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Biomedicine II > 12. Reproductive System Pathologies > Flashcards

12. Reproductive System Pathologies Flashcards

1
Q

Amenorrhoea

A

•‘Amenorrhoea’ = absence of menstruation.
PRIMARY AMENORRHOEA:
•Failure of the menses to occur by expected onset (16, 17 years).
•Mostly caused by congenital defects: failure of ovarian follicles to develop (Turners syndrome).
SECONDARY AMENORRHOEA:
•Lack of menstruation for 3 months in previously menstrual woman.
•Pituitary tumour, PCOS, hypothyroidism, stress.
•Anorexia, excessive exercise (endorphins inhibit GnRH), uterine obstruction, medications (i.e. antipsychotics).

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2
Q

Dysmenorrhoea

A

PRIMARY DYSMENORRHOEA:
• Excessive release of uterine prostaglandins during menstruation causing the myometrium to contract.
• Usually occurs shortly (6-12 months) after menarche.
• No association with identifiable pelvic disease.
SECONDARY DYSMENORRHOEA:
• Associated with specific pelvic or systemic pathologies such as endometriosis, fibroids, pelvic inflammatory disease.

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3
Q

Dysmenorrhoea Treatment

A 
Contraceptive pill (inhibits ovulation)
NSAIDs.
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4
Q

Premenstrual Syndrome (PMS)

A

• Characterised by cyclic physiological, psychological and behavioural changes during the luteal phase(the second half of the menstrual cycle).

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5
Q

Premenstrual Syndrome (PMS): Causes

A
  • Definitive cause unknown –variable.
  • Hormone imbalance: rapid shifts in levels of oestrogen and progesterone, which can influence neurotransmitters.
  • Drop in progesterone in the luteal phase of the cycle and an increased production of prostaglandins.
  • A serotonin deficiency is thought to be a key neurotransmitter relationship.
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6
Q

PMS: Signs & Symptoms

A

Over 150 symptoms have been attributed to PMS

  1. Tension
  2. Anxiety
  3. Reduced concentration
  4. Aggression
  5. Depression
  6. Listlessness
  7. Confusion
  8. Fatigue
  9. Insomnia
  10. Headache (migraines)
  11. Boating
  12. Oedema
  13. Backache
  14. Pelvic pain
  15. Aching legs
  16. Ovarian pain
  17. Sweating
  18. Hot flushes
  19. Bladder problems
  20. Constipation
  21. Excessive weight gain
  22. Fluid retention
  23. Low blood sugar
  24. Cravings -sugar
  25. Pica
  26. Increased appetite
  27. Thirst
  28. Breast tenderness
  29. Greasy skin and hair
  30. Pimples
  31. Palpitations
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7
Q

Premenstrual Syndrome: Treatment

A

• Oral contraceptive pill, counselling.

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8
Q

Pelvic Inflammatory Disease (PID)

A

An infectious and inflammatory disorder of the upper female genital tract including the uterus, fallopian tubes and ovaries.

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9
Q

Pelvic Inflammatory Disease (PID): Causes

A
  • Infection typically results from spread of microorganisms (bacteria) ascending from the cervix.
  • Sexually transmitted infective causes include Neisseria gonorrhoea & Chlamydiatrachomatis.
  • Insertion of intra-uterine device (IUD).
  • Abortion or delivery under non-sterile conditions.
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10
Q

Pelvic Inflammatory Disease (PID): Signs & Symptoms

A
  • Lower abdominal pain (gradual orsudden & severe) -may increase with walking.
  • Deep dyspareunia. Purulent discharge.
  • Occasional dysuria, fever, nausea & vomiting.
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11
Q

Pelvic Inflammatory Disease (PID): Complications

A 
Ectopic pregnancy
Infertility
Peritonitis
Abscesses 
Septicemia.
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12
Q

Pelvic Inflammatory Disease (PID): Treatment

A

Anitbiotics

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13
Q

Endometriosis

A

Endometrial tissue found outside uterine cavity.
• Commonly affects ovaries, fallopian tubes, utero-sacral ligaments, pelvic cavity, intestines. Rarely more distant places e.g. lungs, joints.
• Affects up to 25% of women, estimated that 30-40% of women with infertility are affected.
• Greater risk with family history, women who haven’t given birth, menses >7 days.
• Ectopic endometrial tissue follows the menstrual cycle but there is no exit point for blood that accumulates during menstruation. This leads to irritation, inflammation and pain.

