Chapter 19 Flashcards
Testes job
Spermatogenesis
Epidiymis job
Maturation of sperm
Vas deferens job
Transport of sperm or urethra
Seminal vesicles
Secretion to nourish sperm
Prostate gland
Secretions to balance pH
Cowper glands (bulbourethral)
Secretes alkaline mucus
Penis
Ejeculation of semen
Male hormones: follicle-stimulating hormone (FSH)
Initiates speratogenesis
Male hormones: luteinizing hormone (LH)
Stimulates testosterone testosterone
Male hormones: testosterone
Maturation of sperm, sex characteristics, protein metabolism, muscle development
Congenital Abnormalities of the Penis: epispadias
Urethral opening on ventral or upper surface of the penis
Congenital Abnormalities of the Penis: hypospadias
Urethral opening on dorsal surface (underside) of the penis
— either condition may result in incontinence or infection
Treatment of epispadias and hypospadias
Surgical reconstruction
Cryptorchidism
Testis fail to descend into scrotum properly
- reason not totally understood
Ectopic testis
Testis positioned outside of scrotum
Ectopic testis increased risk of what
Testicular cancer if not fixed by age 5
Ectopic testis can cause what
Degeneration of seminiferous tubules and spermatogenesis
Hydrocele
Occurs when excessive fluid collects in space between layers of the tunica vaginalis of the scrotum
Hydrocele may result from what
Congenital defect
Injury, infection, tumor
Hydrocele effects
Compromise blood supple or lymph drainage in testes
Spermatocele
Cyst containing fluid and sperm that develops between the testis and epididymis
Spermatocele may be related to what
Developmental abnormality
Spermatocele treatment
Surgical remove all
Varicocele
Dilated vein in the spermatic cord
- lack of valves allows back flow in veins; leads to increased pressure and dilation
Varicocele causes what
Impaired blood flow to testes and decreased spermatogenesis
Varicocele requires what
Surgery
Torsion of testes
Testes route on spermatic cord, compressing arteries and veins
Torsion of testes leads to what
Ischemia, scrotum swells
Infaction of testes if torsion not reduced
Torsion of testes: cause
Spontaneous or follows trauma
Torsion of testes treatment
Manually and surgically
Prostatitis
Infection or inflammation of the prostate gland, most often caused by E. Coli
Prostatitis: Acute bacteria
Gland is tender and swollen, urine and secretions contain bacteria
Prostatitis: chronic bacterial
Gland only slightly enlarged, dysuria, frequency, urgency
Prostatitis: non bacterial
Urine and secretions contain large number of leukocytes
Prostatitis: asymtptomatic and inflammatory
Look up
Prostatitis usually what
Ascending infection
Prostatitis: occurs in who
Young men with UTIs Older men with prostatic hypertrophy STDs Instrumentation (catheterization) Through bacteremia
Prostatitis: treatment
Antibiotics (acute or chronic bacterial infection)
Anti inflammatory drugs and prophylactic antibacterial agents
Prostatitis: symptoms
Pretty expected but go look on slide 11
Balanitis
Fungal infection of the glans penis
- sexually transmitted
Balanitis: cause
Candida albicans
Balanitis: patho
Vesicles develop into patches; severe burning
Balanitis: treatment
Topical antifungal medication
Benign Prostatic Hypertrophy: what
Hyperplasia of prostatic tissue
- compression of urethra and urinary obstruction
Benign Prostatic Hypertrophy: related to what
Estrogen-testosterone imbalance
Benign Prostatic Hypertrophy: how can you discover it
Enlarged gland palpated on digital rectal examination
Benign Prostatic Hypertrophy: leads to what
Frequent infections
Benign Prostatic Hypertrophy: continues obstruction causes what
Distended bladder, dilated ureters, hydronephrosis, renal failure
Benign Prostatic Hypertrophy: s/s
Obstructed urinary flow / hesitancy starting urine flow Dribbling Decreased flow strength Increased frequency and urgency Nocturia Dysuria occurs if infection is present
Benign Prostatic Hypertrophy: treatment
Drugs to slow enlargement
Tamulosin (smooth muscle relaxer)
Surgery
Prostate cancer: causes
High androgen levels, increased insulin-like growth factor, history of recurrent prostatitis
Prostate cancer: s/s
Hard nodule felt on periphery of gland Hesitancy in urination Decreased stream Frequent urination Recurrent UTI
Prostate cancer: diagnosis
Serum markers
- prostate-specific antigen (PSA)
- prostatic acid phosphate
Ultrasonography
- biopsy
- bone scans to detect metasteses
Prostate cancer: treatment
Surgery
Radiation
If androgen sensitive, then orchiectomy is effective, as well as antitestosterone drugs
New chemos are in clinical trials
What is the most common solid tumor in young men
Cancer of testes
Cancer of testes originates from what
One type of cell or mixed cells from various sources
Teratoma
Tumor consisting of mixture of different germ cells
Some malignant tumors secrete what? How is this helpful?
