Systemic pathology 400 (reproductive pathologies 2 & 1?) Flashcards
Candidiasis risk factors
hot weather
clothing (esp type of clothes, esp when humid (e.g. tighter, dense clothes?))
immunosuppression
poor hygiene
DIET
—>
“Very high sugar intake may worsen candida infections in people with weakened immune systems.”
PREGNANCY
ANTIBIOTICS
why pregnancy risk factor for CANDIDIASIS
“In addition, some pregnancy-related factors such as increased estrogen levels, increased vaginal mucosal glycogen production, and decreased cell-mediated immunity are likely to cause both asymptomatic colonization and the increased risk of VVC during pregnancy”
why antibiotics a risk factor for CANDIDIASIS?
“Factors that increase your risk of developing a yeast infection include: Antibiotic use. Yeast infections are common in women who take antibiotics. Broad-spectrum antibiotics, which kill a range of bacteria, also kill healthy bacteria in your vagina, leading to overgrowth of yeast.”
clothing and candidiasis?
E.g.
tight (or dense?) yoga clothing, esp when hot humid weather
IUD and candidiasis?
“This study confirms the hypothesis that IUD use predisposes to colonization and infection by Candida albicans and other strains. The fact that the yeast organisms were more prevalent on the IUD tails than in the vaginal mucosa indicates that the IUD tail acts as a reservoir of infection.”
Candidiasis is AKA
AKA – yeast infection
Candidiasis is a ____ infection with ____
Genital infection with CANDIDA ALBICANS
candidiasis – clinical manifestations
Itching, burning
Discharge
Candidiasis – Dx
Symptomatic
SSx
patient history
Candidiasis – Tx
Antifungal medication
Lifestyle modification
where can candidiasis occur?
“A candidiasis infection often appears on your skin, vagina or mouth, where Candida naturally lives in small amounts.”
Candidiasis is …
“Candidiasis is a fungal infection caused by an overgrowth of yeast in your body.”
“Healthy bacteria help balance the amount of yeast and disruption of this balance leads to an infection.”
can men get yeast infections (candidiasis) ?
“Yes, men can get yeast infections, too, which can lead to a condition known as balanitis — inflammation of the head of the penis. Yeast infections in men are common because the fungus that causes yeast infections (candida) is normally present on skin, especially moist skin.”
Genital warts – every single type is caused by …
HPV (human papilloma virus)
—> Keep in mind however that there are many, many strains of HPV
—>
Not all HPV strains cause warts
—>
some are more likely to cause warts in one spot, & others more likely in other spots
genital warts is AKA
venereal warts,
condyloma acuminata,
anogenital warts
condyloma acuminata
“(from Greek κόνδυλος ‘knuckle’, Greek -ωμα -oma ‘disease’, and Latin acuminatum ‘pointed’)”
genital warts are ____ lesions of ____ of the ____
Benign lesions of the skin or mucous membranes of the genitals
some trains of HPV cause ____
Some strains cause flat warts in the cervical canal or anus
Caused by some strains of human papillomavirus (HPV)
___% of women have been affected at least ONCE by age 50
80% of women have been affected once by age 50
most warts ____
Most clear spontaneously within 1-2 years
warts manifestation
Manifestation includes soft, moist, tiny, pink or grey polyps that may become pedunculated
how long after infection do warts show up
could be 6 months
—>
compare to other infections, which generally show up within a few days
genital warts – texture ?
do genital warts typically occur on their own or in clusters?
May be rough or occur in clusters
are genital warts always symptomatic?
Can be asymptomatic
or cause itching/burning
where do genital warts most commonly occur?
vulva,
vaginal wall,
cervix,
perineum,
urethra,
anal region
genital warts – prevention
Prevention includes vaccination
Pelvic inflammatory disease
Infection and inflammation of the upper female genital tract:
Infection and inflammation of the upper female genital tract:
possible locations
cervix,
uterus,
fallopian tubes,
ovaries
pelvic inflammatory disease can cause …
infertility,
chronic pain,
ectopic pregnancy
pelvic inflammatory disease – Etiology
Results from microorganisms ascending from the vagina and cervix into the endometrium and fallopian tubes
which bacteria are MOST COMMON cause
Neisseria gonorrhoeae
Chlamydia trachomatis
pelvic inflammatory disease — ETIOLOGY AND CLASSIFICATION
Cervicitis
Salpingitis
Endometritis
Oophoritis (when severe)
Peritonitis (when severe)
PID – incidence
1 million women affected/year
Young age
Multiple/new sex partners
STIs
why young women more likely to get PID?
more sexually active (?)
