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Mechanisms of Disease > Week 13 Reproductive System Pathology > Flashcards

Week 13 Reproductive System Pathology Flashcards

1
Q

STDs covered

A

Gonorrhea
Syphilis
Chlamydia
Herpes

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2
Q

Male

A

Infertility
- cryptorchidism
- torsion
Benign prostatic hypertrophy
Prostatitis

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3
Q

Female

A

Infertility
Amenorrhea
Endometriosis
Eclampsia/Pre-eclampsia
Ectopic pregnancy
Mastitis

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4
Q

Describe the basics of the male reproductive tract

A
  • Spermatogenesis: begins in testes–> epididymis–> vas deferens–> ejaculatory duct–> urethra
  • Prostate and seminal vesicle secrete products to help support sperm
  • Testes are external to body cavity to provide lower temp to support spermatogenesis
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5
Q

Describe some basics of the female reproductive tract

A
  • Includes breasts, placenta during pregnancy, ovary, uterine/fallopian tube, uterus, cervix, vagina, vulva
  • ovulation occurs about 2 weeks after last menstrual period, but pregnancy is counted from the last period
    * so most pregnancies cannot be detected by a test until about 4 weeks after last menstrual period
  • Takes over a week for implantation to occur
    * placenta will start to develop, which takes a while
    * this is why pregnancy cannot be detected until 2 weeks after fertilization
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6
Q

Clinical definition of infertility

A
  • Inability to conceive w/in 1 year of attempting (cessation of birth control and regular intercourse)
  • Monthly probability–> 20-25%
  • Infertility has not increased
  • Screening and treatment options have increased
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7
Q

Causes/Treatment of Infertility

A
  • about 11% of US reproductive-age population is infertile
    * 1/3 solely male
    * 1/3 solely female
    * 1/3 both or unknown
  • most infertility cases are treated with medication or therapy–> stress can reduce fertility
  • less than 3% of cases are treated with assisted reproductive therapies (ARTs)
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8
Q

Why can infertility be an issue when both parties are producing viable gametes?

A

Females also support embryogenesis, so even if both members of a couple are producing viable gametes, they may still be infertile

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9
Q

Female Infertility overview: 3 steps where disruption can happen

A
  1. Ovulatory
    - anything that impacts ova production will reduce fertility
    * for fertilization to occur, there needs to be something to fertilize
  2. Tubal
    - structural damage to oviducts will prevent movement of ova or fertilization
  3. Uterine
    - damage can prevent implantation or maintenance of pregnancy
    *can be any kind of damage to the uterine wall
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10
Q

Ovary causes

A

Endocrine
- Hypothalamus/pituitary disease
- Insufficient production of gonadotropins–> therefore will affect ovulation
Ovarian Disease
- Polycystic ovarian syndrome–> gonadotropin insufficiency; direct ovarian damage
Other causes
- Chemotherapy/Pelvic irradiation–> both toxic
- Destroy developing oocytes
* other toxins can destroy oocytes as well

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11
Q

Tubal/Uterine causes

A

Usually you do not have movement of fertilized embryo down the tube into the uterus; even if it does get there, it does not implant successfully
Infections–> in tube or uterus
- resulting inflammation, scars, adhesions
- block transport/implantation–> stenosis of the tube
- ectopic pregnancy possible
Pelvic/Abdominal surgeries
- can also cause scarring/adhesions
Exposure to toxins
- damage to endometrium (inner layer of uterus)

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12
Q

Other causes of female infertility

A

Thyroid disease
- results in lack of production of thyroid hormones
- low thyroid levels cause excessive secretion of thyrotropin-releasing hormone
- excessive TRH induces PRL secretion–> at high levels will suppress gonadotropin releasing hormones (GnRH)
- response to low thyroid hormone levels
Androgen excess
- affects oocyte development
- anovulation and amenorrhea
- genetic, environmental causes

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13
Q

More causes of female infertility

A

Hyperprolactinemia
- drugs that alter PRL secretion
- damage to pituitary or patient is taking a drug that alters PRL secretion
- both prevent dopamine from inhibiting PRL secretion
- effect on fertility may be related to excessive dopamine
* altered gonadotropin release
* direct effect on follicles b/c follicle cells that regulate ovulation have receptors for dopamine

