Reproductive System Pathology Flashcards
What is the clinical definition of infertility?
- Inability to conceive within one year of trying
True or false. Infertility rates are increasing.
False. Rates are not increasing, but our screening and treatment options have
Infertility is present in ___% of the US reproductive-age population.
11%
_____ infertility refers to anything that impacts ova production
Ovulatory
_____ infertility refers to structural damage to the oviducts and prevent movement of the ova or fertilization
Tubal
______ infertility refers to damage that can prevent implantation or maintenance of a pregnancy.
Uterine
What are the potential causes of ovulatory infertility?
- Hypothalamus/pituitary disease
- Insufficient production of gonadotropins
- PCOS
- Chemotherapy/pelvic irradiation
What causes polycystic ovarian syndrome (PCOS)?
Gonadotropin insufficiency; directly damages the ovaries
How can infections cause infertility? (3)
- Inflammation, scars, and adhesions prevent implantation
- Block transport/implantation
- Can cause ectopic pregnancies
How can thyroid disease cause infertility?
- Excess TRH, in response to low thyroid hormone levels, induces PRL secretion
- At high levels, PRL will suppress GnRH
How do drugs that alter PRL secretion and/or damage to the pituitary cause hyperprolactinemia?
Prevent dopamine from inhibiting PRL secretion
How does excess dopamine affect fertility? (2)
- Alter gonadotropin release
- Directly effect on follicles
What are some pretesticular factors that can affect spermatogenesis? (5)
- Hormones and medications
- Systemic diseases
- Environmental/lifestyle factors
- Dietary deficiencies
- Toxins
How do anabolic steroids affect spermatogenesis?
Initiate negative feedback loop that reduces LH/FSH levels
What are some testicular causes of infertility? (4)
- Elevated testicular temperature
- Ionizing radiation and alkylating agents
- Developmental disorders
- Local infections
What is the most common cause of male infertility?
Varicocele: abnormally dilated scrotal veins
True or false. Trauma to the testes causes irreversible damage, which leads to infertility
False. It can be reversible with early intervention
What are the two primary circumstances when testicular torsion can occur?
- Neonatal - in utero or shortly after birth; no anatomic defect
- Adult - usually in adolescence
If torsion is reversed within _______, patients generally have a full recovery.
6 hours
What genetic diseases can impact sperm production? (2)
- Klinefelter syndrome
- Microdeletions on the Y chromosome
What is cryptorchidism?
- Complete or partial failure of testes to descend during fetal development
What histological changes are apparent by the age of 2 in cryptorchidism? (2)
- Lack of germ cell development (no spermatogonia, spermatocytes, or spermatids
- Hyalinization and thickening of basement membrane
What are some post-testicular causes of infertility? (3)
- Ductal obstruction (surgical or congenital)
- Ejaculatory issues (obstruction or anejaculation)
- Infections (STDs, E. coli)
How do Gonorrhea infections affect males and females?
- Males: causes urethritis
- Females: often asymptomatic; may lead to pelvic inflammatory disease and infertility
How does Gonorrhea affect newborns?
- Causes conjucntivities that leads to blindness
What bacterium causes gonorrhea? Is it Gram(+) or Gram(-)?
- Neisseria gonorrhoeae
- Gram(-)
What bacterium casues syphilis? Is it Gram(+) or Gram(-)?
- Treponema pallidum
- Gram(-)
What is lymphogranulomma venereum (LGV)?
- Chronic, ulcerative disease caused by certain strains of chlamydia
- Lesion leads to swelling of lymph nodes which can rupture
- If left untreated, can cause fibrosis and stricture of structures of the lower urogenital tract
Both HSV-1 and HSV-2 can infect mucosa, but which is more likely to cause genital herpes?
HSV-2
How can herpes virus remain latent?
Infecting nearby nerves
What are the symptoms of herpes? (6)
- Lesions to the skin
- Corneal lesions (blindness)
- Encephalitis
- Bronchopneumonia
- Esophagitis
- Hepatits
What is dysmenorrhea?
- Irregular menstrual symptoms
- Excessive pain
What is menorrhagia?
Excessive menstrual bleeding
What is metrorrhagia?
Irregular and excessive menstrual bleeding
What is amenorrhea?
Lack of menstrual bleeding
When is amenorrhea normal?
- Pregnancy
- Menopause
What are some abnormal causes of amenorrhea? (4)
- Scarring of the uterus after infection
- Gonadal failure
- Resistance to gonadotropic normones
- Insufficient gonadotropin secretion
What is the presence of endometrium outside the uterus?
Endometriosis
What are the symptoms of endometriosis?
- Dysmenorrhea
- Pelvic pain
- Infertility
Approximately 90% of ectopic pregnancies are located in the _____
Uterine tubes
What are the hallmark symptoms of pre-eclampsia vs. eclampsia?
- Pre-eclampsia - proteinuria
- Eclampsia - convulsions
What is mastitis? When does it typically occur?
- Acute bacterial infection of the mammary glands
- Occurs during 1st month of breastfeeding
In mastitis, which bacterium causes abscesses and which causes cellulitis?
- Abscesses - S. aureus
- Cellulitis - Strep
What is the most common form of prostatitis seen today?
Chronic abacterial
When is granulomatous prostatitis most commonly seen?
Due to cancer/treatment
When do you typically see fungal prostatitis?
Immunocompromised hosts
What part of the prostate is the most common location for benign prostatic hypertrophy (BPH)?
Transitional zone
What is the most common location for inflammation and cancer in the prostate?
Peripheral zone
Explain the pathogenesis of BPH?
- Circulating testosterone is converted to DHT by 5-alpha-reductase
- Excessive cell growth due to DHT
What are the treatment options for BPH?
- Reductase inhibitors
- Minimally invasive treatments (lasers)
- Surgical
What are the common symptoms of BPH? (4)
- Hesitancy
- Urgency
- Nocturia
- Poor urinary stream
