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INFECCIONES EN GINECOLOGIA 29
CCBB 13
INFERTILIDA Y ESTERILIDAD 13
EXTRAS 13
PLANIFICACION FAMILIAR 12
MENOPAUSIA 9
0 10 20 30 40 50 60
FUNCIONALES:
Mastodinea,
Galactorrea.
Ginecomastia.
MASTOPATIA FIBROQUISTICA
TIPOS: no proliferativos 68%, proliferativos sin atipia 26%, hiperplasia
atipica 4%. DX: mastodinea premenstrual bilatral, areas induradas,
nodulos, telorrea. Patron fibroso denso, nodulos diseminados. ECO! Tto:
solo control. Otros hormonas, vitE
CLULAS ESCAMOSAS
CLULAS ESCAMOSAS ATPICAS (ASC)
De significado incierto: ASC-US
No se puede excluir lesin NIC de alto grado: ASC-H
LESIN ESCAMOSA INTRAEPITELIAL DE BAJO GRADO
(LSIL):
incluye VPH+, NIC1, displasia leve.
LESIN ESCAMOSA INTRAEPITELIAL DE ALTO GRADO
(HSIL):
incluye NIC 2-3, displasia moderada, severa y Ca insitu.
CARCINOMA ESCAMOSO
CLULAS GLANDULARES:
CEL. GLANDULARES ATPICAS (AGC)
CEL. GLAN. ATPICAS, POSIBLE NEOPLASIA
ADENOCARCINOMA IN SITU ENDOCERVICAL : AIS
ADENOCARCINOMA
GENERAL ASSESSMENT
DIAGNSTICO Adequate/inadequate for the reason (ie, cervix obscured by inflammation, bleeding, scar)
Squamocolumnar junction visibility: completely visible, partially visible, not visible
Screening en: QxUtero Transformation zone types 1, 2, 3
Inicio Fin HPV vac
Age 21 to 29 Age 30 benigno
Co-testing (pap test and NORMAL COLPOSCOPIC FINDINGS
Pap test ever Original squamous epitheliumMature Atrophic - Columnar epitheliumEctopy - Metaplastic squamous
HPV testing) every five
y three years Same epitheliumNabothian cysts - Crypt (gland) openings - Deciduosis in pregnancy
years (preferred)
recomm
Can consider Pap test every three
Not endatio Location of the lesion: inside or outside the T-zone, location of the lesion by
ACOG primary HPV years General
21 65 indicate ns as clock position. Size of the lesion: number of cervical quadrants the lesion
(2016) testing every principles
Can consider primary d** unvacci covers, size of the lesion in %age of cervix
three years
HPV testing every three nated
for ABNORMAL Grade 1 Thin acetowhite epithelium Fine mosaic
years for women
women age COLPOSCOPIC (minor) Irregular, geographic border Fine punctuation
women age 25 FINDINGS
25
Coarse mosaic - Coarse
Dense acetowhite epithelium
Grade 2 punctuation
Rapid appearance of acetowhitening
(major) Sharp border -Inner border sign
Cuffed crypt (gland) openings
Ridge sign
CLINICA DIAGNOSTICO
Asintomticos ECO TV
Hemorragia uterina BIOPSIA ENDOMETRIAL
Dolor plvico DILATACION Y CURETAJE
Piometra HISTERESCOPIA+BIOPSIA
DIAGNSTICO Y TTO T0
T1 I
No evidence of primary tumor
Tumor confined to ovaries or fallopian tubes
CLINICA Quiste folicular ECO DOPPLER Ca 125 Ca Tumor limited to one ovary (capsule intact) or fallopian tube; no tumor on
Quiste cuerpo luteo RMN/TAC 19.9, CEA, T1a IA ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal
Asintomticos Tumores LDH, AFP, washings
MARCADORES
Tumor palpable inflamatorios DD b HCG, Tumor limited to both ovaries (capsules intact) or fallopian tubes; no tumor
TUMORALES
Dolor plvico Quistes
H. tir T1b IB on ovarian or fallopian tube surface; no malignant cells in ascites or
Ascitis endometriales
peritoneal washings
Tumor limited to one or both ovaries or fallopian tubes, with any of the
IC
The following symptoms are much more likely to occur in following:
T1c IC1 Surgical spill
women with ovarian cancer than in women in the general IC2 Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface
[1,2]
population. These symptoms include : IC3 Malignant cells in the ascites or peritoneal washings
Tumor involves one or both ovaries or fallopian tubes with pelvic extension (below
Bloating T2 II
pelvic brim) or peritoneal cancer*
Pelvic or abdominal pain T2a IIA Extension and/or implants on uterus and/or tube(s) and/or ovaries
T2b IIB Extension to other pelvic intraperitoneal tissues
