Week 1 - Female A&P, Embryology, Health Maintenance in Women, Menstrual Cycle and Gyn/Images

Describes the steps of female embryonic development

1) Primordial Cells travel from yolk sac -> midgut/hindgut -> urogenital/genital ridge

2) Primordial cells form female ooyctes, if no Y chromosome is present

3) Estrogen secretion leads to the development of the paramesonephric/lateral/Mullerian Ducts

4) Mullerian Ducts form uterus, tubes and 2/3 posterior vagina

5) Mullerian Ducts extend to the urogenital sinus

6) Cloaca and urogenital sinus fuse to form external genitalia

Note: Be able to identify the following stuctures on images:

1) urogenital/genital ridge

2) Mullerian Ducts (AKA paramesonephic or lateral ducts)

3) Wolffian Ducts (AKA Mesonephric or medial ducts)

4) Gubernaculum

5) Urogenital Sinus

6) Genital Tubercles

7) Urogenital Folds

8) Genital Swellings

What is the gubernaculum in females?

round ligament of the uterus & suspensory ligament of the ovary

When is female genitalia easily seen?

By 12 weeks gestation

The genital tubercle develops into the ______________?

Clitoris

The genital swellings (genital folds) develops into the _______________?

Labia Majora

The urogenital folds develops into the _______________?

Labia Minora

What is the arterial blood supply of the female genitalia?

Ovarian and uterine arteries

Be able to identify the following muscles on images:

1) Bulbocavernosus M.

2) Transverse Perineal M.

3) Anal Sphincter

4) Urogenital Diaphragm

What artery supplies major pelvic organs?

Internal Iliac Artery

What are the primary abdominal wall incisions?

1) McBurney (form appendectomy)

2) Midline

3) Pfannensteil (a low transverse incision to separate rectus muscles)***

4) Cherney (removes fascia from pubic Symphysis)

5) Maylard (cut through rectus muscle)

How many layers are above the umbillicus?

2 - an anterior and posterior sheath

What are the 4 cycles that are integrated regarding menstruation?

- Hypothalamic GnRH

- Pituitary

- Ovarian

- Endometrial

How many days are in the average menstrual cycle?

28 days

Describe the first two cycles (hypothalamic and pituitary) involved in menstruation?

1) Hypothalamic GnRH

- GnRH is released from hypothalamus in a pulsatile fashion

2) Pituitary

- The release of GnRH, stimulates the Anterior Pituitary to secrete FSH and LH

Describe the ovarian and endometrial cycle of menstratuion

- Menstrual phase - Day 1 to 4: shedding of endometrium, estrogen level increased, multiple follicles develop

- Ovulation on day 14

- Proliferative phase: Day 1-14 (follicular): FSH secrete estrogen until dominant follicle is determined. This follicle is producing a lot of estrogen

Secretory phase: Day 15 to 28 (luteal): corpus luteum secretes progesterone, endometrium thickens, decrease in estrogen and progesterone. Menses day 28

What is the imaging modality of choice for Ob/gyn?

Ultrasound (transvaginal or trans abdominal)

What are indications for pelvic US?

- Pelvic Pain

- Suspicion of a mass

- Abnormal vaginal bleeding

- Obstetrical

What are the pros and cons of trans abdominal US?

- No chaperone needed

- May be more comfortable for pt

- Limited by body habitus

What are the pros and cons of transvaginal US?

-Closer to organs

- May be more uncomfortable for pt

- Requires Chaperone

What is the difference between primary prevention and secondary prevention?

Primary prevention - measure that prevent the onset of illness (e.g. vaccines)

Secondary prevention - measure that can lead to early diagnosis and prompt tx (e.g. mammogram)

What is chemoprevention?

The use of certain drugs to help lower person's risk of developing cancer or to prevent infectious disease

What are the age recommendations for Well Woman visits?

10-65 y.o.

What are the only recognized effective screening tests for gynecologic cancer?

Cervical and breast cancers screenings

What are Grade A & B recommendations for colon cancer screenings?

- Screen all adults 50-75 y.o. (A)

- Screen all adults 45-49 y.o. (B)

What are the Grade A cervical cancer screening guidelines?

- Under 21 - No Pap smear

- 21-29 y.o. - screen with cytology every 3 yrs

- <30 y.o. - No HPV testing

- 30-65 y.o. - cytology every 3 years, HPV testing every 5 years or both

What are the Grade A colon cancer screening guidelines for women of average risk?

- Age: Screening from 50-75 y.o.

- Method & Interval: FOBT annually and FIT DNA test every 1-3 years for average risk

- Method & Interval: Colonoscopy Every 10 years

What are the Grade D Ovarian Cancer screening guidelines?

No screening in asymptomatic women not known to have a hereditary cancer syndrome

Who is considered high risk for developing breast cancer?

- Women with a >20% lifetime risk using The Gail model screening tool

- Those with a BRCA gene mutation

- Having 1st degree relative with a gene mutation

What are the USPSTF Grade B guidelines for breast cancer screening?

Recommends mammogram screening every other year starting at 40

What are the WPSI guidelines for breast cancer screenings?

For average risk, start screening no earlier than 40 and no later than 50, and complete mammogram every 2 years until 74 y.o.

What is the USPSTF Grade B guidelines for osteoporosis screening?

Screen women age 65 y.o. Or older using DEXA Scan to obtain T-Score and Z-Score

What is the USPSTF Grade B screening for STI's?

GC/CT for all sexually active women 13-24 y/o

What is the USPSTF Grade B screening guidelines for IPV?

Annually for all women of reproductive age

What is the USPSTF Grade B screening guidelines for depression?

Screen using PHQ-2 and/or PHQ-9 starting at age 18

What are some patient education interventions than can help with cancer prevention? (7)

- Avoid tobacco

- Stay active

- Healthy weight

- Healthy diet

- limit Alcohol consumption

- UTD with immunizations

- Avoid excess sun exposure

What are Grade A recs for syphillis screening?

Screening for asymptomatic person at increased risk

What are Grade A recs for HTN screening?

Screen with an in office BP for all adults 18+

What are Grade A recs for HIV screenings?

Screen all adults between 15-65 y/o and repeat based on risk

What are Grade A recs for Tobacco use?

Asks all adults about tobacco use and counsel on smoking cessation

What are the Grade A health screening recommendations that should be performed for Women? (7)

- Cervical Cancer Screening

- Colon Cancer Screening

- Folic Acid Supplementation for women of child bearing age

- HIV Screening in adults

- HTN screening in adults

- Syphillis screening in asymptomatic adults

- Tobacco screening and cessation

What are the Grade D health screening guidelines that should not be performed? (5)

- Genital herpes screen in asymptomatic adults

- HRT for primary prevention of chronic conditions

- No Pap smears under 21, after hysterectomy or over 65

- No ovarian cancer screening in asymptomatic women

- No to using risk-reduction medication for women not at increased risk for breast cancer