Repro Flashcards
Male reproductive system embryo
mesoderm
Female reproductive system embryo
mesoderm, week 7 and 8
What structures develop from surface ectoderm?
epidermis, adenohypophysos, lens of eye, epithelial linings of oral cavity, sensory organs of ear, olfactory epithelium, anal canal below the pectinate line, parotid, sweat, mammary gland
Breast embryo
first week of development from cytotrophoblast
What structures develop from surface ectoderm?
epidermis, adenohypophysos, lens of eye, epithelial linings of oral cavity, sensory organs of ear, olfactory epithelium, anal canal below the pectinate line, parotid, sweat, mammary gland
What structures develop from neural tube (ectoderm)?
brain, neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland, retina, spinal cord
What structures develop from neural crest cells (ectoderm)?
ELMO PASSES
Enterochromaffin cells, leptomeninges (arachnoid, pia), melanocytes, odontoblasts, PNS ganglia (dorsal root, cranial, and autonomic), adrenal medulla, Schwann cells, Spiral membrane (aorticopulmonary septum), Endocardial cushions, Skull bone
What structures develop from mesoderm?
muscle, bone, connective tissue, peritoneum, pericardium, pleura, spleen, cardiovascular structures, lymphatics, blood, wall of gut tube, proximal vagina, kidneys, adrenal cortex, dermis, testes, ovaries, microglia, dura mater, tracheal cartilage
What structure develop from endoderm?
gut tube epithelium, most of urethra and distal vagina, lungs, liver, gallbladder, pancreas, eustachian tube, thymus, parathyroid, thyroid follicular and parafollicular cells
Male reproductive system gross anatomy
Internal: ductus deferens, seminal vesicle, ejaculatory duct, prostate
External: testes, glans penis,
Female reproductive system gross anatomy
External: labia, clitoris, vaginal opening
Internal: ovaries, uterine tubes, uterus, broad ligament, and vagina
Mammary gland structure
lobes (12-20) -> lobules -> alveoli -> mammary secretory epithelial cells
Lactiferous ducts: connect all lobes, open into areola to drain milk
Stroma: adipose + fibrous connective tissue (turns into suspensory ligaments of Cooper attach mammary glands to dermis) situated necks to lobes
Breast Structure microanatomy
lobes (12-20) -> lobules -> alveoli -> mammary secretory epithelial cells
Lactiferous ducts: connect all lobes, open into areola to drain milk
Stroma: adipose + fibrous connective tissue (turns into suspensory ligaments of Cooper attach mammary glands to dermis) situated necks to lobes
Areola structure
4th intercostal space lateral to midclavicular line
sebaceous glands
get bigger in pregnancy
secrete oily substances
Nipple
conical in center or areola
no fat, hair, or sweat glands
lactiferous ducts open right into it
made up of circularly arranged smooth muscle fibers
Breast blood supply and innervation
A: medial mammary branches, lateral thoracic, thoraocarmial, posterior intercostal
V: axillary and internal thoracic
N: anterior and lateral cutaneous branches of 4-6th intercostal
Ovaries
lateral pelvic wall attached by mesovarium and suspensory ligament
produce oocytes, estrogen, and progesterone
Blood: ovarian and ascending branch of uterine
N: ovarian plexus and uterovaginal plexus
Fallopian tube structure, blood, nerve
infundibulum -> ampulla -> isthmus
Blood: ovarian and ascending branch of uterine
N: ovarian plexus and uterovaginal plexus
Uterus
body, cervix, external os, internal os, uterine cavity, cervical canal
bw bladder and rectum
B: Uterine arteries
N: Inferior hypogastric plexus
Gametogenesis
- condensation of chromatin strand into visible pairs of chromosomes, cells are duplicated
- maternal and paternal copy of the same chromosome finds each other inside the nucleus
- attach to each other near the telomere region, cluster to one side of nucleus, genetic material is exchanged
- recombination of the four chromatids
- dissolution of the synaptonemal complexes
- remain dormant until puberty
- spindle microtubules attach to homologous pairs of chromosomes and align them along the equator of the spindles
- separated towards opposite poles
- Cytoplasmic division in females occurs asymmetrically and produces a small polar body and a much larger primary oocyte. In males, the cell division is incomplete and spermatocytes retain a cytoplasmic bridge.
- sister chromatids are aligned with the centromeres, they are separated along the spindle fibers to the opposite poles of the cell, four genetically unique haploid cells are produced
Implantation
oocyte is fertilized by sperm, cells divide and turn into blastocyst -> travels down fallopian tube and floats around uterus -> implants
low ratio of estrogen to progesterone allow for this
Embryogenesis
blastocyst get implanted day 5 -> divide into trophoblast and blastocyst -> trophoblast secrete hCG on day 8 which tells corpus luteum to continue to make estrogen and progesterone-> corpus leutm degrades at 13 weeks and syncytiotrophoblast make progesterone, estriol, human placental lactogen -> 2 weeks blastocyst start to organize into two-layered disc of embryonic cells (epiblast and hypoblast outer layer), amniotic cavity opens between it and trophoblast, hypoblast form yolk sac -> 3 weeks cells divide into 3 layers and become multipotent via gastrulation and forming an privative streak -> create endoderm, mesoderm, ectoderm
testes
Lobules, septa, mediastinum of testis, seminiferous tubules (convoluted/straight), rete testis, efferent ductules.
tunica albuginea → lobes → seminiferous tubules and Leydig cells → germinal epithelium → Sertoli cells
Tunica vaginalis
N: Testicular plexus
B: Testicular artery
prostate
true internal connective tissue capsule -> a false external capsule-> peripheral and anterior zone -> central zone -> transitional zone
B: internal pudendal artery, inferior vesical artery, middle rectal arteries.
N: pelvic splanchnic nerves
glans penis
Root (bulb of penis, crura, ischiocavernosus muscles, bulbospongiosus muscle)
Body (distal parts of corpora cavernosa and corpus spongiosum)
Glans (neck and corona of glans)
Tunica albuginea, deep fascia of penis (Buck’s fascia) and superficial fascia/subcutaneous tissue of penis (Colles’ fascia)
glans penis
Root (bulb of penis, crura, ischiocavernosus muscles, bulbospongiosus muscle)
Body (distal parts of corpora cavernosa and corpus spongiosum)
Glans (neck and corona of glans)
Tunica albuginea, deep fascia of penis (Buck’s fascia) and superficial fascia/subcutaneous tissue of penis (Colles’ fascia)
B: internal pudendal artery
N: cavernosal nerves
epididymis
Formed by efferent ductules from testis → join together in head and body → become single duct in tail → continues as ductus deferens
B: testicular arteries
N: testicular plexus
Ectocervix microanatomy
stratified squamous epithelium, non-keratinized
Transformation zone microanatomy
squamocolumnar junction
Endocervix microanatomy
simple columnar epithelium
Uterus cell layer type
simple columnar epithelium w/ long tubular glands in proliferative phase and coiled glands in secretory phase
Fallopian tube microanatomy
simple columnar epithelium, ciliated
Ovary outer surface microanatomy
simple cuboidal epithelium, germinal epithelium covering surface of ovary
What is the pathway of sperm during ejaculation?
