...University of Central Florida College of Medicine Obstetrics and Gynecology Clerkship Revised 5/4/11 lab 1 | P a g e University of Central Florida College of Medicine Obstetrics and Gynecology Clerkship Revised 5/4/11 lab 2 | P a g e TABLE OF CONTENTS GENERAL INFORMATION ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 4 RECOMMENDED TEXTS/RESOURCES ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 5 DIDACTIC EXPERIENCE ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 6 IMPORTANT LOCATIONS ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 7 OBSTETRICAL SERVICE: FLORIDA HOSPITAL AND WINNIE PALMER HOSPITAL ‐‐‐‐‐‐‐‐‐‐‐‐ 8 GYNECOLOGIC AND GYNECOLOGIC ONCOLOGY SERVICES: FLORIDA HOSPITAL AND WINNIE PALMER HOSPITAL ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 11 COMMUNITY WEEK AND SPECIALTY CLINICS‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐14 TIPS FOR A SUCCESSFUL OB/GYN ROTATION ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 15 LOGGING PATIENT ENCOUNTERS (THE PATIENT PASSPORT) ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 16 CLERKSHIP ATTENDANCE POLICY ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 19 CLERKSHIP OBJECTIVES ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐ 20 THE CASE...
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...GYNECOLOGIC CANCER FACTS Gynecologic cancers are malignant tumors that originate from the organs that make up the female reproductive tract. These organs consist of the ovaries, uterus, fallopian tubes, cervix, vagina & vulva. These cancer cells demonstrate an ability to have uncontrolled growth and the potential to spread throughout a woman’s body. Some of these cancers arise sporadically due to unknown reasons while others are related to abnormalities in genes that are either inherited or acquired during a woman’s life. Acquired conditions are usually related to smoking, environmental exposures or infections with certain viruses such as the Human Papilloma Virus. Whatever the reason, these conditions can give rise to and promote cancer formation and abnormal cell growth. There are many different signs & symptoms that can alert a woman that she might have a premalignant or malignant condition. Such identifiable features include external vaginal irritation, irregular vaginal bleeding or spotting, excessive vaginal discharge, pelvic pain or pressure, bloating and abdominal pain, nausea & vomiting, inability to eat normal quantities of food, weight loss & increasing abdominal size. With over 100,000 new gynecologic cancer being diagnosed and 35,000 deaths in the United States each year, no woman is free of risk. Screening with annual exams as well as personal self-awareness and self-examinations often detect some gynecologic cancers in their earliest stages...
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...Fibrous tissue tumor 4 Gynecology Study of the female 5 Hymenectomy Surgical excision of the hymen 6 Mammoplasty Surgical repair of the breast 7 Menorrhea Normal monthly flow 8 Oogenesis Formation of the ovum 9 Dyspareunia Difficult or painful sexual intercourse 10 Genitalia Male or female reproductive system Matching E 1 Laser ablation A Beginning of the monthly flow (menses, menstruation) B 2 Lumpectomy B Surgical removal of a tumor from the breast A 3 Menarche C Abdominal pain that occurs midway between the menstrual periods at ovulation C 4 Mittelscherz D Process in which an ovum is discharged from the cortex of the ovary D 5 Ovulation E Procedure that uses a laser to destroy the uterine lining H 6 Gynecologist F Pertaining to the rectum or vagina J 7 Contraception G Period of gradual changes that lead into menopause G 8 Perimenopause H Physician who specializes in the study of the female I 9 Hysterectomy I Incision into the uterus F 10 Rectovaginal J Process of preventing conception K Lack of monthly flow (menses, menstruation) Abbreviations 1 AH Abdominal hysterectomy 2 DES Diethylstilbestrol 3 Birth control pills BCP 4 Intrauterine device IUD 5 Pelvic inflammatory disease PID 6 Cervical intraepithelial neoplasia CIN 7 DUB Dysfunctional uterine bleeding 8 PMS Premenstrual syndrome 9 Dilation and curettage D & C 10 Toxic shock syndrome TSS Chart Note Questions 1. What is the abbreviation for gynecology? GYN 2. What does...
