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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
Q

Endometriosis: pathophysiology

A

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

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26
Q

Endometriosis: aetiology

A

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

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27
Q

Endometriosis: signs and symptoms

A 
Dysmenorrhoea
Menorrhagia
Pelvic pain occurring around menstruation and lessening after
Dyspareunia
Bloating
Lower back pain
Bowel changes e.g. diarrhoea
Infertility
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28
Q

Endometriosis: diagnostics

A

Ultrasound

Laparoscopy

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29
Q

Endometriosis: complications

A

Recurrent inflammation = formation of fibrous tissue = adhesions

Adhesions = obstruction of uterus/fallopian tubes = infertility

Chocolate cysts - sac containing old blood

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30
Q

Endometriosis: allopathic treatment

A

Combined oral contraceptive pill

Surgery to remove ectopic tissue (45% grows back within a year)

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31
Q

Where does endometriosis commonly affect?

A 
Ovaries
Fallopian tubes
Utero-sacral ligaments
Pelvic cavity
Intestines
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32
Q

Which women are at risk of developing endometriosis?

A

Family history
Women who haven’t given birth
Periods longer than 7 days

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33
Q

Fibroids: definition

A

Benign tumours of the uterus myometrium

Can vary significantly in number and size

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34
Q

Fibroids: aetiology

A

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!)

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35
Q

Fibroids: signs and symptoms

A

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
Q

Fibroids: diagnostics

A

Ultrasound

37
Q

Fibroids: complications

A

Large fibroids can occlude their blood supply causing necrosis

They can calcify which causes pain

38
Q

Fibroids: allopathic treatment

A

NSAIDs
Hormonal therapies (inc oral contraceptive pill)
Surgery (myomectomy or hysterectomy)

39
Q

What do fibroids consist of?

A

Smooth muscle cells

Connective tissue

40
Q

When are women more likely to develop fibroids?

A

More common in reproductive years, tending to subside post-menopause

41
Q

Ovarian Cysts: definition

A

Fluid-filled sac within the ovary

42
Q

Ovarian Cysts: signs and symptoms

A

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
Q

Ovarian Cysts: diagnostics

A

Ultrasound

Laparoscopy

44
Q

Ovarian Cysts: allopathic treatment

A

Surgery (if >5cm)

45
Q

What is the most common type of ovarian cyst?

A

Follicular cyst - failure to ovulate and instead fills with fluid

46
Q

Polycystic Ovarian Syndrome (PCOS): definition

A

An endocrine metabolic condition associated with menstrual dysfunction, ovulatory dysfunction, hyperandrogenism and metabolic disturbances e.g. hyperinsulinemia

47
Q

Polycystic Ovarian Syndrome (PCOS): pathophysiology

A

Dysfunction of the hypothalamic-pituitary (HPO) axis - LH:FSH imbalance

High circulating LH promotes increase in ovarian androgen formation

48
Q

Polycystic Ovarian Syndrome (PCOS): aetiology

A

Genetic links - increased risk with first degree relatives

49
Q

Polycystic Ovarian Syndrome (PCOS): signs and symptoms

A

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
Q

Polycystic Ovarian Syndrome (PCOS): diagnostics

A

Blood tests - increased androgens, low sex hormone binding globulin (SHBG), high LH, low/normal FSH, hyperinsulinemia, elevated blood glucose levels

Ultrasound
Laparoscopy

51
Q

What criteria must be present for a PCOS diagnosis?

A

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
Q

Polycystic Ovarian Syndrome (PCOS): complications

A 
Infertility
Amenorrhoea (increases risk of endometrial cancer) Increased risk of T2D and cardiovascular disease
53
Q

Polycystic Ovarian Syndrome (PCOS): allopathic treatment

A

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
Q

Ectopic Pregnancy: definition

A

When a fertilised egg implants outside of the uterine cavity

55
Q

Where can an ectopic pregnancy occur?

