Female Repro/Breast

location of inflammation

location of inflammation

Anatomical classification describes the

duration (acute/chronic)

Chronologic classification describes the

route of entry (ascending/descending)

Pathogenetic classification describes the

infection type (viral, bacterial, etc.)

Etiologic classification describes the

STIs (gonorrhea) or polymicrobial infections

What causes PID?

ascending and diffuse

Pathogenesis of PID

PID (pelvic inflammatory disease)

A patient presents to the ER for significant abdominal pain and bloody, copious vaginal discharge. Vitals are normal with the exception of a fever. On a vaginal exam, the cervix is extremely tender on palpation. Diagnosis?

fallopian tubes become scarred and lose celia

Why does PID cause infertility and ectopic pregnancies?

infertility, ectopic pregnancy, chronic pelvic pain

Complications of PID

HSV type 1 or 2

Genital herpes are causes by

herpes

A patient presents to the ER for dysuria and a painful genital rash. Vitals are normal with the exception of a low grade fever. On physical exam there are multiple clustered red fluid-filled vesicles. Diagnosis?

HPV 16, 18

What forms of HPV are high risk of cervical cancer

condyloma acuminate, cervical dysplasia

Clinical features of HPV

Squamous cell carcinoma (cervical cancer)

What type of cancer does HPV 16, 18 cause?

syphilis

What is known as the great imitator and is Treponema pallidum?

Macular rash, condyloma latum, hepatitis, painless chancre

Clinical features of syphilis

Malodorous green discharge, strawberry cervix

Clinical features of trichomoniasis

Excess LH, androgen hypersecretion

Pathogenesis of (polycystic ovary syndrome) PCOS

PCOS

A patient presents to the clinic for irregular menstrual cycles and difficulty conceiving. On physical exam, you notice viriliztion and hirsutism. The patient reports recent weight gain and states she cannot get her acne to go away. Thoughts on diganosis?

Retrograde menstruation leads to implantation of endometrial tissue outside the uterus

What is the prevailing theory regarding the mechanism for endometriosis

ovaries, fallopian tubes, parametrial tissue, other organs

Common sites for endometriosis

biopsy

A patient presents to the clinic with chronic pelvic pain and pain during sex. She also reports menstrual irregularities. To confirm what you think is endometriosis, what do you need to order?

uterus body (endometrial carcinoma)

What is the most common tumor of the reproductive tract?

ovary

What is the deadliest tumor of the reproductive tract?

Pap smear, transition zone

What test can be used to find cervical cancer early and where on the cervix is the test done?

Uterine fibroids (leiomyomas)

A patient presents to the clinic with heavy and painful menstrual cycles. She aslo reports pain during sex and general pelvic pain. On US you are able to see a well-circumscribed mass within the uterus. Diagnosis?

HPV (16-18)

Most common cause of cervical cancer

Those on high dose estrogen and/or obese

Who is at a higher risk of developing endometrial carcinoma?

hysterectomy, radiation, chemo

How do you treat an endometrial carcinoma?

surface epithelial, germ cell, sex cord-stromal

Types of ovarian tumors

surface epithelial

Most common ovarian tumor (70%)

abdominal bloating, pain

What symptoms do ovarian tumors cause?

serous tumor

Most common surface epithelial tumor and aggressive if malignant

mucinous ovarian tumor

Less common and usually benign/borderline malignant, may become pseudomyxoma peritonei (jelly belly)

endometrial ovarian carcinoma

Mostly malignant, solid tumors that resemble endometrial glands

Endometrial hyperplasia, endometrial carcinoma

Types of endometrial tumors

they’re more symptomatic

Why are endometrial tumors caught earlier and more often than ovarian tumors

endometrial hyperplasia

A condition caused by prolonged exposure to estrogen which results in abnormal uterine bleeding (heavy periods and spotting)

nonatypical, atypical

Types of endometrial hyperplasia

atypical

Which form of endometrial hyperplasia leads to a higher cancer risk?

Type I (endometrioid carcinoma)

What form of endometrial carcinoma is estrogen dependent

Type II (serous and clear cell carcinomas)

endometrial carcinoma that resembles high-grade ovarian serous tumors or clear cell carcinoma, always grade III, and a poorer prognosis than type I

estrogen exposure, obesity, HTN, diabetes

Risk factors for endometrial carcinomas

endometrial carcinoma

Vaginal bleeding in post-menopausal women is a red flag for

hysterectomy

What is the treatment of choice for endometrial carcinoma

increased breast cancer risk

Why don’t we treat menopause with estrogen?

fibroadenoma

What disease of the breast peaks in the 20s

fibrocystic change

What disease of the breast increases after age 30

breast cancer

What disease of the breast peaks in postmenopausal women?

Acute mastitis, antibiotics

A patient presents to the clinic for breast pain. While collecting a history you discover she recently had a baby and she is breast feeding. What are we thinking team? Treatment plan?

staph

Most common cause of acute mastitis?

breast cancer

If you see mastitis in a non lactating, no baby woman, what needs to be in the differential

fibroadenoma

A well encapsulated benign tumor composed of fibrous and glandular tissue typically found in young women. No malignant transformation risk.

BRCA1, BRCA2, 1st degree relative, prolonged estrogen exposure, atypical hyperplasia, ductal carcinoma in situ (DCIS)

Risk factors for breast cancer

DCIS (its precancer)

Highest risk for breast cancer

ductal (75-80%)

Most common type of breast cancer

ductal, lobular, medullary, mucinous, tubular

Types of breast cancer

breast cancer, biopsy

A patient presents to the clinic for abnormal lumps in her breast. On a physical exam you notice nipple retraction, skin dimpling, and peau d’orange. What are we thinking and what do we need to confirm our suspicions?