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BioMed S2 > 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 does the IVF process entail?

A
  1. The drug Clomiphene causes oocytes to develop
  2. Ova are retrieved from ovaries, examined and incubated with sperm on a petri dish to allow fertilisation (or sperm injected into ovum)
  3. Embryo is transferred to uterus
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3
Q

Amenorrhoea: definition

A

Absence of periods

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4
Q

Primary amenorrhoea: definition

A

Failure to have a period by aged 16/17 (expected onset)

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5
Q

Secondary amenorrhoea: definition

A

Lack of menstruation for 3 months in previously menstrual woman

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6
Q

Primary amenorrhoea: aetiology

A

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

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7
Q

Secondary amenorrhoea: aetiology

A

Excessive exercise (endorphins inhibit GnRH)
Stress (cortisol inhibits GnRH)
Anorexia (neuropeptide Y surpresses GnRH)
Pregnancy!
Pituitary tumour
PCOS (increased testosterone promoting male functions not female)
Uterine obstruction
Hypothyroidism
Medications (e.g. antipsychotics)

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8
Q

Dysmenorrhoea: definition

A

Painful periods

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9
Q

Primary dysmenorrhoea: definition

A

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

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10
Q

Primary dysmenorrhoea: aetiology

A

Raised prostaglandins may be due to low progesterone before menses
No association with identifiable pelvic disease

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11
Q

Secondary dysmenorrhoea: aetiology

A

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

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12
Q

When does primary dysmenorrhoea usually occur?

A

6-12 months after menarche

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13
Q

Dysmenorrhoea: allopathic treatment

A 
Contraceptive pill (inhibits ovulation)
NSAIDs
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14
Q

Premenstrual Syndrome (PMS): definition

A

Physiological, psychological and behavioural changes during the luteal phase (post-ovulatory phase of menstrual cycle)

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15
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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16
Q

Premenstrual Syndrome (PMS): signs and symptoms

A

Over 150 symptoms have been attributed to PMS

Tension, anxiety, reduced concentration, depression, fatigue, palpitations
Headache, bloating, backache, pelvic pain, aching legs, sweating, fluid retention, hot flushes
Low blood sugar, cravings, increased appetite, greasy skin/hair

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17
Q

Premenstrual Syndrome (PMS): allopathic treatment

A

Oral contraceptive pill

Counselling

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18
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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19
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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20
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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21
Q

Pelvic Inflammatory Disease (PID): complications

A

Ectopic pregnancy
Infertility
Peritonitis, abscesses
Septicaemia

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22
Q

Pelvic Inflammatory Disease (PID): allopathic treatment

A

Antibiotics

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23
Q

Endometriosis: definition

A

Endometrial tissue found outside uterine cavity

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24
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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25
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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26
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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27
Q

Endometriosis: diagnostics

A

Ultrasound

Laparoscopy

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28
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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29
Q

Endometriosis: allopathic treatment

A

Combined oral contraceptive pill

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

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30
Q

Where does endometriosis commonly affect?

A 
Ovaries
Fallopian tubes
Utero-sacral ligaments
Pelvic cavity
Intestines
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31
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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32
Q

Fibroids: definition

A

Benign tumours of the uterus myometrium

Can vary significantly in number and size

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33
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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34
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

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35
Q

Fibroids: diagnostics

A

Ultrasound

36
Q

Fibroids: complications

A

Large fibroids can occlude their blood supply causing necrosis

They can calcify which causes pain

37
Q

Fibroids: allopathic treatment

A

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

38
Q

What do fibroids consist of?

A

Smooth muscle cells

Connective tissue

39
Q

When are women more likely to develop fibroids?

A

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

40
Q

Ovarian Cysts: definition

A

Fluid-filled sac within the ovary

41
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

42
Q

Ovarian Cysts: diagnostics

A

Ultrasound
Laparoscopy

43
Q

Ovarian Cysts: allopathic treatment

A

Surgery (if >5cm)

44
Q

What is the most common type of ovarian cyst?

