Endometriosis. Gynaecological diseases of children and teenagers




Скачать 279.21 Kb.
НазваниеEndometriosis. Gynaecological diseases of children and teenagers
страница1/3
Дата12.10.2012
Размер279.21 Kb.
ТипДокументы
  1   2   3
MINISTRY OF PUBLIC HEALTH OF UKRAINE

BUKOVINIAN STATE MEDICAL UNIVERSITY


“Approved”

on methodological meeting

of Department of Obstetrics and Gynecology

with course of Infant and Adolescent Gynecology

“___”______________________ 201_ year

protocol #

T.a.the Head of the department

Professor

________________ O.A. Andriyets


METHODICAL INSTRUCTIONS

for practical lesson


« Endometriosis. Gynaecological diseases of children and teenagers.

Abnormalities of location and development of female genital organs. »


MODULE 4: Obstetrics and Gynecology.

Context module 12: Gynecology diseases.


Subject: Obstetrics and Gynecology

6th year of studying

medical faculty №1, 2

Number of academic hours – 5,5

Methodological instruction compiled by:

assist.prof. A.Berbets


Chernivtsi – 2010


1. Topicality. In the last years the problem of endometriosis acquires the special actuality, that it is predefined growth of frequency of this pathology, and also introduction in practice of modern methods of diagnostics. Important is also knowledge of this pathology by doctors by the specialists of general type, as its clinical symptoms can be alike with other diseases. That is why, the purpose of this employment is a study of etiopatogenesis endometriosis, methods of his diagnostics and treatment.

The anomalies of development and wrong positions of the female reproductive organs (FRO) take important seat in pathology of genitaliy, as reasons of unsatisfactory quality of life and violation of reproduktiv function. Anomalies of development of uterus, vagini are often combined with the defects of the urinary system. It is predefined tim, that these organs develop from the general book-marks of embryos of Myulerovikh and Vol'fovikh of channels. The defects of development of the female reproductive organs are often enough innate are combined with the anomalies of development of the bone system, and in a number of cases with the anomalies of development an intestine. That is why knowledges of reasons, methods of diagnostics and treatment of wrong positions of the female reproductive organs need the doctors of different specialities in their practical activity.

  1. Number of hours – 5,5.

3. Educational objectives

3.1. To know: α=ІІ

  1. Theoretical and clinical aspects of etiology, pathogenesis of endometriosis.

  2. Classification of endometriosis FRO.

  3. Basic clinical symptoms are for endometriosis FRO.

  4. Methods of diagnostics endometriosis FRO.

  5. Basic principles of therapy endometriosis FRO.

  6. A testimony is to surgical treatment of endometriosis FRO.

  7. Basic directions of prophylaxis endometriosis.

  8. Endocrine physiology changes are in early and late childhood, in a juvenile period.

  9. Gynaecological research of teenagers.

  10. Gynaecological diseases of children and teenagers. Etiologic classification and treatment of vul'vovaginit of children's.

  11. Vaginal bleeding in a pubertat period.

  12. Disfunktional uterine bleeding in yuvenil'nomu age.

  13. Basic types of anomalies of development of the female reproductive organs are a clinic, diagnostics and treatment

  14. Reasons of wrong positions of the female reproductive organs.

  15. Classification of wrong positions of the female reproductive organs.

  16. Basic clinical symptoms of wrong positions of the female reproductive organs. Methods of diagnostics of wrong positions of the female reproductive organs

  17. Basic principles of therapy of wrong positions of the female reproductive organs (conservative and surgical).

  18. Prophylaxis of wrong positions of the female reproductive organs.

  19. Infantilism, violation of sexual development.

  20. Factors of risk of damage of urinary bladder are at gynaecological operations.

  21. Most frequent reasons of damage of urethra, tactician.

  22. Reasons of the combined damages of organs of the urinary system, tactician.

  23. Reasons and tactic are at the damage of urinary bladder in obstetric practice.

  24. Reasons and tactic are at the damage of ureters.

  25. Сечостатеві нориці причини, клініка та тактика.

  26. Клінічна класифікація нориць.

  27. Причини травма кишківника та чепця.