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...Case Study Analysis: Uterine Fibroids Victoria Moss COMM/215 5/14/12 David Mumford Case Study Analysis: Uterine Fibroids Uterine fibroids develops in the muscular wall in the uterus are not malignant tumors or growth. Fibroids are found in women and are a type of growth not cancer. It is common in women who are between the ages of 25-45. Uterine fibroids are also called leionyomas or myomas. Fibroids do not cause problems when they remain small. They can grow inside and outside the uterus. Once the fibroids grow larger in size they can cause complications. Sometimes fibroids have grown large enough to fill the whole abdomen. In African American women uterine fibroids exist more than in White women. Researching upon uterine fibroids it is not understood the causes and fibroids grow quicker in African American women. The female hormones estrogen and progesterone can increase or decrease throughout women's life. When a woman goes through menopause it decreases estrogen. When going through menopause fibroids tend to shrink. Birth control pills can cause fibroids to grow because it is a hormonal drug that contains estrogen. Fibroids may cause some of these symptoms like changes in menstruation, heavy periods, and cramps. Vaginal bleeding other than menstrual cycle can cause anemia. Causes pain in the abdomen or lower back. It may inquire pain while acquiring sex or pressure when urinating. The uterus is enlarged, miscarriages, and infertility are other symptoms. When...
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...Defining the disease * Chronic disease marked by presence of endometrial tissue (glands and stroma)outside of endometrial cavity * Can be located anywhere in body * Common places in decreasing order: 1. Ovaries, Anterior/Posterior cul-de-sac, Posterior Broad ligament, Uteroscacral ligament, Fallopian tubes, Sigmoid colon + MORE Three Theories of pathogenesis 1. Halban Theory – Transport via lymphatic system 2. Meyer Theory – multi-potential cells in peritoneum undergo metaplastic transformation 3. Sampson Theory – Retrograde menstruation via fallopian tubes 4. Altered Immunity – deficiency in cellular immunity or NK cells result in inability to recognize the presence of endometrial tissue Epidemiology 1. Prevalence between 10-15%; true Prevalence is unknown – need surgical confirmation for diagnosis 2. Age group : found almost exclusively in age of reproductive women 3. Single most common reasons for hospitalization of women in this age group 4. Suspected in 20% chronic pelvic pain and 30-40% of infertility Clinical Manifestations 1. Timing 1. Begins: Cyclic Pelvic pain begins 1 or 2 weeks before menses 2. PEAKS: 1-2 days before onset of menses 3. Subsides: at onset of menses or shortly there after 2. Classic symptoms: Dysmenorrhea, Pelvic Pain, Dyspareunia, infertility 3. Severity of pain does not reflect extent of disease Perform exam during early menses; implants are more likely to be...
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...Polycystic Ovarian Syndrome commonly known as PCOS have never piqued my interest until late 2006 when my daughter was diagnosed with the disease. My daughter have always been obese growing up and I attributed it to her genetic make-up. At age nine, I have noticed physical changes that accompanied her obesity like skin tags, dark patches of skin on groin, armpits and neck, and excessive facial hair growth. As migrants who just settled in the United States, with little knowledge of healthcare resources, my first resort was over the counter remedy like topical creams to lighten dark spots which did nothing at all. It never entered my mind that my daughter's physical manifestations could be a sign of a more serious health condition until her school nurse brought it to my attention. A week before our appointment with a pediatric endocrinologist, my daughter had to undergo an emergency surgery that resulted to removal of her left fallopian tube because of a ten-centimeter twisting ovarian cyst. Polycystic Ovarian Syndrome (PCOS) is a common disorder in women with a prevalence of 10% in women of childbearing age (Kumar, Anantharayanan, and Rajendiran, 2014), and higher reports in some groups such as indigenous and Asian women (Garad, Teede, and Moran, 2011). Although cause is unknown, condition is linked to excess insulin, which contributes to excess production of androgen by the ovaries; low – grade inflammation (often shown by PCOS women) that stimulates polycystic ovaries to produce...
