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Biomedicine (Semester II) > 12. Reproductive System - Pathologies > Flashcards

12. Reproductive System - Pathologies Flashcards

1
Q

What is in-vitro fertilisation (IVF)?

A

Artificial fertilisation of the ovum by sperm outside the body

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2
Q

What are the success rates of IVF?

A
  1. 3% aged <35
  2. 7% aged 35-37
  3. 8% aged 38-39
  4. 6% aged 40-42
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3
Q

What does the IVF process entail?

A
  1. The drug clomiphene causes oocytes to develop
  2. Eggs retrieved from ovaries, examined and incubated with sperm on a petri dish to allow fertilisation or sperm injected into egg
  3. Embryo is transferred to uterus
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4
Q

Amenorrhoea: definition

A

Absence of periods

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5
Q

Primary amenorrhoea: definition

A

Failure to have a period by aged 16/17

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6
Q

Secondary amenorrhoea: definition

A

Lack of menstruation for 3 months in previously menstrual woman

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7
Q

Primary amenorrhoea: aetiology

A

Congenital defects: failure of the ovarian follicles to develop (Turner’s syndrome)

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8
Q

Secondary amenorrhoea: aetiology

A 
Excessive exercise
Stress
Anorexia
Pregnancy
Pituitary tumour
PCOS
Uterine obstruction
Hypothyroidism
Medications (e.g. antipsychotics)
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9
Q

Dysmenorrhoea: definition

A

Painful periods

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10
Q

Primary dysmenorrhoea: definition

A

Excessive release of uterine prostaglandins during menstruation, causing the myometrium to contract

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11
Q

Primary dysmenorrhoea: aetiology

A

No association with identifiable pelvic disease

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12
Q

Secondary dysmenorrhoea: aetiology

A

Associated with specific pelvic or systemic pathologies such as endometriosis, fibroids, pelvic inflammatory disease

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13
Q

When does primary dysmenorrhoea usually occur?

A

6-12 months after menarche

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14
Q

Dysmenorrhoea: allopathic treatment

A 
Contraceptive pill (inhibits ovulation)
NSAIDs
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15
Q

Premenstrual Syndrome (PMS): definition

A

Physiological, psychological and behavioural changes during the luteal phase (second half of menstrual cycle)

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16
Q

Premenstrual Syndrome (PMS): aetiology

A

Variable: definitive cause unknown

Hormone imbalance - rapid shifts in levels of oestrogen and progesterone which can influence neurotransmitters

Drop in progesterone in the luteal phase of cycle

Increase in prostaglandins

Serotonin deficiency is thought to be a key neurotransmitter relationship

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17
Q

Premenstrual Syndrome (PMS): signs and symptoms

A

Over 150 symptoms have been attributed to PMS - tension, anxiety, reduced concentration, depression, fatigue

Headache, bloating, backache, pelvic pain, aching legs, sweating

Low blood sugar, cravings, increased appetite, pimples

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18
Q

Premenstrual Syndrome (PMS): allopathic treatment

A

Oral contraceptive pill

Counselling

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19
Q

Pelvic Inflammatory Disease (PID): definition

A

Infectious and inflammatory disorder of the upper female genital tract including the uterus, fallopian tubes and ovaries

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20
Q

Pelvic Inflammatory Disease (PID): aetiology

A

Spread of bacteria ascending from the cervix

Sexually transmitted infective causes include gonorrhoea and chlamydia

Insertion of intra-uterine device (IUD) e.g. coil

Abortion

Delivery under non-sterile conditions

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21
Q

Pelvic Inflammatory Disease (PID): signs and symptoms

A

Lower abdominal pain (gradual or sudden/severe) - may increase with walking
Deep dyspareunia
Purulent discharge - pus/foul odour
Occasional dysuria, fever, nausea, vomiting