HcG or AFT, which serve as useful markers for diagnosis
Cancer of testes: typical spreading pattern
- Appear in common iliac and para-aortic lymph nodes
- Then to the mediastinal and supraclavicular lymph nodes
- Then though the blood to the lungs, liver, bone and brain
Cancer of the testes: causes
Genetics (chromosome 12)
Predisposing factor (cryptorchidism)
Exposure to herbicides and other environmental agents
Cancer of testes: s/s
Hard, painless, unilateral tumor Enlarged / heavy testes Aching scrotum and pelvis Hydrocele or epididymus May develop Gynecomastia if tumor of hormone secreting
Cancer of testes: diagnosistic tests
Biopsy Tumor markers Ultrasound CT Lymphangiography
Cancer of testes: treatment
Combination of surgery, radiation, chemo
Vulva consists of what
Mons pubis and labia majora/minors
Mons pubis
Adipose tissue and hair covering the symphysis pubis
Labia majora and minora
Outer and inner thin folds of skin extending back and down from the mons pubis
Clitoris
Erectile tissue anterior to urethra
Vagina
Muscular, distensible canal extending upward from the Vulva to the cervix
Uterus
Muscular organ within which fertilized ovum may implant and develop
Cervix
Opening into uterus and neck of the uterus
Cervix: external os
Opening from vagina filled with thick mucus
Prevents vaginal flora from ascending into the uterus
Cervix is composed of what
Internal and external os
Fallopian tubes (oviducts)
Tubes from ovaries to uterus
Ovaries
Produce ova and estrogen and progesterone hormones
Breasts
Glands produce colostrum and milk for newborn
Adipose tissue
Cycle is how many days
May be from 21 to 45 days
Hormones and the men trial cycle: cycle consists of
Menstruation (days 1-5)
Endometrial proliferation and production of estrogen (days vary)
Maturation of ovarian follicle
Release of LH, causing ovulation
Process of the menstrual cycle
- Follicle becomes the corpus luteum, produced progesterone
- Vascularization of endometrium is preparation for implantation
º12 to 14 days prior to onset of next menstruation
What happens is implantation does not occur?
- Corpus luteum atrophies
- Uterine muscle contracts - ischemia
- Endometrium degeneration
Normal position of uterus
Slightly anteverted and anteflexed
Cervix downward and posterior
Structural abnormalities: Retroflexion of uterus
Uterus tipped posteriorly
May be excessively curved or bent
Marked retro version may cause back pain, dysmenorrhea, dyspareunia
In some cases, infertility may occur
Uterine displacement or prolapse: first degree
When cervix drops into vagina
Uterine displacement or prolapse: second degree
When cervix lies at opening to the vagina
- body of uterus is in the vagina
Uterine displacement or prolapse: third degree
If uterus and cervix protrude through the vaginal orifice
- early stages of prolapse may be asymptomatic
- advanced stages cause discomfort, infection, and decreased mobility
Rectocele
Protrusion of the rectum into the posterior vagina
- may cause constitution and pain
Cystocele
Protrusion of bladder into the anterior vagina
May cause UTIs
Rectocele and Cystocele treatment
If severe, conditions are treated surgically to increase the support of the pelvic ligaments
Amenorrhea
Absence of menstruation
- may be primary or secondary
- primary = genetic
- secondary from hormonal balance
Dysmenorrhea
Painful menstruation caused by excessive release of prostaglandins as a result of endometrial ischemia
Usually begins a few days prior to menses lasts a few days after onset
NSAIDs for release
Premenstrual syndrome
Starts about 1 week before onset of menses; not exactly sure why this happens
Breast tenderness, weight gain, abdominal distention, bloating, irritability, emotional liability, sleep disturbances, depression, headache, fatigue
Premenstrual syndrome treatment
Individualized and may include exercise, limiting salt intake, use of oral contraceptives, diuretics, or antidepressant drugs
Abnormal menstrual bleeding cause
Usual cause is lack of ovulation, but a hormonal imbalances in the pituitary-ovarian axis may be a favor
Menorrhagia
Increased amount and duration of flow
Metrorrhagia
Bleeding between cycles
Polymenorrhea
Short cycles of less than 3 weeks
Oligomenorrhea
Long cycles of more than 6 weeks
Endometriosis
Endometrial tissue occurs outside the uterus
- responds to cyclical hormone changes
- bleeding leads to inflammation and pain
- fibrous tissue May cause adhesions and obstructions of the involved structures
Endometriosis cause
Unknown but thought to be linked to congenital in some cases
Endometriosis treatment
Hormonal suppression
Surgical removal of ectopic tissue
Candidiasis
Form of vaginitis that is not sexually transmitted
Cause: candida albicana
Candidiasis: opportunistic infection - how
Antibiotics
Pregnancy
Diabetes
Reduced host defenses
Candidiasis s/s
Red and swollen, intensely pruritic mucous membranes and a thick, white, curd like discharge
Candidiasis treatment
Antifungal meds
Candidiasis may extend where
Vulvar tissues
Pelvic Inflammatory Disease (PID): what
Infection of uterus, Fallopian tubes, and/or ovaries
- may be acute or chronic
Pelvic Inflammatory Disease (PID): originates as what
As an ascending infection from lower reproductive tract
Pelvic Inflammatory Disease (PID): may occur because of what
Bacteremia
STD
Non-sterile abortion
Childbirth
Pelvic Inflammatory Disease (PID): scarring of tubes increases what
Risk of infertility and ectopic pregnancy
Pelvic Inflammatory Disease (PID): potential acute complications
Peritonitis
Pelvic abscesses
Septic shock
Pelvic Inflammatory Disease (PID): first sign.