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...DEFINITION OF PROCEDURE EXPLORATORY LAPAROTOMY A laparotomy is a large incision made into the abdomen. Exploratory laparotomy is used to visualize and examine the structures inside of the abdominal cavity. Exploratory laparotomy is a method of abdominal exploration, a diagnostic tool that allows physicians to examine the abdominal organs. The procedure may be recommended for a patient who has abdominal pain of unknown origin or who has sustained an injury to the abdomen. Laparotomy may be performed to determine the cause of a patient's symptoms or to establish the extent of a disease. Advameg, Inc. (2012). Laparotomy, exploratory. Encyclopedia of Surgery. Retrieved November 18, 2012, from http://www.surgeryencyclopedia.com/La-Pa/Laparotomy-Exploratory.html#b A 'look-see' operation usually of the peritoneal cavity, in which the surgeon examines all surfaces for lesions– e.g., abscesses and tumor nodules; during exploratory laparotomy, the operator may biopsy the tissue or obtain peritoneal washings from which a specimen for cytology is processed. Indications: Surgical staging of regional malignancy–e.g., ovarian cancer, complications, adhesion formation. Farlex, Inc. (2012). Exploratory laparotomy. The Free Dictionary. http://medical-dictionary.thefreedictionary.com/exploratory+laparotomy By definition, an exploratory laparotomy is a laparotomy performed with the objective of obtaining information that is not available...
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...Pelvic organ prolapse is a very common condition, predominantly amid older ladies. It is assessed that as many as half of females who have kids will experience some kind of prolapse in later life but, because a lot of females don't seek assistance from their doctor in controlling this troubling and possibly humiliating issue, the actual number of females affected by prolapse is anonymous. However, prolapse is not exclusive to females and, whether you are man or woman, some form of prolapse can happen if the Pubococcygeus muscle, which is like a drape that runs between your legs from your spine to your pubic bone, has become too loose and is not supporting the pelvic organs appropriately, letting any one of them to slip out of its usual position. The most upsetting thing is that this lack of tension can be instigated by many factors i.e. childbirth, menopause, obesity, the common deterioration of getting older can all be contributors and the most imperative thing that any lady can do to decrease the risk of suffering from uterine, vaginal, urethral, bladder or rectal prolapse or to avert a mild prolapse from deteriorating is Kegel and pelvic floor workouts. This applies to men as well as ladies, if they want to keep their rectum and intestines in place. If they don't exercise their pelvic diaphragm habitually, then males can also be subject to prolapse. As they age, if not worked at, the Pubococcygeus muscle will stretch and droop to variable degrees, chancing rectal prolapse....
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...Polycystic ovarian syndrome is a problem in which a woman's hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. In PCOS, small cysts form in the ovaries which affect the hormones and disrupt the normal menstrual cycle. PCOS also may cause unwanted changes in the way you look. If it is left untreated, it can lead to serious health issues. There are various symptoms of PCOS such as: irregular periods, acne, weight gain, extra hair on the body and face and trouble in getting pregnant. Diagnosis can be made on the basis of the symptoms and lab tests. When the patient is diagnosed with the PCOS it is then important to get the treatment done in order to get rid of the disease. When it comes to the treatment then the patient can go for the two spectrums of the treatment that is the medicinal treatment in which doctors prescribe birth control pills to reduce the symptoms, Metformin to get the regular periods and fertility treatment for those who are trying to get pregnant. The other spectrum is the lifestyle change in which you can follow the strict nutritional diet, regular exercise and yoga regime. The relaxing and rejuvenating power of yoga helps a lot in tackling the symptoms and problems caused by PCOS. BENEFITS OF YOGA IN PCOS: Yoga needs no introduction, how useful it is for overall health and wellbeing. It reduces the stress, weight and relaxes the body. It can also be practiced as a supplemental exercise for women suffering...