SEVEn UP seminiferous tubules epididymis vas deferens ejaculatory ducts
urethra
penis
Ovary microanatomy
thin capsule of simple cuboidal epithelium
tunica albuginea dense layer of connective tissue
cortex: oocytes (round cell, large nucleus surrounded by zona pellucida (glycoprotein) and follicular cells) and ovarian follicles (single layer of cuboidal granulosa cells, theca cells), highly cellular connective tissue
medulla: losse fibroelastic connective tisse, blood vessels, lymphatic vessels
Leydig cells
interstitium, endocrine cells, seminiferous tubules
F: secrete testosterone in presence of LH, testosterone production unaffected by temp
Menstrual cycle
first 10 days theca cells bind LH and granulosa cells bind FSH → androstenedione and aromatase → aromatase converts androstenedione to 17beta-estradiol → day 10-14 granulosa cells develop LH receptors → follicles grow and ↑estrogen → negative feedback on anterior pituitary → some follicles will stop growing and die off → follicle w/ most FSH receptors becomes dominant → secretes estrogen → pituitary is more responsive to GnRH → ↑ estrogen leads to ↑↑↑FSH ↑↑↑LH → release of oocyte → endometrial lining is shed last for 5 days → ↑ estrogen during day 11-15 thickens endometrium, growth of endometrial glands, spiral arteries grow, and change cervical mucus to allow for sperm → corpus luteum is formed from dominant follicle → theca cell secrete androstenedione →granulosa cells convert it to estrogen, secrete P450scc due to ↓LH and inhibin → ↑ progesterone & inhibin → ↓LH ↓FSH ↓estrogen → endometrium receptive to implantation, spiral ateries longer, uterine gland more mucus → day 15 corpus luteum turn into corpus albicans → ↓estrogen & progesterone → spiral arteries collapse and functional layer sloughs off → mensuration
Spermiogenesis
seminiferous tubules
synthesis of BMP8B
spermatogonia (large round nuclei, round) →primary spermatocytes (large nuclei, big cytoplasm, clumps of chromatin) → secondary spermatocytes (divide quickly) → two haploid/early spermatids (small size, round nuclei)→ late spermatids z9small pointed nuclei) → spermatozoa
Oogenesis
outer layer of ovary
oogonium → mitosis → primary oocyte → at puberty LH/FSH cause development of a number of follicles → primary oocyte finishing first meiotic division → secondary oocyte → at ovulation it is released to uterus
Ovulation
14 days before the next mensural cycle
Physiological changes in cardio in pregnancy
↓SVR and ↑ blood volume → ↑SV→ ↑CO→↑ placental prefusion
hemodilution → ↓oncotic pressure → peripheral edema
Estrogen composition
ovaries, adrenal cortex, placenta, and fat cells
Physiological changes in GI in pregnancy
↓GI motility, ↓ LES tone, gallbladder stasis, constipation, GERD, gallstones
Estrogen regulation
FSH/LH, GnRH
Physiological changes in Respiratory system in pregnancy
respiratory center stimulation → chronic hyperventilation → mild respiratory alkalosis
Estrogen composition
ovaries, adrenal cortex, placenta, and fat cells
cholesterol reaches theca cells → cholesterol desmolase turns it into pregnenolone → 17-hydroxypregenolone → dehydroepiandrosterone → 3beta-hydroxysteroid dehydrogenase converts it into androstenedione → goes to theca cells → aromatase converts to 17beta-estradiol
Physiological changes in Renal in pregnancy
vasodilation → ↑renal plasma flow → ↑GFR→ ↓BUN and ↓creatinine
mild glucosuria, proteinuria, hydronephrosis, hydroureter, pyelonephritis
Progesterone composition/formation
cholesterol reaches theca cells → cholesterol desmolase turns it into pregnenolone → 3beta-hydroxysteroid dehydrogenase converts to progesterone
Estrogen transport
sex-hormone binding globulin
Progesterone composition
cholesterol reaches theca cells → cholesterol desmolase turns it into pregnenolone → 3beta-hydroxysteroid dehydrogenase converts to progesterone
cholesterol in granulosa cells → pregnenolone via P450scc → progesterone via 3beta-hydroxysteroid dehydrogenase
Progesterone transport
transcortin, albumin
Estrogen composition/synthesis
ovaries, adrenal cortex, placenta, and fat cells
cholesterol reaches theca cells → cholesterol desmolase turns it into pregnenolone → 17-hydroxypregenolone → dehydroepiandrosterone → 3beta-hydroxysteroid dehydrogenase converts it into androstenedione → goes to theca cells → aromatase converts to 17beta-estradiol
Estrogen function/effect
make ovarian follicles develop and secrete hormones, thicken endometrium and sprout progesterone receptors,
maturation of fallopian tubes, uterus, cervix, vagina, breast, widening of hips, fat on buttocks, hips & thighs, makes blood vessel walls flexible, sustain bone density, lower LDL, ↑osteoblasts, ↑ clotting factors, ↑steroid-binging protein, ↑ acidification and provides food source for lactobacilli
Estrogen regulation
FSH/LH, GnRH
Progesterone function/effect
maturation of fallopian tubes, uterus, cervix, vagina; skin elasticity, bone strength
Progesterone composition/synthesis
cholesterol reaches theca cells → cholesterol desmolase turns it into pregnenolone → 3beta-hydroxysteroid dehydrogenase converts to progesterone
cholesterol in granulosa cells → pregnenolone via P450scc → progesterone via 3beta-hydroxysteroid dehydrogenase
Progesterone transport
transcortin, albumin
Progesterone function/effect
maturation of fallopian tubes, uterus, cervix, vagina; skin elasticity, ↑lobular development ↓ milk production ↓endometrial growth, ↑endometrial secretion, mucosal secretion become thicken, ↑ total cholesterol, ↑LDL, ↑ Na excretion, ↑ internal temp, ↑ bone growth and strength
Progesterone regulation
FSH/LH, GnRH
Testosterone composition/synthesis
Leydig cells and some in adrenal cortex
cholesterol → dehydroepiandrosterone (DHEA) →androstenedione → testosterone via 17beta-hydroxysteroid dehydrogenase → dihydrotestosterone via 5 alpha-reductase has effects on cell
Testosterone function/effect
enlargement of penis & testes, increased libido, male pattern of hair growth, changes to larynx and vocal folds, growth spurt, closer of plate in puberty, broad shoulders, muscular arms and legs, erythropoiesis
Testosterone transport
Sex-hormone binding globulin, albumin
Testosterone regulation
GnRH, LH/FSH
Estrogen degradation
liver
estradiol → estrone → hydrocylation via CYP1A1 enzymes → 2-OHE2
CYP1B1→ 4-OHE2
CYP3A4→ 16a-OHE2
Progesterone degradation
liver
Testosterone degradation
metabolized to inactive metabolites in the liver, kidney, gut, muscle, and adipose tissue.
