MDC 3 Exam 1 1. Uterine leiomyoma - o Also called fibroids or myomas o Benign, slow growing solid tumors of uterine myometrium (muscle layer) o Excessive local growth of smooth muscle cells Caused by hormones Cause pain for the patient o 80% of woman are likely to have fibroids o Symptomatic or asymptomatic Key symptom is often heavy vaginal bleeding o Ask how many pads/tampons are used daily o Assess pelvic pressure, elimination patterns, abdomen size, dyspareunia, infertility 2. Uterine leiomyoma Classification - Classified depending on layer of uterus Intramural- contained in uterine wall Submucosal-protrude into uterine cavity Subserosal- protrude through outer surface of uterine wall 3. Uterine leiomyoma Diagnostic - CBC- iron deficiency anemia from heavy bleeding Pregnancy test to rule out cause of uterine enlargement Transvaginal ultrasound- able to see if fibroid is protruding into uterine cavity 4. Uterine leiomyoma Treatment - Managing bleeding • Nonsurgical management o Oral contraception- first thing we do Surgical management • MRI focused ultrasound-heat to tumor • Uterine artery embolization- starves tumor of circulation allowing it to shrink • Myomectomy- laser removal • Hysterectomy 5. Erectile Dysfunction: Causes - o Organic- gradual deterioration o Functional- whiskey dick or something like that o Causes (from textbook) Inflammation of the prostate, urethra, or seminal vesicles • Surgical procedures such as prostatectomy • Pelvic fractures • Lumbosacral injuries • Vascular disease, including hypertension • Chronic neurologic conditions, such as Parkinson disease or multiple sclerosis • Endocrine disorders, such as diabetes mellitus (a major cause) or thyroid disorders • Smoking and alcohol consumption • Drugs, such as antihypertensives • Poor overall health that prevents sexual intercourse If the patient has episodes of ED, it usually has a functional (psychological) cause. Men with functional ED usually have normal nocturnal (nighttime) and morning erections. Onset is usually sudden and follows a period of high stress. 6. Erectile Dysfunction: Treatment - The most common intervention for ED is drug therapy. Other interventions include vacuum devices, intracorporal injections, intraurethral applications, and prostheses (implants). First-line oral drugs used to manage ED, phosphodiesterase-5 (PDE-5) inhibitors, work by relaxing the smooth muscles in the corpora cavernosa so blood flow to the penis is increased. The veins exiting the corpora are compressed, limiting outward blood flow and resulting in penile tumescence (swelling). Teach patients to take the pill 1 hour before sexual intercourse. Instruct patients taking PDE-5 inhibitors to abstain from alcohol before sexual intercourse because it may impair the ability to have an erection. Common side effects of these drugs include dyspepsia (heartburn), headaches, facial flushing, and stuffy nose. If more than one pill a day is being taken, leg and back cramps, nausea, and vomiting also may occur. Teach men who take nitrates to avoid PDE-5 inhibitors because the vasodilation effects can cause a profound hypotension and reduce blood flow to vital organ. 7. Education related to treatment for HPV/cervical cancer - o Gardisil o Safe sex o Annual pap smears after the age of 21 8. Breast Cancer: Risk Factors - Teach to use multiple methods for early detection Mammography Breast self-awareness/self-examination More than 90% are detected by patient Clinical breast examination Options for high-risk women • Close surveillance, annual MRIs, prophylactic mastectomy 9. Breast Cancer: Prevention - Teach to use multiple methods for early detection • Mammography • Breast self-awareness/self-examination o More than 90% are detected by patient o One a month, a few days after the onset of period (breast swell) do standing up and laying down, use pad of fingertips • Clinical breast examination Options for high-risk women • Close surveillance, annual MRIs, prophylactic mastectomy 10. Breast Cancer: Diagnostic Tests - Laboratory assessment • Pathologic study of breast mass tissue and lymph nodes • Liver enzymes, serum calcium, alkaline phosphatase Imaging assessment • Mammography • Tomosynthesis- 3D images • Ultrasonography • MRI • Chest x-ray, CT for metastasis 11. Endometrial Cancer: Symptoms - Postmenopausal bleeding is main symptom May also report watery, bloody discharge, low back, pelvic, or abdominal pain Pelvic examination may reveal palpable uterine mass 12. Endometrial Cancer: Risk Factors - Strongly associated with prolong exposure of estrogen without the protective effects of progesterone • Women in reproductive years • Family history of endometrial cancer or HNPCC • Diabetes mellitus • Hypertension • Obesity • Uterine polyps • Late menopause • Nulliparity (no childbirths) • Smoking • Tamoxifen (Nolvadex) given for breast cancer 13. Endometrial Cancer: Diagnostic - CA-125 tumor marker; alpha-fetoprotein (AFP); hCG to rule out pregnancy before treatment (can be elevated with ovarian cancer) Transvaginal ultrasound Endometrial biopsy- gold standard Chest x-ray Abdominal US CT of pelvis; MRI of abdomen and pelvis Liver, bone scans 14. Hysterectomies - Leiomyomas are the most common reason for hysterectomies. Hysterectomies may be performed abdominally, vaginally, or with laparoscopic or robotic assistance based on the patient's clinical reason for hysterectomy and the surgeon's area of technical expertise. 15. Post-Hysterectomy Physical Changes - • You will no longer have a period, although you may have some vaginal discharge for a few days after you go home. • It will not be possible for you to become pregnant, and birth control methods are no longer needed. (Condoms should still be used to decrease the chance of getting a sexually transmitted infection [STI].) • If your ovaries were removed, you may have some menopause symptoms such as hot flushes, night sweats, and vaginal dryness. • It is normal to tire more easily and require more sleep and rest during the first few weeks after surgery