The document discusses several uterine disorders including endometrial polyps, uterine fibroids, endometriosis, and adenomyosis. It provides details on their characteristics, risk factors, clinical presentation, investigations, and treatment options. The document also discusses malignant disorders of the uterus including endometrial cancer and cervical cancer. It covers their etiology, staging, signs and symptoms, diagnostic workup, and management approaches.
A lecture on endometrial hyperplasia and carcinoma, exploring the etiology, clinical features, types, investigations, management and treatment options and prognosis.
This was presented to undergraduate medical students at Livingstone Central Teaching Hospital, Livingstone, Zambia, department of Obstetrics and Gynecology by Nghitukuhamba T.E Kalipi (final year student) Cavendish University Zambia, School of Medicine.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
A lecture on endometrial hyperplasia and carcinoma, exploring the etiology, clinical features, types, investigations, management and treatment options and prognosis.
This was presented to undergraduate medical students at Livingstone Central Teaching Hospital, Livingstone, Zambia, department of Obstetrics and Gynecology by Nghitukuhamba T.E Kalipi (final year student) Cavendish University Zambia, School of Medicine.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
2. 1. Endometrial polyps
Are discrete outgrowths of endometrium,
attached by a pedicle
They may be pedunculated (has stalk) or sessile
(no stalk)
Can cause intermenstrual bleeding
They should be removed in women over the age of
40, premenopausal and menopausal women.
3. 2. Uterine fibroids
A fibroid is a benign tumor of uterine smooth
muscle
Also called a leiomyoma or myoma
They appear as firm, whorled tumor
Fibroids are estrogen dependent.
4. Classification of fibroids
Based on the location within the layers of the uterus.
a) Submucous fibroid- located adjacent to and bulging into
the endometrial cavity
b) Intramural fibroid- centrally within the myometrium
c) Subserosal fibroid- at the outer border of the
myometrium
d) Pedunculated fibroid- attached to the uterus by a narrow
pedicle containing blood vessels
5. Risk factors
Nulliparity
Obesity
Positive family history
Race- African
Older age- incidence of leiomyomas increases as
the woman gets older
6. Clinical features
Majority are asymptomatic
Clinical features include:
Firm pelvic mass
Menstrual disturbance
Pressure symptoms, esp. urinary frequency
8. Treatment
Conservative management for asymptomatic
fibroids
Gonadotrophin releasing hormone (GRH) agonists
for heavy menstrual bleeding
Myomectomy (uterus is preserved) or
hysterectomy where a bulky fibroid uterus causes
pressure symptoms
Uterine artery embolization- involves injection of
polyvinyl alcohol pellets into the uterine artery
9. 3. Endometriosis
Is a condition in which the endometrial tissue lies outside the
endometrial cavity
Endometriotic tissue responds to cyclical hormonal changes and
therefore undergoes cyclical bleeding and local inflammatory reaction
Repeated bleeding and healing leads to fibrosis
The cyclical damage causes adhesions between associated organs
causing pain and infertility.
Common sites involved include:
Uterosacral ligaments
Umbilicus
Pleural cavity
Abdominal scars
10. Clinical features
Dysmenorrhea
Deep dyspareunia- endometriosis in the pouch of
Douglas
Lower back pain
Lower abdominal and pelvic pain
Infertility
Local symptoms for distant sites e.g., cyclical
epistaxis with nasal deposits, cyclical rectal
bleeding with bowel deposits.
12. Management
It is impossible to guarantee complete cure
Medical treatment:
Analgesics- NSAIDS for dysmenorrhea and pelvic pain
COCs initially for 6 months; if symptoms are relieved,
continued indefinitely or until pregnancy is desired
Progestogens e.g., medroxyprogesterone acetate,
levonorgestrel intrauterine systems (LNG-IUS)
Gonadotrophin releasing hormone agonists
13. Cont’d
Surgical treatment:
Conservative surgery- laparoscopic surgery with
diathermy, laser vaporization or excision
Definite surgery- hysterectomy and bilateral
salpingoophorectomy (removal of ovaries and tubes
14. 4. Adenomyosis
Is a condition where endometrial tissue/ glands
invade the myometrium
Incidence is highest in women 40-50 years.
