Pathophysiology for RMT II Study Notes

Pathophysiology for RMT II Notes

Agenda

• Female Reproductive Pathology

Pathology Overview

• Cervical Cancer

• Endometriosis

• Pelvic Inflammatory Disease (PID)

• Ectopic Pregnancy

• Ovarian Cysts

• Ovarian Cancer

• Amenorrhea

• Dysmenorrhea

• Premenstrual Syndrome (PMS)

• Mastitis

• Fibroadenoma

• Breast Cancer

• Gestational Hypertension

• Preeclampsia/Eclampsia

Detailed Pathology

Cervical Cancer

• Definition: Neoplasm of the cervix

• Etiology:

  • Human papillomavirus (HPV) considered an STD

  • Risk factors:

  • Early age of first intercourse

  • Multiple sexual partners

  • Smoking

  • History of STIs

• Major Symptoms:

  • Often asymptomatic; diagnosed via Pap smear

  • Common symptoms: abdominal pain, abnormal bleeding

• Meds/Intervention:

  • Most easily cured cancer of female reproductive system

  • Treatments: surgery, chemotherapy

  • Mortality rate is doubled for black women

• Massage/CIs:

  • Modifications recommended for treatment interventions

  • No contraindications once treatment is complete

Endometriosis

• Definition: Reproductive anomaly where functional endometrial tissue is found outside the uterus

• Etiology:

  • Presence of functional endometrial tissue in locations like ovaries, broad ligament, vagina, intestines

  • Cause of this anomaly is unknown

• Major Symptoms:

  • Ovarian cysts that may rupture, leading to scar tissue

  • Small hemorrhagic lesions termed chocolate cysts

  • Pain due to irritation of surrounding tissues

  • Other complications: bowel obstruction, infertility

  • Dysmenorrhea (pain during menstruation), dyspareunia (pain during intercourse)

• Meds/Intervention:

  • No known cure

  • Surgery or total hysterectomy for severe cases

  • Hormonal medications to suppress the ovulation cycle

• Massage/CIs:

  • Caution with abdominal work due to scarring and adhesions

  • Can effectively address stress and pain

• Research:

  • Vagedes et al., 2019: Massage reduced pain intensity during menstruation for 12 weeks

  • Han et al., 2006: Abdominal massage with essential oils significantly decreased dysmenorrhea

Pelvic Inflammatory Disease (PID)

• Definition: Inflammation of the upper reproductive tract (uterus, fallopian tubes, ovaries)

• Etiology:

  • Usually associated with STIs (chlamydia, gonorrhea)

  • Other bacteria (e. coli, strep) may also be involved

  • Women with IUDs have increased risk after exposure to bacteria

• Major Symptoms:

  • Lower abdominal pain, purulent cervical discharge

  • Adnexal tenderness

  • Potential for pelvic adhesions, infertility

  • Ectopic pregnancy risk, chronic abdominal pain, tubo-ovarian abscess

• Meds/Intervention:

  • Treating causal infections, symptom management

• Massage/CIs:

  • PID requires immediate medical attention; postpone massage until resolved

Ectopic Pregnancy

• Definition: Fertilized ovum implants outside the uterine cavity, frequently in the fallopian tubes

• Etiology:

  • Often results from delayed ovum transport, decreased tubal motility

  • Distorted tubal anatomy is a contributing factor

• Major Symptoms:

  • Initially present with lower abdominal discomfort, often acute on one side

  • Symptoms can progress to severe pain due to rupture

  • Other signs: amenorrhea, bleeding, referred shoulder pain, palpable mass

  • Rupture can lead to decreased fertility or infertility

• Meds/Intervention:

  • Surgical intervention may result in scarring, increasing risk for future ectopic pregnancies

• Massage/CIs:

  • Can treat post-surgical stress; be cautious post-rupture

  • High psychological impact due to loss of pregnancy

  • Abrupt hormonal changes can affect mood, physical balance

Ovarian Cysts

• Definition: Most common form of ovarian tumor

• Etiology:

  • Follicular cysts from occlusion of the duct of the follicle

  • Luteal cysts represented by persistent enlargement of the corpus luteum

• Major Symptoms:

  • Can be benign or cancerous; generally asymptomatic

  • Symptoms may include dull ache if bleeding occurs

  • Ruptured cysts can cause acute abdominal pain

  • Polycystic ovary syndrome may present with multiple cysts, leading to infertility and metabolic issues

• Meds/Intervention:

  • Hormonal drugs and surgical options may be needed

• Massage/CIs:

  • Local contraindications for abdominal treatment due to enlarged cysts

  • Safe to treat other body areas if large cysts are present

Ovarian Cancer

• Definition: Most lethal cancer affecting the urogenital tract

• Etiology:

  • Key risk factor: ovulatory age (longer ovulation periods increase risk)

