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Kydd - Pathophysiology 2 > Genitourinary Disorders - Female > Flashcards

Genitourinary Disorders - Female Flashcards

1
Q

What are the 5 disorders covered under female genitourinary disorders?

A

Pelvic Inflammatory Disease (PID), Breast Cancer, Ovarian Cancer, Uterine (Endometrial) Cancer, and Cervical Cancer.

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2
Q

What is PID?

A

Pelvic Inflammatory Disease is inflammation of the reproduction tract beyond the cervix. It included inflammation of the uterus, tubes, and ovaries.

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3
Q

What is the term to describe inflammation of the uterus?

A

Endometritis

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4
Q

What is the term to describe inflammation of the tubes?

A

Salpingitis

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5
Q

What is the term to describe inflammation of the ovary?

A

Oophoritis

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6
Q

What is the etiology of PID?

A

PID is a bacterial infection, known as polymicrobial, because it can be caused by several types of microorganisms. Example of the microbes that can cause PID are chlamydia, gonococci, staphylococci, streptococci. Pelvie Inflammatory Disease can be caused by an untreated bacteria infection. 10% of cases are gonorrhea, and 20% chlamydia. Most cases are typically sexually transmitted.

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7
Q

What is a pyogenic bacteria?

A

A pyogenic bacteria is one which produces pus.

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8
Q

What is the pathophysiology of Pelvic Inflammatory Disease?

A

Microbes enter the cervix when dilated. The endometrium provides nutrient material for the bacterium as it progesses upward towards the fallopian tubes. There is rapid proliferation as the endometrium sloughs. The infection ascends from the uterus, into tubes, and then ovaries.

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9
Q

What is a common complication of PID?

A

Pelvic Abscess. The infection can move into the body cavity and can lead to peritonitis.

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10
Q

Why is E. Coli often a cause of PID and UTI infections?

A

Due to the anatomical proximity of the anus to the vagina.

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11
Q

What is Parametritis?

A

Parametritis is an inflammation of the parametrium (connective tisue adjacent to the uterus). It is an inflammation of the ligaments around the uterus.

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12
Q

What are the manifestations of Pelvic Inflammatory Disease?

A

Lower abdominal pain, Heavy purulent vaginal discharge, Dyspareunia, Adnexal tenderness, Fever, and Leukocytosis.

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13
Q

What three manifestations of PID are indicative of an infection in the reproductive tract?

A

Heavy purulent vaginal discharge, Fever, and Adnexal tenderness.

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14
Q

What is adnexal tenderness?

A

Ad = toward, Nexal = uterus. “Tenderness palpating around the uterus.

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15
Q

When is vaginal bleeding abnormal in a post-menopausal patient?

A

Any vaginal bleeding is abnormal in a post-mentrual patient.

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16
Q

When is vaginal bleeding abnormal in a pre-menstrual patient?

A

Any bleeding outside of normal mensies is abnormal in a pre-menstrual patient.

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17
Q

When is vaginal bleeding abnormal in a woman during menstration?

A

When the bleeding is heavy, or prolonged.

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18
Q

What is a very serious complication of PID if not treated. This can be particularly devestating for the patient.

A

The patient can become infertile if PID is not quickly treated. Infertility can arise because all parts of the reproductive tract are affected and can become scarred. The ovary releases eggs, the tub is required for fertilization, and the uterus is needed for adhesion.

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19
Q

How is Pelvic Inflammatory Disease diagnosed?

A

Presentation (purulent discharge, adnexal tenderness, fever), Increased Eurthrocyte Sedimentary Rate, Increased CRP, Laparoscopy.

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20
Q

What is the purpose of laparoscopy?

A

Laparoscopy looks for signs of scarring in th reproductive tract.

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21
Q

What is Eyrthrocyte Sedimentary Rate?

A

ESR is a test which measures the rate in which red blood cells sediment in a period of one hour. It is a common hematology test that measures non-specific inflammation.

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22
Q

What is the treatment for Pelvic Inflammatory Disease?

