Exam 2 (ch. 17 &20) Flashcards
What are the phases of a normal menstrual cycle?
Follicular phase then luteal phase
What hormones are produced during a normal menstrual cycle?
estrogen and progesterone
During a normal menstrual cycle, if no pregnancy occurs, what happens?
- corpus luteum degrades
- secretory endometrium shed with blood
- new cycle begins
Ovaries are the site of?
- gametogenesis
2. hormone production
Fallopian tubes
Pathways from ovaries to the uterus;
where is the site of fertilization?
fallopian tubes
Cervix
opening of the uterus
uterus
houses and protects developing fetus
Menorrhagia
heavy menstrual bleeding
Metorrhagia
uterine bleeding at irregular intervals
Dysmenorrhea
painful periods
Vaginal discharge can be associated with what?
superficial infections (STI)
What do you look at when you look at menstrual history?
- length of cycle
- duration
- amount (heavy or light)
- regularity (often)
What occurs during a pelvic examination
- direct inspection of the vulva, vagina and cervix
- bimanual examination (fingers in vagina and tap abdomen)
Pap test can detect what?
HPV and neoplastic lesions
What is a cone biospy
removal of a cone of tissue for histologic exam
Infections of the reproductive tract: types
- STI
a. chlamydia
b. gonorrhea
c. syphilis
d. HPV - Fungus
a. yeast
STIs and fungal infections of the female reproductive tract can lead to what?
- Vaginitis: inflammation of vagina
- Cervicitis: inflammation of cervix
- Salpingitis: inflammation of fallopian tubes
- PID: pelvic inflammation disease
Cervical Polyps
Benign tumors on the surface of the cervical canal
Symptoms of Cervical Polyps
Many are asymptomatic, but can lead to irregular menstrual bleeding
Treatment of Cervical Polyps
removal
Cervical Dysplasia
Abnormal growth of cervical squamous epithelium
Describe how Cervical Dysplasia ranges from mild to severe
- Mild = may regress
2. Severe = pre-cancerous
How do you test to see if a female has Cervical Dysplasia?
Screening –> pap smear
What are risk factors for Cervical Dysplasia?
- HPV infection
- multiple sex partners
- certain HLA genotypes
Describe the progression of cervical cancer
a. Cervical dysplasia (CIN)
b. Cervical carcinoma in situ (not yet invaded BM)
c. invasive carcinoma of cervix
Risk factors for cervical cancer?
HPV & many sex partners
Types of vaginal cancer
- Squamous cell
2. Adenocarcinoma
Signs and symptoms of vaginal cancer
Typically asymptomatic
- often found in routine gynecological exam
Risk factors for vaginal cancer
HPV
Endometrium
Innermost lining of the uterus; part that is shed during period
Myometrium
Smooth outer muscle of uterus; helps with delivery
Disorders of the uterus
- irregular bleeding
- endometriosis
- leiomyomas
- cancer
Leading cause of irregular uterine bleeding
- . Follicle fails to mature and no corpus luteum is formed (anovulatory cycle)
a. no corpus luteum = no progesterone - Endometrial and cervical polyps
- uterine leiomyomas
- uterine carcinoma
Anovulatory bleeding
Uterus is subjected to continuous estrogen stimulation and responds by shedding and bleeding in an irregular manner instead of shedding all at once
Endometriosis
Presence of functioning endometrial tissue outside of uterus
- ectopic
- responds to hormone fluctuations
Possible causes of Endometriosis
a. Retrograde menstruation (sheds up instead of down)
b. spread through vascular or lymphatic systems
c. genetic predispositions
Symptoms of Endometriosis
- pelvic pain
- infertility
- bleeding of ectopic endometrium, causing pooling of blood
- adhesions of internal organs
Diagnosis of Endometriosis
laparoscopy or biopsy
Treatment of Endometriosis
a. Surgical removal of ectopic endometrium
b. Oral contraceptives
c. Medication to inhibit pituitary release of gonadotropins
