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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
Specific infections of STDs
Bacterial (Gram negative) - gonorrhea (Neisseria gonorrhoeae) - chancroid (Haemophilus ducreyi) - granuloma inguinale (Klebsiella granulomatis) - syphilis (spirochete: Treponema pallidum)
26
Gonorrhea
- 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
What is Syphilis?
- 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
What is Lymphopathia Venerea?
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
What is Herpes Simplex Virus infection?
- 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
Female hormonal control
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
Hormonal cycle
- 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
Name the menstrual disorders
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
Amenorrhea
-Normal--> pregnancy, menopause - Uterine disorder * scarring after infection - Ovarian disorder * gonadal failure (multiple causes) * resistance to gonadotropic hormones - Endocrine disorder * insufficient gonadotropin secretion
34
What is endometriosis?
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
Name some diseases assoc. with pregnancy
Ectopic pregnancy Eclampsia/Pre-eclampsia Mastitis
36
Ectopic pregnancy (early pregnancy)
- 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
Eclampsia/Pre-eclampsia (late pregnancy)
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
Pathogenesis of eclampsia/pre-eclampsia
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
Mastitis (after delivery)
-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
What is the function of the prostate?
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
What is prostate disease?
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
What is prostatitis?
Inflammation of the prostate - May be bacterial (acute or chronic), abacterial (chronic), or granulomatous
42
What is prostatitis?
Inflammation of the prostate - May be bacterial (acute or chronic), abacterial (chronic), or granulomatous
43
Acute bacterial prostatitis
- 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
Chronic bacterial prostatitis
- 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
Chronic abacterial prostatitis
- most common form - as chronic bacterial, but bacterial cultures are negative - prostatic secretion will still have leukocytes - no history of recurrent UTIs
46
Granulomatous prostatitis
- 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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