Lbm 6 Repro Nindy

(1)

LBM 6

nindy

(2)

How the cycles of normal menstruation?

•

• The start of the menstrual cycle begins on the first day of bleeding.The start of the menstrual cycle begins on the first day of bleeding.

On about the 5

On about the 5thth_{day, the brain begins producing hormones that}_{day, the brain begins producing hormones that}

cause a few follicles to grow and mature in the ovaries. These cause a few follicles to grow and mature in the ovaries. These follicles then start producing the hormone estrogen.

follicles then start producing the hormone estrogen.

•

• The lining of the uterus (endometrium) responds to the estrogen byThe lining of the uterus (endometrium) responds to the estrogen by

becoming thicker and developing more blood vessels. becoming thicker and developing more blood vessels.

•

• Somewhere around the 14Somewhere around the 14ththor 15or 15ththday of the cycle (if your cyclesday of the cycle (if your cycles

are in the neighborhood of 27-30 days), the most mature follicle are in the neighborhood of 27-30 days), the most mature follicle bursts and releases an egg or

bursts and releases an egg or ovum. This is ovum. This is called ovulationcalled ovulation..

•

• The egg then enters the Fallopian tube.The egg then enters the Fallopian tube. •

• The ruptured follicle begins to secrete the hormone progesterone.The ruptured follicle begins to secrete the hormone progesterone. •

• Progesterone increases the supply of blood and nutrients to theProgesterone increases the supply of blood and nutrients to the

uterus uterus

•

• If the egg unites with a sperm from a man, it becomes fertilized andIf the egg unites with a sperm from a man, it becomes fertilized and

travels down the Fallopian tube, finally settling into the lining of the travels down the Fallopian tube, finally settling into the lining of the uterus. If the egg does

uterus. If the egg does not become fertilized, it soon breaks down,not become fertilized, it soon breaks down, and the follicle stops producing progesterone.

and the follicle stops producing progesterone.

•

• The loss of progesterone causes the lining of the uterus to breakThe loss of progesterone causes the lining of the uterus to break

apart and bleed. The menstrual period then begins, starting apart and bleed. The menstrual period then begins, starting another cycle.

(3)

How the cycles of normal menstruation?

•

• The start of the menstrual cycle begins on the first day of bleeding.The start of the menstrual cycle begins on the first day of bleeding.

On about the 5

On about the 5thth_{day, the brain begins producing hormones that}_{day, the brain begins producing hormones that}

cause a few follicles to grow and mature in the ovaries. These cause a few follicles to grow and mature in the ovaries. These follicles then start producing the hormone estrogen.

follicles then start producing the hormone estrogen.

•

• The lining of the uterus (endometrium) responds to the estrogen byThe lining of the uterus (endometrium) responds to the estrogen by

becoming thicker and developing more blood vessels. becoming thicker and developing more blood vessels.

•

• Somewhere around the 14Somewhere around the 14ththor 15or 15ththday of the cycle (if your cyclesday of the cycle (if your cycles

are in the neighborhood of 27-30 days), the most mature follicle are in the neighborhood of 27-30 days), the most mature follicle bursts and releases an egg or

bursts and releases an egg or ovum. This is ovum. This is called ovulationcalled ovulation..

•

• The egg then enters the Fallopian tube.The egg then enters the Fallopian tube. •

• The ruptured follicle begins to secrete the hormone progesterone.The ruptured follicle begins to secrete the hormone progesterone. •

• Progesterone increases the supply of blood and nutrients to theProgesterone increases the supply of blood and nutrients to the

uterus uterus

•

• If the egg unites with a sperm from a man, it becomes fertilized andIf the egg unites with a sperm from a man, it becomes fertilized and

travels down the Fallopian tube, finally settling into the lining of the travels down the Fallopian tube, finally settling into the lining of the uterus. If the egg does

uterus. If the egg does not become fertilized, it soon breaks down,not become fertilized, it soon breaks down, and the follicle stops producing progesterone.

and the follicle stops producing progesterone.

•

• The loss of progesterone causes the lining of the uterus to breakThe loss of progesterone causes the lining of the uterus to break

apart and bleed. The menstrual period then begins, starting apart and bleed. The menstrual period then begins, starting another cycle.

