reproductive musculoskeletal and cns l.
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  1. Reproductive, Musculoskeletal, and CNS Ah 120

  2. Fibrocystic Disease of the Breast • Benign mixture of fibrotic, cystic lesions with ductal hyperplasia • Caused by the stimulating effects of fluctuating estrogen levels • Diagnosed by needle aspiration or surgical excision • Treated by removing methylxanthines form diet and hormonal therapy eg, birth control pills

  3. Carcinoma of the Breast Most common malignancy in women over 30

  4. Etiology • Heredity • Breast cancer genes BRCA1 and BRCA2 • Menopause • Especially with prolonged treatment with estrogen--progestin

  5. Pathology • Adenocarcinoma replaces normal tissue in a glandular arrangement surrounded by connective tissue and fibrosis • Because of proximity of axillary lymph nodes, it metastasizes early and easily • Most often to lung or bone

  6. Signs & Symptoms • Begins as a painless mass that eventually becomes palpable • Also discharge from nipple or retraction of the nipple • Distortion of the breast surface (mottling or orange-peel effect) • Discoloration • Ulcerative lesion on breast surface

  7. Diagnosis • Breast self exam • Needle biopsy • Surgical excision with biopsy • Ultrasound Fibrocystic Lesion

  8. Diagnosis (cont.) Normal • Mammography Abnormal

  9. Treatment • Surgery • May be radical mastectomy with lymph node resection • “Lumpectomy” with or without lymph node removal • Chemotherapy and Radiation therapy • May be done prior to surgery to shrink tumor • Hormone Therapy • Long term tamoxifen

  10. Endometriosis • Presence of endometrial tissue outside of uterine lining • Usually retrograde migration to ovary but may go anywhere in the abdominal cavity

  11. Signs and symptoms vary throughout the menstrual cycle Abdominal and pelvic pain Excessive and abnormal bleeding Endometrial tissue is still influenced by hormones Infertility Treatment(s) Hormonal therapy Eg, birth control pills Pain meds Surgical excision of lesions that cause intractable pain Surgical excision may cause sterility Endometriosis (cont.)

  12. Endometrial Carcinoma Adenocarcinoma of the uterus usually seen in post-menopausal women

  13. Endometrial Carcinoma (cont.) Etiology • Irregular menstrual cycle history • Infertility/no childbirth • Delayed menopause Pathology • Spreads through uterus, fallopian tubes, ovaries and out into peritoneal cavity • Metastasizes via blood and lymphatic system

  14. Endometrial Carcinoma (cont.) • Primary symptom is post-menopausal bleeding • Diagnosis: Pap smear, D&C with biopsy • Treatment: Hysterectomy with hormone therapy (usually progestin which increases the risk of breast cancer) and possibly chemotherapy

  15. Carcinoma of the Cervix Etiology • Increased “wear and tear” on the cervix • Promiscuity • STDs • Papilloma virus • Maternal history of DES Pathology • Spreads to adjacent structures (usually urethra/bladder and rectum) • Metastasizes via lymphatics

  16. Carcinoma of the Cervix (cont.) Signs & Symptoms • Abnormal bleeding • Bladder & kidney infections (due to metastatic spread) Diagnosis • Pap smear followed by colposcopy

  17. Carcinoma of the Cervix (cont.) Treatment • Excision of the lesion • Surgical (partial or total hysterectomy) • Laser resection • Cryocautery • Freezing the lesion • Radiation (may be done with implants)

  18. Ovarian Lesions Follicular (retention) cysts, adenomas, adenocarcinomas

  19. Follicular (Retention) Cyst • Benign, non-neoplastic cyst • May cause pain and possibility of rupture • May cause internal hemorrhage • Usually regress on their own without treatment

  20. Cystadenoma • Benign, neoplastic cyst filled with serous fluid or mucus • Can become very large and can be quite painful • Treatment is usually surgical resection • May require oophorectomy

  21. Cystadenocarcinoma • Highly malignant adenocarcinoma • May be primary or spread from endometrial carcinoma • Usually no symptoms until it has metastasized • Elevated CA125 • Treated with aggressive surgery, chemotherapy, and radiation

  22. Prostatitis • Inflammation usually caused by STD • Can be acute or chronic • Intense inflammation with abscesses • Acute: swollen and squishy • Chronic: swollen and hardened (because of fibrosis)

  23. Prostatitis (cont.) Signs & Symptoms: • Dysuria and nocturia • Low back pain • Pyuria and leukocytosis • May have fever if acute • Signs and symptoms less severe if chronic • Treated with antibiotics

  24. Benign Prostatic Hypertrophy (BPH) • Enlargement of the prostate that usually starts at age 45-50 • Caused by hormonal imbalance • Increased dihydrotestosterone, a by-product of testosterone metabolization • Causes obstruction of the urethra as it exits bladder

  25. BPH (cont). Signs & Symptoms • Dysuria • Difficulty in starting, stopping, and controlling urine flow • May cause cystitis and pyelonephritis and complete urethral obstruction • Treatment: Finasteride to inhibit dihydrotestosterone or surgery (TURP)

  26. Carcinoma of the Prostate • Usually adenocarcinoma • Very common in men over 50 • Signs and symptoms are similar to BPH • May also have hematuria • S & S may not appear until it has metastasized to another location

  27. Carcinoma of the Prostate (cont.) • Metastasizes throughout body, but preferentially to bone Diagnosed by: • Digital exam • Elevated PSA or acid phosphate in blood • Transrectal ultrasound with needle biopsy

  28. Carcinoma of the Prostate: Treatment • Surgery and /or radiation • Surgery may damage nerves and result in impotence and incontinence • For metatstatic spread – hormone therapy • Removal of testosterone or addition of female sex hormones

  29. Testicular Carcinoma • Most common in men under 30 • Usual only symptom is a palpable mass through the scrotum on a testicle • May metastasize via regional lymph nodes • Treatment: orchiectomy • May need chemo and radiation if cancer cells are found in lymph nodes • Note: testicular cancer cells produce hormones that are seen in pregnancy. Thus a male with testicular cancer may have a positive pregnancy test!

