chap 17 - female reproductive tract

Question 1

normal cycle

Answer 1

Follicular vs. luteal phase
-Hormones
-Estrogen
-Progesterone
If no pregnancy occurs
-Corpus luteum degrades
-Secretory endometrium shed with blood
-New cycle begins

Question 2

female reproductive system

Answer 2

Ovaries
Gametogenesis
Hormone production
Fallopian tubes
Pathways from ovary to uterus
Cervix
Opening to uterus
Uterus
House and protect the developing fetus

Question 3

most frequent and serious problems

Answer 3

Menstrual abnormalities
Amenorrhea
Absence of menstruation
Irregular or excessive menses
Can be caused by underlying hormonal derangement
Sexually transmitted diseases (STDs)
Gonorrhea and chlamydia
Can cause pelvic inflammatory disease
Herpes simplex disease
Causes outbreaks of vesicles in cervix, vagina, and vulva
Human papillomavirus (HPV)
Causes genital warts and carcinoma of the cervix

Question 4

signs, symptoms and tests

Answer 4

Dysfunctional bleeding
- Menorrhagia = heavy menstrual bleeding
- Menorrhagia = uterine bleeding at irregular intervals
Pain
- Dysmenorrhea
Vaginal discharge
- Can be associated with superficial infections
Menstrual history
- Length of the cycle
- Duration
- Amount
- Regulatory
Pelvic examination
- Direct inspection of the vulva, vagina, and cervix
- Bimanual examination
Pap test
- Can detect HPV and neoplastic lesions
Cone biopsy
- Removal of a cone or tissue for histological exam

Question 5

inspection of the reproductive tract

Answer 5

Types
Sti
- Chlamydia
- Gonorrhea
- Syphilis
- HPV
- Fungus
Can lead to
- Vaginitis
- Cervicitis
- Salpingitis - fallopian tubes
- PID

Question 6

disorders of the cervix

Answer 6

Polyps
Cervical dysplasia
Cervical carcinoma

Question 7

cervical polyps

Answer 7

Benign tumors on surface of cervical canal
Many asymptomatic, but can lead to irregular menstrual bleeding
Treatment = removal

Question 8

cervical dysplasia

Answer 8

Abnormal growth of cervical squamous epithelium
Range from mild-severe dysplasia
- Mild = may regress
- Severe = precancerous
Screening
- Pap smear
Risk factors
- HPV infection
- Multiple sex partners
- Genetics

Question 9

vaginal cancer

Answer 9

Rare
Two types
- Squamous cell
- Adenocarcinoma
Signs and symptoms
- Typically asymptomatic
- Often found in routine gynecological exam
Risk factors
- HPV

Question 10

disorders of uterus

Answer 10

Uterus anatomy
- Endometrium
- Myometrium
Conditions
- Irregular bleeding
- Endometriosis
- Leiomyomas

Question 11

irregular uterine bleeding

Answer 11

Leading cause
- Follicle fails to mature and no corpus luteum is formed (anovulatory cycle)
- No corpus luteum = no progesterone
Uterus is subjected to continuous estorgen stimulation and responds by shedding and bleeding in an irregular manner instead of shedding all at once
Other causes of uterine bleeding
- Endometrial and cervical polyps
- Uterine leiomyomas
- Uterine carcinoma

Question 12

disorders of uterus

Answer 12

Endometriosis
- Presence of functioning endometrial tissue outside of uterus
- Ectopic
- Responds to hormone fluctuations
Possible causes
- Retrograde menstruation
- Spread through vascular or lymphatic systems
- Genetic predisposition
Symptoms
- Pelvic pain
- Infertility
- Bleeding of ectopic endometrium, causing pooling of blood
- Adhesions of internal organs

Question 13

endometriosis

Answer 13

Diagnosis
- Laparoscopy or biopsy
Treatment
- Surgical removal of ectopic endometrium
- Oral contraceptives
- Medication to inhibit pituitary release of gonadotropins
- Medication to suppress production of gonadotropin-releasing hormone
- Complete hysterectomy

Question 14

disorders of uterus

Answer 14

Uterine leiomyoma
- Fibroids
- Benign tumors of myoma
Etiology
- Unknown
Risk factors
- Age of at least 30
- Obesity
- Family history of fibroids