Pelvic pain
- increased temp
- guarding
- nausea
- leukocytosis
- purulent discharge may be present
Pelvic Inflammatory Disease (PID): treatmetn
Aggressive antibiotic therapy in hospital
Leiomyoma (Fibroids): what
Benign tumor of the myometrium
- usually multiple, well-defined, unencapsulated masses
Leiomyoma (Fibroids): common what
Reproductive years
Leiomyoma (Fibroids): s/s
Abnormal bleeding
May interfere with implantation
Often asymptomatic until large
Leiomyoma (Fibroids): treatment
Hormonal therapy or surgery
Leiomyoma (Fibroids): classification
By location
Ovarian cyst
Usually multiple, small, fluid-filled sacs (variety of types)
Physiological type lasts about 8-12 weeks and disappears without complications
When are ovarian cysts serious
When bleeding occurs, inflammation occurs
Ovarian cyst treatment
Surgical intervention
Ovarian cyst diagnosis
Ultrasound or laparoscopy
Polycystic Ovarian Disease: what
Fibrous capsule thickens around follicles of ovary
Polycystic Ovarian Disease: s/s
Absence of ovulation and infertility
Hormonal imbalance
Amenorrhea
Hirsutism
Polycystic Ovarian Disease: treatment
May be surgical wedge resection or drugs
Fibrotic breast disease: what
Broad range of breast changes and increased density of breast tissue
Fibrotic breast disease: patho
Cyclic occurrence of nodules or masses in breast tissue
Fibrotic breast disease: increased risk of what
Increase risk of breast cancer is atypical cells are present
Fibrotic breast disease: increased density does what to breasts
Makes breast self-examination difficult
Increased risk of cystic masses with what lifestyle habit
Caffeine intake
Carcinoma of the breast: most arise from what
Most arise from ductal epithelial cells
Carcinoma of breast: metastasize
Metastasis occurs via lymph nodes early in course of disease
Carcinoma of breast: most tumors are what
Unilateral
Carcinoma of breast: what influences treatment
Presence of estrogen and progesterone receptors on tumor cells
Carcinoma of breast: earlier onset associated with what
More aggressive growth
Carcinoma of breast: incidence
Incidence increases after 20 years old
Most cases in women between 50 and 69 years
Carcinoma of breast: predisposing factor s
First-degree relative with the disease Genetics Longer and higher exposure to estrogen Nulliparous or late first pregnancy Lack of exercise Smoking High fat diet Radiation therapy to chest Cancer of uterus, ovaries or pancreas
Carcinoma of breast: initial sign
Single, small, hard, painless nodule
Carcinoma of breast: later signs
Distortion of breast tissue, dimpled skin, discharge of nipple
Carcinoma of breast: diagnosis
Mammogram
Ultrasound
Needle biopsy
Carcinoma of breast: treatment
Surgery Lymph node removal Radiation Chemo Hormone blocking agents Estrogen receptor blockers Drugs inhibiting estrogen production
Different breast cancer treatment drugs
Slide 37
Carcinoma of breast: how big is tumor when metestasis occurs
By the time tumor is 1-2cm in diameter
Carcinoma of breast: lymph node often involved
Axillary lymph node
Carcinoma of breast: secondary tumors
Bone
Lung
Brain
Liver
Carcinoma of cervix: cause
HPV
- vaccines now exist against the causative stains of HPV
Carcinoma of cervix: prevention
Pap smears of cervical cells
- start by age 20 or when sexually active (at intervals)
Pathophysiology of carcinoma of the cervix
Slide 40
Carcinoma of cervix: risk factors
Age < 40 HPV Multiple partners Early sexual intercourse Smoking Hx STD
Most common cancer in post menopausal women
Carcinoma of uterus
Carcinoma of Uterus: early indicator
Painless vaginal bleeding or spotting
Carcinoma of Uterus: risk factors
Age > 50
High dose estrogen hormone treatment without progesterone
Obesity
Diabetes
Carcinoma of Uterus: what cells
Arises from glandular epithelium
Carcinoma of Uterus: characteristics
Slow-growing but invasive
Staging based on degree of localization
Carcinoma of Uterus: treatment
Surgery and radiation
Carcinoma of Uterus: what does NOT detect this cancer
Pap smear
Ovarian cancer: diagnosis
No reliable screening available
- large mass detected by pelvic examination
- transnational ultrasound
Ovarian cancer: why is it considered a silent killer?
