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Primary Care of Adult Women, An Issue of Obstetrics and Gynecology Clinics of North America, E-Book

Primary Care of Adult Women, An Issue of Obstetrics and Gynecology Clinics of North America, E-Book

James N. Woodruff | Anita K. Blanchard

(2016)

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Book Details

Abstract

Obstetrician Gynecologists are frequently responsible for management of the primary care needs of their patients. A survey performed in 2005 found an estimated 37% of, non-pregnant patients, relies on gynecologists for routine primary care. The same study found that almost a quarter of gynecologists reported they needed additional primary care training across a broad set of medical topics (Acad Med. 2007; 82:602–607). The impetus for training in primary care skills is increasing. In response to language in the Affordable Care Act, the Institute of Medicine developed a report on clinical preventative services necessary for women (Clinical Preventative Services for Women: Closing the Gaps IOM. 2011; also Current Opinion in Obstetrics and Gynecology 2011, 23:471–480). The US Department of Health and Human services has adopted these IOM recommendations and, as a result, health plans are required to include these services. While initiatives such as the American Congress of Obstetricians and Gynecologists’ Well-Woman Task Force and recent cross-specialty ACOG educational collaborations have begun to address supplemental educational needs, additional resources covering key primary care topics are necessary. This issue of Obstetrics and Gynecology Clinics is an ideal means for accomplishing this important goal.