Amenorrhea def
absence of mentation in those w/ a uterus
primary: >15 hasn’t had menarche and has secondary sexual characteristic or >13 w/ no menarche or secondary sexual characteristics
secondary: stop having regular cycles for 3 month or 6 mon in those w/ irregular periods
Amenorrhea cause
turner syndrome, Mullerian agenesis, imperforate hymen, pregnancy, mesopause, breastfeeding, functional hypothalamic amenorrhea, hyperprolactinemia, PCOS, premature ovarian failure, Cushing syndrome, Hypo or Hyperthyroid
Amenorrhea RF
FH, eating disorder, over-exercising, genetics, obesity
Amenorrhea comp
hip and wrist fractures, cardiovascular disease,
Amenorrhea clinical
loss of period
Anovulation comp
Endometrial hyperplasia Insulin resistance or type 2 diabetes mellitus Cardiovascular disease Venous thromboembolism Electrolyte derangements Arrhythmias
Anovulation clinical
irregular periods, lack of periods, lighter or heavier mensural bleeding, infertility
Dysfunctional Uterine Bleeding def
uterine bleeding has changed w/ time and absent ovulation
Dysfunctional Uterine Bleeding cause
menopause, imbalance in the sex hormone
Dysfunctional Uterine Bleeding path
estrogen continually secreted→ never turns into follicle →progesterone isn’t produced → uterine lining keep growing annd gets sloughed off at irregular intervals →
Dysfunctional Uterine Bleeding comp
endometrial hyperplasia and cancer
Dysfunctional Uterine Bleeding clinical
painless uterine bleeding, Menstrual bleeding lasting more than 7 days, Menstrual bleeding lasting less than 2 days, Heavy menstrual bleeding, Bleeding or spotting between periods
Menopause/
Perimenopause def
entire year has passed since last menstrual period
Dysfunctional Uterine Bleeding path
estrogen continually secreted→ never turns into follicle →progesterone isn’t produced → uterine lining keep growing annd gets sloughed off at irregular intervals →
Menopause/
Perimenopause RF
female, old age,
Menopause/
Perimenopause comp
fracture, cardiovascular disease,
Menopause/
Perimenopause clinical
hot flashes, night sweats, trouble sleeping, vaginal dryness, dyspareunia, osteoporosis, high LDL
Ovarian Insufficiency/
Failure def
ovaries stop functioning normally before 40
Ovarian Insufficiency/
Failure cause
chromosomal abnormalities (Turner syndrome), BRCA1, fragile X syndrome, chemo/radiation, autoimmune
Ovarian Insufficiency/
Failure path
few or no follicles → started out w/ few or degraded quickly → can’t respond to LH/FSH
OR
dysfunctional follicles → can’t generate gonadotropins, don’t respond to LH/FSH, or can’t make hormone → can’t respond to LH/FSH
Ovarian Insufficiency/
Failure RF
FH, 35-40, folx w/ uterus, genetics
Ovarian Insufficiency/
Failure comp
cardiovascular disease, fractures
Ovarian Insufficiency/
Failure clinical
missed/infrequent periods, infertility/difficulty, hot flashes, night sweats, vaginal dryness, dyspareunia, osteoporosis, spontaneous pregnancy due to intermittent ovarian function
Balanitis def
Inflammation of the glans penis
Ovarian Insufficiency/
Failure path
few or no follicles → started out w/ few or degraded quickly → can’t respond to LH/FSH
OR
dysfunctional follicles → can’t generate gonadotropins, don’t respond to LH/FSH, or can’t make hormone → can’t respond to LH/FSH
Balanitis comp
May cause Infection (STIs, fungal.candida, viral), trauma, irritants
Balanitis cause
inadequate personal hygiene, Candida albicans, Group B and group A beta-hemolytic streptococci, Neisseria gonorrhea, Chlamydia species, chemicals, tetracycline, sulfonamide
Balanitis path
oor hygiene, a tight foreskin, and a buildup of smegma serve as a nidus for bacterial and fungal overgrowth which can lead to irritation and inflammation
Balanitis RF
Uncircumcised males, obesity, diabetes, nursing home, condom catheters, CHF, nephrosis, reactive arthritis, STI
Balanitis comp
May cause Infection (STIs, fungal.candida, viral), trauma, irritants
Balanitis clinical
Inflammation, soreness, itchiness, or irritation of the glans, A thick cheesy white discharge under the foreskin (smegma), smell, Tight foreskin cannot retract, Painful urination, Swollen glands near the penis, Sores
Cervicitis def
swelling or inflamed tissue of the end of the uterus (cervix)
Cervicitis cause
Neisseria gonorrhea, Chlamydia trachomatis, mechanical, and chemical irritants
Cervicitis RF
sexually active, don’t use condom
Cervicitis comp
pelvic inflammatory disease, abscess formation, chronic pain and infection, ectopic pregnancy, and infertility
Cervicitis clinical
purulent or mucopurulent vaginal discharge and intermenstrual or post-coital bleeding, dyspareunia
Cervicitis path
infectious or noninfectious agent sets up shop in the uterus → immune system recognize antigen → causes inflammation and destruction of the area
Endometriosis def
when endometrial cells grow outside of the uterus
Endometriosis path
endometrial cells travel to ovaries, fallopian tubes, uterine ligament via blood caring endometrial cells goes into fallopian tubes →implants or exist via opening in fallopian tube → immune system don’t responds to endometrial implants
Endometriosis RF
FH, never been pregnant, early menarche, late menopause
Endometriosis comp
adhesions, rupture, ovarian carcinomas
Endometriosis cause
retrograde mensuration theory, dysfunction w/ immune system, metaplastic theory, benign metastases theory, extrauterine stem cell theory
Endometriosis path
endometrial cells travel to ovaries, fallopian tubes, uterine ligament via blood caring endometrial cells goes into fallopian tubes →implants or exist via opening in fallopian tube→ immune system don’t responds to endometrial implants
Endometritis cause
Peptostreptococcus, Peptococcus, Bacteroides, Prevotella, Clostridium, groups A and B Streptococci, Enterococcus, Staphylococcus, Klebsiella pneumoniae, Proteus species, and Escherichia coli
Endometritis cause
Peptostreptococcus, groups B Streptococci, Ureaplasma urealyticum, Chlamydia trachomatis, Neisseria gonorrhoeae, tuberculosis
Endometritis RF
pregnancy, cesarean section, placental or fetal tissue not removed, hysteroscopy, IUD,
Endometritis comp
endomyometritis, peritonitis, salpingitis, oophoritis, Asherman’s syndrome (fibrous band, don’t respond to hormone, infertility, recurring pregnancy loss)
Endometritis cause
Peptostreptococcus, groups B Streptococci, Ureaplasma urealyticum, Chlamydia trachomatis, Neisseria gonorrhoeae, tuberculosis
Endometritis path
infectious cause get into the endometrium causing inflammation when they reach upper genital tract
childbirth mucus plug breaks allowing bacteria to enter
Endometritis RF
pregnancy, cesarean section, placental or fetal tissue not removed, hysteroscopy, IUD,
Orchitis cause
viral mumps infection, coxsackie B virus, E. coli
Orchitis path
mumps virus spreads to the testis → replicates and causes inflammation
Orchitis RF
Sexually active
Orchitis comp
atrophy, infertility, reactive hydrocele
Orchitis path
mumps virus spreads to the testis → replicates and causes inflammation
Pelvic Inflammatory Disease def
infection of upper female reproductive system
