes
  • Weight loss
  • Dehydration
  • Fluid and electrolyte imbalance

175
Hyperemesis Gravidarum (contd.)
  • Treatment
  • Hospitalization (in severe cases)
  • Intravenous fluids and electrolyte replacement
  • IV antiemetics

176
Spontaneous Abortion (Miscarriage)
  • Naturally occurring loss of a fetus before the
    20th week of pregnancy
  • About 10-15 percent of all pregnancies terminate
    in spontaneous abortion
  • Majority are the result of a fetus with abnormal
    chromosomes

177
Spontaneous Abortion (contd.)
  • Symptoms
  • Presents with vaginal bleeding
  • Cramping pelvic pain
  • Positive pregnancy test
  • Possible shock (pulse rate increases/blood
    pressure decreases)

178
Spontaneous Abortion (contd.)
  • Treatment
  • If bleeding is not severe, the mother is treated
    conservatively
  • Cervical suture (cerclage) to keep the cervix
    closed
  • Severe bleeding or partial expulsion of the
    contents of the uterus requires surgical
    intervention (D C)

179
Ectopic Pregnancy
  • Occurs when the fertilized ovum implants and
    grows in a structure outside the uterus, most
    often the fallopian tube
  • Ectopic pregnancies can develop when the
    fertilized ovum is unable to enter the uterus and
    is unable to implant and grow

180
Ectopic Pregnancy (contd.)
181
Ectopic Pregnancy (contd.)
  • Symptoms
  • Sudden onset of severe lower abdominal pain
  • Evidence of vaginal bleeding
  • No pain or pain on one side
  • Positive pregnancy test
  • Possible shock and death

182
Ectopic Pregnancy (contd.)
  • Treatment
  • Laparoscopic surgery to terminate the pregnancy
    and remove fetus and placenta
  • Replace lost blood
  • Methotrexate (instead of surgery) may be used to
    terminate ectopic pregnancy that has not ruptured

183
Premature Labor
  • Premature labor occurs before the 37th week of
    gestation (late second or early third trimester),
    or before the fetus has reached a viable weight
  • Symptoms include
  • Contractions with cervical change
  • Increased vaginal discharge

184
Premature Labor (contd.)
  • Predisposing conditions
  • Maternal infection
  • Uterine abnormalities
  • Uterine fibroids
  • Incompetent cervix
  • Certain risk factors
  • Maternal age
  • Gum disease
  • Infection

185
Premature Labor (contd.)
  • There is no effective treatment
  • Medical management includes drug therapy
  • Monitoring
  • Patient
  • Fetal heart
  • Fetal movement

186
Preeclampsia (Toxemia) and Eclampsia
  • Preeclampsia is a serious disease characterized
    by
  • Hypertension
  • Edema (in some cases)
  • Proteinuria (protein in urine)
  • Eclampsia is characterized by
  • Grand mal seizure in a patient with preeclampsia

187
Preeclampsia (Toxemia) and Eclampsia (contd.)
  • Symptoms Preeclampsia
  • Sudden weight gain
  • Edema (primarily in face, hands, and feet)
  • Headaches
  • Epigastric pain
  • Blood pressure greater than 140/90
  • Visual disturbances
  • Elevated protein in urine
  • Clonus

188
Preeclampsia (Toxemia) and Eclampsia (contd.)
  • Etiology Eclampsia
  • Unknown
  • More common in first pregnancy
  • Improves after placenta is delivered

189
Preeclampsia (Toxemia) and Eclampsia (contd.)
  • Treatment
  • Bed rest when symptoms are mild
  • Frequent monitoring of baby and mother
  • Monitoring of blood tests
  • If symptoms are severe the patient may be
    hospitalized and monitored
  • Dark and quiet room (to prevent convulsions)
  • Medications (to reduce blood pressure)

