Primary Care in Obstetrics and Gynecology: A Handbook for Clinicians

551 Pages·2007·5.713 MB·English

by  Joseph S. Sanfilippo MD, MBA, Roger P. Smith MD (auth.)

Primary Care in Obstetrics
and Gynecology
Second Edition
Primary Care in Obstetrics
and Gynecology
A Handbook for Clinicians
Second Edition
Joseph S. Sanfi lippo, MD, MBA
Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences,
University of Pittsburgh School of Medicine, Vice Chairman,
Reproductive Sciences, Magee-Women’s Hospital,
Pittsburgh, Pennsylvania, USA
Roger P. Smith, MD
Professor, Vice Chair and Program Director, Department of
Obstetrics and Gynecology, University of Missouri, Truman
Medical Center, Kansas City, Missouri, USA
Joseph S. Sanfi lippo, MD, MBA Roger P. Smith, MD
Professor Professor
Department of Obstetrics, Gynecology, and Vice Chair and
Reproductive Sciences Program Director
University of Pittsburgh School Department of Obstetrics
of Medicine and Gynecology
Vice Chairman University of Missouri
Reproductive Sciences Truman Medical Center
Magee-Women’s Hospital Kansas City, MO 64108
Pittsburgh, PA 15213 USA
USA
Drug Dosage Notice: The authors and editors of this book have checked carefully to
ensure that drug dosage recommendations are precise and in agreement with accepted
standards at the time of publication. Nevertheless, dosage schedules are changed periodi-
cally as research and clinical experience reveal new data. Therefore, you should check the
manufacturer’s recommendation for dosages of all medications, especially in instances
when the drug is one which you use infrequently or with which you otherwise lack
familiarity.
Library of Congress Control Number: 2006920204