Pelvic Inflammatory Disease cause
Neisseria gonorrhoeae, Chlamydia trachomatis,
Pelvic Inflammatory Disease path
decreased mucus or inability to overcome bacteria w/ mucus, retrograde menstruation, sexual intercourse cause bacteria to get into upper tract → neutrophils, plasma cells, and lymphocytes → damage tubal epithelium → fill with pus → scar tissue is repaired and area w/ damage stick together forming pouches
Pelvic Inflammatory Disease comp
infertility, tubo-ovarian abscess, hydrosalpinx, ectopic pregnancy, chronic pelvic pain, Fitz-Hugh Curtis syndrome (inflammation expends into peritoneum and Glisson’s capsule→ adhesions liver to peritoneum)
Pelvic Inflammatory Disease cause
Neisseria gonorrhoeae, Chlamydia trachomatis, 30% polymicrobial, vagina or cervix
Pelvic Inflammatory Disease RF
sexually active, multiple partners, don’t use condoms
Pelvic Inflammatory Disease clinical
no symptoms or pelvic pain, tenderness around the ovaries & fallopian tubes, fever, abnormal vaginal discharge
Pelvic Inflammatory Disease comp
infertility, tubo-ovarian abscess, hydrosalpinx, ectopic pregnancy, chronic pelvic pain, Fitz-Hugh Curtis syndrome (inflammation expends into peritoneum and Glisson’s capsule→ adhesions liver to peritoneum, RUQ tenderness)
Pelvic Inflammatory Disease clinical
no symptoms or pelvic pain, tenderness around the ovaries & fallopian tubes, fever, abnormal vaginal discharge, cervical motion tenderness
Salpingitis def
Inflammation of the fallopian tubes caused by bacterial infection
Salpingitis cause
Peptostreptococcus, groups B Streptococci, Ureaplasma urealyticum, Chlamydia trachomatis, Neisseria gonorrhoeae,
Salpingitis path
bacteria in the fallopian tube cause immune system to create damage and inflammation
Salpingitis RF
sexually active, multiple partners, no condoms, pregnancy, cesarean section, placental or fetal tissue not removed, hysteroscopy, IUD,
Salpingitis comp
tubal scarring, adhesions, blockages, ectopic pregnancy’s, infertility
Salpingitis clinical
acute: unusual vaginal discharge, abdominal, pelvic, or low back pain, pain during menstruation, ovulation, or sex
chronic: mild or no symptoms
Vaginitis (candidal) def
inflammation or infection of the vagina
Vaginitis (candidal) cause
Candida albicans
Vaginitis (candidal) path
reduction or change of normal vaginal flora → candida can grow
Vaginitis (candidal) RF
DM, recent antibiotic use, immunosuppression, high estrogen levels
Vaginitis (candidal) comp
septic shock
Vaginitis (candidal) clinical
intense itching thick white odorless vaginal discharge vulvar burning dyspareunia dysuria
Bacterial vaginosis (BV) comp
salpingitis and/or endometritis, postsurgical infections, and adverse outcomes in pregnancy, mixed infection
Bacterial vaginosis (BV) clinical
discharge thin/homogenous/off white/foul smell,
Bacterial vaginosis (BV) path
number of lactobacilli decrease→ ↑pH→ bacterial vaginosis can can proliferate
Cryptorchidism def
incomplete/partial descent of testis into scrotal sac
Cryptorchidism path
mispositioned testis found in inguinal can
Cryptorchidism RF
prematurity, low birth weight, twining, 1st trimester maternal exposure to estrogen, FH, genetic syndromes, disorders of sexual development
Cryptorchidism comp
testicular atrophy, infertility, dysfunction, trauma, testicular torsion, germ-cell tumors,
Cryptorchidism clinical
asymptomatic, testes absent from scrotal sac
Epispadias def
dorsal urethral opening
Epispadias cause
hormones, genetics
Epispadias path
genital tubercle grows in posterior direction instead of cranial direction
Epispadias RF
FH, hormonal disturbances, low androgens, maternal age >35, maternal exposure to environmental toxins
Epispadias comp
urinary tract obstruction, UTI, infertility, psychosocial problems
Epispadias clinical
difficulty urinating/incontinence
Hypospadias def
ventral urethral opening
Hypospadias cause
hormones, genetics
Hypospadias path
urethral folds along penile urethra do not close properly -> abnormal opening along penile shafts ventral surface
Hypospadias RF
FH, hormonal disturbances, low androgens, maternal age >35, maternal exposure to environmental toxins
Hypospadias com
urinary tract obstruction, UTI, infertility, psychosocial problems
Hypospadias clinical
difficulty urinating/incontinence
Fragile X syndrome cause
X-linked Dominant, FMR1
Fragile X syndrome def
genetic condition due to changes to FMR1
Fragile X syndrome cause
X-linked Dominant, FMR1
Fragile X syndrome path
increased number of CGG repeats caused by slipped mispairing, promoter is locked into off
Fragile X syndrome RF
FH, genetics,
Fragile X syndrome clinical
intellectual disability, delayed speech, delayed motor development, autism, ADHD, seizures, long/narrow face, prominent jaw & forehead, large ears that stick out, males large testes
Imperforate Hymen def
the hymen remains intact during development
Imperforate Hymen path
hymen central epithelial cells fail to degenerate during fetal development→ during puberty menstrual blood accumulates
Imperforate Hymen comp
retrograde menstruation and endometriosis, and/or fertility complications
Imperforate Hymen clinical
bulging/bluish hymenal membrane, recurrent menstrual cramps and abdominal or pelvic pain
Klinefelter syndrome def
chromosomal male inherits one or more X chromosomes
Klinefelter syndrome cause
extra X chromosome
Klinefelter syndrome path
sperm or egg contains extra x chromosome → meiosis I or meiosis II they don’t sperate→ 2 X in one gamete → ↓Sertoli and Leydig cell function→ ↓testosterone and inhibin→ ↓sperm production, testes maturation, secondary sex characteristics
Klinefelter syndrome RF
FH,
Klinefelter syndrome path
sperm or egg contains extra x chromosome → meiosis I or meiosis II they don’t sperate→ 2 X in one gamete → ↓Sertoli and Leydig cell function→ ↓testosterone and inhibin→ ↓sperm production, testes maturation, secondary sex characteristics
Klinefelter syndrome clinical
hypogonadism, sterile, tall, long legs, short torso, broad hips, gynecomastia, less muscle mass, less facial & body hair, weaker bones, fatigue
Paraphimosis def
foreskin becomes trapped behind the corona and forms tight band of constricting tissue
Paraphimosis path
foreskin becomes trapped behind the corona and forms tight band of constricting tissue
Paraphimosis RF
uncircumcised males
Paraphimosis comp
pain, infection, and inflammation of the glans penis
Paraphimosis clinical
erythema, pain, and swelling of foreskin and glans
Phimosis def
inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis
Phimosis cause
Physiologic phimosis: born with tight foreskin at birth and loosens over time
scarring, infection or inflammation, balanitis xerotica obliterans
Phimosis path
prepuce fits tightly → oily secretion accumulate in preputial sac → build up and irritate skin
Phimosis RF
Being uncircumcised. Diabetes. Frequent diaper rash as an infant. Poor hygiene. Young age.
Phimosis path
prepuce fits tightly → oily secretion accumulate in preputial sac → build up and irritate skin
Phimosis clinical
erythema, itching, discharge, or pain with sexual intercourse.
