Exam 3: Ch. 16-20 Flashcards
1
Q
main function of breasts
A
milk production
2
Q
two main types of breast tissue
A
glandular tissue-lobules and ducts
stromal tissue-supporting tissue
3
Q
stromal tissue
A
fatty and fibrous connective tissue that gives breasts size, shape, and support
4
Q
structure of breast
A
20 lobes of glandular tissue, each made of cluster of milk producing lobules which are connected to the nipple by branching ducts
5
Q
suspensory ligaments
A
bands of fibrous tissue extending from skin to connective tissue covering chest wall muscles
6
Q
where do lymph vessels in the breast lead to?
A
axillary nodes (near armpit), if cancer cells reach here the nodes swell and the cancer is more likely to spread
7
Q
what happens to breasts during puberty?
A
they enlarge in response to estrogen and progesterone
- glandular and fibrous tissue proliferates
- adipose tissue accumulates
8
Q
what happens to breasts during menstrual cycle?
A
responds to hormonal stimulation, they experience hyperplasia (growth) and involution (shrinking) in a cycle
9
Q
what happens to breasts during pregnancy?
A
the glandular and ductal tissues are hypertrophic (cell size increases)
10
Q
what happens to breasts after menopause?
A
sex hormone levels decline, so the breasts gradually decrease in size
11
Q
clinical breast exam
A
-inspection, palpation, examination of axillary tissues
-first w/ arms at sides
-next w/ arms elevated, then lowered
last w/ hands on hips
12
Q
palpation of breasts should begin where?
A
periphery of breast and in clockwise direction
13
Q
mammogram
A
x-ray examination to identify lesions that can’t be detected on a clinical examination
14
Q
baseline age of first mammogram?
A
35-40, or earlier if family history is present
15
Q
when should you get a mammogram annually?
A
at age 40 and after
16
Q
a mammogram is most useful for what population?
A
postmenopausal women, because their breasts contain more fat and less glandular tissue
-a tumor will contrast more sharply with the fatty tissue (less dense)
17
Q
more dense masses show as what color on a mammogram?
A
white
18
Q
less dense masses show as what color on a mammogram?
A
dark
19
Q
cysts and benign tumors are well or poorly circumscribed?
A
well circumscribed, usually even borders and differ sharply from cells around them
20
Q
malignant tumors usually are what?
A
poorly circumscribed, irregular borders and fine flecks of calcium
21
Q
why may MRI be better than a mammogram?
A
it detects small carcinomas better and non-significant breast changes
22
Q
accessory breast/nipple
A
common sites include armpit or lower chest below and medial to normal breasts-when an extra nipple forms
23
Q
unequal development
A
fully developed breasts are usually not exactly the same, one usually fails to develop as much
24
Q
breast hypertrophy
A
puberty; one or both breasts over-respond to hormonal stimulation and results from overgrowth of fibrous tissue
25
gynecomastia
ductal and fibrous tissue of an adolescent male proliferates from a temporary imbalance of female and male hormones at puberty (formation of small female breasts)
26
benign cystic change
very common, also called fibrocystic disease
-where focal areas of proliferation of glandular and fibrous tissue are present our to irregular cyclic response to hormones
27
what diagnoses a benign cystic change
ultrasound, distinguishes cystic from solid mass
28
treatment for benign cystic change
aspiration of cyst (removal of fluid via needle)
| surgical excision
29
fibroadenoma
benign, well circumscribed tumor of the fibrous and glandular tissue that is common in young women and surgically removed
30
risk factors for breast carcinoma
family history (mother or sister), hormonal factors, first pregnancy after age 30, early menarche (1st period), late menopause, occurs in 1/10 women
31
progestin
synthetic compound with progesterone activity, often given with estrogen in combined hormone therapy
32
combined hormone therapy
treats menopausal symptoms, but increases density of breast tissue therefore complicating mammograms
33
long term estrogen+progestin use increases risk of breast carcinoma by what percent?
8%
34
long term use of just estrogen increases risk of breast carcinoma by what percent?
1%
35
mutant BRCA1 gene
increases breast cancer (80%) and ovarian carcinoma (20-40%) risk, large gene with many mutations
36
mutant BRCA2 gene
increases breast cancer (80%) and ovarian carcinoma (10-20%)
37
clinical manifestations of breast carcinoma
- lump in breast
- nipple or skin retraction
- skin edema (orange peel sign, skin around nipple looks like an orange peel)
38
3 classification criteria of breast carcinoma
1. site of origin (ductal, lobular, in situ)
2. presence or absence of invasion
3. degree of differentiation of tumor cells (well-normal tissue, poor-bizarre cells)
39
ductal carcinoma accounts for how many breast carcinomas?
