Reproductive syst. Flashcards
Male reproductive tract-important structures
Seminal vesicles and prostate gland=support sperm
-prostate is below bladder
Prostate urethra proximal to ejaculatory duct
Urethra=sperm travels through
Testis houses sperm/spermatogenous
-sperm goes through epidermis–>vas(ductus) deferens to eject. duct
Prostate(bladder issues)and testis(Affecting fertility)=dangerous dis.
Female reproductive tract-important structures
Ovary(ovum/oogenesis)–>uterin fallopian tube (oviduct) –>uterus/uturim–>vagina –>external genital=vulva
Ovulation=2wks after last period
-implantation is 2 wks after fertilization
-prego.=4wks after ovulation
Infertility
Cnt conceive w/in 1 yr of attempting to conceive
The number of incidence has not incre. over the years
Screen and tx(med/therapy)
-assisted reproductive tech(ART) only tx 3% of cases
Infertilely-female cn be fertile even thought gametes are produce?
No, females cn be infertile w/ gamete production
Infertility-female and ovary
Impacts ova production and decre. fertility -oocytes are affected Causes -endocrine :hypothalamus/pit. dis. :gonadotropin production insuff. -ovarian dis.=polycystic ovarian synd. :caused by gonadotropin insuff./direct ovarian damage (damage oocyte) -other causes :chemo/pelvic irradiation :destroy developing oocytes
Infertility-female and tubal/uterine
Tubal=oviducts receives structural damage
-prevent ova movement/fertilization process
-fertilization=sperm cnt travel in tube which cnt fertilize
Uterine
-Damage prevent implantation or maintenance of prego.
-damage uterine wall
Infertility-male types
Pretesticular
Testicular
Post-testicular
Infertility-female and tubule/uterine Thyroid dis. causes
Decre. T3/4=incre. thyrotropin releasing hormone
- cause PRL secretion
- PRL cn decre. GnRH
Infertility-female and tubule/uterine-Androgen excess causes
Affects oocyte develop
Anovulation and amenorrhea
Genetic, environment cause
Infertility-female and tubule/uterine- Hyperprolactinemia
Both inhibit dopamine from inhibiting PRL secretions
Drugs change PRL secretion
Direct pit. damage
Infertility-female and tubule/uterine causes
Infection Pelvic/abdo. surgeries -cn cause scarring adhesion Toxin exposure=endometrium damage Thyroid dis. Androgen excess Hyperprolactinemia(both dnt dopamine to inhib. PRL secretion) Dopamin is effected by fertility -change gonadotropin release -direct effect on follicles -have dopa Recep.
Infertility-female and tubule/uterine infection causes
Infection
- from inflamation, scars and adhesion(or implantation difficulty)
- block transport(stenosis)/implantation
- ectopic prego. possible
Infertility-female types (basic)
Ovulatory
Tubule
Uterine
Infertility-male and pretesticular
Causes
-endocrine disorder=hormone promoting spermatogen.
:hypothal.-pit def. –>affect horm. prod.–>decre. testosterone/spermatogen.
-drug inhib. horm. effects
:anabolic steroids initiating inhib. neg. feedback loop=decre. LH/FSH level
Factors affecting spermatogenesis
-hormones and med.
-systemic dis.
-environment/lifesyle factors
-dietary def.
-toxins
Infertility-male and testicular affects what?
Direct effect on testicular function
Infertility-male testicular causes(basic)
Direct effect on testicular function -variocele -scortal temp. Trauma Testicular torsion Infection Genetic dis. Cryptorchidism Toxin
Sexually Transmitted Dis.-Chlamydia (chlamydia trachomatis)
Obligate intracell bact.
Lymphophathia Venerea=type of chlamydia
-AKA lymphogranuloma venereum
-infect specific sterotypes (L-type)
:Chlaym. causautive agent
-Chonic
:Initial small lesion
:Lesion growth=incre. lymph. node swelling
*goes to GIT lymph node
*cn rupture if not tx=cause fibrosis/stricture in Lower urogential tract structures and lymph node
-other genital chlamydia apperance ~gonorrhea =need microbio analysis
Infertility-male w/ direct effect on testicular function, testicular damage
Direct effect testicular function (develop. issue)
-Variocele=abnomral dialted scrotal vn.