Pseudohermaphroditism def
person whose gonads are consistent with the chromosomal sex but who has external genitalia of the opposite sex
Pseudohermaphroditism cause
Congenital adrenal hyperplasia, testosterone during pregnancy, mother ovarian tumors, Aromatase deficiency, gonadal dysgenesis, 5-alpha-reductase deficiency, androgen insensitivity syndrome,
Pseudohermaphroditism path
problems w/ testes, problems w/ hormone formation, problem using hormones,
Pseudohermaphroditism RF
exposure to hormones in utero, genetics, FH
Pseudohermaphroditism clinical
infertility, opposite genitalia
Septate Vagina and Uterus def
vagina and uterus are divided to create two of each
Septate Vagina and Uterus cause
genetics
Septate Vagina and Uterus path
problem in embryonic development
Septate Vagina and Uterus RF
premature birth, cesarean birth, fetal growth restriction, pre-labor rupture of membranes, placental abruption
Septate Vagina and Uterus comp
infection, obstruction
Septate Vagina and Uterus clinical
pain, abnormal vaginal bleeding
Turner syndrome def
chromosomal disorder affecting females where one X chromosome is completely or partially absence
Turner syndrome cause
45 X
Turner syndrome path
nondisjunction in sperm cells following meiosis I or II → egg combines w/ it
mosaicism → nondisjunction during mitosis → leading to mix of 45X and 46XX
→ ↓estrogen
Turner syndrome RF
genetic, random
Turner syndrome path
nondisjunction in sperm cells following meiosis I or II → egg combines w/ it
mosaicism → nondisjunction during mitosis → leading to mix of 45X and 46XX
→ ↓estrogen
Turner syndrome clinical
↑ loss of eggs, ovaries fail to form, preductal coarctation of aorta, bicuspid aortic valve, horseshoe kidney, lymphedema, neck webbing, cyanosis, and skeletal abnormalities, ↑ risk of DM II and hypothyroidism, low-set ears, broad chest, arms turn outward, widely spaced nipples, short stature, infertile, and amenorrhea
Erectile dysfunction def
inability to develop and maintain a full erection
Erectile dysfunction cause
stress, performance anxiety, depression, inadequate blood supply, HTN, atherosclerosis, DM, surgery, stoke, trauma, hypogonadism, meds (diuretics, antidepressants, methadone)
Erectile dysfunction path
low testosterone → low NO
Erectile dysfunction RF
mental health conditions, obesity, high fat diet, smoking, alcohol
Erectile dysfunction comp
psychosocial impacts
Erectile dysfunction clinical
not being able to maintain an erection
Hematocele def
hemorrhage into the tunica vaginalis space
Hematocele cause
traumatic or surgical injury or testis tumor
Hematocele RF
varicocele, Hydrocele
Hematocele comp
rupture
Hematocele clinical
a firm and painless scrotal mass
Hydrocele def
Accumulation of serous fluids between visceral and parietal layer of tunica vaginalis of testis
Hydrocele cause
Congenital:
Acquired: Orchitis, Wuchereia Bancrofti , trauma (hernia, torsion), tumor
Hydrocele path
processus vaginalis doesn’t close
Hydrocele RF
premature babies, injury, STI
Hydrocele comp
May cause atrophy of testes due to compression, hematocele, calcification
Hydrocele clinical
Usually painless, may feel heaviness
May cause swelling of scrotum
soft, fluctuant, non-tender fullness in scrotum
Spermatocele def
cystic mass arising from a dilation of the epididymis, Rete testis, or efferent ductules
Spermatocele cause
trauma, infection, autoimmune
Spermatocele clinical
asymptomatic or pain
Varicocele def
abnormal enlargement of the pampiniform venous plexus in the scrotum
Varicocele cause
idiopathic, renal cell carcinoma
Varicocele path
impaired venous drainage → ↑venous pressure → vein dilation in left side → ↑flow of resistance from left testicular vein drainage into left renal vein
Varicocele comp
infertility, ↓sperm concnration, ↓sperm motility, other side can get affected
Varicocele path
impaired venous drainage → ↑venous pressure → vein dilation in left side → ↑flow of resistance from left testicular vein drainage into left renal vein
Diffuse Cystic Mastopathy (Fibrocystic Breast Disease) RF
20-40YO
Diffuse Cystic Mastopathy (Fibrocystic Breast Disease) clinical
Painful, changes with cycle
Diffuse Cystic Mastopathy (Fibrocystic Breast Disease) def
changes to breast tissue
Diffuse Cystic Mastopathy (Fibrocystic Breast Disease) path
acini, stomal fibrosis, calcifications
cells in terminal ductal/lobular epithelium, atypical cells
simple cysts, papillary apocrine changes or metaplasia, stromal fibrosis
Diffuse Cystic Mastopathy (Fibrocystic Breast Disease) comp
invasive carcinoma
Diffuse Cystic Mastopathy (Fibrocystic Breast Disease) comp
sclerosing adenosis inc risk of breast cancer
Diffuse Cystic Mastopathy (Fibrocystic Breast Disease) clinical
bilateral breast pain, tenderness changes with cycle, multiple smooth well-defined mobile lumps usually upper outer quadrant
Galactocele path/cause
ecretory breast epithelium, prolactin stimulus, and ductal obstruction
Distal obstruction of the terminal duct lobular unit causes proximal focal ductal dilatation
Galactocele RF
Difficulty in breastfeeding, If breastfeeding is contraindicated and breastmilk is not emptied, oral-contraceptive pill
Galactocele comp
crystals
Galactocele sx
lump in her breast
solitary, non-tender, firm, discrete, and freely movable, may or may not be associated with a milky discharge from the nipple
Mammary Duct Ectasia def
benign (non-cancerous) breast condition that occurs when a milk duct in the breast widens and its walls thicken
Mammary Duct Ectasia path
inflammation & fibrosis cause blockage in subareloar ducts affected duct becomes dilated and tortuous, either due to breast involution or other factors, and accumulates granular debris with numerous lipid-laden macrophages.
Mammary Duct Ectasia RF
aging, nipple inversion, obesity, smoking
Mammary Duct Ectasia comp
obstruction, mastitis
Mammary Duct Ectasia sx
asymptomatic or nipple discharge ranging from thick to thin, serous, dirty white, yellow, or green and may fluctuate unilateral or palpable mass
Mastitis def
inflammation of breast tissue
Mastitis cause
Staphylococcus aureus, Streptococcus spp, milk stasis, vitamin A deficency
Mastitis path
bacteria from mouth of infant gains entry via cracks or fissure in the nipple -> inflammation and damage
Mastitis RF
cracked/damaged nipples, poor hygiene, ineffective breastfeeding technique, impaired immunity, diabetes, smoking
Mastitis comp
abscess formation
Mastitis sx
localized, firmness, redness, swelling, heat palpable lump breast pain tender/enlarged axillary nodes fever, malaise, myalgias
Traumatic Fat Necrosis def
inflammation of adipose tissue in breast leading to loss of oxygen supply
Traumatic Fat Necrosis cause
breast trauma, fine needle aspiration or biopsy, anticoagulation treatment, radiation, and breast infection
Traumatic Fat Necrosis path
area of fatty tissue gets damages → lipase releases fatty acids → form complex w/ calcium → saponification → more occurs → calcification →fibrosis via reactive inflammatory components
Traumatic Fat Necrosis RF
smoking, obesity, and older age, radiation, chemotherapy, and mastectomy
Traumatic Fat Necrosis comp
infection, need for multiple operations, and breast deformity, pain
