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Pathophysiology > Reproductive system disorders > Flashcards

Reproductive system disorders Flashcards

1
Q

What is BPH?

A

Benign prostatic hyperplasia

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2
Q

What is the H stand for in BPH and what is the difference between hyperplasia and hypertrophy?

A
  • Hyperplasia: increase in cell number

- Hypertrophy: growth in the size of an individual cell

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3
Q

What does BPH mostly effect?

A
  • periurethral zone (next to uretha)

- prostate cancer affects peripheral zone

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4
Q

What is the prostate made up of

A
  • made up of glands that have 2 layers of epithelial cells:

- ->a basal layer of flattened cuboidal epithelial cells covered by columnar epithelial cells (supported by stroma)

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5
Q

Important developer of BPH

A
  • Aging is the biggest contributor
  • at 50, 50% of men will have symptoms
  • in 90-100 year olds, symptoms are 100% seen
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6
Q

Explain what DHT is and how it is involved in BPH symptoms

A

Dihydrotestosterone (DHT): endogenous androgen sex steroid and hormone. The enzyme 5α-reductase catalyzes the formation of DHT from testosterone in certain tissues

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7
Q

What happens to testosterone and estrogen levels in a man as he ages. How might this contribute to the development of BPH?

A
  • Testosterone levels decrease and estrogen levels increase

- affect prostate tissue in a way that it expresses more androgen receptors

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8
Q

Describe the symptoms and complications of BPH.

A

poor urinary stream, increased urinary frequency, nocturia, difficulty with urinary stream stopping and starting, and even painful micturition

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9
Q

What might be used to help diagnose BPH? How do these tests work?

A

Digital rectal exam, urinalysis, and blood tests for serum creatinine and prostate-specific antigen (PSA)

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10
Q

Explain how finasteride, dutasteride, terazosin or prazosin might help BPH

A
  • 5-alpha reductase inhibitors: finasteride, dutasteride; inhibiting the production of DHT
  • alpha-1 antagonists: terazosin, prazosin; smooth muscle contraction
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11
Q

What is a TURP and how might it help?

A

Transurethral resection of the prostate. It involves the insertion of a scope through the tip of the penis until it reaches the prostate tissue. Has a tool that can trim prostate tissue.

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12
Q

Prostate Cancer

A

malignant tumor that forms on glandular structures in the peripheral zone of the prostate gland

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13
Q

Where in the prostate gland does cancer usually arise?

A

peripheral zone of the prostate gland

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14
Q

Why is it advisable to sometime do nothing to treat prostate cancer?

A

slow growing prostate cancer usually won’t be the thing to kill older men.

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15
Q

What ethnic groups have the highest risk and the lowest risk of prostate cancer?

A

African American men have the highest rate and Asian men have the lowest rate

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16
Q

What is BRCA-2?

A

tumor suppressor gene and a mutation in this gene imparts a 20-fold increase in the risk for the development of prostate cancer

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17
Q

When prostate cancer does become aggressive, where does it often spread to?

A

bones, brain, liver, lungs and possibly other areas

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18
Q

What is PSA? What information can a PSA test give us? Why is the PSA test controversial?

A
  • Prostate-specific antigen (PSA): part of the ejaculate where it has the function of liquefying semen coagulate to allow sperm to swim freely
  • prostate cancer, BPH, prostatitis
  • There is variation in PSA for men. Plus if there is high PSA this causes anxiety for men to undergo a biopsy
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19
Q

What is prostate brachytherapy?

A
  • inserting radioactive “seeds”

- needle into the prostate gland between the scrotum and the anus

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20
Q

What is PID and what causes it?

A

-Pelvic inflammatory disease (PID): inflammation of the female reproductive organs

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21
Q

What factors predispose women to developing PID?

A
  • younger than 25
  • younger than 15 when having sex
  • use of IUD or oral contraception
  • multiple sex partners
  • frequent vaginal cleaning
  • history of STD’s
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22
Q

What are common symptoms of PID?

