Alteraitons of the female reproductive system Flashcards
Vaginitis
-Infection of the vagina caused by sexually transmitted bacteria and Candida albicans
-Any change in vaginal discharge may signify a problem
-Dx based on Hx, Physical exam and lab exam of discharge
Leiomyomas
-Benign tumours that develop from smooth muscle cells in the myometrium
-Most common tumour of the uterus, most remain small and asymptomatic
-Cause is unknown, but related to estrogen, increase during pregnancy
-Classified according to locaiton in the uterus linings
-Degenerative changes may happen when a tumour outgrows its blood supply
Fibroids CM
-Major CM are abnormal uterine bleeding, pain, and symptoms r?t preassure (eg dysuria, urinary frequency and urgency)
-Often found when examination reveals a hard and lumpy uterus
Fibroids Treatment
-Watchful Waiting
-NSAIDs
-Horomones (BC, IUD, GnRH agonists, Selective progesterone receptor modulators)
-Embolizaiton
-Myomectomy
-Hysterectomy
Endometriosis
-Presence of functioning endometrial tissue outside of the uterus
-Responds to hormonal cycle
-Found outside the ovary, pelvis, or uterus causes increased risk for endocrine cancers
-Cause unknown, but sevral theories including genetic predisposition
Endometriosis pathology
-Implants may occur throughout the body, usually ovaries, uterine ligaments, rectovaginal septum, and pelvic peritoneum
-If blood supply is sufficient, the tissue proliferates, breaks down, and bleeds in conjunction with normal cycle
-Bleeding causes inflammation, pain in surroundig tissues, may cuase fibrosis, scaring and adhesions
Endometriosis CM
-Variable in frequency and severity, usually include infertility and pain
-In most cases, the severity of endometriosis is not related to the degree of symptoms
-Exact mechanism for infertility is unknown
-Laprascopy required for definitive TX
Endometriosis Tx
-NSAIDS
-Horomones (bcp, progestins (depoprovera), GnHR agonists (lupron), Aromatase inhibitors (Arimidex))
-Surgery
Cancer
-reproductive tract cancers account for about 12.5% of female cancers
-Most common are cervical and ovarian
Cervical Cancer
-Death from cervical cancer decreased by 55% from Pap smears.
-precancerous dysplasia seen more frequently in young women
-Staged according to histology 0 premalignant lesions occour 10-12 years earlier
Continum from
1. Cervical epitheal neoplasia
2.Carcinoma in situ
3. Invasive carcinoma of the cervix
Cerivcal Cancer Risk Factors
-Infection with HPV before age 16
-Multipule partners or a partner with multipule partners
-Smoking
-Poor Nutrition
-HIV
Cervical epithelial neoplasms (Vervical dysplasia)
-Asymptomatic
-Must have screening tests - 90% detected early
-Graded as mild (CIN 1), moderate (CIN 2), severe (CIN 3 )
Carcinoma in situ
-Underlying tissues not affected but all other cells are affected
-cells changing from carcinoma in situ back to intraepithelial neoplasia (CIN 1) is uncommon
Invasive Carcinoma of the cervix
-Direct invasion into adjacent tissues and metastasis (spread of cancer cells)
-Affects the uterus and plevic wall
-Travels though lymph
Ovarian Cancer Risks
-6th most frequent cancer, incidence increases with age
-Cause is unknown at present, risk in creases with 1st degree relatives with disease or breast cancer
-other risks in clude use of fertility drugs, and HRT or dies low in fruits and veg and high in fat
Ovarian Cancer
-Good survival rate if caught early, but only 25% caught early
-Often considered a silent disease, can have divers s&s
-Most obvious symotoms are pain and abdominal distension
-Usually adavanced by time treatment is sought
-May use radiation and chemo
Breast Cancer
-Most common cancer of women
-Leadig cause of death in women age 40-44
-Second leading cause of death from cancer
-Disease of glandular epithelium
-50% occur in upper outer quadrant of the breast (most glandualr tissue found there)
Breast Cancer s&s
-First sign is usually a painless lump
-Manifestaitons vary according to type of tumor and stage of disease ( eg if spread to bone person can feel bone pain)