:MC cause of decre. male infertility
:vn=valvular issues which causes backflow
*b/c gravity/pull
*incre. blood in scrotal tissue w/in
-tunica vaginalis layers
-Incre. scortal temp.
:caused by (affect sperm tissue)
*varicocele
*tight clothing b/c scrotum close to body
*seasonal temp. change
*fever
Testicular damage
-trauma
:early intervention=reversible
:damage=atrophy
:Compartmentalization to sep. sperm from rest of body is brkdwn
*antisperm antBD is form
*sep. help keeps sperm alive
-Testicular torsion of spermatic cord
:disrupted blood flow
:brkdwn tissue
:2 circumstances
*neonatal=in utero/shortly after birth(not anatomic defect)
*adult but mainly adolescence
-sudden onset of testicular pain
-no apparent inj./cause
-linked to bilat. anatomic dfect that incre. mobility
:A vascular disorder=twisting of spermatic cord decre./ inhib. venous drain
*thickened vn’s wall=pampiniform plexus
*remain patent
:infarction b/c decre. venous draining
:full recovery if fixed in 6hrs.
Infertility-male and other testicular causes
Genetic dis. impacting sperm
-klinefelter synd.=chromo abnorm. (XXY)
:lydig cell malfunction
:decre. serum testosteron
:incre. FSH
-microdeletion on Y chromo.
Cryptorchidism =complete/partial failure of testes descend during fetal develop.
-developing disorder
-normally w/in body during embryogen. and descend during fetal develop.
-incre. temp=decre. function
-microscopic structrual changes @ 2yrs. old
:inhib. germ cell develop=inhib. spermatogonia, 1ry/2dry spermatocyte, spermatids
:lost spermatogoniatissue
:hyalinzation and thick BsM
Toxin
-diff. cells r more senstivie
-cig. smoke=incre. erectile dysfunction and sperm DNA formation
-radiation/chemo affect sperm dividing cells
infertility-male and factors affecting spermatogenesis
Hormones/med. Syst. dis. Environment/lifestyle factors Dietary def. Toxin Testicular temp Ionizing of red./alkylating agents develop disorder. Local infections
Infertility-male and post testicular causes
Ductal obstruction
-effect vas deferens and epididymis
-Surgical (trauma, vestectomy-cut vas def.)
-congenital (cystic fibrosis (mucus blockage)
Ejaculatory issues (near prostate)
-cyst cn block eject duct
-duct obstruction (cong./acq.)
-anejaculation (spinal cord injuries)
Infection=STD, E.coli
-b/c urinary tract abnorm. b/c sperm travel through urethra to exit body
-
infertility-male and post testicular factors affecting spermatogenesis
Developmental disorders
Local infections
Dis. assoc. w/ prego.-ectopic prego.
Embryo implantation anywhere but uterus
Location
-90% in uterine tube
-w/in vagina wall
-scar tissue
-cervical
-abdo.
-ovary
-fimbrae of uterine tube
-uterine tube
Predisposing condition=pelvic inflamm. dis. that results dis. in chronic salpingitis
-damaged structures nearby tube
Incre. in patients w/ peritubal scarring/adhesions caused by appendicitis endometriosis, surgery
MC cause=tubal hematoma
Fertilized ovum cn form an placenta and amniotic sac
-embryo–>fetus and implantation
-incre. growth=rupture tube
:massive fatal intraperitoneal hemorrhage
Cn undergo regression/resorption (@ timess mom dnt know) Or spontaneous ejection into abdo. cavity (tubal abortion)
- not an emergency but others are and need abortion
Sexually Transmitted Dis.-specific infect.
Bacterial (gram neg.)