A

abdominal pain, dyspareunia (painful intercourse), purulent cervical discharge, vaginal discharge, burning with urination, irregular menstruation, fever and increased WBC count

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23
Q

What are some complications of PID that treatment can help prevent? How is PID diagnosed and treated?

A
  • scarring that can lead to chronic pain, infertility, and complications with pregnancy
  • Tx: antibiotics
  • Dx: observation of the symptoms and cervical tenderness on examination
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24
Q

What is endometriosis?

A

“ectopic” (abnormal place) endometrial tissue at a site outside of the uterus

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25
Q

What are some common locations for endometriosis?

A

ovaries, uterine ligaments, fallopian tubes, peritoneum, bladder, rectum and intestines

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26
Q

What are some risk factors for developing endometriosis?

A

family history, early age of menarche and shorter menstrual cycles

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27
Q

Briefly describe the theories that attempt to explain the origin of the dispersed endometrial lesions

A
  1. The regurgitation/implantation theory: sloughed off tissue retrograde and deposit fragments of endometrial cells on extra uterine structures
  2. The vascular or lymphatic theory: endometrial cells entered the lymph or vascular circulation and were carried to extra uterine structures where they could implant
  3. The metaplastic theory: endometrial cells do not complete maturation
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28
Q

How are endometrial implants different than the endometria of a healthy uterus?

A
  • they release inflammatory mediators including high levels of prostaglandin E2 (PGE2) which is pro-inflammatory
  • Implants also have high levels of aromatase which produces estrogen that promotes endometrial proliferation
29
Q

What are the common clinical signs and symptoms that accompany endometriosis?

A

painful menstruation, pelvic pain and infertility.

30
Q

Why are NSAIDs, progesterone, and GnRH analogs useful in the treatment of endometriosis?

A
  • NSAIDs help with the pain

- progesterone and GnRH analogs cause endometrial growth suppression.

31
Q

How is adenomyosis different from endometriosis?

A

abnormal deposit of endometrial tissue within the myometrium (muscle layer) of the uterus

32
Q

What is suspected to put a female at greater risk for adenomyosis?

A

Women who have multiple children in their 40s/50s

33
Q

What are the symptoms of adenomyosis?

A

no symptoms to severe and debilitating pain and pain is worse during menstration

34
Q

What treatment options are available for adenomyosis?

A
  • Uterine sparing: hormone manipulation (Tx for endometriosis). Can also do surgery ablation or resection
  • Uterine non sparing: hysterectomy
35
Q

What age group is most affected by this endometrial cancer?

A

postmenopausal women (55-65)

36
Q

What is the difference between type 1 and type 2 endometrial cancer?

A
  • Type 1: excess estrogen, most common type

- Type 2: older women in a setting of endometrial atrophy and estrogen excess is not found

37
Q

What is the major symptom associated with endometrial cancer?

A

abnormal bleeding

38
Q

What are uterine leiomyomas?

A

benign tumors that are non cancerous

39
Q

Describe the common symptoms and treatment options for Uterine Leiomyoma

A
  • heavier bleeding, frequent pee, constipation and rectal pressure, ab pressure
  • removal of tumor or hysterectomy
40
Q

Ovarian Cycle

A
  • estrogen highest during follicular phase of ovarian cycle
  • progesterone highest during luteal phase of ovarian cycle
  • GnRH causes FSH and LH to increase during follicular
  • lack of GnRH causes FSH and LH to decrease during luteal phase
41
Q

Uterine Cycle

A
42
Q

Estrogen positive feedback effects on the hypothalamus and pituitary

A

At the end of the follicular phase, estrogen does a positive feedback and causes an LH surge

43
Q

Corpus luteum production of progesterone

A
  • produces progesterone during the luteal phase

- lack of LH causes corpus albicans-> does not produce much estrogen and progesterone-> menses

44
Q

LH surge and ovulation

A

positive feedback triggers and causes ovulation

45
Q

Role of hCG after fertilization / implantation

A

implanted zygote produces hCG which is an LH agonist and keeps corpus luteum functioning.

46
Q

During which phase of the cycle are levels of progesterone the highest?

A

ovarian luteal phase

47
Q

When is estrogen increasing?

