Term
| what are the 5 key features relevant to a H+P for a pelvic mass pt? |
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Definition
| 1) pt age. 2) symptom acuteness. 3) organ of origin. 4) location of the mass. 5) consistency of the mass (cystic or solid). |
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Term
| what is the most common (benign) uterine mass? how do they present? |
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Definition
| fibroids (also called leiomyoma, myoma, myomata), the symptoms of which include: pelvic pain, pressure (rectal/bladder), and abnormal bleeding. |
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Term
| what is the most common cause of any adnexal mass? |
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Definition
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Term
| what characterizes the different kinds of benign ovarian tumors? |
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Definition
| cystadenoma, follicle cysts (most common - physiologic), corpus luteum cyst (also common), endometriotic cysts, germinal inclusion cyst, theca-lutein cyst (least common), and benign cystic teratoma (dermoid - teeth/hair/nails, needs to be removed). |
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Term
| what are the relative size comparisons that can be used in OB/gyn? |
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Definition
| normal ovary size: 2-3 cm (walnut). golf ball: 4 cm. tennis ball: 6 cm. orange: 8 cm. |
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Term
| what are the malignant ovarian tumors? |
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Definition
| germ cell tumors, epithelial CA, gonadal stromal tumors, and metastatic disease |
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Term
| what are some common causes of fallopian tube masses? |
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Definition
| inflammatory masses, ectopic pregnancy, and CA (unusual) |
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Term
| what are non-gynecologic possible causes for a pelvic mass? |
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Definition
| distended bladder, feces, pelvic kidney, diverticular abscess, appendiceal abscess, abdominal wall hematoma, lymphoma, and GI tumors (cecal CA, crohn's @ terminal ileum, sigmoid colon diverticulitis, appendiceal abscess, and rectosigmoid CA) |
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Term
| what are questions to ask the pt in the history when evaluating a pelvic mass? |
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Definition
| is there pain? change in bowel/bladder habits? fam hx? regular periods (if they are regular, it is more likely not a GYN problem)? pain w/intercourse? pregnancies? flank pain? |
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Term
| what studies can be run to help dx a pelvic mass? |
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Definition
| beta-hCG for pregnancy (good for: amenorrhea/pelvic pain/child bearing years), CA-125 for ovarian neoplasms (<35), pelvic/transvaginal US (latter is better, but if pelvic - bladder must be distended), MRI, CT, diagnostic laparoscopy (if endometriosis/cyst is suspected), diagnostic aspiration of cysts, and exploratory laparotomy (check for scarring from previous sx) |
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Term
| what are the indications for sx in the context of a pelvic mass? |
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Definition
| an ovarian cyst > 5 cm, a solid ovarian lesion, an adnexal mass > 10 cm, ascites, a palpable mass in a postmenopausal woman, and if torsion/rupture is suspected. |
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Term
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Definition
| a glycoprotein which detects *non-mucinous epithelial ovarian CA (most common). it can be used as a tumor marker, but should not be used as a screening tool (major disadvantage: not sensitive - may be elevated in pregnancy, myomas, endometriosis, adenomysosis, PID, colon, pancreas, and breast tumors.) *it really is just a test for inflammation* |
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Term
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Definition
| periurethral glands which can become infected in chlamydia/gonorrhea |
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Term
| how can you tell if a pt likely has a bartholin's abscess? |
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Definition
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Term
| how does a rectocele present? |
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Definition
| as a bulging of the posterior vaginal wall |
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Term
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Definition
| when the bowel protrudes out behind the uterus (support to the perineum is gone - get prolapsed uterus) |
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Term
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Definition
| lacerations in the vaginal mucosa |
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Term
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Definition
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Term
| what is tx for uterine fibroids? |
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Definition
| post/perimenopausal or already given birth: hysterectomy. otherwise - try to salvage uterus and remove fibroids surgically OR embolization. |
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Term
| how is uterine fibroid embolization carried out? |
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Definition
| catheter in femoral artery, go through aorta to opposite side of uterus, inject a substance which will occlude the artery, then bring the catheter back and repeat on that side. this will occlude the uterine/hypogastric artery, causing the fibroid to shrink, die and disappear. (this works b/c there is collateral circulation to the uterus from the ovarian artery) |
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Term
| what can mimic an ovarian neoplasm? |
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Definition
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