Reproductive syst.

Question 1

Male reproductive tract-important structures

Answer 1

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.

Question 2

Female reproductive tract-important structures

Answer 2

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

Question 3

Infertility

Answer 3

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

Question 4

Infertilely-female cn be fertile even thought gametes are produce?

Answer 4

No, females cn be infertile w/ gamete production

Question 5

Infertility-female and ovary

Answer 5

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

Question 6

Infertility-female and tubal/uterine

Answer 6

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

Question 7

Infertility-male types

Answer 7

Pretesticular
Testicular
Post-testicular

Question 8

Infertility-female and tubule/uterine Thyroid dis. causes

Answer 8

Decre. T3/4=incre. thyrotropin releasing hormone

• cause PRL secretion
• PRL cn decre. GnRH

Question 9

Infertility-female and tubule/uterine-Androgen excess causes

Answer 9

Affects oocyte develop
Anovulation and amenorrhea
Genetic, environment cause

Question 10

Infertility-female and tubule/uterine- Hyperprolactinemia

Answer 10

Both inhibit dopamine from inhibiting PRL secretions
Drugs change PRL secretion
Direct pit. damage

Question 11

Infertility-female and tubule/uterine causes

Answer 11

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.

Question 12

Infertility-female and tubule/uterine infection causes

Answer 12

Infection

• from inflamation, scars and adhesion(or implantation difficulty)
• block transport(stenosis)/implantation
• ectopic prego. possible

Question 13

Infertility-female types (basic)

Answer 13

Ovulatory
Tubule
Uterine

Question 14

Infertility-male and pretesticular

Answer 14

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

Question 15

Infertility-male and testicular affects what?

Answer 15

Direct effect on testicular function

Question 16

Infertility-male testicular causes(basic)

Answer 16

Direct effect on testicular function 
-variocele 
-scortal temp.
Trauma 
Testicular torsion 
Infection 
Genetic dis. 
Cryptorchidism 
Toxin

Question 17

Sexually Transmitted Dis.-Chlamydia (chlamydia trachomatis)

Answer 17

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

Question 18

Infertility-male w/ direct effect on testicular function, testicular damage

Answer 18

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.

Question 19

Infertility-male and other testicular causes

Answer 19

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

Question 20

infertility-male and factors affecting spermatogenesis

Answer 20

Hormones/med. 
Syst. dis. 
Environment/lifestyle factors 
Dietary def. 
Toxin 
Testicular temp
Ionizing of red./alkylating agents
develop disorder. 
Local infections

Question 21

Infertility-male and post testicular causes

Answer 21

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
-

Question 22

infertility-male and post testicular factors affecting spermatogenesis

Answer 22

Developmental disorders

Local infections

Question 23

Dis. assoc. w/ prego.-ectopic prego.

Answer 23

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

Question 24

Sexually Transmitted Dis.-specific infect.

Answer 24

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)

Question 25

Sexually Transmitted Dis.-bacterial gram neg.

Answer 25

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

Question 26

Sexually Transmitted Dis.-herpes simplex virus infection

Answer 26

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

Question 27

Female reproductive disorders

Answer 27

Disruption of mensuration

Question 28

Menstrual disorders

Answer 28

Amenorrhea=no menstrual bleeding 
Dysmenorrhea
-irreg. menstrual symp. 
-excessive pain 
Menorrhagia=excessive bleeding 
Metrorrhagia=Irregular/protracted bleeding

Question 29

Menstrual disorder-Amenorrhea

Answer 29

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

Question 30

Endometriosis

Answer 30

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

Question 31

Dis. assoc. w/ prego.-pre. prego./during prego./after prego.

Answer 31

Pre prego.=Ectopic Prego.
During prego.=eclampsia/preeclampsia
After prego.=Matitis

Question 32

Dis. assoc. w/ eclampsia/pre. eclampsia

Answer 32

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.

Question 33

Dis. assoc. w/eclampsia/pre. eclampsia= abnormal placental vasculature

Answer 33

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.

Question 34

Dis. assoc. w/ Mastitis

Answer 34

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)

Question 35

female reproductive-normal hormones

Answer 35

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

Question 36

Prostate gland

Answer 36

Prostate gland products–>urethra
-slightly alkaline fluid
-contain enzymes maintain seminal fluid as liq.
:move sperm in female tract

Question 37

Prostate dis.

Answer 37

Surrounds urethra=inflammation or hypertrophy impact urethral function and dysuria
S/S=difficult urinating(starting vol, incomplete voiding, pain)
-b/c prostate location

Question 38

Male reproductive disorder-prostatis clinical

Answer 38

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

Question 39

Male reproductive disorder-prostatis causative agents

Answer 39

Bacterial
Abacterial
Granulomatous

Question 40

Male reproductive disorder-Acute prostatis bacterial

Answer 40

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

Question 41

Male reproductive disorder-prostatis Abacterial

Answer 41

MC today
Chronic bact. but bact cultures r inhib.
prostatic secretions has leukocytosis =not have urinary bact. infect.

Question 42

Male reproductive disorder-prostatis granulomatous

Answer 42

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

Question 43

Male reproductive disorder-Benign prostate hypertrophy (zones)

Answer 43

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)

Question 44

Male reproductive disorder-Benign prostate hypertrophy and Pathogenesis

Answer 44

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

Question 45

Male reproductive disorder-Benign prostate hypertrophy and pathology

Answer 45

Compression of urethra lumen by hyperplastic glands
Two layers of cells in glands
-inner columnar
-outer basal flattend

Question 46

Male reproductive disorder-Benign prostate hypertrophy (BPH) clinical

Answer 46

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

Question 47

Dis. assoc. w/ eclampsia/pre. eclampsia and pathogen

Answer 47

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

Question 48

Male reproductive disorder-Chronic prostatis bacterial

Answer 48

~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)