A 
Fallopian tube (97%)
Ovary
Cervix
Abdomen
56
Q

Ectopic Pregnancy: aetiology

A

Increased risk with intra-uterine devices
Endometriosis
PID

57
Q

Ectopic Pregnancy: signs and symptoms

A

Initially no symptoms but amenorrhoea
Unilateral pelvic pain
Vaginal bleeding
If ruptures - sudden acute abdominal pain

58
Q

When does an ectopic pregnancy generally occur?

A

6-8 weeks after ovulation

59
Q

Ectopic Pregnancy: complications

A

May cause spontaneous abortion, haemorrhage, peritonitis

60
Q

Infertility: definition

A

Failure to conceive after 1 yr of unprotected intercourse

61
Q

Infertility: aetiology (males)

A

Low sperm count
Poor sperm viability or motility
Blocked sperm ducts
Undescended testes

62
Q

Infertility: aetiology (females)

A 
PCOS
Endometriosis (blocked fallopian tubes)
Fibroids
PID
Menopause
Hypothyroidism
STIs
63
Q

Infertility: aetiology (both sexes)

A 
Metal toxicity
Radiation
Malnutrition
Body weight
Smoking 
Alcohol
Heat
Stress
64
Q

Infertility: allopathic treatment

A

Clomiphene (induces ovulation)

IVF

65
Q

Balanitis: definition

A

Inflammation of glans penis

66
Q

Balanitis: aetiology

A

Infectious - candida albicans, bacterial infection

Non-infectious - lichen sclerosus (autoimmune), ezcema, psoriasis, inadequate cleaning under foreskin

Phimosis - foreskin narrowing, preventing retraction

67
Q

Balanitis: signs and symptoms

A

Pain
Irritation
Dyspareunia

68
Q

Balanitis: complications

A

Chronic infections can result in foreskin fibrosis

69
Q

Balanitis: allopathic treatment

A

Antibiotics
Surgery
Hygiene

70
Q

Undescended Testes: definition

A

When one testicle fails to descend in late foetal development

71
Q

Undescended Testes: aetiology

A

Premature birth - affects 30% of premature boys

72
Q

Undescended Testes: complications

A

Damaged sperm = infertility

Testicular cancer

73
Q

Undescended Testes: allopathic treatment

A 
May descend independently a few months after birth
hCG injection (acts like LH and increases testosterone)

Surgery (6-18 months)

74
Q

Prostatitis: definition

A

Inflammation of the prostate gland

75
Q

What percentage of men are likely to develop prostatitis?

A

8%

76
Q

Prostatitis: aetiology

A

Infectious - bacterial

Non-infectious - lichen sclerosus (autoimmune), eczema, psoriasis, inadequate cleaning under foreskin
UTIs or STIs

77
Q

Prostatitis: signs and symptoms

A

Recurrent UTIs - increased urination, urgency, dysuria, nocturia, hesitancy and incomplete voiding

Painful ejaculation

Fever, malaise

78
Q

Prostatitis: allopathic treatment

A

Antibiotics

Painkillers

79
Q

Benign Prostatic Hyperplasia (BPH): definition

A

Enlargement of the prostate tissue leading to compression of the urethra

80
Q

Who is more likely to develop Benign Prostatic Hyperplasia (BPH)?

A

Men >60 yrs

81
Q

Benign Prostatic Hyperplasia (BPH): aetiology

A

Risk factors - obesity, genetics, sedentary lifestyle, sympathetic activity, pesticides

Increase in 5-alpha-reductase activity

82
Q

Benign Prostatic Hyperplasia (BPH): signs and symptoms

A 
Obstructed/poor urinary flow
Increased urinary frequency
Intermittent urine flow and dribbling of urine
Nocturia
Cystitis (recurrent)
Reduced sexual function
83
Q

Benign Prostatic Hyperplasia (BPH): diagnostics

A

Elevated PSA levels
Digital rectal exam (DRE)
Ultrasound

84
Q

What is 5-alpha-reductase?

A

An enzyme that converts testosterone to dihydrotestosterone (DHT)

Need this conversion for testosterone to affect the prostate

85
Q

Benign Prostatic Hyperplasia (BPH): allopathic treatment

A

5-alpha-reductase inhibitors (finasteride)

Surgery (when obstruction is severe)

Biomedicine (Semester II) (20 decks)

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