A

during the end of the follicular phase

48
Q

Two cell cooperation of steroidogenesis (thecal and granulosa) before and after ovulation

A
  • Thecal: express LH receptors = absorption of LDLs-> cholesterol-> steroids
  • Granulosa: express FSH and LH receptors but LDL cannot cross membrane until after ovulation
  • Granulosa does not have proper enzyme to convert progesterone to a steroid but thecal cells have that enzyme
  • Theca cells can produce estrogen with granulosa’s aromatase enzyme
49
Q

Polycystic Ovary Syndrome

A
  • Occurs when follicles do not ovulate
  • increase in pulsatile GnRH release which explains why there’s lack of high progesterone during a luteal phase
  • follicle doesn’t ovulate=no corpus luteum=no progesterone
50
Q

An increase in GnRH pulse frequency leads to what?

A
  • increase in the amount of LH over FSH
  • follicle may develop but not mature enough to be a functional graffian follicle that can ovulate
  • Follicles that do not ovulate are called cysts
51
Q

PCOS symptoms

A

menstrual irregularity, hyperandrogenism (e.g., hirsutism and acne), infertility, and insulin resistance or hyperinsulinemia

52
Q

What does insulin do to the ovaries and the adrenal cortex?

A

stimulate steroidogenesis in the ovary and the adrenal cortex

53
Q

Why are women with PCOS at increased risk for developing endometrial cancer?

A

prolonged estrogen exposure that can lead to endometrial hyperplasia

54
Q

Recall how PCOS is treated

A
  • administration of progesterone
  • weight loss
  • oral contraceptives: progesterone
  • spironolactone: inhibit androgens receptors
  • metformin: insulin control
55
Q

3 different cell types that ovarian cancer occurs in

A

surface epithelium, germ cells and in stromal cells, and epithelial cells

56
Q

What type of ovarian cancer is most lethal and occurs in older women? What types are lest lethal and can occur in younger women?

A

-Younger: germ and stromal cell tumors

57
Q

Describe the most significant risk factor for ovarian cancer known as ovulatory age

A

how long a woman’s body has been exposed to high estrogen levels

58
Q

What are the names of the two tumor suppressor genes that if mutated increase the risk for ovarian and breast cancer?

A

Mutations of the breast cancer suppression genes BRCA1 and BRCA2

59
Q

What could increase risk Ovarian cancer?

A

high fat western diet and the use of talcum powders in the genital area

60
Q

Cancers in the ovary can cause…

A

produce vague GI symptoms such as abdominal bloating, early satiety and diarrhea

61
Q

What are the two types of carcinomas that may occur with breast cancer

A
  • Ductal carcinoma

- lobular carcinoma

62
Q

What are some of the signs and symptoms that a woman may notice if she has breast cancer?

A

mass, a puckering of the skin, texture changes of the skin, nipple retractions or abnormal discharge

63
Q

What is a Mammography and why is it important?

A

X-ray picture of the breast and can detect a mass as small as 1 mm in size

64
Q

What might make a breast cancer “inherited”? What are the names of the genes involved?

A

BRCA1 and BRCA2.

These are tumor suppressor genes that when they lose their function= greater risk for cancer

65
Q

What are the options that will be considered if such genes are inherited?

A

strict screening regimen and mastectomies

66
Q

Define Radical Mastectomy

A

remove any tumor mass and in extreme cases this may involve the whole breast, underlying muscle and axillary lymph nodes

67
Q

What are the modifiable risk factors for breast cancer?

A

Obesity, physical inactivity, caffeine, alcohol consumption, smoking and long term use of hormone replacement therapy

68
Q

Explain the mechanisms for Tamoxifen and Trastuzumab for treatment of breast cancer

A
  • Tamoxifen: bind the intracellular estrogen receptors and activate or inhibit its action
  • Trastuzumab: monoclonal antibody that can bind and block the HER2 receptors. This helps shrink tumor tissue and slow cancer progression
69
Q

What are aromatase inhibitors and why might they be used to help treat breast cancer?

A

lowering the amount of circulating estrogen available to stimulate breast tissue and tumor growth

Pathophysiology (10 decks)

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