A

Follicular cyst - failure to ovulate and instead fills with fluid

45
Q

Polycystic Ovarian Syndrome (PCOS): definition

A

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

46
Q

Polycystic Ovarian Syndrome (PCOS): pathophysiology

A

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

High circulating LH promotes increase in ovarian androgen formation

47
Q

Polycystic Ovarian Syndrome (PCOS): aetiology

A

Genetic links - increased risk with first degree relatives

48
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

49
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

50
Q

What criteria must be present for a PCOS diagnosis?

A

Oligo/anovulation AND/OR polycystic ovaries

Clinical or biochemical signs of hyperandrogenism (hirsutism,
acne, elevated testosterone)

Exclusion of other causes of hormonal and metabolic dysfunction (androgen secreting tumours, Cushing’s)

51
Q

Polycystic Ovarian Syndrome (PCOS): complications

A

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

52
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

53
Q

Ectopic Pregnancy: definition

A

When a fertilised egg implants outside of the uterine cavity

54
Q

Where can an ectopic pregnancy occur?

A 
Fallopian tube (97%)
Ovary
Cervix
Abdomen
55
Q

Ectopic Pregnancy: aetiology

A

Increased risk with intra-uterine devices
Endometriosis
PID

56
Q

Ectopic Pregnancy: signs and symptoms

A

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

57
Q

When does an ectopic pregnancy generally occur?

A

6-8 weeks after ovulation

58
Q

Ectopic Pregnancy: complications

A

May cause spontaneous abortion, haemorrhage, peritonitis

59
Q

Infertility: definition

A

Failure to conceive after 1 yr of unprotected intercourse

60
Q

Infertility: aetiology (males)

A

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

61
Q

Infertility: aetiology (females)

A 
PCOS
Endometriosis (blocked fallopian tubes)
Fibroids
PID
Menopause
Hypothyroidism
STIs
62
Q

Infertility: aetiology (both sexes)

A 
Metal toxicity
Radiation
Malnutrition
Body weight
Smoking 
Alcohol
Heat
Stress
63
Q

Infertility: allopathic treatment

A

Clomiphene (induces ovulation)
IVF

64
Q

Balanitis: definition

A

Inflammation of glans penis

65
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

66
Q

Balanitis: signs and symptoms

A

Pain
Irritation
Dyspareunia

67
Q

Balanitis: complications

A

Chronic infections can result in foreskin fibrosis

68
Q

Balanitis: allopathic treatment

A

Antibiotics
Surgery
Hygiene

69
Q

Undescended Testes: definition

A

When one testicle fails to descend in late foetal development

70
Q

Undescended Testes: aetiology

A

Premature birth - affects 30% of premature boys

71
Q

Undescended Testes: complications

A

Damaged sperm = infertility

Testicular cancer

72
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)

73
Q

Prostatitis: definition

A

Inflammation of the prostate gland

74
Q

What percentage of men are likely to develop prostatitis?

A

8%

75
Q

Prostatitis: aetiology

A

Infectious - bacterial (UTIs or STIs)

Non-infectious - trauma, stress

76
Q

Prostatitis: signs and symptoms

A

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

Painful ejaculation

Fever, malaise

77
Q

Prostatitis: allopathic treatment

A

Antibiotics

Painkillers

78
Q

Benign Prostatic Hyperplasia (BPH): definition

A

Enlargement of the prostate tissue leading to compression of the urethra

79
Q

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

A

Men >60 yrs

80
Q

Benign Prostatic Hyperplasia (BPH): aetiology

A

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

Increase in 5-alpha-reductase activity

81
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
82
Q

Benign Prostatic Hyperplasia (BPH): diagnostics

A

Elevated PSA levels
Digital rectal exam (DRE)
Ultrasound

83
Q

What is 5-alpha-reductase?

A

An enzyme that converts testosterone to dihydrotestosterone (DHT)

Need this conversion for testosterone to affect the prostate

84
Q

Benign Prostatic Hyperplasia (BPH): allopathic treatment

A

5-alpha-reductase inhibitors (finasteride)

Surgery (when obstruction is severe)

85
Q

What are the success rates of IVF ?

A

32.3% women under 35
27.7% aged 35–37
20.8% aged 38–39
13.6% aged 40–42

BioMed S2 (34 decks)

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