BIOL 2200 Module 11: Reproductive System Disorders & Musculoskeletal System Disorders

Phases of the menstrual cycle

1. Menstrual phase

2. Follicular phase

3. Ovulation phase

4. Luteal phase

Primary dysmenorrhea

Menstrual pain from monthly prostaglandin release from endometrium

Secondary dysmenorrhea

Menstrual pain from pelvic pathological conditions (such as endometriosis) that can occur at any time in the cycle

Primary amenorrhea

No first period (menarche) from a hypothalmic-pituitary-ovarian axis disorder

Secondary amenorrhea

No period for at least 6 months. May be caused by glandular dysfunction or anorexia nervosa

Dysfunctional Uterine Bleeding (DUB)

Abnormally heavy or irregular bleeding despite absence of disease. May be caused by anovulatory cycles (no progesterone)

Endometriosis

Presence of functioning endometrial tissue outside of the uterus. Tissues may follow menstrual cycle, while bleeding causes inflammation in surrounding tissue

Where does endometriosis typically occur?

In the abdominal and pelvic cavities

• Bladder, fallopian tube, colon

Cervical cancer

Cancer almost exclusively caused by HPV. Is quite preventable with pap smears and HPV testing

Pap smear

Medical test used to screen for cervical cancer

Endometrial cancer

Most prevalent female reproductive tract cancer. May be caused by unopposed estrogen exposure, typically occurs in post-menopausal women

Ovarian cancer

Most deadly female reproductive tract cancer. Only 20% detected in early stages

Galactorrhea

Spontaneous breast milk flow in someone not pregnant or nursing

Mastitis

Breast inflammation. Typically from an infection coming from lactation

Ductal disorder

Disorders in the milk ducts — such as intraductal papillomas

Intraductal papillomas

Benign tissue tumors manifesting with bloody nipple discharge

Fibroadenoma

Single non-cancerous breast tumor made of glandular and fibrous connective tissue. Often in premenopausal women

Fibrocystic changes

Non-cancerous breast conditions with lumpiness and fibrous tissue. Most frequent breast lesion

Risk factors of breast cancer

1. Early menarche and late menopause → increases risk

2. Higher breast density

3. Giving birth and breastfeeding → decreases risk

Lobular involution

Where glands and connective tissue are replaced with fatty tissue. Lowers risk of breast cancer

Where in the breast do most breast cancers arise from?

Most breast cancers arise from epithelium of the ducts

What is typically the first sign of breast cancer?

The first sign is typically a painless lump in the breast or underarm

Cryptorchidism

Where the testis DON’T DROP!

Hydrocele

Fluid buildup between tissue layers surrounding the testes

Varicocele

Enlarged scrotal veins (varicose), typically on the left side

Torsion of testis

When the testis rotates, causing ischemia and very intense pain

Benign Prostatic Hyperplasia (BPH)

Non-malignant prostate gland enlargement. Common in older men, and is due to hormonal shifts

When does Benign Prostatic Hyperplasia (BPH) become a problem?

When it compresses the urethra, causing difficulty urinating

Effects of urethral obstruction from Benign Prostatic Hyperplasia (BPH)

Leads to involuntary urine release from a full bladder, and can promote UTIs and kidney damage

Prostate cancer

Common male cancer often located in the urethra’s periphery

How is prostate cancer identified?

May be identified with prostate specific antigen (PSA), but is confirmed with biopsy

Symptoms of late prostate cancer

• Lymph node and liver enlargement

• Bone pain from bone metastasis

• Confusion from brain metastases

Complete fracture

Entire breakage of a bone

Comminuted fracture

Complete fracture with 2+ fragments

Spiral fracture

Fracture encircles bone

Transverse fracture

Fracture is straight across

Oblique fracture

Fracture at an angle

Linear fracture

Fracture along the bone’s length

Incomplete fracture

Where bone remains in one piece despite damage

Greenstick fracture

Incomplete fracture where one side is broken

Torus fracture

Where the outer portion of the bone buckles, but does not outright break

Bowing fracture

Where one bone breaks, but the other bends. In bone pairs such as the tibia/fibula

Open (compound) fracture

Fracture with broken skin

Closed (simple) fracture

Fracture with intact skin

Classification of cause of fracture

• Sudden injury

• Pathologic (disease)

• Stress (new sport)

In fracture repair, where does a clot form?

A clot forms in the medullary cavity, between ends of bone fragments, and under the periosteum

In fracture repair, where does necrosis occur?

At the bone tissue adjacent to the fracture where blood vessels are torn

In fracture repair, what is the role of inflammation?

To help beneficial substances move into the injury site and attract phagocytic cells, which remove dead tissue

In fracture repair, what forms the fibrocartilaginous callus/procallus

Fibroblasts and chondroblasts lay down cartilage and collagen fibers on the network formed by the clot, forming a procallus

In fracture repair, what does the procallus become?

