FLUXUS

STEP 1 Fluxus: Seperti cairan yang banyak dan keluar daari vagina. Secret kind o disc!arge produce by pat!ological cell in cervix vagina. Fluxus tidak selalu patologi" dapat #uga pda ni as yang prolong.

STEP$

1. %!y t!e general p!ysical exa&ination con ir& an ane&ic and obese condition'
(besity continues to rise in t!e US" exceeding )* percent in &ost sex and age groups" according to an article publis!ed in +,-.-+ in /*1*. For e&ales in particular" obesity creates t!e risk o estrogen do&inance" or !aving an excessive a&ount o estrogen circulating in t!e body. 0ig! levels o estrogen are associated %it! increased cancer and diabetes risks. Types of Estrogen -ccording to %eb&[Link]&" estrogen is actually &ade up o several di erent !or&ones: estradiol" estriol" and estrone. Estradiol is t!e pri&ary !or&one or %o&en o c!ildbearing age" and is i&portant in sexual unctioning and bone !ealt!. 1t is also o ten linked to gynecological disorders and cancer. Estriol is created by t!e placenta during c!ildbirt!" and estrone is t!e only estrogen to be present in t!e body a ter &enopause. .en also !ave levels o estrogen" alt!oug! t!ey are supposed to be lo%er t!an in e&ales. T!e %ebsite also discusses t!e luctuations in estrogen levels t!roug!out a li eti&e" seeing !ig!er levels during c!ildbearing years and declining levels a ter &enopause. Estrogen Production (riginating %it! c!olesterol" sex !or&ones are produced a ter a nu&ber o bioc!e&ical reactions. 2ody at plays a large role in estrogen production" bot! too &uc! and too little at. Fe&ales %it! lo% a&ounts o body at o ten !ave lo% sex !or&one levels" states %eb&[Link]&" and can su er ro& dys&enorr!ea and ragile bone structure. 3onversely" a !ig! body &ass index 42.15 can result in increases in estrogen levels. - study publis!ed in t!e +,ournal o t!e -&erican -cade&y o 6er&atology+ in /**1 stated t!at alt!oug! estradiol is &ostly produced ro& t!e ovaries" ot!er sources include adipose" or at" tissue. Adipose and Estrogen -dipose tissue is t!e tec!nical ter& or at deposits" %!ic! contains a substance called aro&atase. -ro&atase pro&pts t!e conversion o

steroids to estrogen" according to t!e article in +,ournal o t!e -&erican -cade&y o 6er&atology.+ 1t is also ound in skin cells" and t!e article states t!at +aro&atase expression in adipose tissue and possibly t!e skin pri&arily accounts or t!e extraglandular 4perip!eral5 or&ation o estrogen and increases as a unction o body %eig!t and advancing age.+ T!us" increases in body at can increase levels o estrogen. Obesity, Estrogen, and Heart Disease - /**7 article in t!e +,ournal o 3ardiovascular Translation 8esearc!+ discussed t!e link bet%een obesity" estrogen" and !eart disease. -ccording to t!is article" adipose tissue in t!e abdo&inal area poses a greater risk o !eart disease t!an subcutaneous" or under t!e skin" at. 2ecause estrogen levels drop a ter &enopause" %o&en &ay develop &ore o an abdo&inal at pad. (verall adiposity is typically controlled by certain areas o t!e brain" and is directly in luenced by sex !or&ones. T!us" t!e article concluded t!at +di erences in cardiovascular disease &ay be under t!e in luence o sex !or&ones eit!er directly in t!e brain or t!roug! t!eir in luence o body at distribution.+ Risks of Obesity and High Estrogen -lt!oug! it !as not been broug!t to t!e public9s general attention until &ore recently" t!e link bet%een estrogen and obesity !as been studied or over /* years. -n article publis!ed in 17:$ in t!e +-&erican ,ournal o 3linical ;utrition+ states t!at obesity causes alterations in t!e &etabolis&" or breakdo%n" o estrogens in t!e body" %!ic! can lead to substances t!at retain estrogenic properties. 2ecause t!ese substances still possess estrogen <ualities" t!e tissues receive &ore estrogen sti&ulation t!an is nor&al. T!e +European ,ournal o 3ancer Prevention+ publis!ed an article t!is year listing t!e conse<uences o unopposed estrogen sti&ulation. (besity" type / diabetes" uterine overgro%t!" prostatic enlarge&ent" prostate cancer and breast cancer are a&ong t!e concerns" as are anxiety" depression" !eart disease and stroke. 8ead &ore: !ttp:==%%%.[Link]&=article=1>?>$1@estrogen@ obesity=AixBB/&[Link]

Aromatase, also called estrogen synthetase or estrogen synthase, is an enzyme responsible for a key step in the biosynthesis ofestrogens. It is a member of the cytochrome P450 superfamily (E !.!4.!4.!", #hich are monoo$ygenases that catalyze many reactions in%ol%ed in steroidogenesis. In particular, aromatase is responsible for the aromatization of androgens into estrogens. &he aromatase enzyme can be found in many tissues including gonads, brain, adipose tissue, placenta, blood %essels, skin, and bone, as #ell as in tissue ofendometriosis, uterine fibroids, breast cancer, and endometrial cancer.
'citation needed(

It is an important factor in se$ual de%elopment.

)%arian aromatase plays the same ma*or role as adrenal aromatase in oestrogen synthesis. &he o%ary, as an endocrine gland, can be considered as ha%ing t#o compartments+ the interstitial or stromal compartment #hich is under the influence of ,-, controls the synthesis of androstene dione by stroma cells. In the thecal compartment, granulosa cells, under the influence of ./-, regulate the 0uantity of aromatase in order to synthesise oestrone and oestradiol. &he le%el of aromatase at o%ulation is 1 to !0 times higher than during menstruation.

