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พยาธิสรีรระบบสืบพันธุ์ - Coggle Diagram

- - - - 13 years old without secondary sexual characteristic
      - 15 years old
    - - Chromosome XํY-Androgen insensitivity syndrome (AIS)
      - Chromosome XX- Mullerian agenesis
    - - Chromosome X0-Turner syndrome
      - Chromosome XX-Ovarian failure
  - - - :check:already started menstruation
      - :check:lack of periods for ш 3 cycle (regular cycle)
      - :check:lack of periods for ш 6 months (irregular cycle)
      - :check:DMPA > 1 year, OCP > 6 months
    - - Gonadal dysgenesis-Turner's syndrome
      - Postmenopausal ovarian failure
      - Premature ovarian failure
        
        Autoimmune, Chemotherapy, Galactosemia,radiation, mumps
  - - - Decrease in hypothalamic GnRH secretion >>> decreased pulses of gonadotropins
    - - •eating disorders (such as anorexia nervosa)
      - • Excessive exercise
      - • stress.
- - - - Ovarian cycle: follicular phase, ovulation,luteal phase
      - Uterine cycle: menstruation, proliferative phase, secretory phase
  - - - Definition: painful menstruation
      - Primary dysmenorrhea:absence of pelvic pathology, ovulation cycle
        
        PATHOGENESIS-Prostaglandin (PG F2α)** :red_flag:**
        
        TREATMENT
        
        • General support
        • Medication
        • Surgery
      - Secondary dysmenorrhea: results from identifiable organic diseases, most common  endometriosis
      - Previous gynecologic history: PID, surgery :red_flag:
      - Investigation
        
        CBC, ESR • Cultures: STD • US
        
        Laparoscopy : gold standard for endometriosis
        
        • HSG: intrauterine scarring,fibroid
        
        • Hysteroscopy
    - - Abnormal uterine bleeding (AUB) :red_flag:
        
        • Estrogen withdrawal bleeding-หยุดทันที่ที่มีอาการ
        
        •Estrogen breakthrough bleeding:• anovulation
        
        •Progesterone withdrawal bleeding
        
        •Progesterone breakthrough bleeding
      - Dysfunctional uterine bleeding (DUB) :red_flag:
        
        Anovulatory DUB
        
        Ovulatory DUB
        
        Treatment
        
        • Advise
        
        • Symptomatic treatment
        
        • Stop bleeding
        
        • Decrease recurrent bleeding
        
        • Treat cause
    - - Definition:physical and emotional symptoms that occur in 1-2 weeks before menstrual period and resolve around the start of bleeding
      - RISK
        
        Age: 30-40 yr
        
        • Genetics
        
        • Personality and stress
        
        • Socioeconomic problem
      - SYMPTOM
      - PATHOPHYSIOLOGY
        
        • Unknown
        
        • Abnormal serotonin production
        
        • Beta-endorphin change in luteal phase
        
        • Decrease GABA function
      - TREATMENT
        
        • Supporting
        
        • Ovarian suppression
        
        • OCP
        • GnRH agonist
        
        • Medication
        
        • SSRI
        • Anxiolytic
        
        • Surgery
- - - - • typically takes place over 4.5 yrs.
      - • 1st sign -- accelerated growth (growth spurt)
      - • Breast budding -- usually 1st recognized pubertal change (thelarche)
      - • Secondary sex characters include: development of the breast, appearance of pubic and axillary hair
      - Height & Growth rate
        
        • Men have 1.5 times the lean body mass & skeletal mass of women
        
        • Women have twice as much body fat as men
      - Genital organs changes:
        
        • Mons pubis, labia majora & minora: increase in size
        
        • Vagina:- length,
        
        • Uterus:- enlarge
        
        • Ovaries:- Increase in size
  - - - – No sexual development at 13 yrs in female
      - – No menstruation by age 15 years
      - – No menstruation 3 years after adrenarche or thelarche
      - – Patient or Parents' concern about the problem
    - - CIOF (Turner syndrome) 26%
        CCOF (Gonadal dysgenesis) 17%
    - - Reversible 18%
        Irreversible 13%
    - - General Health
        Height and Weight Records
        older siblings and parents
    - - Body measurement
    - - Hormone profiles
    - -  Physiologic delay tends to be familial.
      -  Persistent decidual teeth : probable hypothyroidism.
      -  Absent pubic hair with a vaginal pouch : AIS
      -  Absent pubic hair , uterus is present : hypopituitarism
      -  Gonadal dysgenesis : sexual infantilism, increase gonadotropin levels,normal to slightly reduced bone age.
    - - Correction of primary etiology when possible
      - Estrogen and progesterone replacement therapy
      - Removal of gonads in XY individuals
      - Psycho. Support
      - Follow up