Breast cancer dx
-Mammogram and biopsy
-Physical assessment
needel localized biopsy
-Excisional biopsy
Breast cancer treatment
-Surgery
-Chemotherapy depending on receptors
-Horomone therapy ( long term )
-Bone marrow transplantaiton for very serious cases
Impaired fertility
-Inability to conceive after 1 year unprotected intercourse
-Affects 15% of couples
-Tx aimed at correcting the problem
-Best Tx is prevention, especially STD prevention
Factors affecting fertility (Males)
-Diminished quantity/production of sperm
-Diminished quality of sperm
-Anatomical abnormalities
factors affecting fertility (females)
-Malfunctions of fallopiam tubes, ovaries or reproduction hormones
-Adhesions from pelvic infections
-Disruptions of ovulaiton or implantation
-Endometriosis
Fertility testing (for men)
-Men are tested first
-Look at amount, structure, and motility of sperm and obstruction or reproductive tract
Fertility testing (For women)
-Look for patency of reproductive tract, normal ovulaiton, normal endometrial response to hormones, and lack of tumors or infections
Epididymitis pathology
-Inflammation of the epididymis
-Generally occours in young, sexually active men
-Most common cause is chlamydia or gonorrhoea
-Pathogen reaches the epididymis by ascending the vas deferens
-Inflammation process begins
Epididymitis CM
-Pain is main symptom
-Difficulty urinating
-Urethral discharge
-red edematous scrotum
Complicaitons include:
-abscess
-infraction
-Infection
-Infertility
Epididymitis Dx & Tx
DX
-Hx of recent UTI or urethral discharge
-Uretheral swab for C&S and gram stain
TX
-Relief of pain
-Abx
-Bedrest
-Elevation of the testes
Epididymitis Antibiotics
-Usual UTI antibiotics
-Ciproflaxin
-Doxycycline
-Trimethoprim-Sulfamethoxazole (Septra)
-Nitrofurantoin (Macrobid)
Longer Courses
-10-14 days minimum
tortion of the testes
-Testes rotates on its vascular pedicle interrupting the blood supply
-Common in neonates and pubertal adolescents
-Spontaneous onset or after physical activity or trauma
-Ishcemia develops causing scrotal swelling and pain
-Tender, high-riding testes
tortion of the testes Dx and Tx
-Ultrasound of the testes
-If the torsion can not be reduced mannually, emergency surgical intervention within within 6 hours after the onset of symptoms to preserve normal testicular function
-Surgery includes untwisting the spermatic cord and anchoring both testes in correct position
Benign Prostatic Hyperplasia
-Enlargement of the prostate gland
-Commonly occouring phenomenon - Begins at age 40-45
-becomes problematic when the urethra is compressed
-80% of men will have this by there 80th year
-Urine retention becomes chronic
-Try conservative tx or surgery
BPH s&s
- Obstruction
-Incomplete emptying
-Weak stream
-Prolonged vomiting - Irriative
-Frequency
-Nocturia
-Incontinence
Acute Bacterial Prostatitis
-Ascending infection of urinary tract
-Infection stimulated inflammation in prostate
-May follow catheterizaiton or cystoscopy
-Acutely ill and look toxic - treat causitive organism - long term broad spectrum antibiotics
-Complicaitons can include bacterima and septic shock
-Same Rx as UTI and epididymitis
Acute Bacterial Prostatitis CM
-CM similar to acute cystitis or pyelonephritis
(Malaise, low back and perineral pain, high fever, chills, dysuria, inability to empty bladder nocturia)
BPH Antibiotics
-Usual UTI antibiotics
-Ciprofloxacin
-Doxycycline
-Septra
-Macrobid
Longer courses
-4-6 Weeks minimum
Nonbacterial Prostatitis
-Most common prostatitis syndrome
-No evidence of bacterial infection
-May complain of continuous or spasmodic pain or dull ache-prostate gland feels normal
-Diagnosis by exclusion
-Tx to reduce symptoms
Cancer of the prostate
-Most commonly diagnosed malignancy, second leading cause of cancer death in men
-Cause is poorly understood - disease of aging
-Rarely occours in men <40 years
-Many contributing factors including:
-Dietary (high fat, low vitamin D)
-Horomones (androgen sensitive)
-Vasectomy
-Familial (hereditary in 9%)
