DIAGNOSIS AND TREATMENT TACTICS OF THE MAIN GYNECOLOGICAL DISEASES IN WOMEN

Shirley DeeMedical faculty 2

ENDOMETRIOSIS Endometriosis is a benign condition in which

endometrial glands and stroma are present outside the uterine cavity and walls.

Pathogenesis;1. Retrograde menstruation theory2. Mullerian metaplasia theory3. Lymphatic spread theory

Diagnosis/Management Triad of

symptoms;DysmenorrheaDyspareuniaDyschezia

Definitve diagnosis involves;

- histologic findings obtained at laparoscopy or laparotomy.

Management involves;- surgery(hysterectomy,

bilateral salpingo-oophrectomy)

- Pain reliever(NSAIDS), progestins(medroxyprogesterone). Second line treatment involves the use of danazol, which is being replaced with GnRH agonist.

FIBROIDSUterine fibroids, also known as uterine

leiomyoma, myoma, fibromyoma, are benign smooth muscle tumors of the uterus. Fibroids, particularly when small, may be entirely asymptomatic. Symptoms depend on the location and size of the fibroid, Important symptoms include abnormal uterine bleeding, heavy or painful periods, abdominal discomfort.

Diagnosis/Management of Fibroid Pelvic exam

How big is the uterus? Ultrasound CT/MRI CBC to assess for anemia

Management;

Hormonal; estrogen, progesterone, lupron Iron therapy(depending on severity of anemia) Surgical

Myomectomy Hysterectomy

Uterine artery embolization

ECTOPIC PREGNANCY An ectopic pregnancy is a gestation that

implants outside the endometrial cavity. It is estimated to occur in 1 of every 80 spontaneously conceived pregnancies. Most common site includes; fallopian tube(75%-80%), less common sites involves the ovary, uterine cervix.

Clinical diagnosis/ManagementClassic triad of

symptoms includes; prior missed menses, vaginal bleeding, lower abdominal pain.

Diagnosis;- Detection of high

levels of hCG in blood serum.

- Transvaginal ultrasonography.

Surgical management;

- Laparotomy(salpingectomy) Medical management;- Methotraxate- Salpingocentensis(inject

ion of MTX,prostaglandins, hyperosmolar glucose into the amniotic sac).

Implications for future fertilityPatients who have experienced an ectopic

pregnancy are at increased risk for subsequent ectopic pregnancies and problems with infertility. Having one ectopic pregnancy increases the risk for a future ectopic pregnancy by 7 to 13 fold.

VIDEO

Cervical Cancer

Cervical cancer kills about 250,00 women a year worldwide and is the most common cause of death from cancer in women. About 80% of new cases reported each year occur in developing countries. In developing countries, regular screening with papanicolaou(pap) smears has markedly decreased the incidence of the disease, and most cases now occur in women who have not had regular pap smears. HPV has been identified as the cause of virtually all cervical cancers.

Primary Prevention Two prophylactic vaccines are presently

available. The quadrivalent vaccine Gardasil, which protects against serotypes 6, 11, 16, 18. The bivalent vaccine cervarix, which protects against HPV types 16 and 18.

Cervical CytologyPapanicolau smear, ThinPrepExfoliative cytologyHPV typingScreening toolMust biopsy for diagnosis

Source Undetermined

Original image can be viewed here

ColposcopyVisualization of cervix under magnificationMust see entire transformation zoneAcetic acidAssess for vascular changesBiopsyEndocervical currettage

S. Kellam

Source Undetermined

A diagnostic cone biopsy of the cervix is indicated in the following circumstances;

Pap smear shows high-grade lesion, and colposcopic examination is unsatisfactory.

Endocervical curettage shows a high-grade lesion.

Pap smear shows a high-grade lesion that is not confirmed on punch biopsy.

Microinvasion is present on the punch biopsy.

Treatment of Cervical CancerStage 1a(microinvasive carcinoma)- vaginal

hysterectomy.Stage 1a2- modified radical hysterectomy.Stages 1b1 and 1b2- radical hysterectomy,

radical trachelectomy.Stages 2a- chemoradiation therapy.Stages 2b- external-beam

chemoradiation+intracavitary brachytherapy.

Stages 3a and 3b- chemoradiation therapy followed by intracavitary brachytherapy.

Stages 4a- pelvic chemoradiation.Stages 4b- pelvic radation therapy.Recurrent or metastatic disease-

chemotherapy.

Cervical Carcinoma in Pregnancy Carcinoma of the cervix associated with

pregnancy usually implies diagnosis during pregnancy or within 6 months postpartum. It is relatively uncommon; invasive carcinoma occurs in about 1 in 2,200 pregnancies.