  28. A perforation of uterus is reasons, clinic, tactic.

3.2. . To be able to:

  1. To choose from anamnesis given, that characteristic for a presence at sick of endometriosis.

  2. To diagnose endometriosis at the objective inspection of sick.

  3. To work out an individual plan of additional inspection with suspicion on endometriosis FRO.

  4. To conduct a review in mirrors, vaginal research, to put a previous diagnosis.

  5. To estimate information of clinically laboratory and histological inspection.

  6. To work out an individual plan of treatment.

3.3 Master the practical skills: α=ІІІ

  1. Collection of obstetric-gynaecological anamnesis.

  2. Physical and gynaecologic examination.

  3. Estimation of results of blood, tests of functional diagnostics, results of USD, roentgenologic, histological inspection tests.

  4. Embriogenez of ovaries.

4. Базові знання, вміння, навички, що необхідні для вивчення теми (міждисциплінарна інтеграція)


Назви попередніх дисциплін

Отримані навички

Нормальна анатомія людини

Визначати анатомічну будову зовнішніх та внутрішніх статевих органів

Біологічна хімія

Описувати особливості стероїдогенезу

Гістологія

Описувати будову статевих клітин, ендометрія, яєчників, матки та маткових труб

Нормальна та патологічна фізіологія

Визначати особливості фізіологічних змін в організмі жінки залежно від фаз менструального циклу. Володіти забором матеріалу для гормонального та біохімічного дослідження

Пропедевтика внутрішніх хвороб

Збирати анамнез, проводити фізикальне обстежен­ня, розпізнавати клінічні синдроми та симптоми, визначати необхідний об’єм та послідов­ність методів обстеження, оцінювати результати параклінічних методів

Топографічна анатомія та оперативна хірургія

Визначати анатомічну будову зовнішніх та внутрішніх статевих органів


5. Поради студенту

5.1. Зміст теми

Endometriosis  :  Etiology, Pathology, Diagnosis, Management


KEY TERMS AND DEFINITIONS

Adenomyoma

An isolated area of endometrial glands and stroma in the uterine musculature that can be identified grossly.

Adenomyosis

The growth of endometrial glands and stroma into the uterine myometrium to a depth of at least 2.5 mm from the basalis layer of the endometrium.

Chocolate Cyst

A cystic area of endometriosis in the ovary.

Coelomic Metaplasia

The potential ability of coelomic epithelium to develop into several different histologic cell types.

Danazol

A synthetic steroid, an attenuated androgen, that is active when taken orally.

Dyschezia

Difficult or painful evacuation of feces from the rectum.

Endometrioma

An area of endometriosis that can be identified macroscopically, usually in the ovary.

Endometriosis

The presence and growth of glands and stroma identical to the lining of the uterus in an aberrant location.

GnRH Agonists

A group of synthetic hormones that suppresses gonadotrophin secretion, causing secondary diminution of ovarian steroidogenesis.

Retrograde Menstruation



The flow of menstrual blood, endometrial cells, and debris via the fallopian tubes into the peritoneal cavity.





ENDOMETRIOSIS

Endometriosis is a benign, but in many women, a progressive disease. The wide spectrum of clinical problems that occur with endometriosis has frustrated gynecologists, fascinated pathologists, and burdened patients for years. Although endometriosis was first described in 1860, the classic studies of Sampson in the 1920s were the first to emphasize the clinical and pathologic correlations of endometriosis. Even today, many aspects of the disease remain enigmatic.

By definition, endometriosis is the presence and growth of the glands and stroma of the lining of the uterus in an aberrant or heterotopic location. Adenomyosis is the growth of endometrial glands and stroma into the uterine myometrium to a depth of at least 2.5 mm from the basalis layer of the endometrium. Adenomyosis is sometimes termed internal endometriosis; however, this is a semantic misnomer because most likely they are separate diseases.

It is usually stated that the incidence of endometriosis has been increasing over the past 30 years. This “opinion” is secondary to an enlightened awareness of mild endometriosis as diagnosed by the increasing use of laparoscopy. During the past 10 years, diagnostic delay, the average time to the first diagnosis of the disease, has decreased dramatically. However, it has been estimated to take an average time of 11.7 years in the United States and 8 years in the United Kingdom. Evers has advanced a provocative hypothesis that endometrial implants in the peritoneal cavity are a physiologic finding secondary to retrograde menstruation, and their presence does not confirm a disease process. The prevalence of pelvic endometriosis in the general female population has been suggested to be 6% to 10%. The age-specific incidence or prevalence of endometriosis is not known and has only been estimated. Many patients are diagnosed incidentally during surgery performed for a variety of other indications. Conservative estimates find that endometriosis is present in 5% to 15% of laparotomies performed on reproductive-age females. The prevalence of active endometriosis is approximately 33% in women with chronic pelvic pain. The incidence of endometriosis is 30% to 45% in women with infertility. It must be emphasized that all studies of the prevalence of endometriosis are subject to selection bias and are dependent on the definition of “active disease.”