90%
40
in situ cancer
non-invasive, can become invasive
41
mammogram can identify carcinoma up to how long before a manual breast exam?
2 years
42
modified radical mastectomy
aka total mastectomy with axillary lymph node dissection
- resecting (removing) entire breast, axillary tissue with lymph nodes
- can be followed by breast reconstruction
43
partial mastectomy
removing the part of the breast with the tumor
| -axillary nodes removed, radiation follows to make sure all carcinoma is gone
44
lumpectomy
removing the tumor and a small amount of adjacent breast tissue, and the axillary nodes followed by radiation
45
adjuvant therapy
eradicate any tumor cells that may have spread beyond the breast
- anticancer drugs (adjuvant chemo)
- anti estrogen drugs (adjuvant hormonal therapy)
46
in adjuvant therapy, part of the tumor is surgically tested to:
1. detect presence of estrogen and progesterone receptors
| 2. detect amplification of HER-2 gene that speeds growth rate of tumor cells (if positive, prognosis is worse)
47
hormone receptor status
if estrogen receptors (ER) and progesterone receptors (PR) are present in breast carcinoma, prognosis is more favorable
-treatment used is anti estrogen adjuvant therapy
48
recurrent and metastatic carcinoma
- can appear many years after original tumor
| - no longer curable and treatment is to control growth and improve quality of life
49
treatment for recurrent carcinoma
tumor is hormone receptor positive:
-use anti estrogen drugs in premenopausal
-use aromatase inhibitor drugs in postmenopausal
tumor is hormone receptor negative:
-hormonal manipulation
radiation controls deposits in bone
50
breast sarcoma
rare, arises from fibrous tissue or blood vessels
- large and bulky
- may metastasize widely
- treatment is surgical resection (removal)
51
vaginitis
common, causes vaginal discharge, itching, and irritation
52
cervicitis
mild chronic inflammation, common in women that have had children
-can spread to infect tubes and adjacent tissues, causing pelvic inflammatory disease
53
salpingitis
tubal infection
54
pelvic inflammatory disease (PID)
inflammation of fallopian tubes, and sometimes the ovaries
| -manifests as lower abdominal pain and tenderness, fever, and can cause tubal scarring
55
condylomas
venereal warts in genital tract
| -tumor like overgrowths of squamous epithelium transmitted by sexual contact, benign
56
common locations of condylomas
mucosa of cervix and vagina, vaginal opening, anus
57
treatment of condylomas
aims to destroy the lesions
- freezing
- surgical excision
- strong chemical
58
endometriosis
deposits of endometrial tissue outside normal location
- uterine wall, ovary, elsewhere in pelvis, appendix, rectum
- the tissue undergoes cyclic desquamation (shedding) causing intense cramping, can cause scarring
59
what diagnoses endometriosis
laparoscopy-visualization of ectopic deposits followed by removing or destroying the deposits
60
treatment of endometriosis
- synthetic hormones-suppress menstrual cycle
- oral contraceptives-suppress ovulation, retarding progression of endometriosis
- drugs that suppress output of gonadotropin-declin in ovarian function, deposits of endometriosis regress
61
cervical polyps
benign, arise from cervix and usually small
| -need to be surgically removed, erosion of the tip can cause bleeding
62
cervical dysplasia
abnormal growth and maturation of cervical squamous epithelium
-mild and severe dysplasia
63
mild cervical dysplasia
results from cervical dysplasia and regresses spontaneously
64
severe cervical dysplasia
does not regress and can progress to in situ carcinoma, which then may progress to invasive carcinoma
65
cervical intraepithelial neoplasia
different stages in a progressive spectrum of epithelial abnormalities with 3 grades
Grade I: mild
Grade II: moderate
Grade III: severe
66
HPV genital tract infection
80+ strains, 8 are carcinogenic
- common in young sexually active women
- 90% of infections resolve themselves in 6-12 months
67
diagnosis of HPV
pap smear with inconclusive results, HPV test given
68
HPV vaccine
- 1st vaccine: 2006, protects types 6, 11, 16, and 18
| - 2nd vaccine: 2009, protects types 16 and 18
69
types 6 and 11 are responsible for what?
