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    • بسم الله الرحمن الرحيم جامعة ام درمان الأسلامية كلية الطب والعلوم الصحية OBESTRICTIC PROBLEM Patch16-Group4 ezpaseva
    • AMENORRHEA
      • DEFINTION Absence of menstruation
      • Types
      • There are 3types 1- 1ry and 2ry
      • 2- true and false
      • 3- physiology and pathology
      • DIAGNOSIS
      • History
      • Examination
      • Investigation
      • TREATMENT
    • oligomenorrhea
      • DEFINTION
      • Is infrequent or light menstruation
      • Menstrual duration : greater than 35day
      • Mean: 4-9 period/day
      • Common at extremes age of reproductive life (ovulation often does not occur)
      oligomenorrhea
      • CAUSES
      • 1. emotional or physiological stress
      • 2. chronic illness
      • 3. increase level oestrogen
      • 4. eating disorder
      • DIAGNOSIS
      • TREATMENT
    • DYSMENORRHEA
      • DEFINTION
      • Painful menstruation
      • PREVALENCE
      • 45%-95% of women in reproductive age
      • CLASSIFICATION
      • 1-primary
      • 2-secondary
      • AETIOLOGY
      • (1) PRIMARY
      • Duration of menstrual flow of>5days
      • Younger than normal age of menarche
      • Cigarette smoking
      • (2) SECONDARY
      • endometriosis
      • Pelvic inflammatory disease
      • Adenomyosis
      • ( rarely ) cervical stenosis
      • C/F: crampy supra pubic pain
      • INVESTIGATION: history
      • Endocervical swab
      • Pelvic ultrasound
      • Laparoscopy
      • TREATMENT: Medical treatment NSAIDs
      • Oral contraceptive
      • Nifedipine
      • Surgical treatment
    • MENORRHAGIA
      • DEFINTION
      • Blood loss of greater than 80ml/period
      • PREVALENCE
      • Extremely common
      • CLASSIFICATION
      • 1-idiopathic: No organic pathology ( DUB )
      • 2-secondary: fibroid .
      • AETIOLOGY
      • 1. DUB; unclear but disordered endometrial prostaglandin production has been implicated in the aetiology
      2 . secondary;fibroid
      • OTHER PHYSIOLOGY VonWillebrand’s disease
      • Fibroid uterus
      • Endometrial polyp
      • Thyroid disease
      • Drug therapy
      • Bleeding in pregnancy
      • C/F: HISTORY
      • C/examenation
      • ~ physical examenation
      • ~ cervical smear
      • ~ suggest an organic cause
      • ~ Initial investigation {full blood count}
      • TREATMENT
      • MEDICAL treatment
      • Mephanamic acid
      • DANAZOL
      • GESTRINONE
      • GnRHanalogues
      • SURGICAL treatment
      • Endometrial ablation
      • Hysterectomy
    • ABNORMAL PUBERTY Puberty and pubertal changes may occur earlies than normal menstruation + secondary sexual characters become early in life 8-9 years or even 3-4 years of age Puberty and pubertal changes has not developed on 16-17 years old DEFINITION Precocious puberty Delayed puberty Subjective
    • 1. Idiopathic 2. Intracranial lesion 3. Adrenal gland ,ovarian and Thyroid problem 4. Drugs Either constitutional or pathological The pathological causes: 1- chromosomal abnormalities 2- Hypothalamic ,pitutary, Thyroid,Adrenal gland, Ovarian and Uterine causes CAUSES PRE puberty D puberty Subjectives
    • The Idiopathic treated by:- 1- proestrogens 2- Danazol 3- Cyproteroneac- etate 4- LHRHanalogues ----- TREATMENT PRE puberty D puberty Subjectives
    • Sex Hormones & Function
      • GnRH.
      • FSH&LH.
      • Progesterone & Estrogen .
    • GnRH
    • FSH & LH
    • Progesterone & Estrogen
      • Estrogens: 3types estradiol (it is the main estrogen produced by the ovary) ,estriol and esterone.
      • It is a dominant hormone at follicular phase of menstrual cycle.
      • Two cell Theory for estradiol production:
      • -1 LH (low level) stimulate Theca cells
      • Cholesterol androgens
      • 2- FSH (high level) stimulate granulosa cells androgens estrogens
      • Action: 1-secondary sex characteristics of female.
      • 2-proliferation of endometrim during proliferative phase.
      • 3-increase uterine blood flow .
      • 4-development of breast duct.
      • Progesterone: mainly synthesized in the corpus lutum and so it is the dominant hormone in the luteal phase of menstrual cycle.
      • Action : 1-resposible for glandular secretory activity during secretory phase. .
    • Progesterone & Estrogen
      • Estrogens: 3types estradiol (it is the main estrogen produced by the ovary) ,estriol and esterone.
      • It is a dominant hormone at follicular phase of menstrual cycle.
      • Two cell Theory for estradiol production:
      • -1 LH (low level) stimulate Theca cells
      • 2-deciduatization of endometrium in the late luteal phase.