multiple sexual partners
Cervicitis
inflammation of the cervix;
can cause mucopurulent discharge
Salpingitis
inflammation of the fallopian tubes;
can become red, swollen, pus-filled
Endometritis
inflammation of the uterus
oophoritis
inflammation of ovaries
peritonitis
inflammation of peritoneum
PID – Clinical manifestations
Widely variable
Asymptomatic (possible)
Pain/chronic pain
Discharge
Irregular bleeding
Fever, chills
Nausea
Vomiting
can PID be asymptomatic
yes
more clinical manifestations of PID
Dyspareunia (painful intercourse)
Dysuria
Abscess
Menstrual irregularities
Ectopic pregnancies (scarring)
Infertility (scarring)
Death
one way PID can lead to death
“If PID infects the fallopian tubes, it can scar the lining of the tubes, making it more difficult for eggs to pass through. If a fertilised egg gets stuck and begins to grow inside the tube, it can cause the tube to burst, which can sometimes lead to severe and life-threatening internal bleeding.”
PID – Dx
History/exam
Culture
Blood tests
PID – Tx
Antibiotics
Prevention
—> Safe sex practices
—> Checkups
DISORDERS OF CERVIX
..
Cervical polyps
Common benign growths of the cervix or ENDOCERVIX
in what percentage of women does cervical polyps occur?
Occur in about 2 to 5% of women,
possibly due to chronic inflammation.
are cervical polyps usually symptomatic or asymptomatic?
Most cervical polyps are asymptomatic.
however, what is one possible symptom of polyps when symptomatic?
Polyps may bleed between menses or after intercourse or become infected
polyps are usually removed (regardless of where they occur)
WHY?
there is a small chance that polyps can become malignant
polyps – visual description
Polyps are usually reddish pink, < 1 cm in size
are polyps commonly malignant ?
No.
They are rarely malignant (1%)
how are polyps diagnosed?
Diagnosis is by speculum examination
speculum define
“a metal or plastic instrument that is used to dilate an orifice or canal in the body to allow inspection.”
violin-string adhesions (unrelated to cervical polyps notes)
possible adhesion type that can occur @ fallopian tubes
—> d/t scarring / adhesions
—> common risk factor for EP (ectopic pregnancy)
—->
See also:
Fitz-Hugh-Curtis Syndrome
cervical polyps – Tx
Treatment - surgery
cervical cancer – mortality
4000 deaths per year
despite 4000 deaths per year, how has the mortality rate changed since the early 20th century?
Mortality declined rapidly since 1930s
despite current mortality rate of cervical cancer, it is HIGHLY ____
PREVENTABLE
most common cause of cervical cancer
HPV (human papilloma virus)
cervical cancer — RISK FACTORS
Smoking (chemicals)
HPV
Long term oral contraceptives
High parity
LOW socioeconomic class
Ethnicity (esp hispanic)
Multiple sex partners (?)
why is high parity risk factor for cervical cancer?
“Excess risk of cervical cancer among women with high parity is believed to be linked with a high rate of cervical abnormalities during pregnancy,”
high parity define
“High parity (HP), defined as having ≥5 pregnancies of ≥20 weeks of gestation, is among various risk factors which have been hypothesized for fetal growth abnormalities. 2. Although HP has been recognized to be a potential risk factor for abnormal fetal growth, the exact etiological mechanism is not well understood.”
PARITY, define:
“Parity is the number of times a woman has given birth to a live neonate (any gestation) or at 24 weeks or more, regardless of whether the child was viable or non-viable (i.e. stillbirths). Format: 1 digit numeric.”
why oral contraceptives risk factor for cerivical cancer
“In addition, oral contraceptives might increase the risk of cervical cancer by changing the susceptibility of cervical cells to persistent infection with high-risk HPV types (the cause of virtually all cervical cancers).”
cervical cancer – ethnicity as risk factor?
“Importance Black and Hispanic or Latina women are more likely than White women to receive a diagnosis of and to die of cervical cancer.”
cervical cancer – clinical manifestations
Asymptomatic (possible)
Abnormal bleeding
—>
(Like cervical polyps)
cervical cancer – Dx
Pap test
Conization/LEEP
pap test define
“a test carried out on a sample of cells from the cervix to check for abnormalities that may be indicative of cervical cancer; a Pap smear.”
“from a shortening of the name of the anatomist George Nicholas Papanicolaou, who devised the technique”
Conization define
“A procedure in which a cone-shaped piece of abnormal tissue is removed from the cervix. A scalpel, a laser knife, or a thin wire loop heated by an electric current may be used to remove the tissue.”
“The tissue is then checked under a microscope for signs of disease.”
cervical cancer – Tx
Cryotherapy
Laser/excision
Chemotherapy, radiation (metastasis?)
Hysterectomy (uterus)
LEEP diagnosis define
“Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by electric current. It is used to remove cells and tissue in a woman’s lower genital tract. It is used as part of the diagnosis and treatment for areas that are abnormal or cancer.”
cervical cancer – Prognosis
Good; slow growing neoplasm; responds well to treatment
Depends on early detection
Largely preventable with early screening
what is the mortality rate for late detection of cervical cancer?