90% of genital tract condyloma
70
types 16 and 18 are responsible for what?
70% of cervical dysplasia and carcinoma
71
cervical dysplasia and carcinoma
develops in cells between squamous epithelium at exterior cervix and columnar epithelium lining cervical canal (between exterior cervix and cervical canal)
72
treatment for cervical dysplasia and carcinoma
dysplasia and in situ: freezing, surgical excision, hysterectomy (produce excellent results)
invasive carcinoma: radiation, radical hysterectomy (les satisfactory results)
73
radical hysterectomy
resection (removal) of uterus, fallopian tubes, ovaries, and adjacent tissues
74
benign endometrial hyperplasia
irregular uterine bleeding
75
benign endometrial polyps
common, and may cause bleeding if tip is eroded
76
endometrial adenocarcinoma
prolonged endometrial stimulation by estrogen use, has irregular uterine bleeding or postmenopausal bleeding
77
uterine myoma
benign smooth muscle tumor from uterine wall
- 30% women over 30 have them
- cause irregular/heavy uterine bleeding
- pressure on bladder and rectum
78
dysfunctional uterine bleeding
follicle fails to mature and no corpus luteum is formed, subjecting uterus to continuous estrogen stimulation so it sheds and bleeds in an irregular fashion instead of all at once
79
first part of menstrual cycle
endometrial glands and stroma proliferate under influence of estrogen
80
mid-cycle of menstrual cycle
ovulation-follicle discharges egg, become corpus luteum that produces estrogen and progesterone
-endometrium undergoes secretory phase, prepares to receive fertilized ovum
81
what happens if no pregnancy occurs
corpus luteum degrades, estrogen-progesterone levels fall, and secretory endometrium is shed with blood and a new cycle begins
82
dysmenorrhea
primary and secondary-painful periods, typically involving abdominal cramps
83
primary dysmenorrhea
most common, periods painless for first two years after menarche, then prostaglandins are synthesized under influence of progesterone and released from endometrium and cause pain
84
primary dysmenorrhea pain
crampy lower abdominal pain that begins just before menstruation, and lasts for 1-2 days after onset of menstrual flow
treatment: prostaglandin inhibitors and oral contraceptives
85
secondary dysmenorrhea
from diseases of pelvic organs, such as endometriosis
| -treatment: correct the underlying disease
86
ovarian cysts
arise from ovarian follicles or corpora lute that have failed to regress normally and converted to fluid-filled cysts
87
functional cysts
follicle and corpus luteum cysts from deranged maturation and involution (shrink), regress spontaneously, don't become large
88
endometrial cysts
endometrial deposits in ovary filled with old blood and debris
89
benign cystic teratoma
- dermoid cyst
- come from unfertilized ova that undergo neoplastic change
- contain skin, hair, teeth, parts of GI tract, other tissues
90
malignant teratoma
very rare, usually benign
91
ovarian tumors
resemble epithelium found in other parts of genital tract
92
serous tumor
resembles cells lining fallopian tubes
- cystadenoma
- cystadenocarcinoma
93
cystadenoma
benign, cystic serous tumor
94
cystadenocarcinoma
neoplastic epithelium may extend on the surface of tumor and break off, implanting in other places
95
mucinous tumor
resembles mucus-secreting tumor of endocervix
- mucinous cystadenoma
- mucinous cystadenocarcinoma
96
endometrioid tumor
resembled endometrial tissue (endometrioid carcinoma)
97
fibroma
from fibrous connective tissue cells of ovary
98
granulosa
theca cell tumor
- ovarian, produces estrogen
- from granulose cells (estrogen producing cells) that line follicle
- induces endometrial stimulation
99
male hormone-producing ovarian tumors
induces masculinization in a female
100
vulvar dystrophy
- irregular white patches (leukoplakia) on vulvar skin
- intense itching
- can progress to carcinoma, local treatment is usually effective
101
carcinoma of the vulva
- in both pre and post menopausal women
- usually w/ preexisting vulvar dystrophy
- treated by vulvectomy and excision of inguinal lymph nodes
102
toxic shock syndrome
most common in women that use high absorbency tampons
- toxin produced by staphylococci
- menstrual blood and secretions are a good culture medium
103
how do tampons cause toxic shock syndrome
they slow drainage of menstruate, may cause superficial erosions on vaginal mucosa allowing toxin to be absorbed
104
clinical manifestations of TSS
fever, vomiting, diarrhea, muscle pains, sunburn-like rash followed by flaking and peeling
105
treatment of TSS
general supportive measures, discontinue tampon use, antibiotics eradicate staphylococci but do not shorten course
106
what is recurrence rate of TSS?