      • 3-devlopment of breast alveoli.
    • Menstrual cycle
      • -Menstruation: means a periodic discharge of sanguineous fluid and a sloughing of uterine lining.
      • -Parameters: frequency - length and amount of the menstrual flow.
      • A- average of menstrual cycle is frequently quoted to be 28 + 2days.
      • B- average of menstrual 5days.
      • C- average of frequency of blood flow is 60 ml.
      • -Endocrine control of MC.
      • -component of MC.
      • -Role of prostaglandin.
      • -Mechanism of uterine bleeding.
      • -Homeostasis in menstrual endometrium.
    • Androgen Excess
      • -Sources of androgen: 1-endocrine gland.
      • 2- peripheral tissue.
      • 3-liver and gut.
      • -androgen excess mains: Abnormal secretion of adrenal and ovarian androgen.
      • -causes: 1-ovarian tumor.
      • 2 -adrenal tumor.
      • 3 -CAH.
      • 4-decreas SHBG.
      • 5-Pcos.
      • 6-cushing syndrome.
      • 7-pregnacy.
      • 8-idiopathaic.
      • -Symptom:1- general appearance :obesity; muscular male body.
      • 2-miscllenous change.
      • 3- menstrual irregulatory.
      • 4- endocrine change.
      • 5- skin changes.
      • 6- acanthosis Nigricans.
      • -Diagnosis:
      • -History.
      • -Lab finding: testosterone ,17hydroxy progesterone, DHEA, dexamethazone, LH,FSH, lipid.
    • 2-Anti androgen. 3-corticosteroids. 4-promocriptin. 5-Insulin sensitive drugs. 6-surigcal . 7-diet. Treatment: 1- oral contraceptive.
    • Pre menstrual Syndromes PMS or PMTS
      • Definition.
      • Prevalence.
      • Etiology: hormonal, social, genetic, vitamin deficiency, others.
      • C/f :nervous,GIT,mastalgia,Fluid retention.
      • D/D .
      • Treatment.
    • Delay or absent Puberty
      • When the menarche has failed to occur at age of 17years old.
      • Failure of menstruation due to pan hypopitutrism is associated with dwarf +endocrine abnormality patient with XO chromosomal pattern and gonadal dysgensis =dwarf.
      • In some patient puberty delayed even the gonads are present +other endocrine function are normal =primary amenorrhea.
    • Precocious & Delayed puberty
      • It is early but normal pattern of puberty due to an early of gonadotrpin secretion form pituitary it is most frequent endocrine symptom of hypothalmic disease.
      • Abnormal exposure to estrogen lead early development of secondary sexual characteristics without gametogensis .
      • Classification of causes precocious puberty:
      • A- true precocious puberty:
      • Cerebral e.g.: disorder involve posterior hypothalamus
      • tumors .
      • Infection.
      • developmental abnormalities.
      • B- precocious pseudo puberty:
      • -no ovarian development.
      • -Adernal:1- congenital virilizing adrenal hyperplasia .
      • 2- esterogen secreting tuomers.
      • -gonadal: granulosa cell tumors of the ovary.
      • pineal tumor may associated with precocious puberty but
      • associated when there is secondary damage to
      • hypothalamus .
    • Hyper prolactinemia
      • -prolactin contain 199 a.a secreted by endometrium and placenta.
      • Action:
      • 1 causes milk secretion from the breast after estrogen and progesterone priming.
      • Has role in preventing ovulation in lactating mother.
      • 3 Inhibit the effect gonadotropins by an action at level of ovary.
      • -normal plasma prolactin conc is approximately 5ng/ml in men and 8ng/ml in women.
      • Hyper prolactinemia: in up to 70% of patient with chromophobe adenomas of anterior pituitary have elevated plasma prolactin levels, in some . instances, the elevation may be due to damage of pituitary stalk but in some cases the tumor cells are actually secreting the hormone .
      • Hyper prolactinemia may cause glactorrhea, conversely most women with glactorrhea have normal prolactin levels.
      • Observation that 15-20% of women with secondary amenorrhea have elevated prolactin (by blocking action of gonadotropins in ovaries) when the level decrease the normal menstrual cycle and fertility return.
      • - surgical.
      • - Radio therapy.
    • - Hypogondism produce by prolactinomas is associated with osteoporosis due to estrogen deficiency. Treatment : Bromocriptine or other dopamine agonist - surgical. -Radio therapy.
      • CAST
      • Aml Alnor
      • Razan M Jafer
      • Ejlal Abd Mohamed
      • Marwa Mohamed
      • Eman Abd elrahman
      • Arig Sorage
      • Hana Abdelhafeez
      • Nahlaa Marqani
      • Roqia Solima
      • Wedad A Ahmed
      • Shaza Abdelmonem
      • Rehab Alser
      • Fatma Aalim
      • Alaa Abdella
      • Nada
      • Reem
      • Taqwa Bashir
      • AND
      • Shadin Awad Ahmed
      • EZPASEVA 2008
    • شكراًً لحسن المتابعة