75%
Later stages associated with high mortality (~75%)
what is the mortality rate of early diagnosis of cervical cancer?
generally 0%
Early detection = 100% cure
cervical cancer – PREVENTION
regular checkups (?)
Pap test
Barrier protection
Monogamy
Don’t smoke
Endometrial Hyperplasia – define
Benign overgrowth of the endometrium (endometrial cells)
endometrial hyperplasia can be due to …
EXCESS ESTROGEN
and LOW PROGESTERONE
endometrial hyperplasia – MOST COMMON Symptom
abnormal vaginal bleeding
endometrial hyperplasia is a RISK FACTOR for _____.
endometrial cancer
—> Can lead to endometrial
cancer
endometrial hyperplasia — RISK FACTORS
menopausal age,
(skipping or having no periods),
being over-weight,
diabetes,
polycystic ovarian syndrome,
increased levels of unopposed estrogen
why PCOS risk factor for endometrial hyperplasia?
“People with PCOS are more likely to have excess estrogen and higher BMIs. The longer someone goes without shedding the lining of the uterus (or having a period), in the setting of chronic estrogen exposure, the greater their risk for endometrial hyperplasia and endometrial cancer.”
endometrial hyperplasia – Diagnosis
pap smear
endometrial hyperplasia – Treatment
hormones (progesterone?)
hysterectomy
Endometriosis
Estrogen-dependant,
non-cancerous disorder
Functioning endometrial tissue implanted outside the uterine cavity
is endometriosis COMMON?
YES
up to 60% of women
Endometriosis – LOCATIONS (most common)
ovaries,
fallopian tubes,
broad ligaments,
bladder,
pelvic musculature,
perineum,
vulva,
vagina,
intestines
Other unrelated locations endometriosis can occur (implanted)
abdominal cavity,
kidneys,
appendix,
diaphragm,
bone,
lungs,
brain,
nose,
joints
endometriosis — RISK FACTORS
GENETICS
delayed childbearing
short menstrual cycle (<27 days)
long menses (>7 days)
genetics and endometriosis
Incidence of endometriosis is increased in FIRST-DEGREE RELATIVES of women with endometriosis, suggesting that genetics is a factor.
why does not having children increase risk for endometriosis?
“People who have never had a child tend to have a higher risk for endometriosis than people who have given birth. Pregnancy stops the menstrual cycle for a period of time. This break in the menstrual cycle lowers the amount of estrogen a person is exposed to.”
recall – endometriosis –> “estrogen-dependent”
“High estrogen production is a consistently observed feature of endometriosis and this review highlighted the fact that estrogen and its receptors play a key role in the pathophysiology of endometriosis.”
aside –> health risks of not having children?
“Research shows that not having kids can raise the risk of certain health issues, like breast cancer. However, having kids can also raise the risk of cardiovascular disease for some women, and in others it can lead to chronic pain.”
aside – uterine prolapse?
“Uterine prolapse occurs when the muscles and tissue in your pelvis weaken. This allows your uterus to drop down into your vagina. Common symptoms include urine leaking, fullness in your pelvis, bulging in your vagina, low back pain, and constipation.”
endometriosis – Pathogenesis
Endometrial cells transported from the uterine cavity and subsequently become implanted at ectopic sites
how does menstrual tissue reach the abdomen?
Retrograde flow of menstrual tissue through the fallopian tubes could transport endometrial cells intra-abdominally;
how does menstrual/endometrial tissue reach distant sites?
the lymphatic or
circulatory system
could transport
endometrial cells to
distant sites
—>
(this is one theory)
compare endometrial tissue implants to intrauterine endometrium?
Microscopically, endometriotic implants are identical to intrauterine endometrium. These tissues contain estrogen and progesterone receptors and thus usually grow, differentiate, and bleed in response to changes in hormone levels during the menstrual cycle
what does bleeding of endometrial implants (E.g. peritoneal implants) lead to during menstrual cycle?
Bleeding from peritoneal implants is thought to initiate inflammation, followed by fibrin deposition, adhesion formation, and –
eventually – scarring, which
distorts peritoneal surfaces of
organs and pelvic anatomy.
endometriosis may be related to dysregulation of ____ & …
May also be related to
—>
dysregulation of immune system;
metaplasia;
surgical procedures;
abnormal differentiation during embryology
endometriosis – clinical manifestation
Depends on the location of the implants
pain,
dysmenorrhea,
fatigue,
mood changes,
dyspareunia,
pain during defecation,
fever,
diarrhea,
rectal bleeding,
alternation of menses,
infertility
SYMPTOMS DO NOT NECESSARILY CORRELATE WITH SEVERITY OF ENDOMETRIOSIS
Extensive endometriosis can be
asymptomatic;
minimal disease
can cause incapacitating pain.