Traumatic Fat Necrosis sx
feels like a firm, round lump or lumps, painless, fixed mass w/ possible skin or nipple retraction
Fibroadenoma def
benign tumors that arise from periductal stromal tissue
Fibroadenoma path
overgrowth of cellular & myxoid stroma surrounds & compresses epithelium-lined glandular & cystic spaces w/ age stroma become hyalinized, glandular epithelium atrophies
Fibroadenoma RF
premenopausal women
Fibroadenoma sx
asymptomatic
small, well-defined, spherical, painless, solitary, mobile breast mass
older women: mammographic density w/ possible calcification
can increase in size during luteal phase and lactation
Lobular Carcinoma def
a type of breast cancer that begins in the milk-producing glands (lobules) of the breast
Lobular Carcinoma cause
BRCA1 and BRCA2, genetic mutations occur in the DNA of breast duct cells
Lobular Carcinoma path
DNA damage and genetic mutations that can be influenced by exposure to estrogen
Lobular Carcinoma RF
advanced age, FH, ovarian cancer, estrogen exposure (mulliparity, late 1st pregnancy, early menarche, late menopause), alcohol, absence of breastfeeding, obesity, whites
Lobular Carcinoma comp
metastasis
Lobular Carcinoma sx
unilateral, firm, fibrous, rock-hard, palpable, sharp margins
advanced: skin dimpling, nipple retraction
Ductal Carcinoma def
invasive breast cancer arising terminal ductal lobular unit, most common type in males
Ductal Carcinoma cause
genetic mutations occur in the DNA of breast duct cells
Ductal Carcinoma path
DNA damage and genetic mutations that can be influenced by exposure to estrogen
Ductal Carcinoma RF
advanced age, FH, ovarian cancer, estrogen exposure (multiparty, late 1st pregnancy, early menarche, late menopause), alcohol, absence of breastfeeding, obesity, whites
Ductal Carcinoma comp
metastases to lymph nodes,
Ductal Carcinoma sx
bilateral w/ multiple lesions non-palpable
Paget disease of the breast def
ductal carcinoma extends into lactiferous ducts or nipple & areola
Paget disease of the breast sx
eczematous skin lesion or persistent dermatitis
Paget disease of the breast RF
female, 20-30, FH breast cancer,
Paget disease of the breast comp
breast cancer,
Paget disease of the breast sx
bloody/serous nipple discharge
breast feels full
eczematous skin lesion or persistent dermatitis
Benign Prostatic Hyperplasia def
increase in number of cells in the prostate gland
Benign Prostatic Hyperplasia cause
normal part of aging
Benign Prostatic Hyperplasia path
↑5 alpha-reductase w/ age → ↑dihydrotestosterone→ prostate cells live longer and multiple
Benign Prostatic Hyperplasia RF
males, older, >50
Benign Prostatic Hyperplasia comp
obstruction, bladder hypertrophy, bacterial infection, bladder stones, kidney damage, bladder damage
Benign Prostatic Hyperplasia sx
Urgency Frequency Nocturia Involuntary urination Urge incontinence Urinary hesitancy Weak stream Straining Leaking after end of urination Dysuria possible Hesitancy, weak stream, sensation of incomplete emptying, double voiding (within 2hrs), straining, post-void dribbling DRE: Smooth (non-nodular), firm (rubbery), painless enlargement
Acute Bacterial Prostatitis def
inflammation of the prostate due to bacteria
Acute Bacterial Prostatitis cause
E. Coli, Klebsiella, proteus
Acute Bacterial Prostatitis path
infection causes prostate to enlarge and get damaged due to immune response
Acute Bacterial Prostatitis RF
Young men, BPH, epididymitis, orchitis, urethritis, sexually active, STI, immunocompromised, prostate manipulation, urethral stricture, phimosis
Acute Bacterial Prostatitis comp
Prostatic abscesses
Acute Bacterial Prostatitis sx
Sudden onset of fever, severe dysuria, myalgia, malaise
Irritative voiding sx or BOO (oliguria or anuria)
Hematuria, bacteriuria, pyuria
Acutely tender prostate on DRE
Chronic Bacterial Prostatitis def
Inflammation of the prostate gland that is caused by a bacterial infection and that continues or gets worse over a long period of time
Chronic Bacterial Prostatitis cause
Escherichia coli
Chronic Bacterial Prostatitis path
bacteria enters prostate causing infection
Chronic Bacterial Prostatitis RF
Intraprostatic ductal reflux and prostatic calculi
Other infections (eg, acute epididymitis, urinary tract infections)
Phimosis
Unprotected penetrative anal intercourse
Manipulation of the lower urinary tract
Secretory dysfunction of prostate gland
Chronic Bacterial Prostatitis comp
erectile dysfunction, prostate cancer
Chronic Bacterial Prostatitis sx
Fever, chills, pain, urgency, dysuria,
Ovarian Cysts def
fluid-filled growth that develops in/on ovary
Ovarian Cysts cause
functional: no LH surge, dysfunction in hypothalamic-pituitary-ovarian axis, corpus luteum doesn’t dissolve, overstimulation of hCG
neoplastic:
Ovarian Cysts RF
early menarche, obesity, infertility, fertility treatments, PCOS, hypothyroidism, hyperandrogenism, tamoxifen use, smoking
Ovarian Cysts comp
rupture, hemorrhage, ovarian torsion
Ovarian Cysts sx
asymptomatic, pelvic pain/lower abdominal pressure sensation, dyspareunia,
Paraovarian Cysts def
fluid-filled sac found in the fallopian tubes near your ovaries.
Paraovarian Cysts path
remnants of paramesonephric (müllerian) or mesonephric (Wolffian) ducts that are present during urogenital embryologic development
Paraovarian Cysts comp
rupture, torsion, hemorrhage
Paraovarian Cysts sx
asymptomatic
dull unilateral pelvic pain
Polycystic Ovary
Syndrome (PCOS) def
a condition in which the ovaries produce an abnormal amount of androgens
Polycystic Ovary
Syndrome (PCOS) cause
dysfunction in hypothalamic-pituitary-ovarian axis, insulin resistance,
Polycystic Ovary
Syndrome (PCOS) path
insulin resistance → insulin causes theca cells to grow more LH receptors→ GnRH speeds up →anterior pituitary makes ↑LH → theca cells make ↑androstenedione → flows into blood → turned into estrone in adipose cells→ no LH surge to trigger dominant follicle to break free
Polycystic Ovary
Syndrome (PCOS) RF
Oligoovulatory infertility, obesity, insulin resistance, DM, premature adrenarche, FH, anti-seizure meds,
Polycystic Ovary
Syndrome (PCOS) comp
infertility, DM, metabolic syndrome, heart disease, and high blood pressure
Polycystic Ovary
Syndrome (PCOS) sx
amenorrhea, acne, hirsutism, male-patterned baldness, oligomenorrhea, overweight, acanthosis nigricans
Tubo-Ovarian Cysts cause
pelvic inflammatory disease, Escherichia coli, Bacteroides fragilis, other Bacteroides species, Peptostreptococcus, Peptococcus, and aerobic streptococci
Tubo-Ovarian Cysts path
Bacteria from the lower genital tract ascend to create an inflammatory mass involving the fallopian tube, ovary, and potentially other adjacent pelvic organs
Tubo-Ovarian Cysts RF
multiple partners, sexually active, not using condoms, IUD insertion,
Tubo-Ovarian Cysts comp
rupture, sepsis,
Tubo-Ovarian Cysts sx
abdominal pain, pelvic mass on examination, fever, and leukocytosis, vaginal discharge, nausea, and abnormal vaginal bleeding
Choriocarcinoma def
Malignant, fast-growing tumor from trophoblastic cells
Choriocarcinoma def
Malignant, fast-growing tumor from trophoblastic cells from the placenta
Choriocarcinoma cause
miscarriage