30%
107
natural family planning
avoidance of intercourse at the time of ovulation
108
artificial contraception
barrier methods, oral contraceptives, intrauterine contraceptives
109
barrier methods of contraception
diaphragms and condoms, effective, and no side effects
110
oral contraceptives
suppress ovulation, but have side effects such as hypertension and increased risk for thromboembolus
111
intrauterine contraceptive devices
prevent implantation, but increased incidence of tubal infection and tubal pregnancy
112
emergency contraception
prevents pregnancy following unprotected intercourse or sexual assault
-within 12 hours: risk of pregnancy
113
how long do sperm survive in genital tract?
6 days, can still fertilize an ovum
114
fertilization
union of sperm and ovum in fallopian tube
- ovum expelled from follicle at ovulation
- first cell division completed 30 hrs. after fertilization
- only 1 sperm
115
trophoblast
cell that forms the placenta and membranes after fertilization occurs and zygote develops into small ball of cells
116
implantation occurs by...?
the end of the 1st week
- implants in endometrium, amniotic sac and yolk sac form
- organ systems begin to form
117
stages of prenatal development
pre-embryonic period, embryonic period, fetal period
118
pre-embryonic period
3 weeks after fertilization
| -blastocyst becomes implanted and inner mass cell differentiates into 3 germ layers
119
embryonic period
3rd-7th week
- assumes human shape
- organ systems formed
- critical development period
120
fetal period
8th week to term
- fetus continues to grow
- no major structure changes
- subcutaneous fat accumulates
121
duration of pregnancy
time of conception: 38 weeks
| from first day of last period: 40 weeks
122
gestation
total duration of pregnancy from fertilization to delivery
123
amniotic sac
enclosed within chorion, forms protective environment for fetus
124
yolk sac
forms intestinal tract of fetus
125
fetoplacental circulation
circulation from the fetus to the villi
126
uteroplacental circulation
maternal blood circulates around villi
127
functions of placenta
- provide oxygen and nutrition
| - synthesizes hormones (human chorionic gonadotropin HCG)
128
amniotic fluid
produced by filtration and excretion of maternal blood and fetal urine
129
polyhydramnios
increased volume of amniotic fluid
- fetus can't swallow it and it accumulates
- or fluid is swallowed but not absorbed
130
oligohydramnios
reduced volume of amniotic fluid
- fetal kidneys failed to develop and no urine is formed (no excretion)
- or congenital obstruction of urethra doesn't allow urine to form amniotic fluid
131
what causes "morning sickness?"
hormones produced by endocrine glands maintain the pregnancy
-sometimes estrogen increases too rapidly and causes nausea and vomiting that usually subsides by the end of the first trimester
132
hyperemesis gravidarum
excessive vomiting, more prolonged and severe than normal
| -it usually requires treatment if there is weight loss and dehydration present
133
gestational diabetes
hyperglycemia (high blood sugar) is harmful to fetus
- pregnancy hormones induce maternal insulin resistance, and insulin secretion cannot increase to compensate
- usually relents after delivery, but increases change for type 2 diabetes later
134
spontaneous abortion
10-20% of all pregnancies
- early: from chromosome abnormalities, defective implantation, or maldevelopment
- late: from placenta detachment, obstruction of blood supply, or drug abuse such as cocaine that disrupts blood flow to placenta
135
ectopic pregnancy
development of embryo outside the uterine cavity, most commonly in the fallopian tubes
136
predisposing factors to ectopic pregnancy
previous fallopian tube infection, failure of normal contractions of tubal wall, or both fallopian tubes predisposed
137
consequences of ectopic pregnancy
fallopian tube rupture, bleeding from torn vessels, can be life threatening to the mother
138
if oral contraceptives fail and are continually used, what can happen?
