Disorders of the Reproductive System Flashcards
What is Amenorrhoea?
Absence of Menses
Primary - Never Present, also secondary sexual characteristics are absent from age 14
Secondary - Where established Menstruation has ceased for 3 months/6 months
What is PMS?
Pre-Menstrual Syndrome.
Emotional and Physical Symptoms in the 2nd half of the menstrual cycle
What is Menorrhagia?
What is Dysmenorrhoea?
What is Oligomenorrhoea?
Abnormal heavy bleeding or length of a period.
Painful menstruation.
Irregular intervals between menses
What can cause Primary Amenorrhoea?
Outflow Tract Obstruction - Mullarian Agenesis
Imperforate Hymen
Atresic Vagina
Cryptomenorrhoea
Gonadal - Dysgenesis (Turners)
Androgen Insensitivity
Congeital Adrenal Hyperplasia
FSH/LH Receptor Abnormalities
Kallmann’s Syndrome
Hyper/Hypothyroidism
What can cause Secondary Amenorrhoea?
Outflow Tract Obstruction - Intrauterine Adhesions
Gonadal Disorders - Pregnancy
PCOS
Menopause
Hypothalamus - Exercise
Stress
Weight
Pituitary - Sheehan syndrome
Hyperprolactinaemia
Haemochromatosis
What is DUB?
Dysfunctional Uterine Bleeding
Abnormal Bleeding - heavy, prolonged, frequent
Causes 60% of menorrhagia
No obvious cause (pathology/pregnancy or other bleeding disorders), normally anovulatory
What can cause Menorrhagia?
Fibroids DUB Coagulation Defects Endometrial Carcinoma Polyps PID
What is Hyperprolactinaemia?
What does it cause?
Increase Prolactin Secretions
Secondary Amenorrhoea & Chronic Anovulation
What causes Hyperprolactinaemia?
Hint: There are three types
Physiological- Sleep, Stress, Pregnancy/Post-Partum
Pharmocological- Drug inhibits Dopamine
Pathological - Adenoma, 1. Hypothyroidism
What is PCOS?
Enlarged polycystic ovaries, leads to increase in GnRH pulses, LH and androgen secretions and lowered FSH
Androgens often changed to testosterone rather than Oestrogen which -> Symptoms
Associated with Type 2 Diabetes
What does PCOS cause?
Chronic Anovulation
Secondary Amenorrhoea
Physical signs of hyperandrogenism
How do we investigate PCOS?
Blood Test: Increased Testosterone, Increase LH, Decreased Sec Hormone Binding Globulin
Ultrasound: PC Ovaries and Thickened Capsule
What is PID?
Pelvic Inflammatory Disease
Infection ascends from the endocervix
What can PID cause?
Endometriosis; Salpingitis; Oophritis; Parametritis; Tubo-ovarian Abcess Pelvic Peritonitis
What causes PID?
Infection of some kind ascending from the Endocervix
e.g. STIs - Chlamydia, Gonorrhea
e.g. Gardnerella vaginalis
How does PID cause damage?
Infection causes inflammation which can damage the epithelium
e.g. in the tubes, can cause Adhesions to form
What is a tubo-ovarian abcess?
Exudate fills the salpinx
Adhesions form in the tubes
Fibrin exudate blocks the tube
What are some Risk Factors for PID?
Intrauterine Contraceptive Devices
STIs
What are some symptoms of Pelvic Inflammatory Disease?
Pyrexia
Pelvic Pain
Abnormal Bleeding or Discharge
How do you manage PID?
IV antibiotics if severe/inpatient
Surgery if signs of TOA or Peritonitits
IM Ceftrioxone, Doxy or Metro
as an outpatient
What are some potential complications of PID?
Ectopic Pregnancy (tube damage)
Infertility (blockage of tube)
Chronic Pain
Fitz-Hugh-Curtis Syndrome
Reiters Syndrome
Describe Klinefelter Syndrome
XXY Most common chromosomal abnormality 1/1000 boys Normal internal genitalia Breast tissue (gynacomastia) Get small testes and penis Decreased testosterone and Fertility
Describe Turner’s Syndrome
Aneuploidy XO Get Cardiac and Renal Problems Infertile Shield Chest and Webbed Neck Short Stature
Describe Pseudohermaphroditism
Phenotype doesn't match genotype Can be due to androgen insensitivity if XY, testes don't descend, remain in lumbosacral region Get no internal genitalia External is female
Describe True Hermaphroditism
A true mosaic of XY XX XO
Ambiguous Genitalia
Get Teste and Ovarian Tissue Development
Describe Congenital Adrenal Hyperplasia
Increased secretion of androgens
If XX, will have both internal genitalia, with female gonads
External will be male due to testosterone’s action
Can reange in severity
Describe a Bicornate Uterus
Uterus has 2 horns
Appears due to the lack of fusion of the Mullerian /Paramesonephric Ducts
Describe Hypospadia
When there is incomplete fusion of the tubercles
Opening of urethra is not on the head of the penis
Tends to be near glans, on dorsal surface
Describe Ambiguous Genitalia
Large Clitoris
Small Penis
In some cases you can get characteristics of both sexes
What is the normal blood loss in a period?
37-43ml per cycle (most in the first 48 hours)
some people lose up the 80ml per cycle, important to think of what is normal for them with a history (60-70% of them are anaemic)
What defines menorrhagia?
Abnormally long ( over 7 days) or heavy (over 80ml)
but regular
How can age affect a woman’s sexual excitation response?
