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

As a doctor,what you should
know to treat your patient??
PBL-TEAM 1 HOMEWORK 2
Patient 1
Name:Lucy
Diagnosis:myoma of uterus
Question:what’s the main symptom and
treatment for her ?
• Symptoms
• Usually no symptoms.
• Once,there,are,symptoms,the,symptoms,fr
om,leiomysmas,depend,on,their,location,th
e,speed,of,growth,and,degenerations,and,
not,associate,with,the,size,and,the,number
,of,myomas.
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Main symptoms
n1. menstruation change
n2. abdominal mass
n3. leucorrhea
n4. Abdominal pain
n5. compress symptom
n6. infertility
n7. anemia
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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
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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
Patient 2
Name:Betty
Diagnosis:endometriosis or chocolate cyst
Question:How do you know she has this
disease(symptom) and what can you
do ??
• 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 purpleblue nodes.
• When it occersin the ovary (usually lateral )
there may be brown emplastic dated blood
just like chocolate
• •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
Patient 3
Name: Andy
Diagnosis:ovarian tumor
Question:how to give the surgery
operation to your patient??
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.
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.
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
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
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
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
(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.
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.
(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
Patient 4
Name:Lily
Diagnosis:unknown (only disturbance of
menstruation
Question:can you explain menstruation
cycle in Chinese??
FSH-receptor
E2-receptor
T-receptor
• 始基卵泡
窦前卵泡
estrogen
FSH
窦状卵泡
FSH
窦状卵泡的颗粒细胞获得LH-receptor
LH
FSH
• 排卵前卵泡
脑
progesteronLH/FSH峰
• 排卵
• 黄体形成
分泌大量雌激素
下丘
大量释放GnRH,出现
• 黄体形成
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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
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月经期
增生期
分泌期
Patient 5
Name:Eleen
Diagnosis:amenorrhoea
Question:what’s the mechanism of
amenorrhoea??
Amenorrhoea
Physiological factors
• 1 Puberty-not reaching second sexual
characteristics, incontinuous
• 2 Pregnancy
• 3 Mammary period
• 4 Menopause period (average age 49.5)
Pathological factors
• 1 Congenital
• 2 Traumatic (1) endometrium injury (2)
Hysterectomy (3) Ovarian dysfunction
• 3 Infection of endometrium and ovary
• 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
Treatment
• 1 General therapy
• 2 Psychological therapy
• 3 Hormone therapy (1) Estrogen (2)
Progestational therapy(3) Combined
therapy(4) GnRH and FSH therapy
Patient 6
Name:Muya
Diagnosis:cervical erosion
Question:what’s the classification of
cervical erosion and the treatment??
Classification:
According to the nature of erosion
1.simple erosion
2.granule erosion
3.mastoid erosion
According to the area of erosion
1.slight less than 1/3 area of cervix uteri
2.moderate between 1/3 to 2/3
3.severe. more than 2/3
Treatment:
Physical therapy common use
Drug
Patient 7
Name:GiGi
Diagnosis:ovarian tumor
Question:how can you distinguish benign
and malignant tumor??
benign
malignant
history
long history,growing
slowly
Short history,growing
faster
sign
one
side,moveable,cyst,s
mooth surface,without
ascites
double side,cannot
move,solid with cyst or
not,rough surface,with
bloody ascites,in
which cell can be
found
general
condition
B type
ultrasound
Maybe well
cachexia
Fluid
inside,interval,lightband,clear border
Fluid inside,with tiny
dense light-spot
reflect,border unclear
If you want to be a good gynecological doctor,
you must know all the supplementary
examination
This time I will tell one of them
Tumor marker
CA125
CA199
CA724
CEA
AFP
marker of ovarian epithelial tumor
0-35U/ml
marker of gastrointestinal tumor
0-37U/ml
marker of gastric tumor
0-5.3U/ml
we use it to see if there is rectum
metastasis
0-4.6ng/ml
marker of hepatic tumor
0-5.8U/ml
if pregnancy take place it will increase,too
but usually less than 300µg/ml