Unit 6: Repro Paths Flashcards
Vaginitis
Inflammation of the vagina
Common
Candiasis
Trichomonos
Gardnerella bacteria
Itching, bleeding, discharge, dysuria
Vulvitis
Infection of the vulva
Often HPV (genital warts)
Cervicitis
Inflammation of the cervix
Often gonorrhea, chlamydia, HPV, or HSV2
Discharge, pain, dysuria, menstrual abnormalities
Pelvic Inflammatory Disease
Infection of the uterus and/or fallopian tubes
Usually ascends from lower reproductive organs (cervix, vagina
Gonorrhea, chlamydia, vaginal flora, etc
PID: Sx
fever dysmenorrhea dyspareunia abdominal pain irregular bleeding (or asymptomatic)
PID: complications
Peritonitis and sepsis (which can lead to endocarditis, arthritis, and meningitis)
Ectopic pregnancy
Infertility
Chronic pelvic pain
Cervical Dysplasia
Abnormal changes in the cells on the surface of the surface
May be cause by HPV
Usually asymptomatic
Cervical Eversion
A condition in which a portion of the endocervical epithelium protrudes through the external os into the vagina.
Metaplasia: becomes stratified squamous epithleium
Cervical Eversion: Sx
May have the same appearance as early cervical cancer, even though it is not an abnormality
May be associated with non-purulent discharge, and/or post-coital bleeding
Cervical Polyps
Common, benign growths of the cervix or endocervix
2-5% of women.
Usually results from chronic inflammation
Dx with speculum. Small.
May bleed between menses, or post-coital
Endometrial Hyperplasia
Growth of endometrium due to excess estrogen (relative to progesterone levels)
Causes abnormal and heavy menstrual bleeding
Can be treated with oral contraceptives
Cervical Carcinoma: Risk Factors
HPV
Smoking
Oral contraceptives
Immunosupppression
Cervical Carcinoma: Sx
No early symptoms
Later: bleeding, spotting, discharge, pain
Endometriosis
Endometrial cells found outside uterus
Ovary, pelvic peritoneum most commonly
Very common
Growths can’t be shed during menses, so are encapsulated
Also manufacture high levels estrogen
Endometriosis: Sx
Infertility
Dysmenorrhea
Dyspareunia
Endometriosis: Complications
Adhesions
Obstruction of uterine tubes/ectopic pregnancies
Anemia
Uterine hyperplasia
Myometrial tumours
Leimyoma (benign, common)
Leiomyosarcoma (malignant, rare)
Endometrial tumours
Adenocarcinoma (malignant, common)
Leiomyomas
Benign fibroid tumor in or around the uterus
Can range from microscopic to several pounds
20% of women
Stimulated by estrogen
Leiomyomas: Sx
Often asymptomatic, but if big enough can put pressure on nerves, bladder, bowels, or interfere with pregnancy.
Can cause heavy, painful periods, anemia, infertility
Most common invasive cancer of female genital tract
Endometrial adenocarcinoma (7%) Most commonly in 55-65 (peri/postmenopausal) age group
Stage IV cervical cancer usually extends (fatally) to:
Urinary bladder, uterus.
Death by local obstruction, not distant metastases
Uterine Sarcoma
5% of uterine cancers
Nonglandular
Stromal Sarcoma
(Uterine) sarcoma affecting connective tissue
Leiomyosarcoma
Rare, malignant tumour of the uterine muscle cells
Malignant mixed mesodermal tumours
Uterine
Combine features of adenocarcinomas and sarcomas
Uterine Sarcomas: Sx
leukorrhea, pain, pelvic mass, pain with sex, change in bladder/bowel habits, unintended weight loss
Four mechanisms of uterine sarcoma metastasis
Direct contact
Peritoneal fluid
Lymphatics
Circulatory system
Endometrial hyperplasia
Increased proliferation of the endometrial glands (relative to the stroma)
Important cause of abnormal bleeding
Simple or complex
May be premalignant
Endometrial hyperplasia results from
Prolonged exposure to estrogen
Endometrial hyperplasia: S
menorrhagia
metrorrhagia (abnormal bleeding)
Menometrorragia (prolonged/excessive bleeding)
Salpingitis
Inflammation of the fallopian tubes
Follicular ovarian cyst
Most common type
Follicle doesn’t rupture completely, blister forms at site.