(4)

Why she had menstruation over 15 days ?

•

Per

Perdarahan Uterus Disfungsional (DUB

darahan Uterus Disfungsional (DUB))

•

Per

Perdarahan abnormal dari uterus baik

darahan abnormal dari uterus baik dalam jumlah,

dalam jumlah,

frekuensi maupun lamanya, yang terjadi didalam atau

diluar haid sebagai

wujud klinis gangguan fungsional

mekanisme kerja poros hipotalamus-hipofisis-ovarium,

endometrium tanpa kelainan organik alat reproduksi,

seperti radang, tumor, keganasan, kehamilan atau

gangguan sistemik lain.

•

Per

Perdarahan uterus disfungsional

darahan uterus disfungsional dapat berlatar belakang

dapat berlatar belakang

kkelainan-k

elainan-kelainan ovulasi,

elainan ovulasi, suklus haid,

suklus haid, jumlah perdarahan

jumlah perdarahan

dan anemia yang ditimbulkannya

(5)

Berdasarkan kelainan tersebut maka perdarahan uterus disfungsional dapat dibagi seperti table

Dasar kelainan Bentuk klinis

Ovulasi PUD ovulatorik

PUD anovulatorik

Siklus Metroragia

Polimenorea Oligomenorea Amenorea Jumlah perdarahan Menoragia

Perdarahan bercak prahaid Perdarahan bercak paskahaid

Anemia PUD ringan

PUD sedang PUD berat

(6)

(7)

(8)

(9)

Causes:

Abnormal uterine bleeding is a symptom and not a

disease. Its causes include the following:

•

Early pregnancy complications (abortion, ectopic

pregnancy, hydatidiform mole).

•

Pelvic inflammatory disease (PID).

•

Benign tumors (uterine fibroids,cervical polyps

endometriosis, adenomyosis)

•

malignant tumors ( endometrial and cervical

carcinoma)

(10)

Clinical types

:

1. Menorrhagia (regular & cyclical

):

- cyclical bleeding at normal intervals which is

excessive in amount or duration. e.g. 5/28 or 8/28.

- causes: benign organic disease of genital

tract(fibroids, adenomyosios, PID) and may be

dysfuctional (ovulatory).

2. Polymenorrhoea (regular & cyclical

):

- Cyclical bleeding which is normal in amount but

occurring at too-frequent intervals of less than 21

days, e.g. 5/20. Her the uterus is normal.

(11)

Clinical types

:

3. Polymenorrhagia:

- Cyclical bleeding which is both excessive and too

frequent, e.g. 9/20-12/20.

- Caused by: DUB, PID.

4. Metrorrhagia (irregular or acyclical):

- bleeding of any amount which acyclical occurring

irregularly or continuously.

- always originates in the uterus.

- causes(organic) : complications of early pregnancy,

ulceration or infection of benign tumors, malignancies

(perimenopausal)

(12)

Clinical types

:

5. Intermenstrual bleeding:

- often dysfunctional (fall in oestrogen secretion

following ovulation); 60% of ovulatory women have

erythrocytes in their cervical mucus if examined.

- common with cervical and endometrial polyps,

fibroids and cervical carcinoma

(13)

Why she complained that she had irregular menstrual cycles ,

sometimes twice in a month ?

•

What is the probability?

•

Oligomenorhage



siklus lbih panjang, >35 hari,

fase proliferasi lbih panjang, bisa karena adanya

gangguan proliferasi/pematangan sel2

(14)

•

Polimenorhage



mens >1x dlm sebulan,

•

Pengaruh dr

obesitas

, hormonal mempengaruhi siklus

menstruasinya, obesitas

_

kelebihan estrogen

_

menorhagia

•

Polimenorhage = metroraghia?