Question 15

uterine fibroids

Answer 15

Signs and symptoms
- Abdominal fullness
- Change in menstruation
- Bleeding at times other than menstruation
Some symptoms related to location
- Bladder region: urinary frequency and dysuria
- Rectal region: anal-sphincter spasm
- Dysmenorrhea
- Pain
Treatment
- No treatment if small
- Oral contraceptives
- Removal

Question 16

amenorrhea

Answer 16

Etiology
Hypothalamic, pituitary, or endocrine dysfunction
Congenital or acquired abnormalities of the reproductive tract
Extreme weight loss
Consequences
Treatment

Question 17

dysmenorrhea

Answer 17

Painful menstruation
Types
Primary
- Pelvic organs normal
Secondary
- Pelvic organs disease
Examples = endometriosis
Etiology
- Prostaglandins
- Synthesized in uterus under progesterone
- Menstruation leads to release
- Cause cramping of myometrium

Question 18

endometrial carcinoma

Answer 18

Most common cancer of female reproductive tract
- Cancer of endometrium
- Account for almost all cancers of the uterus
Symptoms
- Abnormal uterine bleeding
- Risks
- Age
- Obesity
- Excessive estrogen exposure
Treatment
- Hysterectomy
- Good prognosis

Question 19

disorders of the ovaries

Answer 19

Ovarian cyst
Etiology
- Unknown
Contributors
- Hypothyroidism
- Early age of menarche
Signs and symptoms
- Most women are asymptomatic
- Abdominal fullness
- Low back pain
- Nausea and vomiting
- Abnormal uterine bleeding
Risk for?
Diagnosis
- Ultrasound
Treatment
- Oral contraceptives
- Laparoscopic procedure to drain or remove the cyst

Question 20

polycystic ovary syndome

Answer 20

One of most common female endocrine disorders
- Follicles develop
But they do not ovulate after the LH surge
- Anovulation = infertility
- Amenorrhea
- High LH levels persist
- LH stimulates androgen production
- Male pattern hair growth
- This interferes with ovulation even more
Associated with
- Insulin resistance
- Hypertension
- Dyslipidemia
Treatment
- No cure
- Based on whether you want to get pregnant or not
- Birth control pills or fertility medication
- Diabetes modifications

Question 21

ovarian cancer

Answer 21

Ovarian cancer is the leading cause of death among gynecological malignancies
Ovarian cancer mortality has been rising, whereas cervical and uterine cancer mortality rates have been falling
The prognosis is generally poor for ovarian cancer patients of whom only 25% survive for less than 5 years
Ovarian cancer risk factors
Hereditary
10% of ovarian cancer are hereditary
90% if the hereditary cases are linked to breast-ovarian cancer genes 1 and 2
With BRCA the lifetime risk varies between 15% and 66%
Childbirth and pregnancy
Women who had children about half the risk as do women who have not
Increasing # of children appears to reduce risk a further 15% each
Miscarriage or abortion provide smaller risk reductions
Risk factors
Lactation (breastfeeding)
Reduces the risk of ovarian cancer (as it does for breast cancer)
Oral contraceptives
Ever-users have about half the risk as do never-users
Long term use seems to further enhance protection against ovarian cancer
Hormone replacement therapy
Appears to increase the risk for ovarian cancer, particularly long term use

Question 22

pelvic inflammatory disease

Answer 22

Infection of women’s reproductive organs
Etiology
Untreated STD’s
Symptoms
Pain in lower abdomen
Fever unusual discharge
Complications
Scar tissue
Infertility
Ectopic pregnancy

Question 23

menopause or climacteric

Answer 23

Decreased ovary function
Low estrogen
Osteoporosis risk
Atherosclerosis risk
Less inhibition of pituitary
Increased FSH and LH
Hot flashes
Hormone replacement therapy?

