9.2 - Pathological Changes to the Female Reproductive Tract

Question 1

Ectopic Pregnancy (emily miller THTH)

Answer 1

Cause
- previous pelvic inflammatory disease
- endometriosis
- previous ectopic pregnancies

Patho
- fertilized egg implants outside of the uterus (uterine tube, ovary, abdominal cavity)
- embryo grows, stretching the uterine tube = damage and inflammation = rupture and hemorrhage

Changes
- tubal distention = scarring and thickening = rupture = intrabdominal bleeding

S&S
- unilateral abdomina pain
- vaginal bleeding
- referred shoulder pain

Management:
1) Methotrexate: stops cell division
2) Surgical removal of ectopic tissue ad tube

Question 2

Leioyomas (Fibroids) (Clara)

Answer 2

Cause
- estrogen and progesterone promote fibroid growth
- genetics

Patho
- develops from single smooth muscle cell that mutates into a mass
- growth is stimulated by reproductive hormones (estrogen)

Types
-Intramural: in muscular wall of uterus
- Submucosal: protrude into uterine cavity
- Suberosal: extend outward from uterus

Changes
- uterine enlargement
- bloating
- compressed organs can cause frequent urination or constipation

S&S
- heavy bleeding (iron-deficient anemia)
- pelvic pain
- infertility issues
- pain during intercourse

Treatment
- Hysterectomy: uterus removal
- Myomectomy: removes fibroids
- Meds: to shrink fibroids

Question 3

Endometriosis (Remi)

Answer 3

Cause
- retrograde menstruation: endometrial cells grow outside uterus
- estrogen increases growth of endometrial tissue
- immune dysfunction (abnormal immune response prevent body from clearing endometrial cells outside)

Patho
- endometrial cells adhere to structures outside uterus (ovaries, tubes)
- in response to hormones, cells thicken and break down = blood and tissue with no path to exit the body
- trapped blood and tissue = cysts, scar tissue, adhesions

Changes
1) Adhesions
- fibrous adhesions can bind pelvic organs together = pain and infertility

2) Endometriomas - blood-filled cysts

3) Endometriotic implants - patches of endometrial tissue on pelvic organs

S&S
- pain during menstruation (dysmenorrhea)
- pain during intercourse (dyspareunia)
- infertility
- GI symptoms: bloating, constipation/diarrhea

Question 4

Hypospadias

Answer 4

Cause
- low androgen levels
- Risk factors: old maternal age, exposure to endocrine disrupting substances

Patho
- incomplete fusion of urethral folds which create urethral opening on underside the penis

Types
Mild - near top (glans)
Midshaft (moderate) - near shaft
Proximal (Severe) - near scrotum

Changes
- abnormal location of urethra opening
- chordee: penis curves down
- foreskin is incompletely formed

S&S
- difficult to direct urine
- ↑ UTI risk

Treatment
- Surgery: to reposition opening and straighten penis

Question 5

Testicular Torsion

Answer 5

Cause
- abnormal attachment of testicle to scrotum
- testicle rotates freely = twisted spermatic cord

Patho
- testicle rotates - twists spermatic cord = compresses blood vessels = ischemia = necrosis (if untreated)

Changes
- prolonged ischemia = necrosis
- edema (pooling blood) makes testicle tender and firm

S&S
- sudden, severe pain in 1 testicle
- swelling
- wide leg walking

Complications
- impaired fertility
- loss of testicle function