-Gonorrhea(N. gonorrhoeae)
-Chancroid(haemophilus ducreyi)
-Granuloma inguinal (K. granulomatis)
-Syphilis (spirochete: treponema pallidum)
Bacterial (obligate intracell.)=Chlamydia (chlamydia trachomatis)
Viral=genital herpes(HSV2 infection)
Sexually Transmitted Dis.-bacterial gram neg.
Neisseria Gonorrhoeae
-Effecting male=urethritis
-Effecting female=often Asymp., pelvic inflammatory dis. and infertility
-infected mom delivers newborn w/ conjunctivitis –>blind
-Other ~ gram neg. bact.
:Haemophilus ducreyi=chancroid (skin lesion)
:Klebsiella granulomatis=granuloma inguinale
Syphilis=treponema pallidum (spirochete)
-cn cross placenta=congenital syphilis
Sexually Transmitted Dis.-herpes simplex virus infection
Both HSV-1(oral) and HSV-2(genital herpes) infect mucosa Infect/latent in N. -activated by stress(skin lesion/cold sores), trauma, UV radiation, hormonal change Also cause -corneal lesion(blindness) -Encephalitis -Bronchopneumonia -Esophagitis -hepatitis
Female reproductive disorders
Disruption of mensuration
Menstrual disorders
Amenorrhea=no menstrual bleeding Dysmenorrhea -irreg. menstrual symp. -excessive pain Menorrhagia=excessive bleeding Metrorrhagia=Irregular/protracted bleeding
Menstrual disorder-Amenorrhea
Normal-prego(no secretory), menopause Uterine disorder -scarring after infect=wall not thickening properly :no solough off as horm. decre. Ovarian disorder -Gonadal failure :multiple cause :no ovarian horm.=no wall thcik -Endocrine disorder=insuf. gonadotropin secretion
Endometriosis
Define=endometrium located outside uteur
Affected other parts of reproductive tracts=infertility
-damage tract
Causes intestinal disorder when affecting intestines
Pathogenesis not well understood
S/S=dymenorrhea, pelvic pain, infertility
-infertility=depend on where endometrial tissue as cuased
Dis. assoc. w/ prego.-pre. prego./during prego./after prego.
Pre prego.=Ectopic Prego.
During prego.=eclampsia/preeclampsia
After prego.=Matitis
Dis. assoc. w/ eclampsia/pre. eclampsia
Systemic syndrome of prego.
-Wide spread maternal endoth. dysfunction
-S/S
:Pre=HTN, edema, proteinuria
*maternal HTN no proteinuria
:Eclam.= pre and convulsions
:hypercog., acute renal failure and palm. edema
:HELLP synd.Dis. assoc. w/eclampsia/pre. eclampsia= abnormal placental vasculature
During implantation and placental develop.
-spiral arteries of secretory phase to endometrium r modified to provide blood to placenta
:fetal cell invade decidual plate and destroy the excess sm. muscle
:vessels change from small lumen –> high R to lrg lumen (low R)
*incre. BF and incre. support to placenta and developing fetus
No remodel=no fetal cells invasion/not destroy sm. muscle
-no in pre-eclampsia
-results in placental ischemia and maternal HTN
:may develop atherosis =lipid deposits in decidual vs. intima
:Hemorrhages is visible in liver, brain, heart and ant. pit.
:kid. has excess fibrin in glomeruli(affect function and proteinuria) and thrmobi cortex assoc. w/ bilat. cortical necrosis
*damage filtration memb.
Dis. assoc. w/ Mastitis
Acute bact. infection of breast
-w/in 1st mo. of breast feeding
-during breast feeding
:cracks/fissures develop in nipples=bact. gain access bact. (S. Aureus/strep.cocci)
S/S=fever, painful swelling and edema
Tissue changes=erythema(icre. RBC), abcesses (S. Aureus) or cellulitis (Strep) that inflam. CT tissue
Starts in ducts but may spread to entire breast
Tx w/ antiBT and milk expression (flow own duct and throw away milk b/c bact=give baby formula
Severe=surgical drainage if other tx not wrk (b/c bact cn travel/sepsis)
female reproductive-normal hormones
Normal hormone control
-GnRH(hypothal.)–>pit. to release FSH and LH to act on ovaries
:FSH=follicle develop and +estrogen
:LH=follicle maturation and +progesterone
-ovary hormones act on uterus
:estrogen produce by follicle B4 ovulation =+ prolif. phase
*thicken endometrium form for implantation/period
:Porduce by copus luteum=+secretory phase
*secretory phase=no endometrial thick but thinning of gland/arteries for implantation
*corpus luteum=remnet following ovluation
Prostate gland
Prostate gland products–>urethra
-slightly alkaline fluid
-contain enzymes maintain seminal fluid as liq.