ISBN: 978-0387-32327-5 e-ISBN: 978-0387-32328-2
Printed on acid-free paper.
© 2007, © 1998 Springer Science+Business Media, LLC
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Preface
“The obligation to promote the good of the patients is a basic presump-
tion of medical care giving a defi ning feature of the physician’s ethical
responsibility. To promote the patient’s good is to provide care in which
benefi ts outweigh burdens or harms” [American College of Obstetri-
cians & Gynecologists (ACOG) Committee Opinion #156, 1995].
How does the busy clinician balance this with the confl icting
pressures of time, regulation, paperwork, increased costs, declining
reimbursements, burnout, and ever-changing knowledge? These issues
have affected us at all levels: the medical student, the resident, and the
established practitioner. This second edition of this book has been
designed to address the issue of changing knowledge and to touch on
some of the other issues as well.
Let us begin with medical student training. More informa-
tion, clinical application, problem-based learning (PBLs), and often-
times short but succinct obstetrics and gynecology rotations are the
current name of the game. How can we train our future physicians to
think multisystem? The ability to collate all information and apply it
to the specifi c clinical problem at hand remains a challenge. One objec-
tive of this book is to tie the gynecologic and the medical knowledge
clinical application together and to apply them to the patient who is
currently in front of us.
Residency training continues to stress exposure to primary
and preventive ambulatory health care, i.e., internal medicine, critical
care, geriatrics, and the emergency department. The book is designed
to provide information that can integrate these disparate callings.
Primary care, as obstetricians and gynecologists are asked to
provide, covers the spectrum from the pediatric-adolescent, to the
reproductive-aged woman, to menopause and beyond. Adolescent and
sexual development and awareness, along with psychological and cog-
nitive development, all begin early and proceed rapidly into adulthood.
When should the fi rst pelvic examination be performed? How do we
provide health guidance and counseling based on age? We attempt to
provide guidelines to these questions in this second edition.
vi Preface
Periodic health assessment is important in our day-to-day
clinical activities. How do we as clinicians provide primary and preven-
tive care? How does a busy clinician identify the high-risk patient? For
example, when is a lipid profi le or colorectal screening indicated? What
is the gynecologist’s role in preconception counseling and genetic
testing, hepatitis vaccination, human immunodefi ciency (HIV) assess-
ment, mammography, infl uenza, and human papilloma virus vaccina-
tions? The list goes on.
The second edition of this book is designed to provide a suc-
cinct, immediately clinically applicable source of information. It is our
sincere hope that everyone who has this new revised edition at his or
her disposal can provide excellence in clinical care.
Joseph S. Sanfi lippo, MD, MBA
Roger P. Smith, MD
Contents
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Section I Primary Care and the Obstetrician-Gynecologist
1 Primary Care in Obstetrics and Gynecology: Health
Maintenance and Screening . . . . . . . . . . . . . . . . . . . . . . . 3
Douglas W. Laube
2 Pediatric and Adolescent Patients . . . . . . . . . . . . . . . . . . 33
Mary Anne Jamieson and Joseph S. Sanfi lippo
3 Elderly Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Hugh R.K. Barber† and Roger P. Smith
4 Lesbian Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Joseph S. Sanfi lippo and Ruth Schwarz†
5 The Role of Genomic and Applied Molecular Biology. . . 89
Randall S. Hines
6 Emergencies in the Offi ce Setting . . . . . . . . . . . . . . . . . . 105
Mary Nan Mallory
Section II C linical Management Principles for the
Offi ce Setting
7 Abnormal Pap Smear: Gynecologic Pathology
and Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
Richard S. Guido
8 Mood Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
G. Randolph Schrodt, Jr.
†Deceased.
viii Contents
9 Breast Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
William H. Hindle
10 Cardiovascular Hypertension . . . . . . . . . . . . . . . . . . . . . . 195
Dayton W. Daberkow II and Thomas E. Nolan
11 Chronic Pelvic Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Arnold P. Advincula and Arleen Song
12 Contraception Update. . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Amitasrigowri S. Murthy and Bryna Harwood
13 Coronary Heart Disease in Women: Diagnosis,
Evaluation, and Preventive Therapy. . . . . . . . . . . . . . . . . 265
Nanette K. Wenger
14 Dermatologic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . 283
Jeffrey P. Callen
15 Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
Sri Prakash L. Mokshagundam and Vasti L. Broadstone
16 Gastrointestinal Disorders . . . . . . . . . . . . . . . . . . . . . . . . 327
Roger P. Smith
17 Headaches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Douglas W. Laube
18 Nutrition, Obesity, and Eating Disorders . . . . . . . . . . . . 357
Bernadette McIntire and Joseph A. Lacy
19 Respiratory Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Roger P. Smith
20 Sexual Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Jean D. Koehler
21 Sports Medicine and Injuries in the
Athletic Woman. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433
Tanya J. Hagen and Freddie H. Fu
Contents ix
22 Thyroid Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
Mary Korytkowski and Haruko Akatsu Kuffner
Appendix
Ready Reference Tables for Preventive Health Care and
Health Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 467
Joseph S. Sanfi lippo
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511
Contributors
Arnold P. Advincula, MD
Clinical Assistant Professor, Department of Obstetrics and Gynecology,
Division of Gynecology, University of Michigan, Ann Arbor, MI
48109, USA
Hugh R.K. Barber, MD†
Emeritus Professor, New York University School of Medicine, Depart-
ment of Obstetrics and Gynecology, Lenox Hill Hospital, New York,
NY 10021, USA
Vasti L. Broadstone, MD
Southern Indiana Diabetes and Endocrinology Specialties, Joslin Dia-
betes Center, New Albany, IN 47150, USA
Jeffrey P. Callen, MD
Professor, Department of Medicine (Dermatology), Chief, Division of
Dermatology, University of Louisville, Louisville, KY 40292, USA
Dayton W. Daberkow II, MD
Associate Professor, Department of Clinical Medicine, Internal Medi-
cine Residency Program Director, Department of Internal Medicine,
Louisiana State Health Sciences Center, New Orleans, LA 70112, USA
Freddie H. Fu, MD
Professor and Chairman, Department of Orthopedics, Center for
Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh,
PA 15203, USA
Richard S. Guido, MD
Associate Professor, Department of Obstetrics, Gynecology, and Repro-
ductive Sciences, Division of Gynecology Specialties, Magee-Women’s
Hospital, Pittsburgh, PA 15213, USA
†Deceased.