Ebook Blueprints obstetrics amp; gynecology (6E): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Blueprints obstetrics amp; gynecology (6E): Part 2
Ebook Blueprints obstetrics amp; gynecology (6E): Part 2
Part II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2iew of the many congenital anomalies, epithelial disorders, and benign cysts and tumors of the vulva, vagina, and cervix. Infections of these structures are covered in Chapter 16, and premalignant and malignant lesions arc covered in Chapter 27 (vulva and vagina) and Chapter 28 (cervix).CONGENITAL A Ebook Blueprints obstetrics amp; gynecology (6E): Part 2NOMALIESOF THE VULVA AND VAGINAA variety of congenital defects occur in the external genitalia, vagina, and cervix including but not limited to labialEbook Blueprints obstetrics amp; gynecology (6E): Part 2
fusion, imperforate hymen, transverse vaginal septum, longitudinal vaginal septum, vaginal atresia, and vaginal agenesis. Congenital anomalies of thePart II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2 such as unilateral renal agenesis, pelvic or horseshoe kidneys, or irregularities in the collecting system.LABIAL FUSIONlabial fusion is associated with excess androgens. Most commonly, the etiology is the result of exogenous androgen exposure but may also be due to an enzymatic error leading to in Ebook Blueprints obstetrics amp; gynecology (6E): Part 2creased androgen production. The most common form of enzymatic deficiency is 21'hydroxylase deficiency (Chapter 23) leading to congenital adrenal hypeEbook Blueprints obstetrics amp; gynecology (6E): Part 2
rplasia. This may be phenotypically demonstrated in the neonate with ambiguous genitalia, hyperandrogenism with salt wasting, hypotension, hyperkalemiPart II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2 occurs in roughly 1 in 40,000 to 50,000 pregnancies. The diagnosis is made by elevated I7a-hydroxyprogesterone or urine 17-ketosteroid with decreased serum cortisol.Because cortisol is not being made in the adrenal cortex, the treatment for this disorder is exogenous cortisol The exogenous cortisol Ebook Blueprints obstetrics amp; gynecology (6E): Part 2 then negatively feeds back on the pituitary todecrease the release of adrenocorticotropic hormone (ACTH), thus inhibiting the stimulation of the adreEbook Blueprints obstetrics amp; gynecology (6E): Part 2
nal gland that is shunting all steroid precursors into androgens. If salt wasting IS documented, a mineralocorticoid (usually fludrocortisone acetate)Part II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2 between the urogenital sinus and die sinovaginal bulbs (Fig. 13-1). Before birth, the epithelial cells in the central portion of the hymenal membrane degenerate. leaving a thin rim of mucous membrane at the vaginal mtroitus. This is known as the hymenal ring. When this degeneration fads to occur, t Ebook Blueprints obstetrics amp; gynecology (6E): Part 2he hymen remains intact. This is known as an imperforate hymen. It occurs in 1 in 1.000 female births Other congenital abnormalities of the hymen areEbook Blueprints obstetrics amp; gynecology (6E): Part 2
shown in Figure 13-2. These can result from incomplete degeneration of the central portion of hymen.An imperforate hymen results in an obstruction to Part II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2lar to that seen with a transverse vaginal septum (Fig. 13-3). If not identified at birth, an imperforate hymen is often diagnosed at puberty in adolescents who present With primary amenorrhea and cyclic pelvic pain. These symptoms are due to the accumulation of menstrual flow behind the hymen in th Ebook Blueprints obstetrics amp; gynecology (6E): Part 2e vagina (hematocol-pos) and uterus (hematometra) In these patients, the physical examination may be notable for the absence of an identifiable vaginaEbook Blueprints obstetrics amp; gynecology (6E): Part 2
l lumen, a tense bulging hymen, and possibly increasing lower abdominal girth. Treatment of imperforate hymen and other hymenal abnormalities is with Part II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2UMThe upper vagina is formed as the paramesonephric (Mullerian) ducts elongate and meet in the midline. The internal portion of each duct is canalized and the remaining septum between them dissolves (Fig. 13-1 A). The caudal portion of the Mullerian ducts develops into the uterus and174Chapter 13 / Ebook Blueprints obstetrics amp; gynecology (6E): Part 2Benign Disorders of tFigure 13-1 • Embryonic formation of the vagina and uterus.(From Soder T (orgnwi's AWco' Emfyyotgy.9t-< ed eotimae. Mt> lippincơtEbook Blueprints obstetrics amp; gynecology (6E): Part 2