A

Multiple broad spectrum Abx (90% success rate). Evaluate and treat partner. Surgery may be required for abcesses or for scar tissue removal.

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23
Q

What is the most common form of cancer in women?

A

Breast cancer.

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24
Q

Is breast cancer a major cause of cancer deaths?

A

Yes.

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25
Q

Is breast cancer restricted to women?

A

No. However, it is extremely rare in men.

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26
Q

What are the risks and etiology surrounding breast cancer?

A

Increased age, Genetic predisposition, Hereditary, Hormonal factors

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27
Q

What percentage of cases are hereditary? Which genes and chromosomes are affected?

A

5-10% of breast cancer is due to a hereditary etiology. Breast Cancer Gene 1 on Chromosome 17 & Breast Cancer Gene 2 on Chromosome 13 are both implicated.

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28
Q

What are the four hormonal factors which increase the risk of breast cancer?

A

Estrogen for menopause, Early menarche, Late menopause, Nulliparity.

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29
Q

Why is etrogen for menopause a risk factor of breat cancer?

A

Estrogen is given for hot flashes and menopause. However, exogenous estrogen (hormone therapy) is shown to increase the risk of cancer particularly if the therapy last longer than 2 years.

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30
Q

What does nulliparity mean? Why is it implicated in increase risk of breast cancer?

A

Nulliparity is when a woman has no offspring. It is implicated because those that have not had children are at increased risk due to no break from the regular menstrual cycle.

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31
Q

What is menarche? Why is early menarche, and late menopause, both risk factors in breast cancer?

A

Menarche is the first menstrural period. Early menarche, and late menopause are risk factors because they both conversly mean that the woman has had prolonged exposure of estrogen.

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32
Q

Where in the breast is the most common site of breast cancer?

A

The upper outer quadrant and the tail of spence.

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33
Q

What is ductal carcinoma in situ?

A

Ductal carcinoma in situ is an intraductal, non-invasive form of breast cancer which is made up of the proliferation of malignant cells inside the milk ducts without invasion into the surrounding tissue. It is considered breast cancer stage 0.

34
Q

What is infiltrating ductal carcinoma?

A

Infiltrating ductal carcinoma is the most common form of breat cancer, making up 75% of all types. The tumor arises from the duct system and invades into the surrounding tissues. It is a solid, irregular mass. It will metastisize proximally to the axillary lymph nodes, and distally to the liver, bones and brain.

35
Q

What are the manifestations of breat cancer?

A

The presence of a unilateral, fixed, irregular, painless mass usually found in the upper outter quadrant. Late stage breast cancer can also present with discharge, retraction and edema in the breast.

36
Q

How is breast cancer diagnosis made?

A

Mammography, Biopsy, E&P receptors (in biopsy), Tumor markers (CEA), Most masses are detected by the patient.

37
Q

What is a CEA tumor marker?

A

Carcinoembryonic Antigen. It is a glycoprotein found in the blood and a non-exclusive marker for breast cancer. It is involved in cell adhesion and an increased concentration is evidence there may be cancer in the patient.

38
Q

What are the E & P Receptors in relation to breast cancer?

A

They are surface receptors which measure the amount and quality of estrogen and progesterone. The test will show an increase in numbers because tumore rely on hormones to facilitate growth.

39
Q

What is unfortunate in regards to the patient finding and palpating a mass in their breast?

A

It is unfortunate because if cancer is self-detected in means that it is not an early detection and the cancer may have already metastisized. Mammography is a better detection method because it can detect earlier.

40
Q

What is the triade of treatment for breast cancer?

A

Surgery, Radiation, Cheotherapy. Plus hormone therapy because breast cancer is reliant on hormones.

41
Q

When will hormone therapy be initiated? What are some hormones that will be administered?

A

If and when estrogen and progesterone receptors are elevated, hormone therapy will commence. Different treament that maybe given is: Tomoxifen, which is a nonsteroidal antiEstrogen. Androgens, which have the opposite role of estrogen and counteract it. Progestins. Estrogens.

