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Anatomy of the abdominal viscera: Kidneys, ureters and suprarenal glands
Renal system anatomy and physiology
Renal failure: Pathology review
Anatomy clinical correlates: Anterior and posterior abdominal wall
Anatomy clinical correlates: Inguinal region
Anatomy clinical correlates: Peritoneum and diaphragm
Anatomy clinical correlates: Viscera of the gastrointestinal tract
Anatomy clinical correlates: Other abdominal organs
Appendicitis: Pathology review
Complications during pregnancy: Pathology review
Diverticular disease: Pathology review
Gallbladder disorders: Pathology review
GERD, peptic ulcers, gastritis, and stomach cancer: Pathology review
Inflammatory bowel disease: Pathology review
Mood disorders: Pathology review
Pancreatitis: Pathology review
Anatomy clinical correlates: Female pelvis and perineum
Cervical cancer: Pathology review
Uterine disorders: Pathology review
Extrinsic hemolytic normocytic anemia: Pathology review
Intrinsic hemolytic normocytic anemia: Pathology review
Macrocytic anemia: Pathology review
Microcytic anemia: Pathology review
Non-hemolytic normocytic anemia: Pathology review
Anatomy clinical correlates: Heart
Anatomy clinical correlates: Mediastinum
Anatomy clinical correlates: Pleura and lungs
Anatomy clinical correlates: Thoracic wall
Aortic dissections and aneurysms: Pathology review
Coronary artery disease: Pathology review
Deep vein thrombosis and pulmonary embolism: Pathology review
Pleural effusion, pneumothorax, hemothorax and atelectasis: Pathology review
ECG cardiac infarction and ischemia
Pigmentation skin disorders: Pathology review
Skin cancer: Pathology review
Papulosquamous and inflammatory skin disorders: Pathology review
Anatomy of the abdominal viscera: Esophagus and stomach
Anatomy of the abdominal viscera: Large intestine
Anatomy of the abdominal viscera: Small intestine
Anatomy of the gastrointestinal organs of the pelvis and perineum
Gastrointestinal system anatomy and physiology
Enteric nervous system
Colorectal polyps and cancer: Pathology review
Laxatives and cathartics
Lung cancer and mesothelioma: Pathology review
Nasal, oral and pharyngeal diseases: Pathology review
Obstructive lung diseases: Pathology review
Pneumonia: Pathology review
Tuberculosis: Pathology review
Amnesia, dissociative disorders and delirium: Pathology review
Cerebral vascular disease: Pathology review
Dementia: Pathology review
Electrolyte disturbances: Pathology review
Hypothyroidism: Pathology review
Bile secretion and enterohepatic circulation
Malabsorption syndromes: Pathology review
Bacillus cereus (Food poisoning)
Clostridium difficile (Pseudomembranous colitis)
Vibrio cholerae (Cholera)
Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves
Cardiomyopathies: Pathology review
Heart blocks: Pathology review
Supraventricular arrhythmias: Pathology review
Valvular heart disease: Pathology review
Ventricular arrhythmias: Pathology review
Vertigo: Pathology review
ECG cardiac hypertrophy and enlargement
ECG normal sinus rhythm
ECG QRS transition
ECG rate and rhythm
Kidney stones: Pathology review
Sexually transmitted infections: Vaginitis and cervicitis: Pathology review
Sexually transmitted infections: Warts and ulcers: Pathology review
Urinary tract infections: Pathology review
Central nervous system infections: Pathology review
Shock: Pathology review
Anatomy clinical correlates: Anterior blood supply to the brain
Anatomy clinical correlates: Temporal regions, oral cavity and nose
Headaches: Pathology review
Traumatic brain injury: Pathology review
Vasculitis: Pathology review
Anatomy clinical correlates: Arm, elbow and forearm
Anatomy clinical correlates: Axilla
Anatomy clinical correlates: Bones, fascia and muscles of the neck
Anatomy clinical correlates: Bones, joints and muscles of the back
Anatomy clinical correlates: Clavicle and shoulder
Anatomy clinical correlates: Foot
Anatomy clinical correlates: Hip, gluteal region and thigh
Anatomy clinical correlates: Knee
Anatomy clinical correlates: Leg and ankle
Anatomy clinical correlates: Median, ulnar and radial nerves
Anatomy clinical correlates: Wrist and hand
Seronegative and septic arthritis: Pathology review
Apnea, hypoventilation and pulmonary hypertension: Pathology review
Heart failure: Pathology review
Nephrotic syndromes: Pathology review
Anatomy clinical correlates: Vertebral canal
Back pain: Pathology review
Anatomy clinical correlates: Male pelvis and perineum
Penile conditions: Pathology review
Prostate disorders and cancer: Pathology review
Testicular and scrotal conditions: Pathology review
Testicular tumors: Pathology review
Anatomy clinical correlates: Eye
Eye conditions: Inflammation, infections and trauma: Pathology review
Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review
Eye conditions: Retinal disorders: Pathology review
Bronchodilators: Beta 2-agonists and muscarinic antagonists
Bronchodilators: Leukotriene antagonists and methylxanthines
Pulmonary corticosteroids and mast cell inhibitors
Anatomy clinical correlates: Ear
Vaginal and vulvar disorders: Pathology review
Anxiety disorders, phobias and stress-related disorders: Pathology Review
Atherosclerosis and arteriosclerosis: Pathology review
Bone disorders: Pathology review
Diabetes mellitus: Pathology review
Drug misuse, intoxication and withdrawal: Alcohol: Pathology review
Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review
Drug misuse, intoxication and withdrawal: Other depressants: Pathology review
Drug misuse, intoxication and withdrawal: Stimulants: Pathology review
Dyslipidemias: Pathology review
Hypertension: Pathology review
Movement disorders: Pathology review
Peripheral artery disease: Pathology review
Psychological sleep disorders: Pathology review
Rheumatoid arthritis and osteoarthritis: Pathology review
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Uterine Leiomyoma (Fibroids) Characteristics and Presentation
29-year-old Carmen presents to the physician’s office complaining of severe lower abdominal pain during her menstrual periods as well as pain during intercourse.