ectopic pregnancy
abortion
Choriocarcinoma path
Overexpression of p53 and MDM2
cytotrophoblastic cells function as stem cells and undergo malignant transformation (Placenta)
Choriocarcinoma Rf
maternal age extreme younger than 20 and older than 35, pervious, abortion or ectopic, molar pregnancy
Choriocarcinoma comp
profuse bleeding, hematogenous metastasis to lungs, brain, liver
Choriocarcinoma sx
abnormal uterine bleeding, unexplained amenorrhea, insomnia, anxiety, tachycardia, palpitations, theca lutein cyst, lower abdominal pain, high hCG
mets: coughing, dyspnea, hemoptysis, headache, dizziness, nausea, slurred speech, visual disturbances, neuropathy, hemiparesis
Hydatidiform Mole def
rare complication of pregnancy characterized by the abnormal growth of trophoblasts, the cells that normally develop into the placenta
Hydatidiform Mole cause
an abnormally fertilized egg
Hydatidiform Mole path
error in normal fertilization
empty egg fuses w/ normal sperm
normal egg fuses w/ two sperm
Hydatidiform Mole RF
maternal age extreme younger than 20 and older than 35, previous molar pregnancy
Hydatidiform Mole comp
infection, shock, preeclampsia, sepsis
Hydatidiform Mole sx
complete: ↑hCG, missed periods, positive pregnancy test, vaginal bleeding, insomnia, anxiety, tachycardia, palpitations, N/V, dehydration, pain or pressure on affect side w/ theca lutein cyst, uterus larger than expected age
incomplete: uterus is not larger than expected, missed periods, vaginal bleeding
Invasive Mole def
penetration of molar tissue (complete or partial mole) into myometrium or uterine vasculature, Edematous villus and proliferative trophoblasts invade myometrium
Invasive Mole cause
evacuation of a molar pregnancy
Invasive Mole RF
complete mole pregnancy, prior molar pregnancy, advanced maternal age (>40 years), and Asian and American Indian ancestry
Preeclampsia def
develops after a molar pregnancy and is characterized by the presence of edematous chorionic villi with trophoblastic proliferation invading the myometrium
Invasive Mole sx
abnormal uterine bleeding, unexplained amenorrhea, insomnia, anxiety, tachycardia, palpitations, theca lutein cyst, lower abdominal pain, high hCG
Preeclampsia def
new onset of hypertension (>140/>90) after 20 weeks gestation-6 weeks after delivery
Preeclampsia path
abnormal placenta→ spiral arteries become fibrous →narrow → less blood → placenta releases pro-inflammatory proteins → cause endothelial cells that line blood vessels to become dysfunctional → vasoconstriction and retain Na → local vasospasm → decreased blood flow to organs
Preeclampsia Rf
first pregnancy, multiple gestations, mother >35, HTN, diabetes, obesity, FH
Preeclampsia comp
stroke, placental abruption, emboli, eclampsia
Preeclampsia sx
oliguria, proteinuria, blurred vision, flashings lights, scotoma, elevation in liver enzymes, RUQ pain, edema, cough, SOB, headaches, confusion, seizures
HELP (hemolysis, elevated liver enzymes, low platelets)
Bartholin Cysts def
a small fluid-filled sac just inside the opening of the Bartholin glands on vulva
Bartholin Cysts path/cause
Sometimes the openings of these glands become obstructed, causing fluid to back up into the gland
Bartholin Cysts RF
sexually active, 20-30, infection, injury or surgery, STI
Bartholin Cysts comp
infection, abscess
Bartholin Cysts sx
asymptomatic, soft, painless lump, pain if large
Cystocele vagina def
a condition in which supportive tissues around the bladder and vaginal wall weaken and stretch, allowing the bladder and vaginal wall to fall into the vaginal canal
Cystocele vagina cause
vaginal childbirth, contipation, obesity, heavy lifting, chronic cough, hysterectomy, pelvic prolapse repair, genetics, Ehlers-Danlos
Cystocele vagina path
muscles and tissues supporting the vagina weaken and stretch, allowing the bladder to move out of place
Cystocele vagina RF
older, giving birth vaginally, having a history of pelvic, surgery, overweight, FH
Cystocele vagina comp
urinary retention, kidney damage
Cystocele vagina sx
asymptomatic, a vaginal bulge, pressure in the vagina or pelvis, urinary incontinence, hesitancy, slow stream, frequency, urgency
Reectocele def
Posterior vaginal prolapse, causing the rectum to bulge into the vagina
Reectocele cause
vaginal childbirth and chronic increases in intra-abdominal pressure, Ehlers-Danlos
Reectocele path
occurs when healthy rectovaginal septal tissue loses integrity, and the rectum herniates through into the vaginal lumen
Reectocele RF
age, vaginal birth, constipation
Reectocele comp
Pressure or discomfort in the pelvic area.
Constipation.
Leakage of bowel movements (incontinence)
Sexual dysfunction.
Reectocele sx
Pressure in the pelvic area
Constipation
Leakage of bowel movements (incontinence)
Sexual dysfunction
Urethrocele def
urethra moves from its normal position and presses against the front wall of the vagina
Urethrocele cause
pregnancy and childbirth, being overweight, or with frequent constipation
Urethrocele path
muscles and tissues that hold the urethra in place get weak or damaged
Urethrocele RF
age, pregnancy, obesity,
Urethrocele comp
urinary retention, kidney damage, recurrent UTI
Urethrocele sx
Abdominal pain
Back pain that may be only on one side
Severe side (flank) pain and spasms that may reach to the groin, genitals, and thigh
Blood in the urine
Burning pain while urinating (dysuria)
Fever
Difficulty starting urine flow or slowing of urine flow
Cervical Intraepithelial Neoplasia (CIN) def
dysplasia of basal layer of transformational zone CIN 1 (1/3)→ CIN II (2/3)→ CIN III (3/3)→ CIS→ invasive
Cervical Intraepithelial Neoplasia (CIN) cause
HPV 16, 18, 31, 33 sexually transmitted
Cervical Intraepithelial Neoplasia (CIN) path
virus inserts into the immature squamous cells → integrates its DNA → makes E6 & E7→ inhibits p53 and pRB → uncontrolled replication
Cervical Intraepithelial Neoplasia (CIN) RF
multiple sexual partners, not using condoms, early age at 1st intercourse, smoking, immunosuppression, low SES
Cervical Intraepithelial Neoplasia (CIN) comp
squamous cell carcinoma or adenocarcinoma, vaginal cancer, bladder (hydronephrosis/renal failure), rectum, liver, lungs
Cervical Intraepithelial Neoplasia (CIN) sx
koilocytes
postcoital bleeding, vaginal discomfort, foul-smelling vaginal discharge
Endometrial Hyperplasia def
increased growth of endometrium
Endometrial Hyperplasia cause
exposed to high levels of estrogen for long time, obesity, ganulosa cell tumor, PCOS, estrogen replacement therapy, tamixofen, mutation of PTEN
Endometrial Hyperplasia path
↑estrogen and low progesterone→ leads to ↑gland to low stroma ratio→
Endometrial Hyperplasia RF
early menarche, late menopause, never given birth,
Endometrial Hyperplasia comp
endometrial cancer (need nuclear atypia)
Endometrial Hyperplasia sx
menorrhagia, metrorrhagia, amenorrhea,
Fibroids (Leiomyoma) def
benign smooth muscle tumors of uterus, most common
Fibroids (Leiomyoma) cause
MED12 gene, estrogen and progesterone, hereditary leiomyomatosis and renal cell carcinoma syndrome
Fibroids (Leiomyoma) path
MED12 gene → regulates how transcription factors bind to RNA polymerase