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14
Q

Endometriosis: Causes

A
  • Altered immune surveillance in pelvis, affecting the ability of the body to recognise ectopic endometrial tissue.
  • Oestrogen dominance.
  • Retrograde menstruation: migration of endometrial tissue back through the fallopian tubes or transplant of tissue during surgery.
  • Primordial cellslining other body cavities or organs differentiate into endometrial cells.
  • Transfer of tissue through blood & lymph.
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15
Q

Endometriosis: Signs and Symptoms

A
  • Dysmenorrhoea.
  • Menorrhagia.
  • Pelvic pain occurring around menstruation, lessening after.
  • Dyspareunia.
  • Bloating, lower back pain.
  • Bowel changes e.g. diarrhoea.
  • Infertility.
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16
Q

Endometriosis: Diagnosis

A
  • Ultrasound.

* Laparoscopy

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17
Q

Endometriosis: Complications

A
  • Recurrent inflammation leads to formation of fibrous tissue, which can produce adhesions.
  • Adhesions can obstruct the uterus or fallopian tubes, which can contribute to infertility.
  • Chocolate cysts–sac containing old blood.
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18
Q

Endometriosis: Treatment

A
  • Combined oral contraceptive pill.

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

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19
Q

Fibroids

A
  • Benign tumours of the myometrium of the uterus.
  • Can vary significantly in number and size.
  • Consist of smooth muscle cells and connective tissue.
  • More common in reproductive years, tend to subside post menopause.
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20
Q

Fibroids: Causes

A
  • Development is linked to levels of oestrogen and progesterone.
  • Increased risk with obesity (excess oestrogen), earlier menses, family history and the contraceptive pill.
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21
Q

Fibroids: Signs and Symptoms

A
  • 50-80%are asymptomatic.
  • Menstrual changes: menorrhagia, prolonged menses, spotting/mid-cycle bleeding iron deficiency anaemia (fatigue etc.)
  • Fibroids can press on bladder/rectum causing urgency, frequent urination, constipation.
  • Bloating & heaviness in abdomen.
  • Infertility (2-10% of infertility cases)
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22
Q

Fibroids: Complications

A

• Large fibroids can occlude their blood supply causing necrosis. They can calcify which causes pain.
Leads to hysterectomy

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23
Q

Fibroids: Investigation

A

Ultrasound

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24
Q

Fibroids: Treatment

A
  • NSAIDs

* Hormonal therapies (including OCP), surgery (myomectomy or hysterectomy)

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25
Q

Ovarian Cysts

A
  • Fluid-filled sac within the ovary.
  • Most common type is a follicular cyst: failure to ovulate and instead fills with fluid.
  • Diagnosis is usually made by ultrasound and/or laparoscopy.
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26
Q

Ovarian Cysts: Signs and Symptoms

A
  • Often asymptomatic (and often harmless)
  • Dull ache or sudden sharp/severe pain if rupture.
  • Large cysts may affect bladder function.
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27
Q

Ovarian Cysts: Treatment

A

Surgery (>5cm)

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28
Q

Polycystic Ovaries

A

• The presence of many cysts within the ovaries. At least one of the following criteria should be present to establish polycystic ovaries:

  1. 12 or more follicles
  2. Increased ovarian volume (>10 cm³).
29
Q

Polycystic Ovarian Syndrome (PCOS)

A

• An endocrine metabolic condition associated with:
1. Menstrual dysfunction.
2. Ovulatory dysfunction.
3. Hyperandrogenism.
4. Metabolic disturbances i.e. hyperinsulinaemia.
• Affects approx. 10% of women during their lives.
• Endocrine abnormalities tend to begin soon after menarche.
• Inheritable (genetic) links –risk with first degree relatives.
• Obesity has been shown to increase risk & expression of PCOS.