Role of ovarian aromatase

2fter menopause, the androgens originating from the adrenal gland (androstenedione, testosterone" are con%erted into oestrogens by the li%er, muscle, hair, adipose tissue and tumour cell aromatase. 2romatase inhibitors stop this oestrogen production.

Action of anti-aromatase drugs

2ntiaromatase drugs therefore play an essential role in the treatment of breast carcinoma, since they halt the production of oestrgens. Prescription of substituti%e hydrocortisone (as in treatment by aminogluthetimide" is not necessary.

Denapa pada pria yang ge&uk &engala&i gyneco&astia' Pada laki laki yang ge&uk" le&ak akan dipeca! &en#adi estrogen. Estrogen akan naik dan &e&pengaru!i pertu&bu!an payudara.

Abstract
2n imbalance bet#een estrogen action relati%e to androgen action at the breast tissue le%el results in gynecomastia. Enhancement of aromatization of androgens to estrogens is important in the pathogenesis of gynecomastia associated #ith obesity, aging, puberty, li%er disease, thyroto$icosis, !34o$osteroid reductase deficiency. 5linefelter6s syndrome, and neoplasms of the testes, adrenals and li%er. 2 primary aromatase e$cess syndrome #ith e$uberant gynecomastia had been found both sporadically and in a familial setting. 2lthough aromatase inhibition #ould appear to be an important class of drugs to treat gynecomastia, relati%ely little published data #ith these drugs e$ist and most concern the use of delta!4testolactone, #hich reduces the size of the breast glandular tissue, but does not completely ameliorate the problem. /tudies #ith the ne#er generation of more potent aromatase inhibitors need to be carried out.

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/. F!y t!e &enstrual cycle %as irregular' -nd F!y t!e &enstrual !appen t%ice in a &ont!' Apa yang dapat merangsang reseptor di uterus meningkat? 0asil diskusi sa&a ik!e : siklus ovulasi terganggu" tidak ter#adi siklus ovulasi" akan ter#adi penurunan progesteron dan peningkatan !or&on estrogen. Peningkatan estrogen dikarenakan tidak adanya siklus ovulasi dan selan#utnya ter#adi penebalan dinding endo&etriu&. 6an ter#adi !iperplasi dinding endo&etriu&.

). F!y s!e elt pain in severe abdo&inal'

?. F!y s!e !ad been &arried or seven years but never conceived'

E. F!y t!ere %as re<uent oul s&elling vaginal disc!arge bet%een &enstrual cycle'

>. F!at t!e relations!ip bet%een t!e !istory o !er &ot!er die because ca cervix and !is sy&pto&s'

$. F!y does t!e pasien get &ens over t!an 1E days %it! large a&ount o blood' 1rregular karena &etroragia" perdara!an dala& #u&la! banyak" durasinya lebi! la&a dan siklusnya tidak teratur. Darena kondisi uterus &isal &yo&a

uteri" !iperplasi pada endo&etriu&. Sala! satu aktor adala! &yo&a uteri" karena ber!ubungan dengan estrogen yang &eningkat dan progesteron. 6an &enngakibatkan perdara!an yang &engakibatkan ane&ia. 6urasi la&a dan #u&la! perdara!annya banyak" ke&ungkinan &engakibatkan kelainan pada arteri di uterus. .enoragi : siklus nor&al tetapi #u&la! perdara!an banyak dan durasinya la&a .etroragia : perdara!an dala& #u&la! banyak" durasinya lebi! la&a dan siklusnya tidak teratur Fanita tidak perna! berada diluar siklus &enstruasi sela&a dia &asi! &enstruasi.

:. F!at t!e relations!ip bet%een )/ years old and !er sy&pto&s' Usia )/ ta!un &erupakan aktor resiko untuk ter#asdinya &yo&a uteri

7. F!y t!e ginecological exa&ination ounded t!at uterus in ante lexi position and siBe %as about an adult ist' ;or&alnya uterus teraba sebesar telur aya&. Tetapi teraba sebesar kepalan tangan" ke&ungkinan &yo&a suda! &e&besar dan teraba sebesar kepalan tangan

1*.F!y t!e doctor consider to do USG and !istopat!ology exa&ination' Pe&eriksaan USG untuk &eli!at posisi dari uterus dan pe&besaran dari uterus" seperti &yo&a uteri" ga&barannya irregular" ada okus yang !ipoekoik dan ga&baran acoustic. Pada !istopat!ology dilakukan untuk &engeta!ui proli erasi dari sel" yang ke&ungkinan terdapat sel sel ganas pada uterus. Dan dilakukan untuk menentukan diagnosis pasti dari aringan sel pada kasus keganasan yang tidak diketahui tumor tersebut inak atau ganas!

11.F!at anot!er exa&ination ro& t!is cause' Pe&eriksaan laboratoriu& 4dara! rutin5 2iopsy

TUG-S T-.2-0-; 1. Delainan &enstruasi la&a" siklus dan #u&la! perdara!an'

/. Denapa dilakuakn pe&eriksaan 03G pada pasien ini' ). 66 dari &enoragi" &etroragi dan &eno&etroragi' ?. Faktor resiko untuk 3a endo&etrii" endo&etriosis" &yo&a uteri dan syndro&a du! tubu!' 6icari aktor resiko" &ani estasi kliis dan pe&eriksaan lab dasar serta penun#ang #uga tata laksana'

E. 0al !al yang &e&pengaru!i perti&bangan pe&ili!an terapi'