1. Geriatric Gynecology Zachary C. Kuhlmann, DO, FACOG Clinical Assistant Professor Dept OB/Gyn University of Kansas SOM - Wichita

2. 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.

3. Life Expectancy http://www.cdc.gov/nchs/data/hus/hus08.pd f#026 http://www.cdc.gov/nchs/data/hus/hus08.pd f#026

4. 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

5. 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

6. 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

7. 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

9. 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

10. 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

11. 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

12. 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

13. Itchy and Scratchy Show

14. 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

15. Name that Pathology www.john-libbey-eurotext.fr/e-docs/00/03/F9/9...

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

17. Pathology www.globalpov.com/images/oldlady.jpg

18. Atlas of Vulvar Disease, 2008 Pathology

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

20. Atlas of vfulvar Disease, 2008 Pathology

21. Differential Dx of Vulvar Lesions Syphilis HSV Chancroid Lymphogranuloma venereum Granuloma inguinale Bechet’s Vulvar Carcinoma

22. Sexual Intercourse

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

25. Cases/Questions?