30
Q

Polycystic Ovarian Syndrome (PCOS): Pathophysiology

A
  • Dysfunction of the hypothalamic-pituitary (HPO) axis
  • LH:FSH imbalance: high circulating LH promotes increased ovarian androgen formation.
  • Insulin resistance
  • Occurs in approx. 40% irrespective of body weight.
  • Suppresses Sex Hormone-Binding Globulin (SHBG) = increases free circulating androgens.
  • The excess androgen production will suppress ovulation.
31
Q

Polycystic Ovarian Syndrome (PCOS): Symptoms

A
  • Amenorrhoea / Oligomenorrhoea.
  • Lack of ovulation
  • Infertility
  • Hirsutism (60-80%)
  • Acne & oily skin
  • Acanthosis nigricans
  • Alopecia/baldness
  • Weight gain & difficulty losing weight
  • Increased risk of miscarriage.
  • Anxiety & depression
32
Q

Polycystic Ovarian Syndrome (PCOS): Investigations

A

Blood tests:
•Increased androgens
•Low sex hormone binding globulin (SHBG).
•High LH: normal or low FSH.
•Hyperinsulinemia & elevated blood glucose levels.
Ultrasound: To investigate for PCO.
Laparoscopy

33
Q

Polycystic Ovarian Syndrome (PCOS): Diagnosis

A

The following diagnostic criteria must be present for PCOS diagnosis:

  1. Oligo/anovulation AND/OR polycystic ovaries
  2. Clinical or biochemical signs of hyperandrogenism (hirsutism, acne, elevated testosterone).
  3. Exclusion of other causes of hormonal & metabolic dysfunction (androgen-secreting tumours, Cushing’s)
34
Q

Polycystic Ovarian Syndrome (PCOS): Complications

A
  • Infertility.
  • Amenorrhoea increases risk of endometrial cancer.
  • Increased risk of type II diabetes & cardiovascular disease
35
Q

Polycystic Ovarian Syndrome (PCOS): Treatment

A
  • Oral contraceptive pill andmetformin.
  • Anti-androgen topical creams.
  • ‘Clomiphene’ Stimulates ovulation.
36
Q

Ectopic Pregnancy

A
  • Fertilised ovum implants outside of the uterine cavity.
  • Can occur in the fallopian tube (97%), ovary, cervix, abdomen.
  • Increased risk with Intra-Uterine Devices and endometriosis.
  • May cause spontaneous abortion, haemorrhage & peritonitis.
37
Q

Ectopic Pregnancy: Signs and Symptoms

A
  • Initially causing no symptoms but amenorrhea.
  • Unilateral pelvic pain and vaginal bleeding.
  • If ruptures: Sudden acute abdominal pain.
  • Generally 6-8 weeks after ovulation.
38
Q

Infertility

A

• Failure to conceive after 1 year of unprotected intercourse.

39
Q

Infertility: Causes

A
  • Male 40%: Low sperm count, poor sperm viability or motility, blocked sperm ducts, undescended testes, metal toxicity, smoking.
  • Female 40%: PCOS, endometriosis (blocked fallopian tubes), fibroids, PID, menopause,, hypothyroid, STIs.
  • Both 20%: Toxicity, radiation, malnutrition, body weight, smoking/alcohol, stress.
40
Q

Infertility: Treatment

A

Clomiphene

IVF

41
Q

In-Vitro Fertilisation (IVF)

A
  • Artificial fertilisation of the ovum by sperm outside the body –‘in vitro’.
  • When other methods of assisted reproductive technology have failed.
  • Success rates: 32.3% women under 35; 27.7% aged 35-37; 20.8% aged 38-39; 13.6% aged 40-42.
42
Q

IVF: Process

A
  1. The drug Clomiphenecauses oocytes to develop.
  2. Eggs retrieved from ovaries, examined and incubated with sperm on a petri dish to allow fertilisation to occur (or sperm injected into egg).
  3. The embryo is then transferred to the uterus with the intent to establish a successful pregnancy.
43
Q

Breast Cancer: Signs and Symptoms

A
  • Asymptomatic usually.
  • Painless, unilateral fixed lump.
  • Overlying skin changes i.e. dimpling, ‘orange peel’ appearance.
  • Inverted & discharging nipple.
  • Enlarged axillary lymph nodes
44
Q

Breast Cancer: Risk Factors

A
  • Family history (breast, ovarian cancer) & age
  • Genetic mutations in BRCA1 or BRCA2
  • Poor diet and sedentary lifestyle, regular alcohol intake and smoking, oestrogen excess.
45
Q

Breast Cancer: Diagnosis

A
  • Mammography(increases risk of breast Ca).