42
Q

What is the rational in giving estrogen hormone therapy, when estrogen is implicated in breast cancer?

A

This is known as “down regulating”. By increaseing the amount and dose of estrogen, more damage will occur at the site of the receptors, there-by reducing the cell’s sensitivity to estrogen.

43
Q

What is a lumpectomy?

A

Removal of the mass and surround tissue.

44
Q

What is a quadrantectomy?

A

Removal of a quadrant of the breast.

45
Q

What is a mastectomy? What is a radical mastectomy?

A

Removal of the entire breast. A radical mastectomy includes removal of the glands as well.

46
Q

What anatomoical structures will be radiated in breat cancer treatment?

A

Limited to breast and anxillary lymph nodes.

47
Q

If lymph nodes are involved, is prognosis better or worse?

A

Worse prognosis.

48
Q

What is Ovarian Cancer?

A

Ovarian cancer is the most lethal female reporductive cancer. It is very difficult to diagnose. 75% of cases have already metastised at the time of detection.

49
Q

What is the etiology and risk factors associated with ovarian cancer?

A

Aging (mostly between 65 & 84), Autosomal dominant, Family history, Other factors (nulliparity, infertility, dysmenorrhea).

50
Q

Why is ageing an important risk factor in ovarian cancer?

A

Culmulative expose to carcinogens as the longer you live, the more expose one has undergone. It is a direct relation to ovulatory age and having to do with the period of exposre to sex hormones from puberty till menopause.

51
Q

What is the pathophysiology of ovarian cancer?

A

There are many diverse types of ovarian cancer. However, 90% is of epithelial origin. It can also occur in germ cells or stromal tumors. Growth is silent and spread through extension to the tubes, uterus, ligaments to the other ovary. Seeding can cause the cancer to spread to the bowel surfaces, liver and other abdominal organs. Pressure can also be place upon adjoining abdominal structures and cause distention, particularly if the growth is large. Metastsis can occur via lymph and blood.

52
Q

What are the manifestations of ovarian cancer?

A

Early manifestations are difficult to detect because they are typically non-specific GI disturbances. Abdominal distention, Pain, Urinary and bowel obstruction. Ascities with dyspnea, Pelvic Mass.

53
Q

What is the issue with most of the manifestations of ovarian cancer?

A

All are associated with other diseases and disorders. They also all lead to an eventual pelvic mass, which is typically the first finding (unfortunately late).

54
Q

What is treatment for Ovarian Cancer?

A

Treatment is determined by exploratory surgery. Aggressive treatment will excise the uterus, tubes, ovaries, and the omentum. Chemotherapy will be administered to intermediate and advanced disease. A laparotomy post surgery 6-24 months will be conducted to determine further treatment. Some patients fully recover.

55
Q

What and were does uterine (Endometrial) cancer occur? What age bracket does it typically affect?

A

Endometrial cancer is cancer that arises from the endometrium, which is the lining of the uterus or womb. It is the most common pelvic cancer in women. Malignancy peaks in those aged 55-65 years old.

56
Q

What is the etiology of endometrial cancer?

A

Uterine cancer is mostly related to high estrogen levels. However, some is not related. Family history also plays a part.

57
Q

What are some risks which might contribute to uterine cancer?

A

Obesity, Age, Pelvic Radiations, Diabetes

58
Q

Why is obesity an elevated risk for endometrial cancer?

A

Obesity carries a higher risk because of the associated increase in estrogen production and storage. Adipose tissue both stores estrogen and can synthesize it.

59
Q

What type of cancer is endometrial cancer usually? What percentage of cases is made of up this type?

A

Usually adenocarcinoma, it makes up about 85% of uterine cancers.

60
Q

What is the pathophysiology of uterine cancer?

A

Excessive estrogen leads to endometrial hyperplasia. There are two types of uterine cancer; Type 1, 90% and Type 2, 10%. Progession of uterine cancer is slow. It spreads to the uterus and vagina. Late stage might metastsis via lymph and blood. There is no reliable screening for uterine cancer.