190
Abruptio Placentae
  • The premature detachment of a normally positioned
    placenta occurring during pregnancy
  • When the placenta separates from the uterine wall
    too early during pregnancy, it causes the mother
    to hemorrhage and fetal distress

191
Abruptio Placentae (contd.)
  • Symptoms
  • Variable bleeding to hemorrhage
  • Painful contractions
  • Abdominal pain
  • Fetal distress
  • Fetal heart rate abnormalities
  • Fetal death

192
Abruptio Placentae (contd.)
  • Cause
  • In many cases cause is unknown
  • Trauma, infection, maternal vascular disease and
    multiple gestation are predisposing factors
  • Women with preeclampsia or who use cocaine are at
    higher risk

193
Abruptio Placentae (contd.)
  • Treatment
  • Hospitalization
  • Bed rest
  • Labor may be induced if near term or bleeding is
    excessive
  • Surgery if fetal heart rate declines or maternal
    shock is indicated
  • Blood replacement may also be needed

194
Placenta Previa
  • Condition in which the placenta that is implanted
    in the lower uterine segment encroaches on the
    internal cervical opening, causing bleeding

195
Placenta Previa (contd.)
  • Symptoms
  • Painless, bright vaginal bleeding
  • Abdomen is soft and not tender
  • Vital signs may indicate shock
  • Fetal blood supply may be compromised
  • Prior cesarean delivery and multiple gestation
    increase risk

196
Placenta Previa (contd.)
  • Treatment
  • Partial PP Close observation and monitoring in
    hospital setting
  • Surgery is indicated when fetus is near term or
    bleeding is profuse
  • Complete PP Immediate surgical termination of
    the pregnancy (by cesarean section) to save both
    mother and baby

197
Hydatidiform Mole
  • An intrauterine tumorous growth that results from
    a genetic anomaly during fertilization
  • The patient experiences symptoms that mimic
    pregnancy but usually no fetus develops
  • What does develop is a mass of clear grapelike
    vesicles

198
Hydatidiform Mole (contd.)
199
Hydatidiform Mole (contd.)
  • Symptoms
  • Abnormalities noted on ultrasound
  • Uterus increases in size disproportionately to
    gestational age
  • Nausea and vomiting
  • Greatly elevated hCG levels

200
Hydatidiform Mole (contd.)
  • Treatment
  • Surgical intervention (D C)
  • Observation for hemorrhage
  • If mole is found to be cancerous, patient may
    receive chemotherapy

201
Diseases of the Breast
  • Diseases of the breast can range from mild to
    fatal and necessitate frequent screening, monthly
    self-examinations, and routine mammograms
  • Although most diseases of the breast are most
    common in women, men do experience diseases of
    the breast

202
Cystic Disease of the Breast
  • Common, benign breast disorder where lumps and
    cysts develop in one or both breast
  • The most common female breast disease
  • The breasts are tender when pressure is applied
    and some women may experience shooting pains in
    the breast tissue

203
Cystic Disease of the Breast (contd.)
  • Diagnosis
  • Physical examination
  • Mammogram
  • Ultrasonography may be used to determine whether
    lump is hollow or solid

204
Cystic Disease of the Breast (contd.)
  • Treatment
  • No specific treatment
  • Some physicians remove fluid (aspirate) from the
    cysts with a needle
  • Other recommendations
  • Wearing a firm, supporting bra
  • Avoid caffeine
  • Avoid smoking

205
Mastitis
  • Inflammation of the breast tissue that occurs
    during lactation following birth
  • Often caused by a strep or staph infection that
    invades the milk ducts and creates inflammation
    and blockage
  • Milk stagnates due to blockage and produces a
    dull pain

206
Mastitis (contd.)
  • Symptoms found in breast post delivery
  • Sudden pain
  • Redness
  • Sensation of heat (at either beginning or end of
    lactation period)
  • Feels hot, doughy, and tough
  • Discharge from nipple

207
Mastitis (contd.)
  • Treatment
  • Firm, supporti
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