d. Medication to suppress production of gonadotropin-releading hormone
e. complete hysterectomy
gonadotropins
FSH and LH
gonadotropin-releading hormone
controls the release of FSH and LH
Uterine Leiomyoma
“Fibroids”
- benign tumors of myometrium
Etiology of Uterine Leiomyoma
- unknown
Risk factors of Uterine Leiomyoma
- age of at least 30
- obesity
- family history of fibroid
- African Caribbean decent
- not having had children
Signs and symptoms of Uterine Leiomyoma (uterine fibroid)
- abdominal fullness
- change in menstruation
- bleeding at times other than menstruation
- dysmenorrhea
- pain
- some symptoms are related to the location
- bladder region: urinary frequency and dysuria
- Rectal region: anal-sphincter spasm
Treatment of Uterine Leiomyoma (uterine fibroid)
- no treatment if small
- oral contraceptives
- removal
Amenorrhea
not having period for 3 consecutive months
Etiology of Amenorrhea
- Hypothalamic, pituitary, or endocrine dysfunction
- Congenital or acquired abnormalities of reproductive tract
- extreme weighloss
Consequences of Amenorrhea
infertility, osteoporosis because loss of estrogen
Treatment of Amenorrhea
oral contraceptive pills
Dysmenorrhea
- painful menstruation
Types of Dysmenorrhea
- Primary
- pelvic organs are normal but painful menstruation - Secondary
- pelvic organ disease (endometriosis)
Etiology of Dysmenorrhea
- Prostaglandins
- synthesized in uterus under progesterone
- menstruation leads to release
- causes cramping of myometrium to hell shed blood of endometrium
Endometrial Carcinoma
Most common cancer of female reproductive tract; cancer of endometrium…account for almost all cancers in uterus
Endometrial Carcinoma Symptoms
abnormal uterine bleeding
Risks of Endometrial Carcinoma
obesity, excessive estrogen exposure
Treatment of Endometrial Carcinoma
Hysterectomy, good prognosis
Ovarian Cyst
Fluid filled sac on ovary
Etiology of ovarian cyst
- unknown
- hypothyroidism
- early age of menarche
Signs and Symptoms of ovarian cyst
- most asymptomatic
- abdominal fullness
- low back pain
- nausea and vomiting
- abnormal uterine bleeding
Diagnosis on ovarian cyst
ultrasound
Treatment of ovarian cyst
- oral contraceptives
- laparoscopic procedure to drain or remove cyst
Polycystic Ovary Syndrome (PCOS)
One of the most common female endocrine disorders,
a. follicles develop, but they do not ovulate after the LH surge
b. high LH levels persist
c. LH stimulates androgen production (male pattern hair growth which interferes with ovulation evenmore)
Polycystic Ovary Syndrome (PCOS) is associated with…?
- insulin resistance
- hypertension
- dyslipidemia
Treatment of Polycystic Ovary Syndrome (PCOS)
- no cure
- based on whether you want to get pregnant or not (yes, birth control pills…no, fertility medication)
- diabetes modifications
Ovarian cancer
Leading cause of death among gynecological malignancies
Ovarian cancer mortality has been ____, whereas cervical and uterine cancer mortality rates have been _____.
Rising, falling
What is the prognosis for ovarian cancer
The prognosis is generally poor for ovarian cancer patients of whom only ~25% survive for >5 years
Symptoms of ovarian cancer
- abdominal fullness
- weight gain
- not a ton of symptoms
Ovarian cancer risk factors
- Heredity
a. 10% of ovarian cancer are hereditary
b. 90% of the hereditary cases are linked to breast-ovarian cancer genes 1 and 2
c. with BRCA the lifetime risk varies between 15% and 66% - Childbirth and Pregnancy
a. women who had children about half the risk as do women who haven’t
b. increasing number of children appears to reduce risk a further 15% each
c. miscarriage or abortions provide smaller risk reductions
What are three factors that reduce the chances of developing ovarian cancer and why?