  • Family history can also increase risk

• Major Symptoms:

  • Often asymptomatic, earning it the title “silent killer”

  • Symptoms may include abdominal distress, bloating, flatulence post-eating

• Meds/Intervention:

  • Surgical removal of affected reproductive organs is primary treatment

  • Lymph node biopsies often performed; chemotherapy applied as needed

  • 5-year survival rate is approximately 80-90% for early detection cases, but only 25% of cases are diagnosed early

  • Overall survival rate is around 50%

• Massage/CIs:

  • Contraindications apply to interventions

  • Supportive massage can enhance quality of life post-surgery

Amenorrhea

• Definition: Failure to begin or loss of menstruation

• Etiology:

  • Primary: failure to menstruate by age 14 with absence of secondary sex characteristics

  • Possible causes: congenital issues, hypothalamic-pituitary-ovarian axis disorder, infections

  • Secondary: cessation of menses for at least six months

• Major Symptoms:

  • Absence of menstruation

• Meds/Intervention:

  • Treatment may involve progesterone or combined hormone therapy

• Massage/CIs:

  • Can provide supportive care that may ease anxiety and enhance body awareness

Dysmenorrhea

• Definition: Pain or discomfort associated with menstruation

• Etiology:

  • Primary: menstrual pain not linked to physical abnormalities

  • Secondary: pain resulting from specific conditions like endometriosis, PID

• Major Symptoms:

  • Symptoms include headache, nausea, diarrhea, fatigue

• Meds/Intervention:

  • Pain relief medications, hormone therapies, lifestyle modifications

• Massage/CIs:

  • Avoid deep or invasive work if diagnosis is unclear; can help with symptomatic relief

Premenstrual Syndrome (PMS)

• Definition: Common reproductive pathology occurring 3-14 days before menstruation

• Etiology:

  • Linked to endocrine imbalances, particularly estrogen and progesterone levels

• Major Symptoms:

  • Include bloating, painful breasts, mood changes, insomnia, cravings, and weight gain

• Meds/Intervention:

  • Treatment with diuretics, tranquilizers, exercise, dietary adjustments, supplements

• Massage/CIs:

  • Massage can reduce symptoms; position modifications needed for comfort

Mastitis

• Definition: Inflammation of breast tissue, common during lactation

• Etiology:

  • Infections from organisms like Staphylococcus and Streptococcus may ascend from the nipple

  • Hormonal fluctuations, tumors, and trauma could also trigger this condition

• Major Symptoms:

  • Symptoms include hardened, inflamed, and tender breasts

• Meds/Intervention:

  • Untreated cases may develop into an abscess requiring drainage

  • Treatment options: antibiotics, hot/cold application, analgesics

• Massage/CIs:

  • Contraindicated if infective; possible for post-treatment scar tissue management

Fibroadenoma

• Definition: Benign fibrous/cystic mass in premenopausal women aged 30s and 40s

• Etiology:

  • Likely hereditary; cause remains unknown

• Major Symptoms:

  • Characterized by a firm, movable mass with asymptomatic nature

• Meds/Intervention:

  • Simple excision may be performed if needed

• Massage/CIs:

  • Can treat post-surgical scar tissue

Breast Cancer

• Definition: Neoplasm of the breast; most common cancer in women

• Etiology:

  • Risk factors include gender, age, familial history, prior benign breast diseases, hormonal influences

  • Approximately 10% are hereditary due to mutations in BRCA1 and BRCA2

• Major Symptoms:

  • Symptoms such as a palpable mass, puckering, nipple retraction observed

• Meds/Intervention:

  • Regular breast self-exams, clinical exams every 3 years (20-40 years) then yearly post-40

  • Mammography for early detection but newer technologies like thermography are effective

• Massage/CIs:

  • Contraindications due to cancer; supportive treatment post-surgery is possible

Preeclampsia/Eclampsia/Gestational Hypertension

• Preeclampsia:

  • Pregnancy-specific hypertension: BP >140 mmHg systolic or >90 mmHg diastolic after 20 weeks, often with proteinuria

  • Predispositions include first pregnancies, multiple fetuses, and other pre-existing health conditions.

  • Theory suggests increased sensitivity to vasoconstrictors in the renin-angiotensin-aldosterone pathway.

• Eclampsia:

  • Presentation of tonic-clonic seizures in women with preeclampsia; attributed to coagulability increases and vascular deposition

• Gestational Hypertension:

  • Increased BP after mid-pregnancy without accompanying proteinuria

• Massage/CIs:

  • Advanced training preferred for accommodating hypertension; often not advisable with preeclampsia/eclampsia

Additional Considerations

• Clinical Connections: Discussion points on how these conditions may relate to broader health issues

• Homework: Review and reflect on the material

Important Notes on Treatment Modifications

• Body positioning, comfort measures, and individual client needs/key considerations for treating various reproductive health issues.