The cause of endometriosis is uncertain and may involve retrograde menstruation, vascular dissemination, metaplasia, genetic predisposition, immunologic changes, and hormonal influences, as discussed later on. In addition, there is increasing evidence that environmental factors may also play a role, including exposure to dioxin and other endocrine disruptors. Clinically, it is most difficult to predict the natural course of endometriosis in any one individual. For example, the clinician is uncertain as to which woman with mild disease in her 20s will progress to severe disease at a later age.

The typical patient with endometriosis is in her mid-30s, is nulliparous and involuntarily infertile, and has symptoms of secondary dysmenorrhea and pelvic pain. The classic symptom of endometriosis is pelvic pain. However, in clinical practice the majority of cases are not “classic.” Aberrant endometrial tissue grows under the cyclic influence of ovarian hormones and is particularly estrogen dependent; therefore the disease is most commonly found during the reproductive years. However, 5% of women with endometriosis are diagnosed following meno-pause. Postmenopausal endometriosis is usually stimulated by exogenous estrogen. Endometriosis in teenagers should be investigated for obstructive reproductive tract abnormalities that increase the amount of retrograde menstruation.

Endometriosis is a disease not only of great individual variability but also of contrasting pathophysiologic processes ( Table 1 ). It is a benign disease, yet it has the characteristics of a malignancy—that is, it is locally infiltrative, invasive, and widely disseminating. Although the growth of ectopic endometrium is stimulated by physiologic levels of estrogen use of contraceptive steroids of various doses are usually beneficial for treatment. Another contrast often noted is the inverse relationship between the extent of pelvic endometriosis and the severity of pelvic pain. Women with extensive endometriosis may be asymptomatic, whereas other patients with minimal implants may have incapacitating chronic pelvic pain. However, as would be expected, women with deep infiltrating endometriosis, especially in retroperitoneal spaces, often experience severe episodes of pain. Finally, there is speculation as to the underly-ing pathophysiology that produces infertility in women with endometriosis.


Table 1   -- Endometriosis: A Disease of Clinical Contrasts

Characteristics

Contrasts

Benign disease

Locally invasive

Widespread disseminated foci

Proliferates in pelvic lymph nodes

Minimal disease

Severe pain

Many large endometriomas

Asymptomatic patient

Cyclic hormones cause growth

Continuous hormones reverse the growth pattern







  1   2   3

Похожие:

Endometriosis. Gynaecological diseases of children and teenagers iconThe aim of the present study was to determine the difference in executive functions among adhd children and non-adhd children. On the bases of literature review

Endometriosis. Gynaecological diseases of children and teenagers iconMarried, two children, two step-children

Endometriosis. Gynaecological diseases of children and teenagers icon1er symposium européen de la sergs (Society of European Robotic Gynaecological Surgery), Milan, septembre 2009 / Delporte, Femke

Endometriosis. Gynaecological diseases of children and teenagers iconInfectious diseases

Endometriosis. Gynaecological diseases of children and teenagers iconSelected Anomalies and Diseases of the Eye

Endometriosis. Gynaecological diseases of children and teenagers iconHepatic Liver Diseases – Methods for Diagnosis and

Endometriosis. Gynaecological diseases of children and teenagers iconR. M. Anderson and R. M. May, Infectious Diseases of Humans: Dynamics and

Endometriosis. Gynaecological diseases of children and teenagers iconPrecancerous diseases of the female reproductive organs

Endometriosis. Gynaecological diseases of children and teenagers iconOcular Syndrome and Systemic Diseases, Fourth Edition

Endometriosis. Gynaecological diseases of children and teenagers iconThe Dementias & Neurodegenerative Diseases Research Network(DendroN) Web-link

Разместите кнопку на своём сайте:
Библиотека


База данных защищена авторским правом ©lib.znate.ru 2014
обратиться к администрации
Библиотека
Главная страница