- Lactation
a. reduces the risk for ovarian cancer (as it does for breast cancer) - Oral contraceptives
a. Ever-users have about half the risk as do never-users
b. Long term use seems to further enhance the protection against ovarian cancer - Having kids
* these all reduce the risk for developing ovarian cancer because the women does not ovulate*
Hormone replacement therapy, does it increase or decrease the risk of ovarian cancer?
Appears to increase the risk for ovarian cancer, particularly long term use
Pelvic Inflammation Disease (PID)
Infection of women’s reproductive organs
Etiology of Pelvic Inflammation Disease (PID)
untreated STDs
Symptoms of Pelvic Inflammation Disease (PID)
- pain in lower abdomen
- fever
- unusual discharge
Complications of Pelvic Inflammation Disease (PID)
- scar tissue
- infertility
- ectopic pregnancy
Menopause or Climacteric
Decrease in ovary function
- around 51 years
- low estrogen
- less inhibition of pituitary gland
low estrogen is a risk factor for what?
osteoporosis and atherosclerosis
Less inhibition of pituitary gland leads to what?
increased FSH and LH, which contributes to hot flashes
Why is hormone replacement therapy no longer the standard care for menopause?
- increased risk for ovary/breast cancer
- increased risk for stroke
Contraception: Natural Family Planning
Avoidance of intercourse at time of ovulation (day 9-14)
Contraception: Artificial Contraception
- Barrier Method
a. diaphragms and condoms; effective, no side effects, keep sperm away from egg - Oral Contraceptive
a. suppress ovulation
b. side effects –> increased tendency for thromboembolic complications, especially among smokers; hypertension - IUD
a. prevent implantation
b. increased incidence of tubal infections and tubal pregnancies
c. fertilization can still happen but not implantation
Emergency contraception
Prevent pregnancy following unprotected intercourse or sexual assault
Explain how emergency contraception works
a. sperm can survive as long as 6 days in genital tract and can still fertilize an ovum, thus…
b. it prevents pregnancy by interfering with ovulation; tubal transport of ovum; and implantation within endometrium
Explain the effectiveness of emergency contraception
a. If taken within 12 hours, risk of pregnancy <1% and 3% if taken within 72 hours
b. Some protection is still provided for as long as 5 days
Infertility
The inability to get pregnant after trying for 1 year
Etiology of infertility for females
- hormonal imbalances
- structural problems
- eating/nutritional disorders
Etiology of infertility: general lifestyle factors
- emotional stress
- obesity
- malnutrition
- alcohol
- tobacco or drug misuse
- cancer and cancer treatment
- age
Male primary sex organs
testis –> produce sperm and testosterone
Male accessory sex organs
seminal vesicles, vas deferens, penis, prostate
Common signs and symptoms of male reproductive system diseases and disorders
Urinary complaints
- frequency, urgency, incontinence, dysuria, nocturia
- pain in any reproductive organ or unusual discharge
- swelling or enlargement of any reproductive organs
- any sexual disorder or concern
What is the prostate gland
The prostate secretes fluid that nourishes and protects sperm; size of walnut
Disorders of prostate
- prostatitis
- benign prostatic hyperplasia (BPH)
- carcinoma of the prostate
Prostatitis
Inflammation of the prostate gland
Acute Prostatitis
Spread of infection from bladder to urethra into prostate
Chronic Prostatitis
mild inflammation. common, few symptoms
Signs and symptoms of Prostatitis
- fever and chills
- urethral discharge
- dysuria
- malaise
- tender, enlarged, prostate gland
Treatment of Prostatitis
- extended course of antibiotics
- opiate analgesics
analgesics
manage pain
Benign Prostatic Hyperplasia (BPH)
Enlargement of the prostate gland
Symptoms of Benign Prostatic Hyperplasia (BPH)
- obstructs flow of urine
- urinary hesitancy
- frequent urination
- nocturia
Benign Prostatic Hyperplasia (BPH): the hyperplasia is due to what?