Wilioms Ẵ Wikini; 2003 }upper vagina (Fig. 13-1B and C). The lower vagina is formed as the urogenital sinus evaginates to form the sinovaginal bulbs Part II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2nal plate degenerates (Fig. 13-1C). This process is known as canalization or vacuolization.The vagina is formed as the Mullerian system from above joins the sinovaginal bulb-derived system from below. This takes place at the Mullerian tubercle (Fig. 13-IB). The Miillerian tubercle must be canalized Ebook Blueprints obstetrics amp; gynecology (6E): Part 2for a normal vagina to form. If this does not occur, the tissue may be left as a transverse vaginal septum These septa often lie near the junction betEbook Blueprints obstetrics amp; gynecology (6E): Part 2
ween the lower two-thirds and upper one-third of the vagina (Fig. 13-3) but can be found at various levels in the vagina This occurs in approximately Part II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2imary amenorrhea and cyclic pelvic pain accompanied by menstrual symptoms. On physical examination. patients typically have normal external female genitalia and a short vagina that appears to end in a blind pouch. The transverse vaginal septa are usually less than 1 cm thick and may have 3 central p Ebook Blueprints obstetrics amp; gynecology (6E): Part 2erforation. Ultrasound and MRI can be used to characterize the thickness and location of the septum and to confirm the presence of other parts of theEbook Blueprints obstetrics amp; gynecology (6E): Part 2
reproductive tract. Surgical correction is the only form of treatmentVAGINAL ATRESIAVaginal atresia (also known as agenesis of the lower vagina) is ofPart II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2he ovaries, uterus, cervix, and upper vagina arc all normal. Developmentally, vaginal atresia results when the urogenital sinus fails to contribute the lower portion of the vagina (Fig. 13-1). It presents during adolescence with primary amenorrhea and cyclic pelvic pain Physical examination reveals Ebook Blueprints obstetrics amp; gynecology (6E): Part 2the absence of an introitus and the presence of a vaginal dimple. Pelvic imaging With ultrasound and/or MRI may show a large hematocolpos and confirmEbook Blueprints obstetrics amp; gynecology (6E): Part 2
the presence of a normal upper reproductive tract. Surgical correction can be achieved by incising the fibrous tissue and dissecting it until the normPart II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2roitus and sutured to the hymenal ring This is known as a vaginal pull-through procedure.VAGINAL AGENESISVaginal agenesis, also known as Mayer-Rokitansky-Kuster-Idauser syndrome (MRKH), occurs in 1 to 2.5 per 10,000 female births. It is characterized by the congenital absence of the vagina (Color Pl Ebook Blueprints obstetrics amp; gynecology (6E): Part 2ate 8) and the absence or hypoplasia ofFigure 13-2 • Congenital abnormalities of the hymen. (A) Normal. (B) Imperforate. (C) Microperforate. (D) SeptaEbook Blueprints obstetrics amp; gynecology (6E): Part 2
te.176 • Blueprints Obstetrics & GynecologyVaginal septumFigure 13-3 • Transverse vaginal septumall or part of the cervix, uterus, and fallopian tubesPart II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2 normal ovarian function. These patients are phenotypically and genotypically female with normal 46.XX karyotypes. These patients typically present in adolescence With primary amenorrhea. Pelvic imaging with ultrasound and MRI can be used to assess the vagina, uterus, ovaries, and kidneys because th Ebook Blueprints obstetrics amp; gynecology (6E): Part 2ese patients will often have associated urologic and skeletal anomalies.Treatment for patients with vaginal agenesis involves a combination of psychosEbook Blueprints obstetrics amp; gynecology (6E): Part 2
ocial support, counseling, and nonsur-gieal and surgical correction individualized to the patient. In motivated patients, a vagina can be created usinPart II GynecologyBenign Disorders-| -J of the Lower Genital Id TractBENIGN LESIONS OF THE VULVA, VAGINA, AND CERVIXThis chapter encompasses an overvi Ebook Blueprints obstetrics amp; gynecology (6E): Part 2t. If this nonsurgical approach fails, a variety of vaginal, laparoscopic, and abdominal procedures are available to create a neovagina. The most commonly used is the Nklndoe procedure. In this procedure a split-thickness skin graft is taken from the buttocks and is placed over a silicone mold to cr Ebook Blueprints obstetrics amp; gynecology (6E): Part 2eate a tube with one closed end (Fig. 13-4). A transverse incision is then made at the vaginal dimple and the fibrous tissue in the location of the noEbook Blueprints obstetrics amp; gynecology (6E): Part 2
rmal vagina. The tissue is then dissected tothe level of the peritoneum. The mold and graft are inserted into the neovagina. Once the mold is removed,Gọi ngay
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