Usually resolves on its own
Corpus luteum ovarian cysts
Follicle doesn’t heal normally after ovulation
Creates pregnancy-like symptoms until resolution (2-3 months)
May cause bleeding into peritoneum
Polycystic Ovarian Syndrome
AKA Stein-Leventhal syndrome
Formation of multiple cysts on the ovaries
Affects 3-6% of reproductive aged women
PCOS: Related conditions
Metabolic syndrome Obesity Hirsuitism Anovulation Endometriomas Cystadenomas Dermoid cysts
PCOS: Sx
Often asymptomatic unless cyst ruptures
Dyspareunia
Back pain that radiates to legs
May compress other organs
Early signs may mimic advanced ovarian cancer Sx
Breakdown of ovarian neoplasms
Surface epithelium 70% (90% of malignancies)
Germ cells 20%
Sex cord stromal cells 10%
Ovarian neoplasms: surface epithelium
Most common ovarian neoplasm (70%)
Develop near sites of ovulatory rupture, so oral contraceptives reduce risk
Ovarian neoplasms: germ cells
20% of ovarian neoplasms Affect young (
Ovarian neoplasm
Second most common gynecologic cancer
Most deadly reproductive cancer
Subtypes of surface epithelial ovarian tumours
Serous (25% malignant). May be associated with BRCA1 & 2
Mucinous (15% malignant)
Endometroid (100% malignant)
Most common germ cell tumour
Teratoma (benign)
95% of germ cell tumours
Ovarian neoplasms: Sx
Abdominal pain and distenstion
Urinary tract symptoms
Vaginal bleeding
A uterus that has not been hormonally primed with estrogen and progesterone …
Cannot allow an embryo to implant
Morning sickness
Increased estrogen levels
May cause dehydration, weight loss, alkalosis, hypokalemia
Can start in 6th week of pregnancy
Hyperemesis gravidarum
Really effing bad morning sickness
1% of pregnancies
Ectopic pregnancy
Embryo implants in fallopian tubes, not uterus
Ectopic pregnancy: Risk factors/pathogenesis
Anything that may affect the transportation of the egg, fallopian motility, or that otherwise distorts anatomy,
PID
Abortion
STI
IUD
Miscarriage
Pregnancy loss before viability
Half of embryos miscarried in the first 13 weeks have chromosomal abnormalities
Four categories of hypertension in pregnancy
- chronic hypertension
- preeclampsia (hypertension + proteinuria + systemic edema)
- eclampsia (preeclampsia + convulsions)
- gestational hypertension (HBP after 20 weeks, returns to normal, no signs of preeclampsia)
Hypertension in Pregnancy: Complications
HELLP
Hemolysis
Elevated Liver enzymes
Low Platelets
Toxemia
Another name for preeclampsia
Placenta previa
Implantation of the placenta over of near the cervix
1/200 deliveries
Requires c-section
Gestational Trophoblastic Disease
Placental abnormality leading to either hydatidiform mole or choriocarcinoma
Hydatidiform Mole
Trophoblastic condition
Results from doubling up of paternal chromosome, loss of maternal
Sx of pregnancy, but no viable/identifiable fetus
May lead to malignancy
Choriocarcinoma
Trophoblastic condition
Malignancy of placental cells (50% from complete molar pregnancy)
Good prognosis if it hasn’t spread to brain.
Gestational Diabetes
Glucose intolerance developed during pregnancy, often third trimester
Breast Lumps: Pie Chart
40% fibrocystic changes 30% no disease 13% miscellaneous benign 10% cancer 7% fibroadenoma
Fibroadenoma
7% of breast lumps Benign Well-encapsulated, hormone-sensitive, freely movable Firm on palpation Easily removed
Breast Cancer
2nd most frequently diagnosed cancer in women
1:8 lifetime risk
Most Dx in women 50 and older
Types of breast cancer
Ductal carcinoma (70-80%) Lobular carcinoma (5-10%) Also: Inflammatory breast cancer Paget disease of the breast Medullary breast cancer
Breast Cancers: Risk factors
Age (50+) Estrogen exposure (early menarche, late menopause, few/no pregnancies) 1+ drink/day History of chest radiation BRCA 1/2 (5-10% Dx)
Breast Cancer: Metastases
Usually primary/in situ, then spread to:
Lymphatics Bones Liver Lung Brain
Genital herpes
Caused by HSV-2
Asymptomatic periods with recurring episodes of small, painful, fluid-filled ulcers.
Flare ups can be stimulated by stress or depressed immunity.