  30. Musculoskeletal Diseases

  31. Bone Fracture Types • Proper healing requires realignment and stabilization • Stabilization may be done through external fixation (casts and splints) or internal fixation (surgical reduction with pins and rods)

  32. Abnormalities of the Vertebral Column • Kyphosis –abnormal posterior curvature in upper back (“hunchback”) • Caused by degenerative disease such as arthritis or by injury

  33. Abnormalities of the Vertebral Column (cont.) • Lordosis – abnormal anterior curvature in the lower back (“swayback”) • Caused by congenital defect, injury, muscular dystrophies, or poor posture

  34. Abnormalities of the Vertebral Column (cont.) • Scoliosis – abnormal lateral curvature • Due to congenital defect, poor posture, injury • May compromise lung function • Treated with exercises, physical manipulation, and in severe cases, surgery

  35. Herniated Nucleus Pulposus • Herniation of disk material puts pressure on nerve roots • Most common in lumbar spine) • Caused by injury, or degenerative disease • Causes pain and paresthesia on affected side and down affected leg

  36. Herniated Nucleus Pulposus (cont.) • Diagnosed by myelogram, MRI, or CT Treatment: • Rest, muscle relaxants, analgesics • Manipulation • Various surgical procedures

  37. Osteomyelitisinflammation of bone caused by infection • Caused by staph or strep • Skin lesions, compound fractures, orthopedic surgical procedures • More common in children • Damages medullary canal and weakens bone and makes it prone to further fracture and deformity • Acute symptoms: bone pain and fever (may become chronic with minimal symptoms) • Initially treated with antibiotics

  38. Osteoporosisdecrease in bone density due to calcium loss Etiology: • Aging, menopause, steroid therapy, immobilization, low dietary calcium • Causes vertebral column abnormalities and increases the chances of fracture in weight bearing joints, eg hip and vertebral column • Treated by:calcium supplements, vitamin D, and possibly hormone therapy

  39. Osteosarcoma • Malignancy that develops in long bones • Most common in the knee (distal portion of femur) • More common in children • Causes pain and limited range of motion • Treated with chemotherapy followed by surgery • Often metastasizes to lung

  40. Muscular Dystrophy • Duchenne’s (most severe) and Becker’s (less severe) • Inherited sex-linked recessive disease causing atrophy of muscle cells and replacement with fibrous and adipose tissue • Causes postural abnormalities, difficulty with walking and eventually standing. May progress to affect the diaphragm and respiration • Treatment is palliative

  41. Myasthenia Gravis • A progressive loss of muscular strength with activity and then returns to normal after rest • Is a descending weakness/paralysis • Caused by an autoimmune reaction which damages the acetylcholine receptor site at the myoneural junction • Treatment: Steroids and immunosuppressive drugs, plasmapheresis, thymectomy

  42. Osteoarthritis(Degenerative Arthritis) • Degeneration of cartilage leading to roughening of the articular surface of bones • Caused by aging and increased wear and tear • Injury may lead to arthritis also

  43. Normal Knee Osteoarthritic Knee

  44. Osteoarthritis (cont.) • Signs and symptoms: painful, swollen joints with limited range of motion • Treatment: Exercises and physical therapy, pain meds, joint replacement, alternative treatments, ie, shark cartilage

  45. Rheumatoid Arthritis • An autoimmune disease that affects ALL joints • Usually starts in hands and feet • Autoantibodies attack the synovial lining of joint capsules causing chronic damage and fibrosis • Ankylosing (“fusing”) of joints eventually occurs

  46. Rheumatoid Arthritis (cont.) • Signs and symptoms similar to osteoarthritis except that all joints become involved • Patient may also develop skin nodules, lung fibrosis, and inflammation and vasculitis in the heart • Treatment is similar to osteoarthritis • Patients may also be put on methotrexate

  47. Central Nervous System Disease

  48. Cerebral Vascular Disease • Atherosclerosis in circulatory system of the brain • Often starts in the carotid arteries • Risk factors are the same as for coronary artery disease (atherosclerosis in the coronary circulation) • Smoking, obesity, high cholesterol, lack of exercise, high fat diet, hypertension, diabetes, age and heredity

  49. Transient Ischemic Attack(TIA) • Transient ischemia caused by cerebral atherosclerosis that produces symptoms without causing permanent death of brain tissue • A TIA is to the brain what angina pectoris is to the heart! • Symptomology usually subsides within hours

  50. Cerebral Vascular Accident(CVA) Neurologic deficit due to severe and long lasting ischemia “STROKE” or “BRAIN ATTACK”