fibroids ↑ receptors for estrogen and progesterone→ ↑fibroid growth
Fibroids (Leiomyoma) RF
African descent, premenopausal, never having a pregnancy, ↑ menstrual cycles, diethylstilbestrol
Fibroids (Leiomyoma) comp
infertility, miscarriage, fetal malpresentation, preterm labor, postpartum hemorrhage
Fibroids (Leiomyoma) sx and types
Types: intramural (most common), subserosal, submucosal, pedunculated, cervical
round, firm, grayish-white, Asymptomatic or Compressive sxs Bleeding abdominal pain Urinary frequency
Invasive Carcinoma of the Cervix def
Cancer that has spread from the surface of the cervix to tissue deeper in the cervix or to other parts of the body
Invasive Carcinoma of the Cervix cause
HPV 16, 18, 31, 33 from Cervical Intraepithelial Neoplasia sexually transmitted
Invasive Carcinoma of the Cervix path
virus inserts into the immature squamous cells → integrates its DNA → makes E6 & E7→ inhibits p53 and pRB → uncontrolled replication
Invasive Carcinoma of the Cervix RF
early onset of sexual activity, multiple sexual partners, not using condoms, PHM STI, immunosuppression, OCPs, low SES, smoking, genetics,
Invasive Carcinoma of the Cervix comp
vaginal cancer, bladder (hydronephrosis/renal failure), rectum, liver, lungs
Invasive Carcinoma of the Cervix sx
postcoital bleeding, vaginal discomfort, foul-smelling vaginal discharge
Leiomyosarcomas def
malignant tumor of smooth muscle from myometrium
Leiomyosarcomas path
mutations to oncogenes or tumor suppressors
Leiomyosarcomas RF
postmenopausal
Leiomyosarcomas comp
metastasis
Leiomyosarcomas sx
abdominal uterine bleeding, abdominal or pelvic pain or pressure
single lesion w/ necrosis and hemorrhage
Erection
physical stimulation or thoughts→ parasympathetic nerve fiber release Ach→ bind to muscarinic receptors on endothelial cells → activates nitric oxide synthase→ converts arginine to citrulline and NO → NO enters smooth muscle cells → activates guanylate cyclase → GTP to cGMP→ fall in intracellular Ca smooth muscle relax → cavernosal spaces expand and compress veins
Chancroid def
gram negative coccobacillus, non-motile, facultative anaerobic, oxidase +, catalase -, chocolate agar +
Chancroid cause
Haemophilus ducreyi
Chancroid path
enter cell through skin or mucosal breaks → attaches to cell via Flp1, Flp2, Flp3 → make its secrete IL-6 and IL-8 → CD4 T, neutrophils, macrophage → produce ROS → Haemophilus produces copper-zinc superoxide dismutase → produces HdCTD and cytotoxic hemolysin → cell death and lysis of foreskin epithelial cells, macrophage, T cell, and B cell → disorganization of epidermis →erythematous papules
Chancroid RF
multiple sex partners, unprotected sex,
Chancroid comp
HIV
Chancroid sx
erythematous papules→ pustules → soft canker gray/yellow purulent exudate, bleeds easily
men: corona, prepuce, glans
female: labia, vaginal introitus, perianal areas, dysuria, dyspareunia, abnormal vaginal discharge, rectal bleeding, painful defecation, unilateral lymphadenopathy
Herpes Simplex Virus (HSV) 1 def
enveloped, double strained DNA
Herpes Simplex Virus (HSV) 1 cause
Herpes Simplex Virus (HSV) 1 due to stress, skin damage, viral illness
Herpes Simplex Virus (HSV) 1 path
dives into mucosa→ binds to epithelial receptors→ virus enters cells →transcribed and translated →new viral proteins→ travel up axon of sensory neurons (latent) in trigeminal or sacral
Herpes Simplex Virus (HSV) 1 RF
young age, sharing thing w/ infected person,
Herpes Simplex Virus (HSV) 1 comp
encephalitis (brain infection) or keratitis (eye infection)
Herpes Simplex Virus (HSV) 1 sx
no symptoms,
lesions on gums, palate, tongue, lip, and facial area, fever and enlarged lymph nodes, pharyngitis (children)
cluster of small, painful, fluid-filled blisters that ooze and ulcerate
Reactivation: asx, vermillion border lesions on one side, smaller
HSV 2 path
dives into mucosa→ binds to epithelial receptors→ virus enters cells →transcribed and translated →new viral proteins→ travel up axon of sensory neurons (latent) in sacral or trigeminal
HSV 2 cause
HSV 2 due to stress, skin damage, viral illness
HSV 2 path
dives into mucosa→ binds to epithelial receptors→ virus enters cells →transcribed and translated →new viral proteins→ travel up axon of sensory neurons (latent) in sacral or trigeminal
HSV 2 RF
sexually active, not using condome, STI, HIV,
Human Papillomavirus (HPV) def
non-enveloped DNA virus
Syphilis cause
Treponema pallidum
Syphilis sx
Primary: Painless chancre
Secondary: Fever, lymphadenopathy, skin rashes, condylomata lata
Tertiary: Gummas, tabes dorsalis, general paresis, aortitis
Human Papillomavirus (HPV) cause
Human Papillomavirus 6, 11, 16, 18
Human Papillomavirus (HPV) path
virus inserts into the immature squamous cells → integrates its DNA → makes E6 & E7→ inhibits p53 and pRB → uncontrolled replication
Human Papillomavirus (HPV) RF
multiple sex partners, immunocompromised, smoking, radiation
Human Papillomavirus (HPV) comp
cervix, vagina, vulva, penis, anus cancer
Human Papillomavirus (HPV) sx
numerous warts, skin-collored, range in size, cauliflower look, painless, itching, burning, local pain or bleeding
Syphilis def
gram-negative, spirochete, obligate parasite, endoflagella,
Syphilis cause
Treponema pallidum
enter through body fluids via cuts or sexual contact or contaminated needles or direct contact w/ skin lesion or congenital
Syphilis path
1-3 week destroy skin where they enter body → 6-12 weeks enter blood → lymph node→ tissues → latent phase in capillaries of organs & tissues → tertiary type IV hypersentivity
Syphilis RF
sexual activity, no condom, IV drugs,
Syphilis comp
coagulative necrosis, damage to heart (endarteritis, aortic aneurysms), brain (loss of vibration and proprioception’s, paralysis, memory loss, paresis), liver, joint, testes, Argyll Robertson pupil, stillborn
Syphilis sx
Primary: Painless chancre
Secondary (most infectious): Fever, lymphadenopathy, non-itchy maculopapular rash, pustular or papulosquamous condylomata lata (genital smooth small flat growth, grey)
Tertiary: Gummas (non-cancerous growth), tabes dorsalis (demyelination of dorsal column), general paresis, aortitis, fever, edema,
Toxic Shock Syndrome (TSS) def
gram +, facultative anaerobes, non-motile, no spores, catalase +, cocci, coagulase +
Toxic Shock Syndrome (TSS) path
mediated by toxic shock syndrome toxin-1 → growth of S. aureus in vagina/surgical sites → multiple organ dysfunction
Toxic Shock Syndrome (TSS) RF
immunosuppression, IV drugs, recent invasive procedure, foreign material in body, dialysis
Toxic Shock Syndrome (TSS) comp
sepsis, bacteremia, invasive infection
Toxic Shock Syndrome (TSS) sx
fever, hypotension, rash, coagulopathy, tissue necrosis
Trichomoniasis def
flagellated protozoan parasite
Trichomoniasis path
sexually transmitted→ infects squamous epithelium of lower genital tract → replicates by longitudinal binary fission → inflammatory response
Trichomoniasis RF
sexual activity, multiple sex partners, female
Trichomoniasis comp
HIV, premature birth, urethritis, cystitis
Trichomoniasis sx
asymptomatic, watery, foul-smelling vaginal discharge, burning, Vaginitis, strawberry cervix, motile in wet prep, pruritus, urethral discharge