Geriatric GynecologyZachary C. Kuhlmann, DO, FACOG

Clinical Assistant ProfessorDept OB/Gyn

University of Kansas SOM - Wichita

Goals of this Lecture

Why is this topic important? How do I approach an old person? Understand the health concerns for women

as they age.

Life Expectancy

http://www.cdc.gov/nchs/data/hus/hus08.pdf#026

Aging

Growing old is mandatory, growing up is optional Chili Davis

How old would you be if you didn’t know how old you were? Satchel Paige

Few people know how to be old Francois de la Rochefoucauld

Aging…defined

Definition Constellation of changes in structure and function,

generally beginning after sexual maturation Concepts

Homeostenosis Slow and progressive narrowing of physiologic reserve

with increasing age and the accompanying decreased ability to withstand stress or injury

Heterogeneity Wide range of differences in individuals who are at a

point in the aging process when age no longer is closely correlated with functional capability

Care of Aging Women, Vol 8, #4, Oct 2009

Theories of Aging

Genetic programmed events Free radicals Somatic mutations Nonenzymatic glycation of proteins Clonal senescence

Care of Aging Women, Vol 8, #4, Oct 2009

Coronary Heart Disease

Leading cause of death for women in the U.S.

Accounts for up to 1/3 of visits in women seeking primary care thru Ob/Gyn

Presenting symptoms may be different in women than in men

Sensitivity/Specificity for non-invasive diagnostic testing different for men and women

Litwin and Priester, 2010

Litwin and Priester, 2010

Diagnostic Tests for CAD

Conventional Exercise treadmill Exercise stress echo Dobutamine echo Stress SPECT Diagnostic invasive

coronary angiography

Newer Modalities Coronary calcium score Coronary CT

angiography Stress cardiac MRI

Litwin and Priester, 2010

Coronary Artery Calcium Assessment

Volume of Ca found in all coronary arteries and proportional to total burden of plaque

Noncontrast CT scan Fast, non-invasive Not useful in women < 40 and cannot

quantify luminal obstruction Good predictor of cardiovasular events

Litwin and Priester, 2010

Coronary CT Angiography

Direct visualization of coronary arteries Can quantify location, amount, composition,

and severity of atherosclerosis Sensitivity approaches 95% compared to

invasive angiography

Litwin and Priester, 2010

Cardiac MRI

Shows perfusion of myocardium and assesses myocardial structure, function, and viability

Cannot assess coronary arterial anatomy Not a good screening test for early

atherosclerosis

Litwin and Priester, 2010

Itchy and Scratchy Show

The Vulva

Problems may present as itching, pigment changes, or lesions

Biopsy: Recent pigmentation Excoriation White epithelium Any lesion

Care of Aging Women, Vol 8, #4, Oct 2009

Name that Pathology

www.john-libbey-eurotext.fr/e-docs/00/03/F9/9...

Pathology

http://en.wikipedia.org/wiki/Extramammary_Paget's_disease

Pathology

www.globalpov.com/images/oldlady.jpg

Atlas of Vulvar Disease, 2008

Pathology

Pathology

womensvoicesforchange.org/.../07/Melanoma.jpg

Atlas of vfulvar Disease, 2008

Pathology

Differential Dx of Vulvar Lesions

Syphilis HSV Chancroid Lymphogranuloma venereum Granuloma inguinale Bechet’s Vulvar Carcinoma

Sexual Intercourse

Estrogen Vaginal Cream Treatment of atrophic vaginitis Has been used for urinary incontinence Generally regarded as safe in breast CA

patients

Cases/Questions?