As a doctor,what you should know to treat your patient??

1. As a doctor,what you should know to treat your patient?? PBL-TEAM 1 HOMEWORK 2

2. Patient 1 Name:Lucy Diagnosis:myoma of uterus Question:what’s the main symptom and treatment for her ?

3. Symptoms • Usually no symptoms. • Once,there,are,symptoms,the,symptoms,from,leiomysmas,depend,on,their,location,the,speed,of,growth,and,degenerations,and,not,associate,with,the,size,and,the,number,of,myomas.

4. Main symptoms • n1.  menstruation change • n2.  abdominal mass • n3.  leucorrhea • n4.  Abdominal pain • n5.  compress symptom • n6.  infertility • n7.  anemia

5. Treatment • nChoice of treatment depends on • 1.Patient age • 2.Pregnancy status • 3.Desire for future pregnancies • 4.General health • 5.Symptoms • 6.The size, location, and state of leiomyomas

6. Method • 1.GnRH • Indication: • 1.Control of bleeding from myoma • 2.shrinkage may be sufficient to allow laparoscopically assisted vaginal hysterectomy, standard vaginal hysterectomy and in certain cases for myomectomy • 2.Androgen • 3.Mifepristone • Surgical measures • nIndication:the size of uterus is>= 2.5M pregnancy,obvious anemia. • nInclude • 1.Myomectomy • 2.Hysterectomy

7. Patient 2 Name:Betty Diagnosis:endometriosis or chocolate cyst Question:How do you know she has this disease(symptom) and what can you do ??

8. The chief pathologic change of endometriosis is that the ectopic endometrium has cyclic bleeding under the effects of ovarian hormone,which is accompanied by the fibrous tissues hyperplasia,and forms purple-brown spots,finally develops different size purple-blue nodes. • When it occersin the ovary (usually lateral ) there may be brown emplastic dated blood just like chocolate

9. •Treatment: • •the actual treatment should be taken according to patient’s age, symptoms, focus position and whether or not need reproduction • •1.Temporization:fit for the patient without • symptom or with slight symptoms.follow up once several month • •For patients who hope pregnancy • 2.Drug therapy: • The commonly used drug therapy is as follows: • (1)oral contraceptive • (2)high effect progesterone: • (3)Danazol • (4)gestrinone • (5)GnRH-a • •3.Surgery therapy • •(1)operation of reserving reproductive function

10. Patient 3 Name: Andy Diagnosis:ovarian tumor Question:how to give the surgery operation to your patient??

11. Surgery operation for ovarian tumor Operation is the first choice for ovarian tumor. The operative range is determined according to the age, the desiring of pregnancy, the nature of tumor, clinical stage & general conditions,etc.

12. The classification of ovarian tumor :Epithelial ovarian tumor Nonepithelial ovarian tumor: ovarian sex cord stromal tumor ovarian germ cell tumor ovarian metastasis tumor The following is about the epithelial ovarian tumor.

13. Surgery method:i. benign ovarian tumor:once the diagnosis is confirmed, operation should be performed (i). young patient with unilateral tumor or bilateral tumor, retain ovary as much as possible. (ii). postmenopausal patient with benign ovarian tumor, hysterectomy and adnexectomy of both sides. (iii) . manipualtion principle of operation

14. ii.borderline ovarian tumor (i). stage I and II: total hysterectomy and bilateral adnexectomy. For young patient with stage I tumor who needs reserving ovarian and reproductive function, adnexectomy of the ill side could be considering. (ii).stage III and IV:same with late stage ovarian cancer

15. iii. malignant tumor: the treating principle is chiefly by operation , while the chemotherapy and radiotherapy are as the accessory treatments (i) operation:operation plays the key role for the treatment,especially the first time of operation i). probe during operation

16. ii). operating range: (a). for stage Ia or Ib : hysterectomy and bilateral adnexectomy (b). for stage Ic or over Ic : including resection of greater omentum & postperitoneal lymphadenectomy. (c). cytoreductive operation for over ll iii). the indications of reserving contralateral ovary: (a). stage Ia, well differentiated (b) .no tumor is found in the contralateral ovary (c). has the condition of closely postoperative follow up

17. (ii).chemotherapy • Chemotherapy is a chief accessory therapy. malignant ovarian tumor is relatively sensitive to the chemotherapy, the chemotherapy has certain effect even if the tumor has extensively metastasized.