61
Q

What are some characteristics of Type 1 Uterine CA?

A

Type one makes up about 90% of uterine CA’s. It is estrogen sensitive (dependent) causing endometrial hyperplasia. It has a better prognosis of the two.

62
Q

What are some characteristics of Type 2 Uterine CA?

A

Type two makes up about 10% of uterine CA’s. It is non-estrogen dependant. It is linked to endometrial atrophy. It has a poor prognosis.

63
Q

What are the manifestations of Uterine CA?

A

Painless bleeding, Other manifestations related to invasion and metastasis.

64
Q

What is the treatment for uterine CA?

A

Based on the stage of cancer. Typically surgery with radiation.

65
Q

What is cervical cancer?

A

Cervical cancer is cancer found in the cervix.

66
Q

What is the etiology and risks associated with cervcal cancer?

A

HPV infection. Early age sex, Multiple sexual partners, Smoking, Hx of STDs.

67
Q

What is the cure rate for cervical cancer is caught before metastasis?

A

100%

68
Q

What is HPV? What does it cause? How many strains are there? How many strains are sexually transmitted?

A

Human papillomavirus is a sexually transmitted disease. It causes cervical cancer. There are roughly 100 stains of HPV with approximately 40 which are sexually transmitted.

69
Q

How many strains of HPV are of particular interest? What are they and what do they cause?

A

There are four strains of HPV which are of particular interest. Strains 6 and 11 are implicated in 90% of genital warts. Strains 16 and 18 are implicated in 70% of cervical cancers.

70
Q

What is the pathophysiology of cervical cancer?

A

Cervical cancer is mostly of sqaumous cell origin. There is initial dysplagia which forms a pre-cancerous lesion. Carcinoma then forms in the epitheal layer which further invade into deeper layers. There is typically several years between the preCA and invasive stages. Cervical cancer progesses through different levels eventually leading to metastsis via lymphatics.

71
Q

What is the CIN scale? (Name and Levels)

A

Cervical Intraepithelial Neoplasia (CIN levels). It is a measurement of the depth in the epitheial layers.
CIN1: Mild dysplasia.
CIN2: Moderate dsyplasia
CIN3: Severe dysplasia & carcinoma in situ
It is important to remember that all CIN levels are CA and just denote the level of change of depth, do not confuse with staging of CA.

72
Q

How is cervical cancer diagnosed?

A

PAP and colposcopy.

73
Q

What is a PAP?

A

A Papanicolaou test is a universal method of cervical screening used to detect potentially pre-cancerous and cancerous processes in the cervix. The test is named after Georgios Papanikolaou. During the procedure exfoliating cells are collected and then cultured and stained. The slide is then investigated for normal squamous cells, or if the cells have undergone any changes.

74
Q

What is a colposcopy?

A

A colposcopy is a medical diagnosti procedure to examine and illuminated, magnified view of the cervix and tissues of the vagina and vulva.

75
Q

What are the manifestations of cervical cancer?

A

Vaginal discharge and bleeding, Metrorrhagia, Increased frequency of menses, Pain.

76
Q

Which of the manifestations occur late in the disease course?

A

Pain.

77
Q

What is the treatment for cervical cancer?

A

Early - excision, Invasive - radiation and surgery, Cyrosurgery, Conization, Laser, Radical hysterectomy

78
Q

What is cyrosurgery?

A

Cryosurgery is the use of extreme cold to destroy abnormal or diseased tissue.

79
Q

What is a radical hysterectomy?

A

A hysterectomy is the surgical removal of the uterus. A radical hysterectomy also includes the removal of the cervix, ovaries, fallopian tubes and other surroundng structures.

80
Q

What is coniztion?

A

Conization is a cone biopsy. It is an extensive form of a cervical biossy. It is where a cone-shaped wedge of tissue is removed from the cervix and examined under a microscope. It removes abnormal tissue that is high in the cervical canal.

Kydd - Pathophysiology 2 (22 decks)

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