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14
Q

Male fertility overview: 3 areas affected

A
  1. Pretesticular
    - endocrine disorders
    - drugs
  2. Testicular
    - trauma, infections of testicles
    - environmental, developmental
  3. Post-testicular
    - tubal obstruction
    - autoimmune
    - developmental–> damage that could affect movement through the tube
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15
Q

Pretesticular factors affecting spermatogenesis

A
  • hormones and meds
  • systemic diseases
  • environmental/lifestyle factors
  • dietary deficiencies
  • toxins
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16
Q

Pretesticular causes

A

Focuses on hormones that promote spermatogenesis
- hypothalamus/pituitary deficiencies
- affect hormone production
- reduced testosterone slows spermatogenesis
Or drugs that inhibit their effects
- anabolic steroids initiate negative feedback loop that reduces LH/FSH levels
*certain genetic diseases also impact hormone production

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17
Q

Testicular factors affecting spermatogenesis

A
  • hormones/meds
  • systemic diseases
  • environmental/lifestyle factors
  • dietary deficiencies
  • toxins
  • testicular temp elevated
  • ionizing radiation and alkylating agents
  • developmental disorders
  • local infections
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18
Q

Testicular causes

A

Direct effect on testicular function
- most common cause of reduced male fertility is variocele
- Variocele: abnormally dilated scrotal veins
* cause not well known, but believed to be valve issue in veins–> blood flows back and pools w/in scrotal tissue
* scrotal temp increased
* other things that can increase scrotal temp= tight clothing, seasonal temp changes, fevers

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19
Q

Testicular damage

A

Trauma (reversible with early intervention)
- damage can result in atrophy
- antisperm antibodies form when compartmentalization breaks down
Torsion of the spermatic cord can break down compartmentalization
- disrupted blood flow–> ischemic damage
Infections
- swelling causes necrosis, atrophy in spermatogenic tissue

20
Q

Testicular Torsion

A

Neonatal (in utero or shortly after birth) or adult (adolescence)
Adult Torsion
- sudden onset of testicular pain
- no apparent injury/cause
- linked to bilateral anatomic defect that increases mobility of the testes
* surgery to decrease mobility
Considered a vascular disorder as twisting spermatic cord will reduce/eliminate venous drainage
- veins are usually thick-walled (pampiniform plexus)
- will remain patent (open/unobstructed)
Leads to infarction (emergency)
If torsion is reversed w/in 6 hours, generally have full recovery
- if infarction develops, this is an emergency; patient needs immediate treatment

21
Q

Other testicular causes

A

Genetic diseases that impact sperm
- Klinefelter syndrome (XXY)–> chromosomal abnormality resulting in Leydig cell malfunction, high FSH, low-normal serum testosterone
- Microdeletions on Y chromosome–> that will impact sperm production
Cryptorchidism (failure of descent)
- developmental disorder
Toxins
- different cells have diff sensitivities
- cigarette smoke–> also increases risk of erectile dysfunction
- other toxins–> radiation, chemotherapeutic agents, which will affect the rapidly dividing spermatogenic cells

22
Q

What is cryptorchidism?

A

Complete or partial failure of testes to descend during fetal development
- higher temp impairs function and will result in loss of spermatogenic tissue
- structural changes (microscopic) are apparent by 2 years of age
* lack of sperm cell development (no spermatogonia, spermatocytes, spermatids)
* hyalinization and thickening of basement membrane of tubules

23
Q

Post-testicular factors affecting spermatogenesis

A
  • developmental disorders
  • local infections
24
Q

Post-testicular causes

A

Ductal obstruction (vas deferens, epididymis)
- surgical (trauma, vasectomy)
- congenital (cystic fibrosis)–> ductal obstruction due to very thickened mucus
Ejaculatory issues
- duct obstruction assoc. with concretions or cysts that block ejaculatory duct (congenital or acquired)
- anejaculation (spinal cord injuries)–> affect innervation required for ejaculation
Infections (STDs, E. coli)
- can be due to urinary tract abnormalities
* in most post-testicular cases, if spermatogenesis is not affected, sperm can be recovered by medical procedures and used for IVF for assisted reproductive technologies