Table of Contents

Section Title Page Action Price
Front Cover Cover
Primary Care of Adult Women\r i
Copyright\r ii
Contributors iii
CONSULTING EDITOR iii
EDITORS iii
AUTHORS iii
Contents vii
Foreword: Are Obstetrician-Gynecologists Primary Care Physicians?\r vii
Preface: Primary Care of Adult Women\r vii
Preventive Care in Women’s Health\r vii
Primary Care of Adult Women: Common Dermatologic Conditions\r vii
Clinical Management of Obesity in Women: Addressing a Lifecycle of Risk\r vii
Evaluation and Management of Behavioral Health Disorders in Women: An\rOverview of Major Depression, Bipolar Disorder, Anxiety Disorders, and Sleep in\rthe Primary Care Setting\r viii
Evaluation of Anemia\r viii
Cardiovascular Disease in Women: Primary and Secondary Cardiovascular Disease Prevention\r viii
Hypertension in Women: Evaluation and Management\r viii
Women’s Health and Lung Development and Disease\r ix
Primary Care Endocrinology in the Adult Woman\r ix
Primary Care Evaluation and Management of Gastroenterologic Issues in Women\r ix
Primary Care for the Older Adult Patient: Common Geriatric Issues and Syndromes\r x
OBSTETRICS AND GYNECOLOGY CLINICS\r xi
FORTHCOMING ISSUES xi
September 2016 xi
December 2016 xi
March 2017 xi
RECENT ISSUES xi
March 2016 xi
December 2015 xi
September 2015 xi
Foreword: Are Obstetrician-Gynecologists Primary Care Physicians?\r xiii
Preface: Primary Care of Adult Women\r xv
REFERENCES xvi
Preventive Care in Women’s Health 165
Key points 165
INTRODUCTION 165
BEHAVIORAL COUNSELING: UNINTENTIONAL INJURIES, SUICIDE, AND HOMICIDE 168
Incidence and Mortality 168
Screening Modalities and Recommendations 168
Motor vehicle accidents 168
Suicide 168
Homicide 170
IMMUNIZATIONS 170
Impact of Immunizations on Disease Incidence and Mortality 170
Recommendations 172
Human Papilloma Virus Vaccine and Cervical Cancer Prevention 172
Incidence and mortality of cervical cancer 172
Immunization and primary prevention 172
CANCER SCREENING 173
Breast Cancer 173
Incidence and mortality 173
Screening modalities and recommendations 174
Identifying women at high risk for breast cancer 174
Screening Adjuncts 174
MRI 174
Ultrasound 174
Three-dimensional mammography 175
CHEMOPREVENTION 175
SUMMARY 177
REFERENCES 177
Primary Care of Adult Women 181
Key points 181
MELASMA 181
Epidemiology 181
Presentation 182
Diagnosis 182
Treatment 182
Prognosis 183
ROSACEA 183
Epidemiology 183
Presentation 183
Diagnosis 184
Treatment 185
Prognosis 185
VITILIGO 185
Epidemiology 185
Presentation 186
Diagnosis 186
Treatment 186
Prognosis 187
ACNE 187
Epidemiology 187
Presentation 187
Diagnosis 187
Treatment 188
Prognosis 188
ALOPECIA 189
Epidemiology 189
Presentation 189
Diagnosis 190
Treatment 191
Prognosis 191
BASAL CELL CARCINOMA AND SQUAMOUS CELL CARCINOMA 192
Epidemiology 192
Presentation 192
Diagnosis 192
Clinical Management of Obesity in Women 201
Key points 201
THE GENDER GAP 202
CONSEQUENCES 203
WHAT IS OBESITY? 203
BIOLOGICAL BASIS OF EXCESS ADIPOSITY 204
DEVELOPMENTAL CONSIDERATIONS 205
LIFESTYLE DRIVERS 206
BEHAVIORAL DRIVERS 206
PSYCHOLOGICAL DRIVERS 207
ENVIRONMENTAL DRIVERS 207
DIAGNOSIS 207
Nonpregnant Women 210
Pregnant Women 210
ASSESSMENT 211
TREATMENT STRATEGY 211
STEP 1: REMOVAL OF WEIGHT GAIN–PROMOTING MEDICATIONS 211
STEP 2: LIFESTYLE THERAPIES 212
DIET 212
EXERCISE 215
SLEEP 216
STRESS 216
STEP 3: PHARMACOTHERAPY 216
STEP 4: SURGERY 217
WEIGHT LOSS DEVICES 223
REFERRAL 223
SUMMARY 224
ACKNOWLEDGMENTS 224
REFERENCES 224
Evaluation and Management of Behavioral Health Disorders in Women 231
Key points 231
INTRODUCTION 231
ASSESSMENT AND DIFFERENTIAL DIAGNOSIS 232
MAJOR DEPRESSIVE DISORDER 233
Nonpharmacologic Treatments 233
Psychotherapy 233
Other nonpharmacologic treatments 233
Pharmacotherapy 233
Major Depression and the Female Reproductive Life Cycle 234
Menstrual cycle 234
Perinatal 234
Menopause and perimenopause 234
BIPOLAR DISORDER 235
Nonpharmacologic Treatments 235
Psychotherapy 236
Other nonpharmacologic treatments 236
Pharmacotherapy for bipolar disorder 236
Bipolar Disorder and the Female Reproductive Life Cycle 236
Menstrual cycle 236
Perinatal 236
Menopause and perimenopause 238
ANXIETY DISORDERS 238
Generalized Anxiety Disorder 238
Panic Disorder 239
Evaluation and Management 239
Nonpharmacologic Treatment 239
Pharmacotherapy for Anxiety Disorders 239
Anxiety Disorders and the Female Reproductive Life Cycle 239
Menstrual cycle 239
Perinatal 240
Menopause and perimenopause 240
SLEEP DISORDERS 240
Evaluation and Management 240
Nonpharmacologic Interventions 241
Pharmacologic Treatments 241
Insomnia and the Female Reproductive Life Cycle 241
Menstrual cycle 241
Perinatal 241
Menopause and perimenopause 242
REFERENCES 243
Evaluation of Anemia 247
Key points 247
GENERAL CONSIDERATIONS 247
MACROCYTIC ANEMIA 248
Causes 249
Megaloblastic anemia 249
Medications 249
Myelodysplastic disorders 249
Alcohol abuse 249
Liver disease 250
Reticulocytosis 250