Fewer rhythmic contractions of the uterus
Lose of muscular tone of vagina (lose of expansile ability)
Reduced desire
Reduced lubrication (due to reduced vasocongestion)
Resolution is more rapid
Vaginal tissue loses elasticity
What are the 2 aspects affected by sexual dysfunction?
desire
arousal
How can desire be affected?
Most common dysfunction hyperactive/nymphomaniac hypoactive CNS lesion - Kluver Bucci syndrome Aversion- fear or revulsion of one or more aspects, usually due to assault
How can arousal be affected in men?
Can be scared/psychological
Tears in corpora cavernosa
Vascular - atherosclerosis, diabetes
drugs- alcohol and anti-hypertensives
How can arousal be affected in women?
Cannot retain lubrication-swelling response
How do you treat arousal dysfunction?
Viagra
inhibits cGMP breakdown
What are the methods of contraception?
Natural - Abstain, Rhythm Method, Coitus Interruptus
Barrier - Condom, Diaphragm/Cap
Vasectomy- prevent sperm
Prevent Ovulation - OCP
Sterilisation - occlude fallopian tubes
Inhibit sperm getting through the cervix - OCP, Progesterone Pill/Implant. Thick mucus, hostile!
Inhibit implantation - IUCD, post-coital contraceptive, hormonal contraceptive
What are the signs of breast disease?
Pain
Nipple Discharge
Mammographic Changes
Masses
Skin Changes and Lumps
When is pain more likely a sign of physiological/benign problems of the breast?
If it is cyclic and diffuse
What are the types of nipple discharge?
What can each indicate?
Blood- benign (papilloma, adenoma) or malignant lesion
Milky - endocrine disorders, medication (OCP)
More worrying if occurs spontaneously and unilaterally
What are the types of mass in the breast?
Normal nodularity
Worry- hard, craggy, non-motile
Fibroadenoma - “breast mice” motile lump
What changes can you see in mammography?
Example that causes this…
Calcification - Ductal carcinoma (DCIS)
Densities - fibroadenoma, cysts, invasive carcinomas
Describe breast screening
Women 47-73
Every 3 years
mammogram
looks for densities, calcification, parenchymal deformalities
What are some physiological changes of the breast?
Post-ovulation- oedema, and lobules proliferate
Pregnancy - increase in size and number of lobules, adipose tissue, decrease in stroma
Post-lactation- atrophy but not to previous size
Menopause/Old age- involution of breast tissue, adipose replaces fibrous stroma, decrease in terminal ducts
What are some benign changes in the breast?
Fibroademona - localised hyperplasia
Fibrocystic Changes - disappears after FNA
Milk Line remnants- accessory axillary tissue and polythelia
Gynacomastia
Epithelial hyperplasia (can become carcinoma)
Papilloma - small palpable mass, discharge
What are some inflammatory conditions of the breast?
Acute Mastitis - S. aureus infection when lactating, nipple cracks
Fat Necrosis - trauma or surgery
What are the benign stroma disorders?
Describe each
Fibroadenoma- common in younger women, mobile, elusive mass, well circumscribed, white, rubbery, compresses epithelia
Phyllodes Tumour - most benign, grow quickly, nodules of stroma covered in epithelia, stroma cellular and atypical, excise with wide margin
What can cause gynacomastia?
Liver cirrhosis Klinefelters Drug related Puberty (transient) Gonadotrophin excess
Due to increased oestrogen and decreased androgens
What are some breast cancers?
In situ:
DCIS
Paget’s disease
Invasive carcinoma:
Can be ductal (70-80%), tubular (1-2%), lobular (5-15%) or mucinous (1-6%)
Tubular and Mucinous have best prognosis
Lobular - lines of cells infiltrate, lack cohesion
What are the risk factors for breast malignancy?
OCP, Late menopause, early menarche, female, HRT
(Oestrogen Exposure)
Obesity- peripheral tissues produce oestrogen Radiation Breast Feeding Reproductive History Genetics
Where do breast cancers metastasise to?
Through the Blood: Brain Liver Lung Bone
Axillary Lymph Nodes
Where can lobular carcinomas spread to?
Retroperitoneum, Peritoneum, Ovaries, GI tract, Uterus
How do you manage breast cancer?
Localised?
Systemic?
Surgery - mastectomy or breast sparing
Axillary surgery (test with sentinel node sampling)
Post Op Radiotherapy
Neo-adjuvant Chemotherapy
Hormonal - tamoxifen
Herceptin
What genes are involved in breast cancer?
Her2 expression
Oestrogen receptors
BRCA gene - associated with negative ^ have high grade and poor prognosis :(
What is the triple approach?
breast cancer
Investigations to do
1) Clinical - history, family histort, examination
2) Imaging - mammogram or ultrasound
3) Pathology - core biopsy, fine needle aspiration (cytology)
Examples of teratogenic agents and infectious agents that can cross the placenta
Alcohol
Lithium and Thalidomide
Smoking
Varicella Zoster
CMVirus
Rubella
Toxoplasma gondii
What is Foetal Alcohol Syndrome?
Visible Features
Maternal drinking causing developmental defects in the foetus as it harms the CNS development and neural cell migration
Short Palpabral Fissure
Flat Maxilla
Lack of philtrum, thin upper lip
Describe Pre-eclampsia
Hypertension and Proteinurea during pregnancy
Unknown circulating factor damages the endothelium, this causes systemic vasoconstriction which causes hypertension.
The mother is unable to make a low resistance vascular bed for the placenta which can lead to insufficiency and growth restriction of the foetus
What is eclampsia?
Seizures during pregnancy