* Thermography(safer & more effective method of detecting earlier cell changes)

46
Q

Breast Cancer: Complications

A

• Metastatic spread via lymphatics.

47
Q

Breast Cancer: Treatment

A

Radiotherapy
Surgery
Tamoxifen (blocks oestrogen receptors).

48
Q

Balanitis

A

• Inflammation of the glans penis.

49
Q

Balanitis: Causes

A
  • Infectious: Candida albicans, bacterial infection.
  • Non-infectious: Lichen sclerosus (autoimmune), eczema, psoriasis, inadequate cleaning under foreskin.
  • Phimosis (foreskin narrowing, preventing retraction).
50
Q

Balanitis: Symptoms and Complications

A
  • Pain, irritation, dyspareunia.

* Chronic infections can result in foreskin fibrosis.

51
Q

Balanitis: Treatment

A

Antibiotics
Surgery
Hygiene.

52
Q

Undescended Testes

A

One testicle fails to descend in late foetal development and remains in the abdomen.

53
Q

Undescended Testes: Causes

A
  • Unclear: may be hormonal or structural.

* Premature birth (affects 30% of premature boys).

54
Q

Undescended Testes: Complications

A
  • Damaged sperm -> infertility.

* Testicular cancer.

55
Q

Undescended Testes: Treatment

A

May descend independently a few months after birth. hCGinjection (acts like LH, increases testosterone). Surgery (6-18 months).

56
Q

Testicular Cancer

A
  • Most common cancer in young men (15-35yrs).
  • Higher risk if undescended testis & family history.
  • Excellent prognosis if caught early: orchidectomy.
57
Q

Testicular Cancer: Signs and Symptoms

A
  • Hard, painless, unilateral mass.
  • Dragging sensation & dull ache.
  • Metastasises to bone, brain, lungs & liver.
58
Q

Prostatitis

A
  • Prostatitis describes inflammation of the prostate gland that can be infectious (bacterial) or non-infectious.
  • 8% of men have prostatitis at some point in their lives.
  • Can be associated with UTI’s or STI’s.
59
Q

Prostatitis: Symptoms

A
  • Recurrent UTI’s (↑urinary frequency, urgency, dysuria, nocturia, hesitancy & incomplete voiding.
  • Painful ejaculation, fever & malaise.
60
Q

Prostatitis: Treatment

A

Antibiotics

Painkillers

61
Q

Benign Prostatic Hyperplasia (BPH)

A
  • Enlargement of prostate tissue leading to compression of the urethra.
  • Very common in older men (60years+).
62
Q

Benign Prostatic Hyperplasia (BPH): Causes

A
  • The main risk factors are abdominal obesity, genetics, being sedentary, sympathetic activity & pesticides.
  • For testosterone to affect the prostate, it must be converted to dihydrotestosterone (DHT) by the enzyme 5-alpha-reductase. DHT has twice the effect on the prostate as testosterone.
  • Associated with an increased in the activity of 5-alpha-reductase.
63
Q

BPH: Signs and Symptoms

A
  • Obstructed/poor urinary flow.
  • Increased urinary frequency.
  • Intermittent urine flow & dribbling of urine.
  • Nocturia.
  • Cystitis (recurrent).
  • Reduced sexual function.
64
Q

BPH: Diagnosis

A
  • Elevated PSA levels

* Digital Rectal Examination (DRE), Ultrasound.

65
Q

BPH: Treatment

A
  • 5α-Reductase Inhibitors (Finasteride).

* Surgery when obstruction is severe.

66
Q

Prostate Cancer

A
  • Most common cancer in men. Generally 50+ years. Increasing incidence.
  • 90% of prostate cancer never grow out of the capsule.
67
Q

Prostate Cancer: Signs and Symptoms

A
  • Same urinary symptoms as BPH
  • Key symptoms include nocturia and haematuria.
  • Back pain can indicate bone metastases.
68
Q

Prostate Cancer: Investigations

A
  • Elevated PSA
  • Digital rectal examination
  • Biopsy
69
Q

Prostate Cancer: Treatment

A
  • Radiotherapy(localised, non invasive).
  • Androgen deprivation therapy.
  • Chemotherapy.
  • Surgery(removal) –50% never recover urinary/erectile function.

Biomedicine II (16 decks)

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