She has been trying unsuccessfully to get pregnant for the first time for the past 2 years.
Pelvic examination shows a normal sized uterus.
Later that day, 44-year-old Susanna comes to her physician reporting heavy menstrual periods that last about 10 days.
This has been occurring for the past 6 months and is accompanied with a feeling of “fullness” in the lower abdomen as well as fatigue.
On further history, she has never been pregnant.
Physical examination shows an enlarged uterus with multiple round masses.
Laboratory studies reveal iron deficiency anemia.
Based on the initial presentation, Carmen and Susanna both have some form of uterine disorder.
Let’s first review physiology real quick.
The uterus consists of 3 layers, an outer layer called the perimetrium or the serosa, a middle smooth muscle layer called the myometrium, and the innermost layer, the endometrium.
The endometrium has two layers, an inner functional layer made up mainly of glands and supporting connective tissue, called stroma, and an outer thin basal layer which regenerates the overlying functional layer after each menstrual cycle.
Okay, now, the first uterine disorder is endometritis or inflammation of the endometrium.
This is usually caused by normal bacterial flora of the lower genital tract, meaning the cervix, vagina or external genital organs, that travel upwards into the endometrium.
A high yield risk factor to remember is the retention of products of conception, like parts of the placental or fetal tissues, following delivery or abortion.
Another risk factor is the presence of a foreign body, like an intrauterine contraceptive device.
Both can provide a good environment for bacteria to grow and cause an infection in the uterus.
Less commonly, endometritis can be caused by outside bacteria such as Chlamydia trachomatis or Neisseria gonorrhoeae, which are transmitted sexually, or Mycobacterium tuberculosis, which spreads from the lungs into the blood and travels to other organs such as the uterus.
Now, endometritis can be acute or chronic.
On your test, an individual with acute endometritis, typically presents with symptoms like fever, abnormal uterine bleeding, lower abdominal pain, dysuria, which is painful urination, or dyspareunia, which means pain during sexual intercourse.
In contrast, in chronic endometritis, people often have no symptoms and normal physical examination, however, some may experience similar symptoms to those of acute endometritis, although milder.
Diagnosis of is usually based on clinical findings.
An endometrial biopsy can help make the diagnosis, although it’s not routinely done.
What you absolutely have to remember is that microscopic examination of acute endometritis shows neutrophils in the endometrium, which are the hallmark of acute inflammation, while in chronic endometritis, the presence of lymphocytes, especially plasma cells, in the endometrium is diagnostic.
Uterine disorders are conditions that affect the uterus, the female reproductive organ that is responsible for gestating a fertilized egg. Common uterine disorders endometritis, asherman syndrome, endometrial hyperplasia, endometrial polyps, endometriosis, and leiomyomas.
Endometritis refers to the acute or chronic inflammation of the endometrium due to invasion by bacteria normally found in the lower genital tract. Asherman syndrome involves intrauterine adhesions following procedures like dilation and curettage and can result in amenorrhea, infertility, or recurrent pregnancy loss. Endometrial hyperplasia is the excessive growth of the endometrial glands, most commonly caused by long-standing increased exposure to estrogen without the counteracting effect of progesterone.
There is also endometrial cancer, which is a type of cancer that begins in the lining of the uterus, called the endometrium. There can also be endometrial polyps, which are benign growths of the endometrial glands and stroma that protrude into the uterine cavity. Next, there is endometriosis in which there is the presence of endometrial tissue outside the endometrial cavity, usually on the ovaries, causing pelvic pain and bleeding that gets worse during menstruation. Finally, there are leiomyomas or uterine fibroids, which are extremely common benign smooth muscle tumors that usually develop in premenopausal women, in response to estrogen. Leiomyomas can present with abnormal uterine bleeding, pain, iron deficiency anemia, or fertility issues.
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