Exam (elaborations)
Nuro 733 - Dysmenorrhea and pelvic pain Questions With Complete Solutions
- Course
- Nuro 733
- Institution
- Georgetown University
Nuro 733 - Dysmenorrhea and pelvic pain Questions With Complete Solutions
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Nuro 733 - Dysmenorrhea and pelvic pain Questions WithComplete Solutions
A total hysterectomy is Correct Answers the standard
recommended therapy for postmenopausal hyperplasia or
endometrial intraepithelial neoplasia.
Adenomyosis also may be associated with Correct Answers
elevated levels of follicle-stimulating hormone and luteinizing
hormone as well as a history of depression.
Adenomyosis is a Correct Answers prevalent, benign disorder
in which the en- dometrial glands and stroma invade the
myometrium, either diffusely or focally.
Adenomyosis is a benign condition Correct Answers that may
involve all or part of the uterus.
Adenomyosis occurs Correct Answers when endometrial
glands and stroma, normally sequestered in the endometrium,
invade the myometrium. So the glandular endometrial tissue
invades the thick, muscular uterine myometrium.
After menopause, vaginal bleeding is likely to be Correct
Answers associated with an endometrial carcinoma
After ruling out anatomic abnormalities, pregnancy,
breastfeeding etc, the initial step is to Correct Answers
measure TSH and prolactin. An elevated TSH and prolactin is
indicative of hypothyroidism. Amenorrhea can also be caused
by hyperthyroidism.
,Although the cause of adenomyosis is unknown, evidence
suggests that the disease is associated with Correct Answers
chronic disruption of the margin between the basal layer of the
endometrium and the myometrium, allowing significant
invasion of en- dometrial glands and stroma into the
myometrium. This margin between the endometrium and
myometrium is dif- ferent from margins between mucosal and
muscular layers elsewhere in the body. At the endometrial-
myometrial mar- gin, there is no submucosal layer, allowing for
physiologic and necessary penetration in early pregnancy.
Trophoblastic invasion during pregnancy disrupts this margin
and allows endometrium to invade myometrium as myometrial
fibers change during pregnancy.
Amenorrhea can be a common occurrence during Correct
Answers the peri-menopausal period.
Amenorrhea is also common in the initial period Correct
Answers after menses starts.
Among premenopausal women, the incidence of endometrial
hyperplasia is highest amongst those with Correct Answers
PCOS and oligomenorrhea at 20%; and among those with AUB
at 10%.
Another mechanism leading to the development of ade-
nomyosis includes Correct Answers tissue injury and repair
The theory states that adenomyosis develops due to chronic
myometrial peri- stalsis or hyperperistalsis that causes
microscopic trauma at the margin between the endometrium and
, myometrium; this process launches a tissue injury and repair
mechanism. Local estrogen production increases, further
increasing peristalsis and a self-perpetuating cycle. The process
of tissue injury and repair then increases chronic inflammation
and growth of adenomyotic implants.
As early as 2 days after the medication regimen (progestin
challenge) is completed (withdrawn), and usually within a week,
vaginal bleeding may occur, Correct Answers thereby
establishing the presence of endogenous estrogen and the
patency of the outflow tract. The woman should stop taking
progesterone when the bleeding occurs, as the challenge has
succeeded.
Because combined hormonal contraceptives decrease
prostaglandin synthesis and menstrual flow, Correct Answers
these drugs are frequently used on an off-label basis for the
treatment of women with dysmenorrhea. Need parents approval
for this off-label use of cocs.
Candidates for the LNG-IUS include women free of the
following contraindications: Correct Answers known or
suspected preg- nancy; current or recent pelvic inflammatory
disease or lower genital tract infection; genital tract bleeding of
unknown eti- ology; breast, uterine, or cervical malignancy;
cervical dys- plasia; progestogen-dependent tumors; uterine
anomalies in- cluding fibroids if they distort the uterine cavity;
acute hepatic disease; and hypersensitivity to any components of
the LNG- IUS.
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