Question 24

contraception

Answer 24

Types
Natural family planning
Artificial contraception
Barrier methods and oral contraceptives
Side effects of oral contraceptives = increased tendency for thromboembolic complications, especially among smokers, hypertension
Intrauterine contraceptive devices
Increased incidence of tubal infections and tubal pregnancies

Question 25

emergency contraception

Answer 25

Prevents pregnancy following unprotected intercourse or sexual assault
Sperm can survive as long 6 days in genital tract and can still fertilize and ovum
Thus
Prevents pregnancy by interfering with ovulation; tubal transport of ovum; and implantation within endometrium
Examples: plan B, progesterone, prevent or delay ovulation
Effectiveness
If taken within 12 hours after intercourse, risk of pregnancy <1% and 3% if taken within 72 hours
Some protection is still provided for as long as 5 days

Question 26

infertility

Answer 26

Infertility defined as?
Etiology
Female
Hormonal imbalances
Structural problems
Eating disorders and nutritional disorders
General lifestyle factors
Emotional stress, obesity, malnutrition, alcohol, tobacco or drug misuse, cancer and cancer treatment, age

Question 27

placenta

Answer 27

Crucial role during pregnancy
Dual origin
- Maternal
- Fetal
- No actual intermixing of maternal and fetal blood
Fetus connected to placenta by umbilical cord
- Endocrine function
- Estrogen
- Progesterone
- Human chorionic gonadotropin (HCG)

Question 28

pregnancy

Answer 28

Potential complications
Nausea
Ectopic pregnancy
Hypertension
Preeclampsia and eclampsia
Gestational diabetes
Spontaneous abortion
Hyperemesis gravidarum

Question 29

spontaneous abortion

Answer 29

Up to 50% of all pregnancies
Most occur early
Early abortion results from
Chromosome abnormalities
Defective implantation
Maldevelopment of fetus
Late abortion results from
Detachment of placenta
Obstruction of blood supply through cord
Complication: disseminated intravascular coagulation
Cocaine abuse: disturbs blood flow to placenta and may cause placental abruption and intrauterine fetal death

Question 30

hormone-related conditions associated with pregnancy

Answer 30

Hormones produced by endocrine glands and the placenta
Maintains the pregnancy and sustains the fetus
Nausea and vomiting during early pregnancy
Estrogen increases rapidly early in pregnancy
Causes nausea and vomiting
Usually subsides by the end of the first trimester
Hyperemesis gravidarum
Excessive vomiting, more prolonged and severe than normal
Weight loss and dehydration require treatment

Question 31

gestational diabetes

Answer 31

Hyperglycemia in mother
Harmful to fetus
Congenital malformations
Obesity
Type 2 diabetes
Larger babies at birth
Delivery by c-section
Pathophysiology
Pregnancy hormones induce maternal insulin resistance
Diabetes results from inability to increase insulin secretion to compensate for increased insulin resistance
Diagnosis = screening
Diabetes usually relents following delivery but can lead to type 2 diabetes in mom

Question 32

ectopic pregnancy

Answer 32

Implantation of fertilized egg outside of uterus
Etiology
Mechanical obstruction
Diagnosis
Positive pregnancy test
Blood test
Abdominal ultrasound
Signs and symptoms
Signs of pregnancy
Sharp pelvic
Bleeding
Treatment
Surgical removal of the embryo
Predisposing factors
Previous infection of fallopian tubes
Scarring due to STD
Consequences if embryo not removed
Rupture of fallopian tube
Profuse bleeding from torn vessels
Potentially life-threatening to mother

Question 33

preeclampsia and eclampsia

Answer 33

Toxemia of pregnancy
Preeclampsia = pregnancy associated elevated blood preussre exceeding 140/90, protein in the urine
Eclampsia = BP 160/110
Also may cause convulsions
Due to inadequate blood flow to the placenta
Causes blood vessel constriction, blood pressure elevation
Mild cases managed by bed rest and observation
Condition relents when placenta is expelled after delivery
Complications:
Lack of blood flow to placenta
Placental abruption
Organ damage

Question 34

complications associated with placenta

Answer 34

Placenta previa
Placenta attached lower half of uterus
Can lead to
Vaginal bleeding
Can be deadly to mom and baby
Will need c-section

Question 35

twins

Answer 35

Dizygotic
Monozygotic
Different types
Disadvantages of twinning
Smaller size
Prematurity
Reduced change of survival
Congenital malformation 2x as often