15. Clinical features
Severe secondary dysmenorrhea
Increased menstrual blood loss (menorrhagia)
Enlarged, firm, and tender uterus
17. Treatment
Treatments that induce amenorrhea will relieve
pain and excessive bleeding e.g., COCs, POPs
Hysterectomy is the only definitive treatment
19. 1. Endometrial cancer
Adenocarcinoma is the most common type of cancer
affecting the uterus
Staging:
I. Stage I endometrial cancer: confined to
endometrium
II. Stage II cancer: also involves the cervix
III. Stage III: reaches the vagina or lymph nodes
IV. Stage IV: spread to the bowel; or bladder mucosa
and/ or beyond the pelvis
20. Risk factors
Women in reproductive age
Nulliparity
Family history
Uterine polyps
Late menopause
Chronic conditions e.g., DM and HTN
Tamoxifen
21. Clinical manifestations
Post-menopausal bleeding
Watery, bloody vaginal discharge
Low back pain
Abdominal and low pelvic pain
Palpable uterine mass or uterine polyp
Enlarged uterus if the cancer is advanced
22. Investigations
Serum tumor markers to assess for metastasis-
AFP, CA-125
Transvaginal ultrasound
Endometrial biopsy
Chest X-ray
MRI of the abdomen and pelvis
Liver and bone scans
23. Management
Surgical management:
Stage I disease- total hysterectomy and bilateral
salpingoophorectomy (removal of uterus, fallopian
tubes, and ovaries)
Stage II- radical hysterectomy with bilateral pelvic
lymph node dissection and removal of the upper third
of the vagina
Brachytherapy- prevent disease recurrence
Chemotherapy- palliative treatment in advance and
recurrent disease, with distant metastasis
24. 2. Cervical cancer
The ectocervix is covered with squamous cells
The endocervical canal is lined with columnar
(glandular) cells
The squamocolumnar junction (SCJ) is the
transformation zone where most cell
abnormalities occur- because of rapid cell division
Papanicolaou (PAP) tests sample cells from both
areas as a screening test for Ca cervix.
25. Cervical Intraepithelial Neoplasia (CIN)
Premalignant changes are described on a
continuum from atypia (suspicious) to CIN to
Carcinoma In-Situ (CIS)
CIS is the most advanced premalignant change
CIS is cancer that has extended through the full
thickness of the epithelium of the cervix.
26. CIN
CIN is graded on a scale of 1 to 3 depending on
the appearance of the cervical tissue under a
microscope:
1. CIN 1 (Mild dysplasia): little abnormal tissue
2. CIN 2 (moderate dysplasia): more tissue appears
abnormal
3. CIN 3 (severe dysplasia and CIS): most tissue
looks abnormal
27. Origin
Most cervical cancers arise from the squamous
cells on the outside of the cervix.
The other cancers arise from the mucus-secreting
glandular cells (adenocarcinoma) in the
endocervical canal.
28. Spread
By direct extension to the vaginal mucosa, lower
uterine segment, parametrium, pelvic wall,
bladder, and bowel.
Distant spread can occur through lymphatic
spread and circulation to the liver, lungs, or
bones.
29. Etiology and risk factors
Most cases of ca cervix are caused by HPV (Human Papilloma Virus),
especially strains 16 and 18.
The risk factors include:
Girls and young women
HPV infection
Multiparity
HIV/AIDS
Family history of ca cervix
Multiple sexual partners
Early sexual debut (<18 yrs)
History of STIs
Obesity
Intrauterine exposure to DES (Diethylstilbestrol)- synthetic estrogen
30. Clinical manifestations
Pre-invasive cancer is often asymptomatic
Invasive cancer presents with painless vaginal
bleeding, spotting between menstrual periods or
after sexual intercourse.
Increased vaginal discharge
Indurated cervix
Stony hard and enlarged cervix
Large fungating mass
33. Management
Surgery for early disease:
Loop Electrosurgical Excision Procedure (LEEP)- diagnostic and
therapeutic procedure
Laser therapy
Cryotherapy
Conization- cone biopsy
Hysterectomy- total hysterectomy for treatment of microinvasive
cancer
Radial hysterectomy and bilateral pelvic lymph node dissection for
cancer that has extended beyond the cervix (but not pelvic walls)
Radiotherapy- invasive cervical cancer
Chemotherapy- adjunctive therapy
34. Health promotion for Ca Cervix
HPV vaccines:
1. Gardasil- a quadrivalent vaccine against HPV 16, 18, 31, and 38.
Given to adolescents at 0, 2, and 6 months IM in the deltoid
muscle
2. Cervarix- bivalent against HPV 16 and 18. Given 0.5mls at 0, 1,
and 6 months.
Girls and young women (9-26 years) should get HPV
vaccine before their first sexual contact.
Boys and young men (9-26 Yrs) are also given to prevent
genital warts (caused by HPV strains 6 and 11) and
prevent anal cancer (caused by HPV strains 16 and 18).
35. Cont’d
Immunity lasts 10 years, and re-immunization may
be required.
Periodic pelvic examinations and Pap tests to
screen for ca cervix early.
Screening starts at the ae of 21 years.
Women between 21-65 years should have a Pap
smear test every 3 years.