the developing embryo is exposed to synthetic estrogen and progestin compounds, which may induce congenital abnormalities in the fetus
139
velamentous insertion
umbilical cord attaches to the fetal membrane instead of the placenta
- may tear or be compressed during labor
- can be fatal to the infant
140
placenta previa
placenta attaches to the lower part of uterine wall instead of high
- central and partial
- causes episodes of bleeding
- requires c section delivery
141
central placenta previa
placenta covers entire cervical opening
142
partial placenta previa
partially covers cervical opening
143
3 disadvantages of having twins
1. twins are smaller than a single infant at comparable gestational stage
2. overdistention (over stretching) of uterus promotes premature delivery
3. congenital malformations occur 2x as often
144
twin transfusion syndrome
vascular anastomoses (joined blood vessel) connects placental circulation of identical twins
- one is polycythemic (increased RBC), one is anemic
- fatal if amount of blood is too disproportionate
145
vanishing twin
one twin dies in the womb and is reabsorbed
146
blighted twin
one twin dies in the womb and persists as a degenerated fetus
147
fraternal twins
2 separate ova fertilized by 2 separate sperm, results in two babies born at the same time that don't look alike
148
identical twins
single ovum that splits into two ova, results in two babies born at the same time that look almost exactly alike
149
conjoined twins
union between identical twins
150
perinatal period
time period immediately before and after birth
151
preeclampsia
high blood pressure and signs of organ damage in a pregnant women-condition that sometimes progresses to eclampsia
152
symptoms of preeclampsia
proteinuria, feet/hand swelling, could have seizure or stroke causing decreased delivery of blood to the baby
153
signs of preeclampsia
abdominal pain, persistent headache, high weight gain
154
causes of preeclampsia
pregnant with twins or more, advanced maternal age, obesity, first pregnancy, history of hypertension
155
when does preeclampsia start developing and when do signs/symptoms occur?
starts developing during 1st trimester, symptoms seen in 2nd trimester
156
eclampsia
condition that follows preeclampsia
| -marked by seizures in a pregnant woman
157
symptoms of eclampsia
muscle aches, seizures, severe agitation, unconsciousness
| -can cause organ failure and death
158
high blood pressure and proteinuria of preeclampsia usually resolve within:
6 weeks
159
diagnosis of preeclampsia
blood pressure greater than 140/90, and greater than 300mg of protein in urine
160
previous preeclampsia brings what risk of getting hypertension again?
4x
161
gestational trophoblast disease
trophoblastic cells covering the villi continue to grow at an excessive rate, producing higher human chorionic gonadotropin
- tissue may invade uterus, vagina, etc
- hydatidiform moles
162
hydatidiform mole (fluid filled vesicle)
occurs in 80% of affected patients
- complete, partial, invasive mole
- abnormal fertilization of an ovum lacking chromosomes, fertilized by single sperm bearing X chromosome duplicated to form 46
163
hydatidiform mole (complete)
- both x chromosomes come from father
- no embryo
- villi become cystic structures resembling mass of grapes
164
hydatidiform mole (partial)
- normal ovum fertilized by 2 sperm, resulting in fertilized ovum with 3 sets of chromosomes (69)
- embryo forms but does not survive
165
invasive mole
occurs in gestational trophoblast disease
- trophoblastic tissue invades deeply into the uterine wall
- very aggressive, occurs in 15% of affected patients
166
choriocarcinoma
arise following incomplete removal of invasive mole or incompletely removed mole
- proliferating trophoblast may extend to vagina, metastasize to lungs and brain
- treatment is hysterectomy and chemo
167
erythroblastosis fetalis
mother is sensitized to an antigen in fetal RBCs, she forms antibodies against the antigen that cross the placenta, which damage the fetal RBCs. fetus will increase blood production to compensate
168
hydrous fetalis
complication of erythroblastosis fetalis
| -severe anemia (RBC deficiency) that causes heart failure, edema, death during last trimester
169
less intense hemolytic process
complication of erythroblastosis fetalis
| -infant is born alive but anemic (RBC deficient)
170
mild disease
complication of erythroblastosis fetalis
| -infant appears normal at birth, then becomes anemic and jaundiced and develops edema
171
Rh hemolytic disease
the baby and the mother are either Rh-positive (contain the D antigen) or Rh-negative (don't contain D antigen) but are not the same
- usually RH negative mother, and RH positive baby, mother forms anti-D antibodies that cross placenta
- normal in first pregnancy
172
prevention of Rh hemolytic disease
Rh immune globulin
- if administered within 72 hours after delivery, antibody coats Rh antigen sites on surface of fetal red cells in maternal circulation to reduce sensitization and development of antibodies
- some drs recommend late preg. injections and after delivery
173
ABO hemolytic disease
mother is type O (has anti-A and anti-B antibodies) while infant is type A or type B
- maternal antibodies attach to fetal red cells
- milder than RH hemolytic disease, A and B antigens are less developed
174
ureter
conveys urine into bladder by peristalsis
175
renal pelvis
expanded upper portion of ureter, inside of kidney
176
major calyces
subdivision of renal pelvis
177
minor calyces
subdivisions of major calyces into with renal papillae discharge
178
bladder
stores urine
| -discharge urine to urethra
179
urethra
conveys urine from the bladder for excretion
180
kidneys
produce urine
| -divided into outer cortex and inner medulla
181
3 basic functions of kidneys
1. excrete waste products of food metabolism (CO2 and H2O, urea and other acids)
2. regulate mineral and H2O balance
3. produces erythropoietin and renin
182
erythropoietin
specialized cells in the kidneys that regulate RBC production in bone marrow
183
renin
specialized cells in the kidneys that regulate blood pressure
184
nephron
basic structural and functional unit of the kidney
| -made of glomerulus and renal tubule
185
how many nephrons in one kidney?