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22
Q

Pelvic Inflammatory Disease (PID): complications

A

Ectopic pregnancy, infertility

Peritonitis, abscesses, septicaemia

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23
Q

Pelvic Inflammatory Disease (PID): allopathic treatment

A

Antibiotics

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24
Q

Endometriosis: definition

A

Endometrial tissue found outside uterine cavity

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25
Endometriosis: pathophysiology
Ectopic endometrial tissue follows the menstrual cycle but there's no exit point for that blood that accumulates during menstruation This leads to irritation, inflammation and pain
26
Endometriosis: aetiology
Altered immune surveillance in pelvic cavity affecting the body's ability to recognise ectopic endometrial tissue Oestrogen dominance, causing endometrial tissue (wherever it is) to proliferate Retrograde menstruation - migration of endometrial tissue back through fallopian tubes/transplant of tissue during surgery Primordial cells lining other body cavities or organs differentiate into endometrial cells Transfer of tissue through blood/lymph
27
Endometriosis: signs and symptoms
``` Dysmenorrhoea Menorrhagia Pelvic pain occurring around menstruation and lessening after Dyspareunia Bloating Lower back pain Bowel changes e.g. diarrhoea Infertility ```
28
Endometriosis: diagnostics
Ultrasound | Laparoscopy
29
Endometriosis: complications
Recurrent inflammation = formation of fibrous tissue = adhesions Adhesions = obstruction of uterus/fallopian tubes = infertility Chocolate cysts - sac containing old blood
30
Endometriosis: allopathic treatment
Combined oral contraceptive pill Surgery to remove ectopic tissue (45% grows back within a year)
31
Where does endometriosis commonly affect?
``` Ovaries Fallopian tubes Utero-sacral ligaments Pelvic cavity Intestines ```
32
Which women are at risk of developing endometriosis?
Family history Women who haven't given birth Periods longer than 7 days
33
Fibroids: definition
Benign tumours of the uterus myometrium | Can vary significantly in number and size
34
Fibroids: aetiology
Development is linked to levels of oestrogen and progesterone Increased risk with obesity (excess oestrogen) Earlier menses (more oestrogen) Family history Contraceptive pill (more oestrogen!)
35
Fibroids: signs and symptoms
50-80% are asymptomatic Menstrual changes - menorrhagia, prolonged menses, spotting/mid-cycle bleeding Leading to iron deficient anaemia Urgent/frequent urination, constipation Bloating, heaviness in abdomen Infertility - 2-10% of infertility cases
36
Fibroids: diagnostics
Ultrasound
37
Fibroids: complications
Large fibroids can occlude their blood supply causing necrosis They can calcify which causes pain
38
Fibroids: allopathic treatment
NSAIDs Hormonal therapies (inc oral contraceptive pill) Surgery (myomectomy or hysterectomy)
39
What do fibroids consist of?
Smooth muscle cells | Connective tissue
40
When are women more likely to develop fibroids?
More common in reproductive years, tending to subside post-menopause
41
Ovarian Cysts: definition
Fluid-filled sac within the ovary
42
Ovarian Cysts: signs and symptoms
Often asymptomatic (and often harmless) Dull ache Sudden sharp/severe pain if ruptured (if on rhs could present as appendicitis) Large cysts may affect bladder function
43
Ovarian Cysts: diagnostics
Ultrasound | Laparoscopy
44
Ovarian Cysts: allopathic treatment
Surgery (if >5cm)
45
What is the most common type of ovarian cyst?
Follicular cyst - failure to ovulate and instead fills with fluid
46
Polycystic Ovarian Syndrome (PCOS): definition
An endocrine metabolic condition associated with menstrual dysfunction, ovulatory dysfunction, hyperandrogenism and metabolic disturbances e.g. hyperinsulinemia
47
Polycystic Ovarian Syndrome (PCOS): pathophysiology
Dysfunction of the hypothalamic-pituitary (HPO) axis - LH:FSH imbalance High circulating LH promotes increase in ovarian androgen formation
48
Polycystic Ovarian Syndrome (PCOS): aetiology
Genetic links - increased risk with first degree relatives
49
Polycystic Ovarian Syndrome (PCOS): signs and symptoms
Amenorrhoea/oligomenorrhoea, lack of ovulation, infertility, hirsutism, acne/oily skin, weight gain/difficulty losing weight, increased risk of miscarriage (all due to increased testosterone) Acanthosis nigricans - sign of insulin resistance Alopecia/baldness Anxiety/depression
50
Polycystic Ovarian Syndrome (PCOS): diagnostics