The procallus becomes a bony callus, when osteoblasts synthesize bone matrix which later calcifies

In fracture repair, what is remodelling?

Remodeling describes the resorption of excess callus and formation of trabeculae along lines of stress

Dislocation

Displacement of bone(s) in a joint where ALL contact is lost

Sublucation

Displacement of bone(s) in a joint where SOME contact is lost

SCOLIOSIS

LATERAL deviation of the spinal cord. May be genetic, from cerebral palsy, or to adapt to different leg lengths

Kyphosis

Upper spine curvature. Typically from joint fusion or bone density loss

Lordosis

Lower spine curvature. Typically from misaligned vertebrae

Strain vs Sprain

Strains → tearing or stretching of a muscle or tendon

Sprains → tearing of a ligament

Avulsion

A complete separation of a ligament or tendon from a bone. Type of sprain

Where are strains most common?

In the neck portion of spine (whiplash) or lower back

Where are sprains most common?

In the ankle, less frequently in the wrist and elbow

Osteoporosis

Fragile bones caused by demineralization of bone

What is the general process of osteoporosis?

Old bone is reabsorbed faster than new bone is deposited. E.g. from hyperparathyroidism (PTH)

Post-menopausal osteoporosis

Osteoporosis caused by decreased estrogen and bone decline after menopause

Effect of estrogen on osteoclasts

Lower estrogen = osteoclast stimulating → leads to bone breakdown post-menopause

Why is osteoporosis less common in men than women?

Because men have slower loss of bone protecting hormones, and begin with denser bones

Secondary osteoporosis

Osteoporosis caused by an underlying medical condition or external cause. E.g. alcoholism, corticosteroid use, Cushing’s syndrome

Clinical manifestations of osteoporosis

• Kyphosis

• Fractures (particularly neck of the femur and ribs)

Exogenous osteomyelitis

Infectious bone disease from pathogens entering a joint, such as in surgery or bites

Hematogenous osteomyelitis

Infectious bone disease where blood carries pathogens to the bone from elsewhere in the body

Primary causative organism of osteomyelitis

Staphylococcus aureus, but also other fungi, bacteria, parasites, and viruses

Sequence of events in Hematogenous osteomyelitis

1. Pathogens enter area near growth plate

2. Sequestrum → death of bone from purulent exudate causing ischemia

3. Involucrum → osteoblasts lay layers of bone on top of sequestrum

Osteoarthritis

Loss of articular cartilage leading to osteophytosis and reduced mobility

Osteophytosis

New bony growths (osteophytes) developing along joint margins

What causes growth of osteophytes in osteoarthritis?

When articular cartilage wears away, and the body mistakenly compensates by developing osteophytes

When osteophytes break off and irritate the synovial membrane, what occurs?

Synovitis and joint effusion occur, and the joint capsule becomes thickened and restricts movement

Joint effusion

Inflammatory exudate or bone entering the joint cavity, increasing synovial fluid. Common in osteoarthritis due to ostephytes

Inflammatory joint disease

Due to inflammatory damage in the joints. Can be infectious (wound/bloodstream) or noninfectious (autoimmune disease)

Rheumatoid arthritis

Autoimmune disease involving formation of autoantibodies (rheumatoid factors) reacting to host antibodies in synovial membrane

What tissues does rheumatoid arthritis first affect?

It first affects the synovial membrane, and alter affects articular cartilage, joint capsule, and surrounding tissue

In rheumatoid arthritis, what occurs when an unknown antigen in synovial tissue triggers an immune response?

B cells produce antibodies (rheumatoid factors), which complex with IgG and activate the complement

What leads to the formation of pannus in rheumatoid arthritis?

Cytokines stimulating edema and cells (e.g. macrophages and fibroblasts)

Pannus

Granulation tissue consisting of lymphocytes, mast cells, macrophages, and fibroblasts

How can a pannus destroy a joint?

Through growing over and eroding articular cartilage and bone

Clinical manifestations of rheumatoid arthrities

• Stiff joints

• Fever, fatigue, weakness

• Deviation of hands, muscle atrophy

Heberden’s nodes

Bony swelling developing on the joint near the fingertip. Sign of osteoarthritis

Bouchard’s nodes

Bony swelling developing on the middle joints of the fingers. Sign of osteoarthritis

Ankylosing spondylitis

Inflammatory joint disease, where excessive bone formation leads to fusing of the sacroiliac joint and vertebral column

What causes fusing of the sacroiliac joint and vertebral column in ankylosing spondylitis?

Fibrocartilage disc inflammation, leading to damage, repair by fibroblasts, and eventual ossification

Equinovarus (clubfoot)

Where one or both feet turn inward and downward. Often positional or idiopathic

How is clubfoot treated?

By casting soon after birth, surgical alterations, or bracing

Developmental hip dysplasia

Imperfect hip joint development. E.g. loosely fitting ball and socket joint where femur and pelvis meet

Pavlik harness

Device used in infants to treat developmental hip dysplasia