about 1 million
186
glomerulus
tuft of capillaries that filters the urine
187
mesangial cells
phagocytic cells that hold the capillary tuft together and regulate the diameter of capillaries which affects filtration rate
188
renal tubule
reabsorbs most of filtrate, secretes unwanted components into tubular fluid, regulates H2O balance
189
proximal end of renal tubule is called..
Bowman's capsule
190
distal end of renal tubule is called...
Bundle of His-collecting tubules that the renal tubule empties into
191
3 requirements for normal renal function
1. free flow of blood through glomerular capillaries
2. normally functioning glomerular filter
3. normal outflow of urine
192
angiotensin II
vasoconstrictor-raises blood pressure by causing peripheral arterioles to constrict
- higher blood pressure, increased fluid in vascular system
- stimulates aldosterone secretion from adrenal cortex which increases absorption of water by kidneys
193
normal kidney development
- kidneys arise from mesoderm, develop in pelvis, ascend to position
- bladder derived from lower end of intestinal tract
- excretory ducts develop from buds that extend from bladder into developing kidneys
194
renal agenesis
failure of one of both kidneys to develop
- bilateral: cannot live; rare
- unilateral: common, other kidney enlarges to compensate
195
duplications of urinary tract
complete duplication: formation of extra ureter and renal pelvis
incomplete duplication: only upper part of excretory system duplicates
196
malposition
one or both kidneys, associated with:
- kindey fusion
- horseshoe kidney
- fusion of upper pole of kidneys
197
glomerulonephritis
inflammation of glomeruli caused by antigen-antibody reaction within glomerulus
- failure to remove excess fluid, electrolytes, and waste from bloodstream
- primary: occurs on its own
- secondary: as a result of another disease
198
signs and symptoms of glomerulonephritis
- pink or cola colored urine from hematuria (RBC in urine)
- foamy urine from proteinuria
- hypertension
- edema in face, hands, feet, and abdomen
- fatigue from anemia or kidney failure
199
what tests diagnose glomerulonephritis?