Blood tests - increased androgens, low sex hormone binding globulin (SHBG), high LH, low/normal FSH, hyperinsulinemia, elevated blood glucose levels Ultrasound Laparoscopy
51
What criteria must be present for a PCOS diagnosis?
Oligo/anovulation AND/OR polycystic ovaries Clinical or biochemical signs of hyperandrogenism Exclusion of other causes of hormonal and metabolic dysfunction (androgen secreting tumours, Cushing's)
52
Polycystic Ovarian Syndrome (PCOS): complications
``` Infertility Amenorrhoea (increases risk of endometrial cancer) Increased risk of T2D and cardiovascular disease ```
53
Polycystic Ovarian Syndrome (PCOS): allopathic treatment
Oral contraceptive pill, metformin (to deal with insulin resistance, but causes nausea and increases levels of an amino acid when in excess: homocysteine, which can lead to atherosclerosis) Anti-androgen topical creams Clomiphene = stimulates ovulation
54
Ectopic Pregnancy: definition
When a fertilised egg implants outside of the uterine cavity
55
Where can an ectopic pregnancy occur?
``` Fallopian tube (97%) Ovary Cervix Abdomen ```
56
Ectopic Pregnancy: aetiology
Increased risk with intra-uterine devices Endometriosis PID
57
Ectopic Pregnancy: signs and symptoms
Initially no symptoms but amenorrhoea Unilateral pelvic pain Vaginal bleeding If ruptures - sudden acute abdominal pain
58
When does an ectopic pregnancy generally occur?
6-8 weeks after ovulation
59
Ectopic Pregnancy: complications
May cause spontaneous abortion, haemorrhage, peritonitis
60
Infertility: definition
Failure to conceive after 1 yr of unprotected intercourse
61
Infertility: aetiology (males)
Low sperm count Poor sperm viability or motility Blocked sperm ducts Undescended testes
62
Infertility: aetiology (females)
``` PCOS Endometriosis (blocked fallopian tubes) Fibroids PID Menopause Hypothyroidism STIs ```
63
Infertility: aetiology (both sexes)
``` Metal toxicity Radiation Malnutrition Body weight Smoking Alcohol Heat Stress ```
64
Infertility: allopathic treatment
Clomiphene (induces ovulation) | IVF
65
Balanitis: definition
Inflammation of glans penis
66
Balanitis: aetiology
Infectious - candida albicans, bacterial infection Non-infectious - lichen sclerosus (autoimmune), ezcema, psoriasis, inadequate cleaning under foreskin Phimosis - foreskin narrowing, preventing retraction
67
Balanitis: signs and symptoms
Pain Irritation Dyspareunia
68
Balanitis: complications
Chronic infections can result in foreskin fibrosis
69
Balanitis: allopathic treatment
Antibiotics Surgery Hygiene
70
Undescended Testes: definition
When one testicle fails to descend in late foetal development
71
Undescended Testes: aetiology
Premature birth - affects 30% of premature boys
72
Undescended Testes: complications
Damaged sperm = infertility | Testicular cancer
73
Undescended Testes: allopathic treatment
``` May descend independently a few months after birth hCG injection (acts like LH and increases testosterone) ``` Surgery (6-18 months)
74
Prostatitis: definition
Inflammation of the prostate gland
75
What percentage of men are likely to develop prostatitis?
8%
76
Prostatitis: aetiology
Infectious - bacterial Non-infectious - lichen sclerosus (autoimmune), eczema, psoriasis, inadequate cleaning under foreskin UTIs or STIs
77
Prostatitis: signs and symptoms
Recurrent UTIs - increased urination, urgency, dysuria, nocturia, hesitancy and incomplete voiding Painful ejaculation Fever, malaise
78
Prostatitis: allopathic treatment
Antibiotics | Painkillers
79
Benign Prostatic Hyperplasia (BPH): definition
Enlargement of the prostate tissue leading to compression of the urethra
80
Who is more likely to develop Benign Prostatic Hyperplasia (BPH)?
Men >60 yrs
81
Benign Prostatic Hyperplasia (BPH): aetiology
Risk factors - obesity, genetics, sedentary lifestyle, sympathetic activity, pesticides Increase in 5-alpha-reductase activity
82
Benign Prostatic Hyperplasia (BPH): signs and symptoms
``` Obstructed/poor urinary flow Increased urinary frequency Intermittent urine flow and dribbling of urine Nocturia Cystitis (recurrent) Reduced sexual function ```
83
Benign Prostatic Hyperplasia (BPH): diagnostics
Elevated PSA levels Digital rectal exam (DRE) Ultrasound
84
What is 5-alpha-reductase?
An enzyme that converts testosterone to dihydrotestosterone (DHT) Need this conversion for testosterone to affect the prostate
85
Benign Prostatic Hyperplasia (BPH): allopathic treatment
5-alpha-reductase inhibitors (finasteride) Surgery (when obstruction is severe)

Biomedicine (Semester II) (20 decks)

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