Difficulty eating or feeling full quickly Tumor involves one or both ovaries or fallopian tubes, or peritoneal cancer, with
T3 III cytologically or histologically confirmed spread to the peritoneum outside the pelvis and/or
Urinary symptoms (urgency or frequency) metastasis to the retroperitoneal lymph nodes
IIIA Positive retroperitoneal lymph nodes and/or microscopic metastasis beyond pelvis
IIIA1 Positive retroperitoneal lymph nodes only (cytologically or histologically proven)
IIIA1 (i) Metastasis up to 10 mm in greatest dimension
T3a
IIIA1 (ii) Metastasis more than 10 mm in greatest dimension
Microscopic extrapelvic (above the pelvic brim) peritoneal involvement, with or without
IIIA2
positive retroperitoneal lymph nodes
Macroscopic peritoneal metastasis beyond pelvis up to 2 cm in greatest dimension, with or
T3b IIIB
without positive retroperitoneal lymph nodes
ATROFIA DE PIEL
ATROFIA UROGENITAL
INCONTINENCIA URINARIA
SEQUEDAD VAGINAL
DISMINUCION DE LA LIBIDO
COMPLICAIONES
ENFERMEDAD CV
OSTEOPOROSIS
DEMENCIA
Hepatopatas aguda
Contraind. TRH Conectivopatas
Historia de IMA
Enf. Tromboembolica activa Historia de ACV
Cancer de mama-endometrio
GINECOLOGA qxmedic.edu@gmail.com www.qxmedic.com
INFERTILIDAD y ESTERILIDAD
SISTEMATICO
Anamnesis y exploracin fsica: temperatura
basal.
Hormonas: P, luego otras. Serologa (rubeola,
VIH).
Ecografa transvaginal (2mm/da)
Seminograma: 2-7ml, ph>7.2, 20-120millones,
>50% progresivos o >25% rapidos. >15%
normales.
Histerosalpangiografia (OBSTRUCCION
TUBARICA)
Potential Contraindications
Suggested Dose and Precautions According to
Drug Dose Schedule FDA Labeling*
Conjugate 25 mg IV Every 46 Contraindications include, but are not limited, to
d equine hours for breast cancer, active or past venous thrombosis or
estrogren 24 hours arterial thromboembolic disease, and liver dysfunction
or disease. cardiovascular or thromboembolic risk factors.
ACO Monophasic 3/D X 7D Contraindications include, but are not limited to, cigarette
ACO that smoking (in women aged 35 years or older), hypertension,
contains 35 history of deep vein thrombosis or pulmonary embolism,
micrograms known thromboembolic isorders, cerebrovascular
of ethinyl disease, ischemic heart disease, migraine
estradiol with aura, current or past breast cancer, severe liver disease,
diabetes with vascular involvement, valvular heart disease
with complications, and major surgery with prolonged
immobilization.
MEDROXI 20 mg orallyThree Contraindications include, but are not limited to, active or
times per past deep vein thrombosis or pulmonary embolism, active or
day for 7 recent arterial thromboembolic disease, current or past
days breast cancer, and impaired liver function or liver disease.
Tranexami 1.3 g orally Three Contraindications include, but are not limited to, acquired
c acid or times per impaired color vision and current thrombotic or
10 mg/kg IV day for 5 thromboembolic disease. The agent should be used with
(maximum days caution in patients with a history of thrombosis (because of
600 (every 8 uncertain thrombotic risks), and concomitant administration
mg/dose) hours ) of combined oral contraceptives needs to be carefully
consider
DEFINICIN EPIDEMIOLOGA
CLNICA
Endometrio fuera de la cavidad uterina. 10% mujeres. Feritles. Ciclos
(adenomiosis es endmetriosis cortos o menorragia. Tabaco
DOLOR 95%. Dismenorrea progresiva.
miometrial asintomtica) protege.
Dispareunia.
Alteracion menstrual 65%: poli+meno.
Infertilidad 41%: multifactorial. TTO ETIOPATOGENIA
Otros: distencin abdominal,
Laparoscopia: eleccin Desarrollo in situ. (Muller)
rectorragia, disuria, Ca125.
Ciruga radical. Teoria induccin:
Laparoscopa lesin en Medico: ACO, DIU levonorgestrel, mesnquima.
DX: quemadura de polvora. anlogos GnRH, Danazol, gestgenos. Teoria implante:
menstruacin retrgrada.
LOCALIZACIN
Ovario. Quiste achocolatado.
Ligamentos uterosacros, fosa
ovrica, Douglas.
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