CMA Chapter 21

• Dysfunctional uterine bleeding


  Abnormal or irregular uterine bleeding, including heavy, irregular, or light bleeding caused by an endocrine imbalance
• Types of abnormal uterine bleeding


  • Menorrhagia: excessive bleeding during menses
  • Metrorrhagia: irregular bleeding at times other than menses
  • Polymenorrhea: abnormally frequent menses
  • Postmenopausal bleeding: bleeding after menopause that is not associated with tumor, inflammation, or pregnancy
• Diagnosis of dysfunctional uterine bleeding


  Ruling out other causes, such as hormonal imbalance, tumor, or another condition of the endometrial lining of the uterus
• Premenstrual syndrome (PMS)


  Characterized by a wide variety of physical, psychological, and behavioral signs and symptoms that occur on a regular, cyclic basis
• Premenstrual dysphoric disorder (PMDD)


  A more severe form of PMS where symptoms and mood changes affect routine daily activities
• PMS and PMDD usually diminish within a few days after the onset of menses, and the cause is idiopathic (unknown)
• Diagnosis of PMS and PMDD


  Based on the physician's assessment of the history and physical examination, with patients charting their symptoms for several months on a calendar that includes the menstrual cycle
• Endometriosis


  A condition of unknown cause in which endometrial tissue grows outside the uterine cavity
• Endometriosis is often found in the fallopian tubes, ovaries, the uterosacral ligaments, and in rare cases, in other parts of the abdominal cavity
• Diagnosis of endometriosis


  Confirmed by direct visualization, usually by way of a laparoscopy
• Degrees of uterine prolapse


  • First-degree: uterus has descended to the level of the vaginal orifice
  • Second-degree: uterine cervix protrudes through the vaginal orifice
  • Third-degree: entire cervix and uterus protrude beyond the vaginal orifice
• Uterine displacement


  The uterus is tilted from its normal slightly forward position on the bladder
• Leiomyomas


  Benign tumors of the uterus, including fibroid tumors, myomas, and fibromyomas
• Diagnosis of leiomyomas


  Bimanual examination and sounding of the uterus, and ultrasound to confirm presence
• Cervical and breast cancers have an excellent prognosis when detected and treated early, but left untreated or diagnosed in later stages, these cancers are deadly
• The American College of Obstetricians and Gynecologists (ACOG) recommends that the first Pap test and pelvic exam be performed about 3 years after the first sexual intercourse or by age 21 years, whichever comes first, and annually until age 30 years. Women over age 30 years who have had three negative Pap tests can have less frequent screening
• Ovarian cysts, including functional cysts and polycystic ovaries, are benign
• Functional ovarian cysts


  Fluid-filled sacs that cause few if any problems, usually asymptomatic unless large or ruptured
• Diagnosis and treatment of functional ovarian cysts


  Detected during surgery, treated by puncture or excision
• Initially, the abnormal growth of cancerous cells in the cervix is asymptomatic
• Pap test


  A grading of any abnormal tissue scraped from the cervix using a classification system
• Pap test results


  • Normal
  • Atypical squamous cells (ASC)
  • Squamous intraepithelial lesions (SIL)
  • Atypical glandular cells
  • Cancer
• Squamous intraepithelial lesions


  May be noted as high grade (HSIL) or low grade (LSIL)
• Not all abnormal Pap results indicate cancer
• Colposcopy


  A magnified examination of the cervical tissue with a special instrument called a colposcope
• Other reasons for an abnormal Pap result include inflammation of the cervix and some sexually transmitted diseases such as human papillomavirus (HPV) infection
• Polycystic ovary syndrome (Stein-Leventhal syndrome)


  A troublesome and complex disorder affecting both ovaries, most often found in adolescent girls and young women, with symptoms of an endocrine imbalance
• Diagnosis of polycystic ovary syndrome


  Pelvic examination, ultrasonography, laparoscopy, or exploratory laparotomy
• Treatment of polycystic ovary syndrome


  Depends on the signs and symptoms and the patient's desire for future pregnancy, includes hormone therapy or oral contraceptives
• Female infertility is more difficult to diagnose than male infertility
• Diagnosis of female infertility


  Eliminating the male as the infertile party, then focusing on the female partner, usually not started until after 1 year of unprotected intercourse without conception
• Causes of female infertility


  • Uterine or cervical abnormalities
  • Tubal occlusion or scarring
  • Hormonal imbalance
  • Psychological factors
• Diagnosis of female infertility


  Complete history and physical examination, endometrial biopsy, progesterone blood levels, hysterosalpingography
• Treatment of female infertility


  Identifying and correcting the problem, procedures such as in vitro fertilization may be recommended
• Sexually transmitted diseases (STDs) are easily transmitted
• All STDs must be reported to the local health department by the medical office
• Reporting STDs


  May require filing a form, writing a report, or using a phone reporting system, depending on local policy and procedure
• The patient should be encouraged to notify sexual partners so they may also receive treatment
• Stages of HIV infection


  • Acute infectious state with flulike symptoms
  • Latent period without symptoms but still infectious
  • Weight loss, lymphadenopathy, fever, diarrhea, anorexia, fatigue, skin rashes
  • Onset of immunodeficiency disorders
• There is currently no cure for AIDS, but research to find more effective treatments and a possible cure is ongoing