:move sperm in female tract
Prostate dis.
Surrounds urethra=inflammation or hypertrophy impact urethral function and dysuria
S/S=difficult urinating(starting vol, incomplete voiding, pain)
-b/c prostate location
Male reproductive disorder-prostatis clinical
Clinical synd.
- found in biopsy w/ acute/chronic inflam.(depend on cell present)
- histo: chronic=inflam. VS. Acute small abcess, lrg abcess necrosis, diffuse edema, congestion suppuration
Male reproductive disorder-prostatis causative agents
Bacterial
Abacterial
Granulomatous
Male reproductive disorder-Acute prostatis bacterial
Acute
-causative agents~ cystitis/bladder inflam.
-access prostate=urinary reflux(bladder/urethra b/c bact. access to prostate), surgery, lymphatis/blood from distant (lymphoematogenesis spread)
-S/S=fever and chills(bact.), dysuria
-Exam=enlarged/tender prostate
:bulgy
-DX=urine culture/Sx and exam
-tx=antBT is difficult b/c hard to penetrate prostate
Male reproductive disorder-prostatis Abacterial
MC today
Chronic bact. but bact cultures r inhib.
prostatic secretions has leukocytosis =not have urinary bact. infect.
Male reproductive disorder-prostatis granulomatous
Specific agent ID (bact.) VS. nonspecific NOT ID(abact.) Caused by cancer tx Fungal w//in immunocomp. host Nonspecific=rupture duct/acini -inflam. rxn from duct/secretion rxn
Male reproductive disorder-Benign prostate hypertrophy (zones)
Around vas deferen
3 zones
-Peripheral zone (PZ)
:main glands w/ long ducts
:1ry location for inflammation/cancer(more firm)
-Transition zone (TZ)
:mucosal glands empty directly–>urethra
*urethra function comp.
:commonly location for hypertrophy(BPH)
Male reproductive disorder-Benign prostate hypertrophy and Pathogenesis
Testoosteron–>dehydrotestosteron(DHT)
-by 5 alpha reductase in prostatic stroma
B/c incre. DHT=excessive cell grwoth
Tx w/ reductase inhib. slows growth and relieves symp.
-other TX=destroy tissue
:minimally invasive
:surgical
Male reproductive disorder-Benign prostate hypertrophy and pathology
Compression of urethra lumen by hyperplastic glands
Two layers of cells in glands
-inner columnar
-outer basal flattend
Male reproductive disorder-Benign prostate hypertrophy (BPH) clinical
Only clinically in 10% of patients S/S -histancy -urgency -nocturia -poor urinary stream Chronic obstruction=incre. risk of UTI Acute obstruction=damage bladder or kidney
Dis. assoc. w/ eclampsia/pre. eclampsia and pathogen
Pathogen.=not well understood but linked 3 specific changes
-abnormal placental vasculature
-Endoth. dysfunction(imbalance of anti/angiogenic factors)
:defective vascular develop. iin placenta 2ndry to hypoxia
-Coag. abnorm.
:reduced endoth. production of antithrombotic factos
Male reproductive disorder-Chronic prostatis bacterial
~causative agents as acute Asymp. and not need to follow acute(cn just be chronic) S/S -low back pain -dysuria -perineal/suprapubic discomfort :b/c prostate inflam. Caused by recurrent urinary tract infect DX=leukocytosis in prostatic secretion -+ bact. culture (not in acute)