•

Polimenorhage : mens > 1x sebulan, berkelanjutan,

berulang2 memang seperti itu tiap bulannya, dlm mens

nya ttep 4-7 hr

•

Metrorhagia : mens > 1x sebulan yg tdk teratur, haid

berkepanjangan, keadn patologis, bisa krna kelainan

hormonal, siklusnya pendek, lama mensnya >15hr,

jumlah darah mensnya normal

(15)

(16)

•

Dysmenorrhea

primer terjadi karena banyak

faktor, diantaranya faktor endokrin, yaitu

penurunan kadar progesteron yang dapat

meningkatkan prostaglandin, antara lain PGE2 dan

PGF2

alfa

yang mana akan merangsang

miometrium sehingga terjadi peningkatan

kontraksi dan disritmia uterus. Akibatnya akan

terjadi penurunan aliran darah ke uterus dan ini

akan mengakibatkan iskemia. Prostaglandin dan

endoperoksid juga menyebabkan sensitisasi dan

selanjutnya menurunkan ambang rasa sakit pada

ujung-ujung syaraf

aferen nervus pelvicus

(17)

•

Dysmenorrhea

sekunder yaitu rasa nyeri kram

pada perut bawah yang disebabkan karena

adanya kelainan pada daerah pelvis, misalnya

endometriosis, mioma uteri, stenosis serviks,

malposisi uterus atau adanya IUD

dan biasanya

muncul seminggu sebelum menstruasi

berlangsung (McFerren, 1996).

•

Etiologi:

•

Penyebab dari dismenore sekunder adalah:

endometriosis, fibroid, adenomiosis, peradangan

tuba falopii, perlengketan abnormal antara organ

di dalam perut, dan pemakaian IUD.

(18)

Perbedaan gambaran klinis dismenore primer dan sekunder

Dismenore primer Dismenore sekunder

Onset singkat setelah menarche Onset dapat terjadi kapan saja setelah menarche (khasnya setelah 25 tahun).

Nyeri kram di perut bawah atau pelvis dengan awal keluarnya darah selama 8-72 jam.

Waktu dari nyeri berubah-ubah sepanjang siklus menstruasi.

Pola nyeri sama setiap siklus. Memburuk setiap waktu, dapat unilateral, dapat memburuk pada waktu berkemih

Nyeri pada paha dan pinggang, sakit kepala, diare, mual dan muntah dapat dijumpai.

Dijumpai gejala ginekologi: dispareunia danmenorragia.

(19)

Why she had frequent foul-smelling vaginal discharge

between menstrual cycles ?

•

Normal Vaginal Discharge

- All women have

some vaginal discharge. Normal discharge

may appear clear, cloudy white, and/or

yellowish when dry on clothing. It may also

contain white flecks and at times may be thin

and stringy. Changes in normal discharge can

occur for many reasons, including menstrual

cycle, emotional stressors, nutritional status,

pregnancy, usage of medications - including

birth control pills, and sexual arousal.

(20)

•

Effects of the Menstrual Cycle

- The menstrual

cycle affects the vaginal environment. You may

notice increased wetness and clear discharge

around mid-cycle. The pH balance of the

vagina fluctuates during the cycle and is the

least acidic on the days just prior to and

during menstruation. Infections, therefore, are

most common at this time.

(21)

Correlation her mother died cause by cervical cancer

and her condition ?

•

First-degree relatives of women with myomas have a

2.5 times increased risk of developing myomas (23,

24). Women reporting myomas in two first-degree

relatives are more than twice as likely to have strong

expression of VEGF-a (a myoma-related growth factor)

than women who have myomas but no family history

(25). Monozygous twins are reported to be hospitalized

for treatment of myomas more often than dizygous

twins, but these findings may be the result of reporting

bias (26).

•

William H. Parker, M.D.

•

Department of Obstetrics and Gynecology, UCLA

(22)

What the correlation between general physical

examination (anemic and obese )?

•

A prospective study found that the risk of myomas

increased 21% with each 10 kg increase in body weight

and with increasing body mass index (30). Similar

findings have been reported in women with greater

than 30% body fat (31).

Obesity increases conversion

of adrenal androgens to estrone and decreases sex

hormone

_–

binding globulin.

The result is an increase in

biologically available estrogen, which may explain an

increase in myoma prevalence and/ or growth.