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...VELEZ COLLEGE F. Ramos St., Cebu City College of Nursing A CASE ANALYSIS REPORT ON PATIENT N.M.C., 47 YEARS OLD, FEMALE, DIAGNOSED WITH UTERINE LEIOMYOMA (s/p TOTAL ABDOMINAL HYSTERECTOMY and BILATERAL SALPINGO OOPHORECTOMY), BILATERAL OVARIAN NEWGROWTHS, METABOLIC SYNDROME, AND HYPERTENSION Submitted By: Villavelez, Carmina Anne Z. BSN III-C Submitted to: Mrs. Miraluna Echavez, RN, MN March 2013 UTERINE LEIOMYOMA/ UTERINE FIBROIDS Uterine fibroids are noncancerous growths of the uterus that often appear during your childbearing years. Also called fibromyomas, leiomyomas or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer. As many as 3 out of 4 women have uterine fibroids sometime during their lives, but most are unaware of them because they often cause no symptoms. Your doctor may discover fibroids incidentally during a pelvic exam or prenatal ultrasound. In general, uterine fibroids seldom require treatment. Medical therapy and surgical procedures can shrink or remove fibroids if you have discomfort or troublesome symptoms. Rarely, fibroids can require emergency treatment if they cause sudden, sharp pelvic pain or profuse menstrual bleeding. Symptoms In women who have symptoms, the most common symptoms of uterine fibroids include: * Heavy menstrual bleeding * Prolonged menstrual periods — seven days or more of menstrual bleeding * Pelvic pressure or pain *...
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...Debby come in complaining about chronic pelvic pain during her menstruation. What makes her condition worst are her untreated symptoms. The doctors she has already seen told her her pain is related to extra heavy menstruation flow and her test would come back negative. This is having an direct effect on her reproductive system, because she has been unsuccessful in conceiving. Due to the lack of research in endometriosis make it difficult to diagnosis since the symptoms are almost like other pelvic diseasea The first step with this patient to do a complete pelvic exam , also order lab s to test for cell CA-125, uterine ultrasound. Base on the finding of the test we can determine of this patient has endometriosis. Endometriosis is a condition that affects lot of women during reproductive years. Patients generally complain about pain, heavy menstruation cycles, and infertility issues. Most of the time doctors and patient can be aware of cause these condition less the appropriate test is conducted. The uterus is lined with three layers of lining, myometrium, stratum basalis of endometrium, and stratum functionalist Endometrium. The stratum functionalist layer is the layer shed monthly during menstruation and support fetal development. The cells in that layer can detach and move to other parts of the and pelvic and body create problems. When the endometrial cells go to other parts of the body it can cause scaring, swelling, bleeding in the wrong area. Such then the patient will...
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...The fallopian tubes are attached to the uterus on the left and right sides. Under normal circumstances, the egg as it is ovulated from the ovary, it will be picked up by the fallopian tube every month, and then the egg and sperm meet in one of the two tubes, forming an embryo, which will travel through the tube into the uterus. Thus, if the fallopian tubes are blocked, called salpingemphraxis, women will have little chance to be pregnant. As a matter of fact, salpingemphraxis is the leading cause of infertility of woman, making a lot of couple desperate and divorced finally. But this disease actually can be prevented in our daily life. I believe that as long as we can keep these habits, we can reduce the risk of developing salpingemphraxis effectively. First of all, we need to pay more attention to personal hygiene, especially the hygiene of the vulva. We should remember not to use the same tub, towel or other hygienic things, in case that it would cause cross-infection. We should also have healthy sex, and after having sex, it’s better to wash and clean the vulva. But we don’t need to use any other lotion to wash it everyday. Besides, it’s very important to keep it dry. Changing the underwear everyday is of great necessity. Secondly, don’t accept intrauterine operation such as induced abortion and cesarean as they can induce hydrosalpinx or inflammations which can lead to salpingemphraxis when getting worse. if the operations are unavoidable, they must be done with...