Genital Warts
AKA verrucae
Common benign viral infections of the genitals
Caused by HPV
Treated with laser, cryotherapy or surgery
Syphilis
Easily treated with antibiotics
If untreated can affect any system
Syphyllis: Primary Stage
Chancre
Inguinal lymphadenopathy
Syphyllis: Secondary stage
2 months to 2 years after infection.
Systemic spread
Macular rash, hepatitis, inflammation of other organs
Syphyllis: Tertiary
Can occur 10-20 years after infection
CNS, cardiovascular lesions
Other systematic lesions
Gummatous Syphyllis
Tertiary
Rubbery granulomatous lesions form in liver, bones, testes, etc.
May break down, ulcerate, fibrose
Cardiovascular Syphyllis
Tertiary
Chronic inflammatory destruction of Vado vasorum –>Aneurysm formation in ascending aorta –> aortic valve insufficiency
Neurosyphyllis
Disruption of dorsal roots –> impaired sensation, proprioception. (Tabes dorsalis)
Cortical damage –> “general paresis of the insane”
General paresis of the insane
AKA paralytic dementia, is a severe neuropsychiatric disorder, classified as an organic mental disorder and caused by the chronic meningoencephalitis that leads to cerebral atrophy in late-stage syphilis
Tabes dorsalis
Tabes dorsalis, also known as syphilitic myelopathy, is a slow degeneration (specifically, demyelination) of the nerves primarily in the dorsal columns (posterior columns) of the spinal cord (the portion closest to the back of the body). These nerves normally help maintain a person’s sense of position (proprioception), vibration, and discriminative touch.
Chlamydia
Bacterial (Chlamydia trachomatis)
Urethral pain without discharge
Men: mostly asymptomatic
Most common cause of bacterial urethritis in men
Chlamydia
Candiasis
Yeast infection
Itching, discharge
Bacterial vaginosis
Bacterial infection of vagina
Caused by imbalance of bacterial flora
Abnormal discharge, unpleasant odour
Often confused with candiasis
Vulvodynia
Chronic pain syndrome
Cause often unidentified
Orchitis
Inflammation of testes
Can be isolated, or comorbid with epididymitis
Often follows chlamydia or mumps infection, or complication of medical procedure
Orchitis: Sx
Swollen and painful testis
Fever, malaise
Epididymitis
Inflammation of the epididymis
Epididymitis is usually a complication of
urethritis or prostatitis
medical procedures
TB
(or in younger men, STIs)
Epididymitis: complications
testicular infarction, pyocele, loss of fertility,
Testicular torsion
abnormal twisting of the spermatic cord, which cuts off blood supply to the testis
Usually results from abnormal development of the spermatic cord or the membrane covering the testis
Most often in young men (puberty - 25)
Pain, swelling, nausea
Medical emergency
Hypogonadism
Diminished functional activity of the gonads
Deficiency of sex hormones –> defective primary and/or secondary sexual development
Two types of testicular cancer
Germ cell (95%) -- seminomas and nonseminomas Non-germ cell (5%) -- stromal (usually benign) or sex cord
(Rarely secondary)
Seminoma
Malignant germ cell tumour of the testicle.
Easily treatable.
Nonseminoma
Germ cell tumour of the testicle.
Include teratomas, embryonal carcinomas (most common), endodermal sinus tumors (yolk sac tumors), and choriocarcinomas
Testicular cancer
Most common solid organ tumour in young men
Affects Westerners, caucasians more
Teratoma
Differentiated, benign nonseminoma. Can contain teratocarcinoma cells
Teratocarcinoma
Malignant nonseminomatous germ cell tumour
Which tumour type can result in a positive pregnancy test for men?
Choriocarcinomas and yolk sac tumours
Produce hCG
Usually found in teratocarcinomas
Benign Prostatic Hyperplasia
Enlarged prostate gland
50% of men over 50; 70% over 70 etc
90% don’t need treatment
BPH: Sx
Difficult urination
Weak flow, incomplete emptying, leaking
UTI
Acute urinary retention
Prostate Cancer
Most common cancer of internal organs in males
Second most common cause of cancer related deaths
Hormone sensitive; diet involved
Prostate tumours tend to metastasize to
Local lymph nodes, vertebrae, other bones
Prostate Cancer: Sx
Enlarged, hard prostate Obstruction of urethra Pain with urination, ejaculation Blood in urine Can't maintain erection LBP which refers to legs
Looks like BPH