urinalysis, blood test (levels of waste in blood), imaging tests, kidney biopsy (determine cause of swelling)
200
dialysis
artificial filtration when kidneys begin to fail
| -peritoneal dialysis and extracorporeal dialysis
201
peritoneal dialysis
-exchange of fluids across abdomen, can be done at home
202
extracorporeal dialysis
filtration of waste products, must be done in a clinic attached to a machine up to a few times per week
203
nephrotic syndrome
marked loss of protein in the urine-results from other diseases such as diabetes, lupus, other kidney diseases
- excretion of protein > protein production
- causes edema and ascites (fluid buildup in peritoneal cavity, causing abdominal swelling)
204
prognosis of nephrotic syndrome in children vs. adults
children-minimal glomerular change, complete recovery
| adults-manifestation of severe progressive renal disease
205
arteriolar nephrosclerosis
complication of severe hypertension where renal arterioles thicken from carrying blood at a high pressure
-glomeruli and tubules degenerate, causing narrowing (reduced filtration, kidneys shrink, death from renal insufficiency)
206
diabetic nephropathy
complication of long-standing diabetes
- thickening of glomerular basement membranes
- progressive impairment of renal function
- can lead to nephrotic syndrome
- can lead to renal failure, no treatment to slow progression
207
gout-associated nephropathy
-elevated blood uric acid levels lead to increased uric acid, may collect in Henle's loop and collecting tubules, causing tubular obstruction
208
manifestation of gout-associated nephropathy
impaired renal function, which can lead to renal failure
209
urinary tract infections
very common, can be acute or chronic
| -mostly caused by gram negative bacteria that contaminate perianal and genital areas and ascend the urethra
210
predisposing factors to UTI
- condition that impairs free urine drainage
- stagnation of urine, favors bacteria
- catheter or instruments into the bladder
- kidney stones injuring mucous, allowing bacteria to invade
211
cystitis
affects the bladder, and more common in women because the urethra is shorter, and elderly men because enlarged prostate interferes with bladder emptying
212
manifestations of cystitis
- burning pain on urination
- desire to urinate frequently
- urine has bacteria and leukocytes
- responds well to antibiotics, but can spread upward into renal pelvis and kidneys if not treated
213
pyelonephritis
involvement of upper urinary tract from an ascending bladder infection, or an infection being carried to the kidneys from the bloodstream
214
clinical manifestations of pyelonephritis
- localized pain and tenderness over affected kidney
- responds well to antibiotics
- some cases become chronic and lead to kidney failure
215
vesicoureteral reflux
urine back flows into the ureter during urination
| -predisposes to UTI and pyelonephritis
216
urinary calculi
stones that form anywhere in the urinary tract
217
predisposing factors to urinary calculi
- high concentration of salta in urine
- UTIs reduce solubility of salts, so more UTIs predisposes to calculi
- urinary tract obstruction: causes stagnation, promoting infection
218
staghorn calculus
urinary stones that increase in size to form large branching structures that adopt to the shape of the renal pelvis and calyces
219
renal colic
type of pain caused by small kidney stones that pass through the ureters-stones can also become impacted and need removal
220
treatment of urinary calculi
cystoscopy-removes stones lodged in distal ureter
| shock wave lithotripsy-breaks up stones in proximal ureter to be excreted
221
urinary obstruction leads to what
progressive dilation of urinary tract, causing atrophy of kidneys, can cause stone formation or infection
222
foreign bodies in urinary tract
- usually inserted by the patient
- can injure the bladder
- predisposes to infection
- removed by cystoscopy unless necessary to surgically open the bladder
223
single renal cyst
not associated with impaired renal function, common
224
multiple renal cysts
most common cause is congenital polycystic kidney disease, where the cysts enlarge and destroy renal tissue leading to early onset of renal failure (middle age)
225
renal tumors
cortical tumor, transitional cell tumor
226
cortical tumor
arise from epithelium of renal tubules
- adenomas usually small and asymptomatic
- carcinomas are more common
- hematuria is often the first manifestation, metastasizes to the bloodstream
227
transitional cell tumor
arises from transitional epithelium lining urinary tract
- hematuria is usually first manifestation
- low malignancy, good prognosis
- from bladder epithelium
228
nephroblastoma (Wilms tumor)
rare, highly malignant, affects infants and children
- diagnosed by urinalysis, x ray and ultrasound, renal biopsy
- treated by nephrectomy, chemo, radiation
229
renal failure (uremia)
retention of excessive byproducts of protein metabolism
| -acute or chronic
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acute renal failure
- caused by tubular necrosis from impaired blood flow to kidneys, or effects of toxic drugs
- renal function usually returns
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chronic renal failure
progressive, chronic kidney disease; 50% from chronic glomerulonephritis
-also from diabetic nephropathy, nephrosclerosis
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manifestations of renal failure
- weakness, loss of appetite, vomiting
- anemia
- toxic manifestations from retained waste products
- edema
- hypertension
233
treatment of renal failure
