Pathology_Unit_4

Pathology_Unit_4 - Pathology Notes Unit 4 Pelvic Cavity,...

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Pathology Notes Unit 4 Pelvic Cavity, Female breast and reproductive organs, Male reproductive organs Patterns of Normal and Abnormal Uterine Bleeding Normal Menstrual Cycle Length: 21-35 days (some sources: 23-39 days) Menses: 2-7 days Average blood loss: 40 ml (range: 25-69 ml) Amenorrhea: greater than 6 months without menstruation in a nonmenopausal woman Menorrhagia: greater than 80 ml blood loss per cycle at regular intervals. The most common causes are: fibroids, endometriosis, and dysfunctional uterine bleeding. Metrorrhagia: irregular , frequent intervals between menses. Menometrorrhagia: prolonged and/or heavy bleeding at irregular intervals Oligomenorrhea: more than 35 days between cycles, often due to a prolonged follicular phase Polymenorrhea: less than 21 days between cycles; may be caused by a luteal phase defect Dysfunctional Uterine Bleeding (DUB) DUB, also known as “estogenized anovulation” is abnormal uterine bleeding not due to an organic (anatomic) cause. It is due to a functional cause. It is characterized by amenorrhea or irregular uterine bleeding. It is unrelated to an anatomic lesion of the uterus, pregnancy or a systemic disease such as a coagulopathy. (Anatomic lesions of the uterus that produce irregular bleeding include leiomyoma, cervical erosion, uterine cancer, and inflammation/infection of the genital tract.) Other events and disorders that must be ruled out prior to making a diagnosis of DUB are: stress, eating disorders, excessive exercise, weight loss, chronic illness and polycystic ovarian syndrome. It is a chronic state of elevated estrogen and a deficit of progesterone. Consequent to the hormonal imbalance, the endometrium outgrows its blood supply and sheds at irregular intervals, thus producing the irregular bleeding. 85% of DUB is anovulatory. It is due to a disorder of the hypothalamic-pituitary-ovarian axis. Anovulatory DUB occurs around menarche and perimenopause. Due to the decrease in the number of follicles and their sensitivity to FSH and LH during perimenopause, estradiol levels are insufficient to initiate the midcycle LH surge and subsequent ovulation. However, estrogen continues to stimulate the proliferation of the endometrial stratum functionalis. Estrogen levels may decline at some point which precipitates bleeding. In other cases, estrogen levels may also reach the critical threshold to produce the LH surge and ovulation followed by heavy menstruation due to a prolonged menstrual cycle. Some cases of DUB are due to an inadequate luteal phase in which the corpus luteum is dysfunctional, thus producing decreased amounts of progesterone.
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Obstetrics: Perineal Tears during parturition 1 st degree: involves the skin and mucosa 2 nd degree: skin/mucosa plus superficial fascia, the superficial transverse perineal muscle, and perineal body 3 rd degree: involves all 1 st and 2 nd degree structures plus the exeternal anal sphincter 4 th degree: involves 1 st , 2 nd and 3 rd degree structures plus the rectal mucosa
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Pathology_Unit_4 - Pathology Notes Unit 4 Pelvic Cavity,...

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