Few diagnosed in early stage
Ovarian cancer: risk factors
Obesity BRCA1 gene Early menarche Nulliparous or late first pregnancy Use of fertility drugs
Ovarian cancer: what may protect
Oral contraceptives containing progesterone are someone protective
Ovarian cancer: treatment
Surgery and chemo
Infertility
Male and females
Infertility risk factors
Hormonal imbalances Age of parents Structural abnormalities Infections Chemo Workplace toxins Environmental factors Idiopathic
Sexually Transmitted Diseases: bacterial infections
Chlamydial infection
Gonorrhea
Syphilis
Sexually Transmitted Diseases: viral infections
Genital herpes Condylomata acuminata (genital warts)
Sexually Transmitted Diseases: protozoan infections
Trichomoniasis
Chlamydial infections: cause
Chlamydia trachomatis
Chlamydial infections: what’s effected in males
Urethritis and epididymitis
Chlamydial infections: s/s in males
Dysuria, itching, white discharge from penis (urethritis symptoms)
Painful swollen scrotum, usually unilateral, fever (epididymitis); inguinal lymph nodes swollen
Chlamydial infections: females
Often asymptomatic until PID or infertility develops
Newborns may be infected during birth
Gonorrhea: cause
Neisseria gonorrhea
Many strains have become resistant to penicillin and tetracycline
Gonorrhea: males
Most common site is urethra, which is inflamed
Some males asymptomatic
Gonorrhea: females
Frequently asymptomatic
PID and infertility are serious complications
Gonorrhea: newborns
May infect eyes of newborn, causing irreversible damage and blindness
Gonorrhea: spread
May spread systemically to cause septic arthritis
Syphilis: cause
Treponema pallidum (a spirochete)
Syphilis: primary stage
Presence of chancre at site of infection - genital region - anus - oral cavity Painless, firm, ulcerated nodule
Syphilis: s/s occur when
About 3 weeks after exposure
Syphilis: primary treatment
Lesion heals spontaneously but patient is still contagious
Syphilis: secondary stage
If untreated, flu-like illness with symmetrical rash (self limited but client remains contagious)
Syphilis: latent stage
May persist for years
Transmission may occur
Tertiary syphilis
Irreversible changes
- gummas in organs and major bv
- dementia, blindness or motor disabilities
Tertiary Syphilis: transmission
Can be transmitted in utero
Tertiary Syphilis: baby born with it
Changes are not reversible
Tertiary Syphilis: treatment
Antimicrobial drugs
Syphilis: treatment cautions
Increase in antibiotic resistant strains causing an increase in prevalence
Herpes: cause
HSV-1 or HSV-2
HSV-1: transmission
Can be oral sex
Genital herpes: s/s
Recurrent outbreaks of blister-like vesicles on genitalia
- preceded by tingling or itching sensation
- lesions are extremely painful
Genital herpes: what happens after acute
Virus migrates back to dorsal root ganglion
Genital herpes: infection greater when
When symptoms are present
Genital herpes: reactivating is common and may be associated with what
- stress
- illness
- menstruation
Genital herpes: treatment
Antiviral drugs
Genital herpes: infection is considered what
Lifelong
Condylomata acuminata (Genital warts): cause
HPV
Condylomata acuminata (Genital warts): incubation period
Up to 6 months
Condylomata acuminata (Genital warts): symptoms
May be asymptomatic
- vary in appearance
- appear wherever contact with virus has occurred
Condylomata acuminata (Genital warts): can predispose to what
Cervial or vulvar cancer
Condylomata acuminata (Genital warts): treatment
Can be removed by different methods
Trichomoniasis: cause
Trichomonas vaginalis - a protozoan parasite
- localized infection
Trichomoniasis: men
Usually asymptomatic
Trichomoniasis: women
May be sub clinical
Flares up when microbial balance in vagina shift
Causes intense itching
Trichomoniasis: treatment
Systemic treatment necessary for both partners