Hyperplasia is due to dihydrostestosterone (DHT) hormone in prostate
–> testosterone is converted to DHT by 5-alpha reductase and binds to androgen receptor
Who does Benign Prostatic Hyperplasia (BPH) target?
men in their 7th decade of life –> affects 75% of them
Complications of Benign Prostatic Hyperplasia (BPH)
Inflammation of bladder/kidneys, UTI, kidney stones
Treatment of Benign Prostatic Hyperplasia (BPH)
- 5-alpha reductase inhibitors
- heat
- resection
Carcinoma of the prostate
Most common cancer of internal organs in males
- >100,000 new cases per year
What is the most common cause of death from cancer in men over age of 75?
Carcinoma of the prostate
What accounts for 29% of all cancers in males?
Cancer of the prostate
2nd leading cause of cancer deaths in males
cancer of the prostate
Describe the symptoms of prostate cancer
- asymptomatic until it’s advanced stages
- symptoms are similar to BPH
Risk factors for cancer of the prostate
- dietary
- hormones
- vasectomy
- chronic inflammation
- family factors
- ethnicity
Diagnostic procedures for prostatic cancer
- Digital rectal exam
- Biopsy
- CT scan or ultrasonography
- PSA blood test
PSA blood test
can not solely use for the diagnosis of prostate cancer, but it helps aid as a tool in diagnosing it
BPH vs Prostate cancer
- identical symptoms
- both in prostate
- BPH cannot spread (benign)
- PSA can be high in both
Tumor of Testis
- Rare but important; most common in men 25-45 years old
- Majority germ cell tumors
- Usually malignant but can be successfully treated by surgery & chemo or radiation
What is the cure rate for tumor of the testis
high cure rate; >90% of patients survive
Signs and symptoms for tumor of the testis
- lump on testis / scrotum
- pain in scrotum/lower abdomen
Cryptorchidism
Testes do not descend normally
- absence of one or both testes from scrotum
Testes normally descend to aid in what?
sperm production
Treatment of Cryptorchidism
- Time –> most will descend on own
2. surgery
Complications of Cryptorchidism
- testicular cancer
- fertility issues
- testicular torsion
- inguinal hernia
Testicular Torsion
Twisting of spermatic cord due to rotation of testicles
- reduces blood flow
- more common in boys 12-16 because active
Symptoms of testicular torsion
- acute onset testicular pain
- swelling of involved testis
Complications of testicular torsion
medical emergency –> death of testis within 6-12 hours
Orchitis
Inflammation of testis
Etiology of Orchitis
- mumps virus infection
- STIs
Signs and Symptoms of Orchitis
- testicular pain and inflammation
- edema
- fever
- malaise
- urethral discharge
Diagnosis of Orchitis
- recent history of mumps infection
- presenting signs and symptoms
- culture of urethral discharge
- ultrasound
Treatment of Orchitis
- antibiotics
- analgesics
- cold compress
- scrotal support
Hydrocele
Scrotal abnormality
- excess fluid accumulates
- treated by aspiration
Varicocele
Scrotal abnormality
- varicose veins in spermatic cord
- usually involves left side of scrotum
- may impair fertility
- treatment required only is varicocele causes discomfort or impairs infertility
Erectile Dysfunction (ED)
Difficulty developing and maintaining full erection throughout intercourse
- age related
Causes of ED
- Stress, emotional factors
- chronic disease
- renal failure
- diabetes mellitus
- penile diseases/trauma
Treatment of ED
Phosphodiesterase inhibitors
What is the neural control of a penile erection
- Parasympathetic nerves release acetylcholine and nitric oxide (NO)
- NO produces vasodilation
- cGMP is inactivated by PDE-5 mediated conversion to GMP
Etiology of infertility in males
- sperm deficiencies
- congenital abnormalities
- endocrine imbalances
- surgical intervention
- infection or chronic inflammation of the testes, epididymis, vas deferens