25
Q

Specific infections of STDs

A

Bacterial (Gram negative)
- gonorrhea (Neisseria gonorrhoeae)
- chancroid (Haemophilus ducreyi)
- granuloma inguinale (Klebsiella granulomatis)
- syphilis (spirochete: Treponema pallidum)

26
Q

Gonorrhea

A
  • infection with Neisseria Gonorrhoeae
  • males: causes urethritis–> inflammation of urethra
  • females: often asymptomatic; may lead to pelvic inflammatory disease and infertility
  • in newborns, causes conjunctivitis that leads to blindness if during delivery there is an active infection in that area
  • 2 other gram negative bacteria:
    * Haimophilus ducreyi causes chancroid (a skin lesion uncommon in the US)
    * Klebsiella granulomatis causes granuloma inguinale (uncommon in the US)
27
Q

What is Syphilis?

A
  • infection with Treponema pallidum (spirochete)
  • can cross the placenta (congenital), so neonates can be born with congenital syphilis
  • image shows spirochetes stained with silver stain
28
Q

What is Lymphopathia Venerea?

A

Type of Chlamydia
- aka lymphogranuloma venereum
- infection with specific serotypes (L type) of causative agents of chlamydia
Chronic infection
- initial lesion is small
- bacterial growth leads to swelling of lymph nodes
- can lead to lymph node rupture if swelling is large enough
- if untreated, causes fibrosis and stricture in structures of the lower urogenital tract
Other genital chlamydia infections appear clinically like gonorrhea
- microbiological analysis needed to determine which disease it is

29
Q

What is Herpes Simplex Virus infection?

A
  • Both HSV-1 and HSV-2 infect mucosa
    * HSV-2 more likely to cause genital herpes
    * HSV-1 more likely to cause oral
  • Can infect nearby nerves and remain latent
    * activated by stress, trauma, UV irradiation, hormonal changes
  • Causes lesions on skin
  • Can also cause:
    * corneal lesions (blindness)
    * encephalitis
    * bronchopneumonia
    * esophagitis
    * hepatitis
    Often inflammatory response can cause damage to reproductive tract structures
  • this is how STDs may eventually lead to some fertility issues
30
Q

Female hormonal control

A

Pituitary hormones act on the ovaries (GnRH)
- stimulates ovulation
- FSH–> follicle development, estrogen (follicle stimulating hormone)
- LH–> follicle maturation, progesterone (luteinizing hormone)
Ovarian hormones act on the uterus
- Estrogen: produced by follicle prior to ovulation; stimulates proliferative phase of the uterus
* endometrium thickens in prep for implantation
- Progesterone: produced by corpus luteum (remnants of follicle following ovulation); stimulates secretory phase
*glands and arteries lengthen
* glands produce rich product
* all to support implantation

31
Q

Hormonal cycle

A
  • Complex interaction of hormones
  • Pregnancy halts the cycle in the secretory phase
  • Other structures involved
  • Pituitary hormones can be detected in blood (LH, FSH)
  • Estrogen assoc. with proliferative phase
  • Progesterone assoc. with secretory phase
32
Q

Name the menstrual disorders

A
  1. Amenorrhea
    - lack of menstrual bleeding
  2. Dysmenorrhea
    - irregular menstrual symptoms
    - excessive pain
  3. Menorrhea
    - excessive bleeding
  4. Metrorrhagia
    - irregular/protracted bleeding (b/t periods)
33
Q

Amenorrhea

A

-Normal–> pregnancy, menopause
- Uterine disorder
* scarring after infection
- Ovarian disorder
* gonadal failure (multiple causes)
* resistance to gonadotropic hormones
- Endocrine disorder
* insufficient gonadotropin secretion

34
Q

What is endometriosis?