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...Polycystic Ovary Syndrome or (PCOS) is a common condition in women of reproductive ages. Up to 70% of women with PCOS remain undiagnosed. Infertility is the most common symptom of PCOS. Polycystic ovary syndrome causes irregular menstrual cycles excessive body or facial hair and polycystic ovaries as the main symptom. Women with PCOS produce higher amounts of a male hormones known as androgen which contribute to some of the symptoms of the condition. Polycystic ovary syndrome is a constellation of symptoms rather then a specific disease and the cause or causes are not completely understood. Interestingly the ovaries may develop cysts but that is not necessary for the diagnosis polycystic ovary syndrome. Many females that suffer from PCOS are over weight or obese and it is one of the most common hormonal problems in young women. Polycystic ovary syndrome or so called (PCOS) is in imbalance of the female sex hormones, the ovaries are apart of the female reproductive system along with the fallopian tubes, uterus and vagina. Your ovaries contain a womens life time supply of eggs. These eggs are immature and are stored in tiny fluid filled structures called follicles. Your pituitary gland located at the base of the brain produces hormones that direct the function of your ovaries. Each month the hypothalamus (Brain) makes the hormone GnRh which is released into a special circulation feeding to the pituitary gland. Then the pituitary releases its follicle stimulating hormones...
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...INTRODUCTION Ovarian cancer is a type of cancer that begins in the ovaries. Women have two ovaries, one on each side of the uterus. The ovaries, each about the size of an almond, produce eggs as well as the hormones estrogen, progesterone and testosterone. Ovarian cancer often goes undetected until it has spread within the pelvis and abdomen. At this late stage, ovarian cancer is difficult to treat and is often fatal. Ovarian cancer treatments are available. Researchers are studying ways to improve ovarian cancer treatment and looking into ways to detect ovarian cancer at an earlier stage. SYMPTOMS Symptoms of ovarian cancer are not specific to the disease, and they often mimic those of many other more-common conditions, including digestive and bladder problems. When ovarian cancer symptoms are present, they tend to be persistent and worsen with time. Signs and symptoms of ovarian cancer may include: • Abdominal pressure, fullness, swelling or bloating • Pelvic discomfort or pain • Persistent indigestion, gas or nausea • Changes in bowel habits, such as constipation • Changes in bladder habits, including a frequent need to urinate • Loss of appetite or quickly feeling full • Increased abdominal girth or clothes fitting tighter around your waist • A persistent lack of energy • Low back pain CAUSES It is not clear what causes ovarian cancer. In general, cancer begins when healthy cells acquire a genetic mutation that turns normal cells into abnormal cells. Healthy...
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...Disease Process Worksheet _______________________________________________ Name of Presenter ___________________Polycystic Ovary Syndrome (PCOS)_______________________ Disease or Illness Note: You may use this form as your format or include these topics in a PowerPoint presentation. Overview of Disease or Disorder (what is it? What does it do to the patient? What are usual outcomes?) | Polycystic ovary syndrome (PCOS) is a common disorder among women of reproductive age. Women with PCOS can have enlarged ovaries that contain fluid called follicles located in each ovary that can be seen during an ultrasound. Women with PCOS produce higher amounts of male hormones known as androgens which contribute to some of the symptoms. Women with PCOS have infrequent or prolonged menstrual periods, excessive hair growth, acne and obesity can occur. | Clinical Signs (How does the disease present?) | Women with PCOS usually have the following symptoms: Obesity, Acne, Infertility, Pelvic pain, Enlarged polycystic ovaries, Hirsutism (excess facial and body hair), Infrequent, absent or irregular menstrual cycle, Hypertension, Sleep apnea, Pre-diabetes or type 2 diabetes | Etiology (What causes the disease or illness?) | It is not known what causes PCOS but excess insulin, heredity and low-grade inflammation may play a role. | Epidemiology (The incidence, distribution, and control of disease in a population.) | Between 1 in 10 and 1in 20 women of childbearing age has PCOS. As many as 5...
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