hemodialysis (peritoneal and extracorporeal) and treating the hypertension
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renal transplantation
kidney must be from close relative donor or cadaver, and must have as similar HLA antigens as possible
- identical twins only have identical HLA antigens
- immune defense will respond to foreign antigens and attempt to reject the kidney unless suppressed by drugs
- 90% of transplanted kidneys survive for 5 years
235
duct system to transport sperm from testes to urethra
- starts at epididymis
- continues as vas deferens
- extends upward in spermatic cords
- enter prosthetic urethra as ejaculatory ducts
- urethra divided into long penile urethra and short prostatic urethra
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prostate
spherical gland that surrounds urethra just below bladder base
-secretes fluid with high concentration of an enzyme, discharged into urethra during ejaculation
237
seminal fluid
secretions from seminal vesicles mixed with prostatic secretions
238
prostate has inner group and outer group of glands
inner glands: surround urethra, give rise to benign hyperplasia
outer glands: bulk of prostatic glandular tissue, give rise to prostatic carcinoma
239
benign prostatic hyperplasia
- enlargement of prostate glands, common in elderly men
- involves inner group of glands
- obstructs outflow of urine
- only significant if it obstructs neck of bladder leading to incomplete emptying or causes complete tract obstruction
240
complications of benign prostatic hyperplasia
cystitis (inflammation of bladder), pyelonephritis (inflammation of kidneys and pelvis), calculi formation, hydronephrosis (distention (enlargement) of renal pelvis with urine due to obstruction)
241
gold standard of treatment of benign prostatic hyperplasia
transurethral resection-part of the prostate is removed through the urethra with an instrument
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prostatitis
inflammation of the prostate
- acute: acute inflammation from spread of infection from bladder or urethra
- chronic: mild inflammation, common, and causes few symptoms
243
gonorrhea
common STDs, inflammation can spread to urethra and rectal mucosa. obstruction of vasa may block sperm transport and cause sterility
244
nongonococcal urethritis
caused by chlamydia, causing acute urethritis, very similar to gonorrhea
245
carcinoma of the prostate
originates in outer group of prostate glands
- common in elderly men, can be asymptomatic early on
- urinary obstruction from narrowed bladder neck
- infiltration of surrounding tissues
- spreads to bones of spine and pelvis
- slow growing, may take 10 years before it metastasizes or obstructs bladder
246
acid phosphatase
substance secreted by normal prostatic cells and tumor cells that leaks into the bloodstream
-high levels of this substance detected in prostate cancer
247
prostate-specific antigen PSA
secreted by prostatic cells, not specific to prostate cancer but also elevated in prostatic hyperplasia
248
diagnosis of prostate cancer
digital rectal exam, PSA or acid phosphatase test, biopsy, ultrasound
249
treatment of prostate cancer
radical prostatectomy and radiation, removal of testes if metastasizing has occurred
250
radical prostatectomy
removal of small localized tumor, but can cause erectile dysfunction due to disruption of nerve supply to the penis
251
cryptorchidism
testis does not descend normally into the scrotum
- usually retained in the abdominal cavity or inguinal canal
- germ cells are destroyed at normal body temperature, which is higher in the abdomen
- testis must be surgically replaced in scrotum
252
how long should it take testes to descend in newborns?
within 6 months after birth
| -if not occurred by 1 year, should be surgically brought into the scrotum
253
testicular torsion
abnormally attached testis, leading to twisting of spermatic cord
- cuts off blood supply and leads to infarction unless promptly untwisted
- surgically untwisting and anchoring of testis
254
hydrocele
excess fluid accumulates in tunica vaginalis (area behind testis), treated by aspiration (draining) or resection (removal)
255
varicocele
varicose veins in spermatic cord, usually involving the left side of the scrotum
-can impair fertility, and treatment only required if it causes discomfort or impairs fertility
256
3 bodies of vascular erectile tissue in penis
two lateral bodies: corpora cavernosa
midline body: corpora spongiosum that surrounds urethra
-all surrounded by thick fibrous connective tissue capsule
257
erectile dysfunction
inability to achieve and maintain an erection, common and frequency increases with age
258
causes of erectile dysfunction
- low testosterone
- damage to nerves supplying penis
- impaired blood supply to penis
- stress, emotional factors
- certain BP drugs
259
how an erection occurs
penile arteries normally constricted
- sexual arousal causes nitric oxide release, which causes relaxation of smooth muscle walls that allows penile arteries to dilate
- pressure of blood in cavernous bodies must be high to close draining veins
- blood must flow into the penis faster than it drains out
260
carcinoma of testis
cancer of testis, treated by removal of testicle and associated structures and chemo
261
seminoma
malignant neoplasm of semen-producing epithelium
262
malignant teratoma
composed of several types of malignant tissues
263
choriocarcinoma
arises from trophoblastic tissues in the uterus
264
carcinoma of the penis
- rare in circumcised males
- secretions accumulating under foreskin may be carcinogenic
- treatment: partial/complete amputation of penis and removal of inguinal lymph nodes