Hypothyroidism 250
Spurious macrocytosis 250
Evaluation 250
MICROCYTIC ANEMIA 251
Causes 251
Iron deficiency anemia 251
Thalassemia 253
β-Thalassemia 253
α-Thalassemia 253
Cardiovascular Disease in Women 265
Key points 265
INTRODUCTION 265
PRIMARY PREVENTION 266
Nonmodifiable Risk Factors 266
Age 266
Race 267
Family history 267
Modifiable Cardiovascular Disease Risk Factors 267
Smoking 267
Hypertension 267
Diabetes mellitus 269
Elevated body mass index 270
Physical inactivity 271
Diet 271
Alcohol 271
Vitamins 271
Risk prediction models 272
Cholesterol/statin therapy 273
Aspirin 273
Hormonal therapy 274
CEREBROVASCULAR DISEASE 274
PERIPHERAL VASCULAR DISEASE 274
SEX-SPECIFIC RISK FACTORS 275
Gestational Hypertension and Pre-Eclampsia 275
Gestational Diabetes 275
Other Pregnancy-Related Risk Factors 275
Polycystic Ovary Syndrome 275
Functional Hypothalamic Amenorrhea 275
Breast Cancer Therapy 275
Risk assessment with sex-specific risk factors 276
DISEASE MANAGEMENT AND SECONDARY PREVENTION 276
Coronary Heart Disease 276
Medications 277
Antiplatelet agents 277
Renin-angiotensin-aldosterone blockers 277
β-blockers 277
Nitrates 278
Other considerations 278
Cardiac rehabilitation 278
Depression screening 278
Influenza vaccination 278
Hormonal therapy 278
Oral contraceptives 278
Hormonal replacement therapy 278
Cerebrovascular Disease 278
Peripheral Vascular Disease 279
SUMMARY 280
REFERENCES 280
Hypertension in Women 287
Key points 287
INTRODUCTION 287
HYPERTENSION AND CARDIOVASCULAR RISK IN WOMEN 288
SPECIAL CONSIDERATIONS FOR WOMEN 289
Role of Obesity 289
Hypertension and Combined Oral Contraceptives 290
Hypertension and Polycystic Ovarian Syndrome 290
Role of Menopause 291
DIAGNOSIS OF HYPERTENSION 291
White Coat Hypertension 292
Ambulatory and Home Blood Pressure Monitoring 293
INITIAL EVALUATION OF HYPERTENSION 293
History and Physical Examination 293
MANAGEMENT OF HYPERTENSION 298
Lifestyle Interventions 298
Maintenance of a Healthy Body Weight 299
Physical Activity 299
Cigarette Smoke Exposure 299
Pharmacotherapy 300
General principles 300
Individualized treatment plan 300
Ongoing Management Considerations 300
Resistant Hypertension 302
SUMMARY AND DISCUSSION 303
REFERENCES 303
Women’s Health and Lung Development and Disease 307
Key points 307
INTRODUCTION 307
SEX-BASED DIFFERENCES IN PULMONARY PHYSIOLOGY 307
OBSTRUCTIVE LUNG DISEASE 308
Chronic Obstructive Pulmonary Disease 308
Asthma 310
INTERSTITIAL LUNG DISEASE 312
Lymphangioleiomyomatosis 312
LUNG CANCER 314
PULMONARY ARTERIAL HYPERTENSION 315
VENOUS THROMBOEMBOLISM 317
THORACIC COMPLICATIONS OF ENDOMETRIOSIS 318
REFERENCES 319
Primary Care Endocrinology in the Adult Woman 325
Key points 325
DIABETES MELLITUS 325
Background 325
Pathophysiology and Classification 326
Prevention 326
Assessment of Overall Risk and Screening Recommendations 326
Clinical Presentation 327
Management 327
Summary 329
THE THYROID GLAND 329
Background 329
Thyroid hormone synthesis and action 329
Perturbations of Thyroid Function and Structure 332
Hypothyroidism 332
Clinical manifestations and diagnosis of hypothyroidism 333
Management in nonpregnant women 333
Management in pregnant women 334
Thyrotoxicosis 334
Thyroid nodules and thyroid cancer 336
Summary 336
OSTEOPOROSIS 336
Background 336
Assessment of Overall Risk 336
Screening for Osteoporosis 338
Diagnosis of Osteoporosis and Low Bone Mineral Density 339
Management 343
Summary 344
REFERENCES 344
Primary Care Evaluation and Management of Gastroenterologic Issues in Women 347
Key points 347
INTRODUCTION 347
COLORECTAL CANCER 348
Current Screening Modalities and Guidelines 348
High-Risk Populations 349
Colorectal Cancer in Women 349
IRRITABLE BOWEL SYNDROME 351
Diagnosis 351
Pathophysiology 351
Management 352
Management of Irritable Bowel Syndrome with Constipation 352
Management of Irritable Bowel Syndrome with Diarrhea 352
PEPTIC ULCER DISEASE 353
Clinical Presentation 353
Risk Factors 353
Endoscopic Evaluation and Management 354
GALLBLADDER DISORDERS 355
Biliary Colic 355
Cholelithiasis and Cholecystitis 355
Gallbladder Disease and Pregnancy 356
INFLAMMATORY BOWEL DISEASE 356
Inflammatory Bowel Disease Therapy 357
Inflammatory Bowel Disease and Pregnancy 358
GASTROESOPHAGEAL REFLUX DISEASE 359
Gastroesophageal Reflux Disease Therapy 360
Gastroesophageal Reflux Disease and Pregnancy 360
Barrett’s Esophagus 361
REFERENCES 362
Primary Care for the Older Adult Patient 367
Key points 367
INTRODUCTION 367
COGNITIVE IMPAIRMENT AND DEMENTIA 368
Epidemiology 368
Diagnosis 368
Risk Factors and Screening 368
Evaluation 369
Management 370
FALLS 371
Epidemiology 371
Screening 371
Evaluation 372
Treatment and Prevention 372
POLYPHARMACY 372
Definition and Epidemiology 372
Risks 373
Evaluation and Management 373
LATE LIFE AND END-OF-LIFE PLANNING AND CARE 374
Care Planning for Multimorbid Patients 374
Delivering Bad News 374
Advance Care Planning 375
SUMMARY 376
REFERENCES 376
Index 381