Prostate cancer pathology
-More than 95% are adenocarcinomas, occour in periphery of the prostate
-Agressiveness of cancer depends on differentiation rather than size of tumor
-Little is known about horomone involvement
-Major hormone is testosterone
Prostate cancer CM
-Often causes no symptoms until far advanced
-Look for bladder outlet obstruction, then perhaps rectal obstruction
-Late symptoms include pain at sites of bone metastasis, edema of lower extremities, liver enlargment, pathologic bone fractures, mental confusion
Prostate Cancer Dx and Tx
-Digital rectal exam as screenign test for all men over 40 and prostate spesific antigen test added in men over 50. When transrectal untrasonography is added, ability ot predict cancer increases significantly
-Surgical and non-surgical treatments, tx can lead to urinary incotinence
Gonorrhea
-Caused by gonocci
-Endocervical canal unually site of original infection in women
-Infect the urethra in males
-Incubaiton period (males 3-10 days, dysuria is often first sign) (females up to 10 days or just before next period, 50% are asymptomatic)
Gonorrher infection rates and transmission
-80% for women to contract from men
-30% for men to contract from women
Routes: Vaginal, Oral, Anal, From mom to babe
Gonorrhea Tx
Ceftriaxone IM
Chlamydia
-Most common STD
-Reportable disease
-Highest in women under age 20
-Rarely seen in the sexually inexperienced
-Obligate, gram negative intracellular bacteria and lacks the ability to reproduce independently
Chlamydia s & s
-urethral syndrome (dysuria, urinary, frequency, presence of pus in the urine)
-Mucopurulent cervicitis
-PID
-asymptomatic chlamydia common
-Gonorrhea & Chlamydia often occour together
Chlamydia Dx
-Tissue culture Immunoassay
-DNA Test from same tissue culture
Chlamydia Tx
-Abx for affected person and partners
-4 pills at once in the facility
Pelvic infalmmatory disease pathology
-Acute inflammaiton caused by infection
-May invade any organ or combination
-Often caused by ST microorganisms that miagrate from the vagina
-Mediated by virulence of organism, size of dose or defense status of individual
-Usually polymicrobial
-Microbes ascend from the cervix to infect the uterus
-Gonorrhea and chlamydia may facillitate the invasion of other organisms
-Also facilitated by movement of sperm or bacterial vaginosis
-15-21% develop long term infertility, chronic pain, and pelvic adhesions
-8-9% motality usually from septic shock
PID CM
-Vary from sever pain with seisure to asymptomatic
-Symptoms more likley to develop during or after menstraiton
-Pain may worsen with intercorse or other physical activity
-Dysuria or irregular bleeding may be present
-Dx based on Hx. tenderness, lab tests
PID tx
-Bedrest
-No intercourse
-Antibiotics
-Partner tx
Genital Herpes Patho
-Virus enters mucocutaneous sites
-VIrus replicates itself and destroys the cell and then moves to another cell and into sensory nerves
-Virus then moves into dorsal root where it remains in a latent stage
Genital Herpes reactivaiton of virus by:
-Physical
-Hormonal
-Immunologic stimuli
-Menstruation
-Stress
-Sun Exposure
-During reactivaiton the virus travels up the peripheral sensory nerves back to dermal surface
Genital Herpes
-Blisters (cold sores) to genital areas
-Not a reportable disease
-Non-curable
-Spread through intemate contact by a person shedding the virus in secretion or from peripheral lesion or mucosal surface
-Mostly transmitted by those who dont have s & s
Genital herpes can be from 2 diffrent viruses
HSV 1
HSV 2
Genital herpes recurrent infection
-Occour an avrage of 5-8 times a year but may be as frequent as every month or as rare as many years
-Vaginal discharge and dysuria
-Can be serious for infants (CNS involvment including seizures, 50% mortality)
Genital Herpes Dx and Tx
-Pap smear
-Non curative treatment
-Oral medicaitons are used for outbreaks to prevent recurrences
-Can be transmitted diring latent periods
-Condoms
Genital Herpes Drugs
-Acyclovir
-Valacylovir (valtrex)
-Famciclovir (Famvir)