18. The chemotherapy may be either for the prevention of recurrence or for the postoperative treatment in the patient whose tumor can not be thoroughly removed. • For late stage patient who does not fit for the operation, the chemotherapy can shrink the tumor and create the condition for afterwards operation.

19. (iii). radiotherapy:the accessory treatment for the operation and chemotherapy. • dysgerminoma is very sensitive to the radiotherapy, • granulosa cell tumor is moderate sensitive to the radiotherapy • epithelial ovarian cancer also has certain sensitivity to the radiotherapy

20. Patient 4 Name:Lily Diagnosis:unknown (only disturbance of menstruation Question:can you explain menstruation cycle in Chinese??

21. FSH-receptor E2-receptor T-receptor • 始基卵泡　　窦前卵泡　 窦状卵泡 窦状卵泡的颗粒细胞获得LH-receptor estrogen FSH FSH LH FSH

22. 排卵前卵泡　　分泌大量雌激素　　下丘脑 大量释放GnRH,出现LH/FSH峰排卵前卵泡　　分泌大量雌激素　　下丘脑 大量释放GnRH,出现LH/FSH峰 • 排卵 • 黄体形成 progesteron

23. 黄体形成　　未受精：排卵后９－１４日开 始退化　　白体　　 月经来潮黄体形成　　未受精：排卵后９－１４日开 始退化　　白体　　 月经来潮 • 　　　　　　受精：增大为妊趁黄体　　于 妊趁６－７周前产生雌激 素＆孕激素以维持妊趁　　 妊趁１０周黄体功能由胎 盘取代，黄体开始萎缩

24. 　月经期　　增生期　　　　　分泌期

25. Patient 5 Name:Eleen Diagnosis:amenorrhoea Question:what’s the mechanism of amenorrhoea??

26. Amenorrhoea

27. Physiological factors • 1 Puberty-not reaching second sexual characteristics, incontinuous • 2 Pregnancy • 3 Mammary period • 4 Menopause period (average age 49.5)

28. Pathological factors • 1 Congenital • 2 Traumatic (1) endometrium injury (2) Hysterectomy (3) Ovarian dysfunction • 3 Infection of endometrium and ovary

29. 4 Endocrine (1) Pituitary gland dysfunction (2) Ovarian dysfunction and tumor (3) Thyroid gland (4) Adrenal gland (5) Pancreatic gland • 5 General factors • 6 Others

30. Treatment • 1 General therapy • 2 Psychological therapy • 3 Hormone therapy (1) Estrogen (2) Progestational therapy(3) Combined therapy(4) GnRH and FSH therapy

31. Patient 6 Name:Muya Diagnosis:cervical erosion Question:what’s the classification of cervical erosion and the treatment??

32. Classification:According to the nature of erosion1.simple erosion2.granule erosion3.mastoid erosionAccording to the area of erosion1.slight less than 1/3 area of cervix uteri2.moderate between 1/3 to 2/33.severe. more than 2/3Treatment:Physical therapy common useDrug

33. Patient 7 Name:GiGi Diagnosis:ovarian tumor Question:how can you distinguish benign and malignant tumor??

35. Ifyou want to be a good gynecological doctor, you must know all the supplementary examination This time I will tell one of them

36. Tumor marker CA125 marker of ovarian epithelial tumor 0-35U/ml CA199 marker of gastrointestinal tumor 0-37U/ml CA724 marker of gastric tumor 0-5.3U/ml CEA we use it to see if there is rectum metastasis 0-4.6ng/ml AFP marker of hepatic tumor 0-5.8U/ml if pregnancy take place it will increase,too but usually less than 300µg/ml