•

William H. Parker, M.D. Department of Obstetrics and

Gynecology, UCLA School of Medicine, Los Angeles,

California

(23)

•

A random sample of women aged 35 to 49 was

evaluated by self-reported bleeding patterns and by

abdominal and transvaginal sonography to determine

presence, size, and location of myomas (54). Of the 878

women screened, 564 (64%) had myomas, and 314

(36%) did not. Forty-six percent of the women with

myomas

reported ‘‘gushing blood’’ during their

menstrual periods compared with 28% without

myomas. Gushing blood and length of periods were

related to size of myomas (large myomas RR ¼ 1.9, CI

1.5 –

2.5), but not to presence of submucous myomas or

to multiple myomas.

•

William H. Parker, M.D.

•

Department of Obstetrics and Gynecology, UCLA

(24)

DD?

Mioma Uteri

1. Teori Stimulasi

Berpendapat bahwa estrogen sebagai faktor etiologi, mengingat bahwa :

• Mioma uteri sering kali tumbuh lebih cepat pada masa hamil • Neoplasma ini tidak pernah ditemukan sebelum monarche • Mioma uteri biasanya mengalami atrofi sesudah menopause

• Hiperplasia endometriumsering ditemukan bersama dengan mioma

uteri

• Mioma servikalis (terletak di dekat leher rahim)

2. Teori Cellnest atau genitoblas

Terjadinya mioma uteri itu tergantung pada sel-sel otot imatur yang terdapat pada cell nest yang selanjutnya dapat dirangsang terus

(25)

Mioma Submukosa Mioma intramural Mioma Subserosa atau subperitoneal

Tumbuhnya tepat di bawah endometrium. Paling sering menyebabkan perdarahan yang banyak, sehingga memerlukan histerektomi, wlaupun ukurannya kecil. Adanya mioma submukosa dapat dirasakan sebagai suatu

“curet bump” (benjolan waktu

kuret). Kemungkinan

terjadinya degenerasi sarcoma juga lebih besar pada jenis ini.

Sering mempunyai tangkai yang panjang sehingga

menonjol melalui cervix atau vagina, disebut mioma

submucosa bertangkai yang dapat menimbulkan

“miomgeburt”, sering

mengalami nekrose atau

Terdapat di dinding uterus di antara serabut

miometrium.Karena

pertumbuhan tumor, jaringan otot sekitarnya akan terdesak dan terbentuk simpai yang mengelilingi tumor. Bila di dalam dinding rahim dijumpai banyak mioma, maka uterus akan mempunyai bentuk yang berbenjol-benjol dengan

konsistensi yang padat. Mioma yang terletak pada dinding depan uterus, dalam

pertumbuhannya akan menekan dan mendorong kandung kemih ke atas,

sehingga dapat menimbulkan keluhan miksi.

Letaknya di bawah lapisan tunica serosa, kadang-kadang vena yang ada di bawah

permukaan pecah dan menyebabkan perdarahan intra abdominal. Kadang-kadang mioma subserosa

timbul di antara dua ligalatum, merupakan mioma

intraligamenter, yang dapat menekan uterus dan A. Iliaca. Ada kalanya tumor ini

mendapat vascularisasi yang lebih banyak dari omentum sehingga lambat laun terlepas dari uterus, disebut sebagai parasitic mioma. Mioma subserosa yang bertangkai dapat mengalami torsi. (Sastrawinata S:154)

(26)

Endometriosis

•

Adalah suatu keadaan di mana jaringan

endometrium yang masih berfungsi terdapat

di luar kavum uteri.

•

Jaringan ini terdiri atas kelenjar-kelenjar&

stroma,terdapat di miometrium di sebut

Adenomiosis dan bila di luar uterus di sebut

Endometriosis,,

(27)

Endometriosis

• Endometriosis terdapat pada wanita yang lebih muda&yang umumnya

infertil.

• Jaringan endometrium di temukan di luar kavum uteri&di luar

miometrium.

• Endometrium sering di temukan di ovarium,peritonium&ligamentum

sakrouterinum,kavum douglasi,dinding blkg uterus,tuba fallopii,plika

vesikouterina,ligamentum rotondum&sigmoid,septum rektovaginal,kanalis iunginalis,apendiks,umbilikus,serviks

uteri,vagina,kandungkencing,vulva,perineum,parut laparatomi,kelenjar limfe,pleura&perikardium.