A

Presence of endometrium outside the uterus
- causes infertility if it affects other parts of the reproductive tract b/c it can damage other parts of the tract
- causes intestinal disorders when it affects the intestines
- pathogenesis is not well understood
- symptoms: dysmenorrhea, pelvic pain, infertility

35
Q

Name some diseases assoc. with pregnancy

A

Ectopic pregnancy
Eclampsia/Pre-eclampsia
Mastitis

36
Q

Ectopic pregnancy (early pregnancy)

A
  • Implantation of embryo anywhere but the uterus
  • About 90% are in uterine tubes
  • Predisposing condition: pelvic inflammatory disease that results in chronic salpingitis
  • Increased in patients with peritubal scarring/adhesions caused by appendicitis, endometriosis, surgery
  • Most common cause of tubal hematoma
  • Fertilized ovum develops as usual
    * forms placenta
    * amniotic sac surrounds developing fetus
  • Growth of fetus will cause rupture of uterine tube
    * massive potentially fatal intraperitoneal hemorrhage
  • May also undergo regression and resorption, or spontaneous ejection into abdominal cavity (tubal abortion)
37
Q

Eclampsia/Pre-eclampsia (late pregnancy)

A

Systemic syndrome of pregnant women
- widespread maternal endothelial dysfunction
- Sx: HTN, edema, proteinuria (Pre), convulsions (eclampsia)
- also can develop hypercoaguability, acute renal failure, and pulmonary edema
- remember HELLP syndrome

38
Q

Pathogenesis of eclampsia/pre-eclampsia

A

Not well understood, but linked to 3 specific changes
- abnormal placental vasculature
- endothelial dysfunction (imbalance of anti-/pro-angiogenic factors)
* defective vascular development in the placenta secondary to hypoxia
- coagulation abnormalities
* reduced endothelial production of antithrombotic factors

39
Q

Mastitis (after delivery)

A

-Acute bacterial infection of the breast
* typically occurs during first month of breastfeeding
* during breastfeeding, cracks and fissures may develop in nipples
* allows excess bacteria like S. aureus of Streptococci
-Sx: fever, painful swelling, edema
- Tissue changes: erythema, abscesses (S. aureus) or cellulitis (strep)
- Starts in ducts and may spread to entire breast
- Usually treated with antibiotics and milk expression to flush out the ducts
* may be infected, so dispose of milk
- If severe, may require surgical drainage along with abx

40
Q

What is the function of the prostate?

A

Releases product into urethra
- Slightly alkaline fluid
- Contains enzyme that maintains seminal fluid as liquid to facilitate movement of sperm into female reproductive tract

41
Q

What is prostate disease?

A

Prostate surrounds the urethra, so inflammation of hypertrophy impact urethral function
- Sx: difficulty urinating (starting, volume, incomplete voiding, pain)
* dysuria b/c of anatomical location of the prostate

42
Q

What is prostatitis?

A

Inflammation of the prostate
- May be bacterial (acute or chronic), abacterial (chronic), or granulomatous

42
Q

What is prostatitis?

A

Inflammation of the prostate
- May be bacterial (acute or chronic), abacterial (chronic), or granulomatous

43
Q

Acute bacterial prostatitis

A
  • causative agents are same that cause cystitis (bladder infection)
  • access to prostate is through urinary reflux, surgery, or lymphatics/blood from distant site
  • Sx: fever, chills, dysuria
    -Exam: prostate will be enlarged and tender, also boggy/fluid-filled feeling
    -Dx: urine culture and sx/exam
  • Tx: abx–> can be difficult b/c abx do not penetrate the prostate well
44
Q

Chronic bacterial prostatitis

A
  • causative agents as above
  • may be asymptomatic; not necessarily preceded by acute infection
  • Sx: low back pain, dysuria, perineal/suprapubic discomfort due to inflammation of prostate
  • Hx: recurrent UTIs
  • Dx: leukocytosis in prostatic secretions; positive bacterial cultures
45
Q

Chronic abacterial prostatitis

A
  • most common form
  • as chronic bacterial, but bacterial cultures are negative
  • prostatic secretion will still have leukocytes
  • no history of recurrent UTIs
46
Q

Granulomatous prostatitis

A
  • specific or nonspecific
  • most common is due to cancer treatment
  • fungal seen in immunocompromised hosts
  • nonspecific is due to ruptured ducts and acini

Mechanisms of Disease (10 decks)

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