Patho Test 4

Cleft Lip

Failure of maxillary processes to fuse with nasal elevations or failure of upper lip fusion (4-8 weeks into fetal development)

Cleft Palate

Failure of hard and soft palates to fuse 7-12 weeks into gestation

Etiology of hyperkeratosis leading to oral cancers (SCC)

• Hyperkeratosis: Excess keratin production

• Leukoplakia

  • Whitish plaque 

  • Chronic irritation

  • Possibly pre- cancerous

• Cancer

  • Squamous cell carcinoma

Periodontal disease (gingivitis, periodontitis)

• Plaque-bacterial sheet

• Caries (cavities)

• Gingivitis

  • Surface

  • early

• Periodontal disease

  • Roots

  • advanced

• Tartar/calculus

  • Hardened plaque

Sialadenitis and infectious parotitis (mumps)

• Salivary gland disorders

  • Sialadentitis

    • Infectious or non-infectious

  • Infectious parotitis

    •  (Mumps)

Describe dysphagia and achalasia

• Difficulty swallowing

  • Achalasia

    • Loss of innervation of lower esophageal sphincter

  • Congenital atresia

  • Stenosis

  • Esophageal diverticula

  • Tumors

Congenital esophageal atresia

A developmental defect where the esophagus isn’t connected.

Esophageal cancer

(squamous cell carcinoma), very malignant and quick to metastasize, S/S: dysphagia due to narrowed lumen, weight loss, obstruction

Hiatal hernias

A portion of the stomach and the gastroesophageal junction move above the diaphragm. 

Describe GERD

Periodic flow of gastric contents into the esophagus. Often seen in conjunction with a hiatal hernia.

Discuss the pathophysiology of acute and chronic gastritis (pp. 452-454)

• Acute: 

  • Gastric mucosa is inflamed and edematous due to irritants such as allergies, spicy foods, and radiation therapy. S/S: nausea, vomiting, epigastric pain/cramps, sometimes fever, headache, diarrhea

• Chronic

  • Atrophy and irritation of the stomach mucosa, leading to reduced secretions and presenting as dyspepsia (indigestion). A loss of parietal cells leads to achlorhydria (absence of stomach acid). Can be caused by genetic, autoimmune, and bacterial factors; H. pylori is present. Loss of intrinsic factor is due to an autoimmune cause.

Describe the etiology of gastroenteritis

Inflammatory process in the stomach and intestines, usually caused by an infection, but it is also possibly caused by an allergy. Handwashing helps prevent this, and it’s often caused by food- or waterborne illnesses. Gastric mucosal inflammation stimulates vomiting and diarrhea.

Peptic ulcer disease (PUD), gastrointestinal ulcers, and their complications

A form of inflammation with erosion of the gastric mucosa, with H. pylori usually causing it. Crater with an area of surrounding necrosis, affected by gastric acid. Issues come from bleeding (melena, hematemesis, penetration), cicatrization (pyloric stenosis), and duodenal ulcer perforation (food empties into the abdominal cavity, peritonitis). Pain is relieved by reducing stomach acid.

Dumping syndrome

Lack of pyloric sphincter, food moves directly into the small intestine, and abnormal chyme (Hyperosmolar-draws water and results in diarrhea, cramps, and hypoglycemia)

Pyloric Stenosis

The opposite problem from dumping, where the pylorus is narrow. Persistent feeling of fullness, bloating, and vomitus has undigested food.

Describe the pathophysiology of gastric cancer

On the decline in the U.S., but it is associated with countries with high seafood diets and smoked and salted foods. H. pylori infection increases risk and metastasizes to lymph nodes, liver, abdominal organs, and lungs. Adenocarcinoma that affects secretory epithelium. S/S: dyspepsia, pain, weight loss, mass in the stomach.

Describe the congenital disorder biliary atresia

Describe the pathophysiology of biliary obstruction and cholecystitis

• Biliary obstruction – Choledocholithiasis pertains to obstruction caused by gallstones of the biliary tract

• Cholecystitis refers to inflammation of the gallbladder and cystic duct.

Know difference between cholelithiasis, choledocholithiasis, cholestasis, cholecystitis, cholangitis

• Choledocholithiasis refers to inflammation of the gallbladder and cystic duct. 

• Cholelithiasis refers to the formation of gallstones, which are masses of solid material or calculi that form in the bile

• Cholestasis increases from cholelithiasis, bile accumulation in the liver, and the bloodstream

• Cholecystitis refers to inflammation of the gallbladder and cystic duct, without the presence of stones. Chronic symptoms include belching, bloating after fatty foods, and mild epigastric or RUQ pain. 

• Cholangitis is inflammation usually related to infection of the bile ducts.

<break into multiple cards?>

Jaundice

Yellow staining of skin and eyes due to excessive bilirubin in circulation.

Pre-hepatic

excessive RBC breakdown

Hepatic

hepatocyte damage

Post-hepatic

obstructive, bile cannot flow

Know the ins-and-outs of jaundice (icterus)—what causes it (slides 54,55—move pictures out of the way)

• Jaundice - Yellow staining of skin and eyes due to excessive bilirubin in circulation.

• Pre-hepatic - excessive RBC breakdown

• Hepatic - hepatocyte damage

• Post-hepatic - obstructive, bile cannot flow

Hepatitis - Differentiate between A, B, C, D & E (particularly transmission route, see table)

<split into multiple?>

• Hepatitis A: 

  • Spreads from feces that contaminates food and water

• Hepatitis B:

  • Spreads from blood/blood derived body fluids

    • Childbirth

    • Contact with infected bodily fluids

    • Sexual contact 

• Hepatitis C:

  • Spreads from blood/blood derived body fluids

    • Contact with infected bodily fluids

    • Sexual contact

• Hepatitis D:

  • Spreads from blood/blood derived body fluids

    • Contact with infected body fluid (only occurs in people who infected with hepatitis B)

    • Sexual contact

• Hepatitis E:

  • Spreads from feces that contaminates food and water

Understand the course of hepatitis B

MASLD - Define metabolic dysfunction-associated steatototic liver disease (slide 62)

• Defined by underlying obesity/dyslipidemia or another metabolic condition, often asymptomatic at first

• AKA “fatty” liver disease

• Inflammation to hepatocytes leading to fibrosis and eventually cirrhosis, related to MASH and as non-alcoholic steatohepatitis (NASH)

Alcoholic liver disease

• Initial stage—fatty liver

  • Enlargement of the liver

  • Asymptomatic and reversible with reduced alcohol intake

• Second stage—alcoholic hepatitis

  • Inflammation and cell necrosis

  • Fibrous tissue formation–irreversible change

• Third stage—end-stage cirrhosis

  • Fibrotic tissue replaces normal tissue.

  • Little normal function remains.

Cirrhosis & Liver Failure Manifestations

• Fatty Liver

  • Slightly enlarged

  • Pale yellow

  • Excessive build-up of fat

  • Excessive fat impacts normal cell function

  • Obesity & alcoholism

Portal hypertension

• Related to liver failure

• Increased pressure in portal system

• Obstruction in liver causes back-up

  • Blood into other organs (swelling)

  • Varices

• Causes:

  • Cirrhosis

  • Fibrosis

Esophageal varices

• Due to portal hypertension

• Blood backs up into vessels around esophagus

• Potential for rupture & bleeding

Liver Failure

• Due to variety of diseases including cirrhosis

• Loss of function

  • Less albumin production (hypoalbuminemia)

    • Ascites

  • Fibrinogen & prothrombin decrease

    • Blood clotting

  • Detoxification fails

    • Hepatic encephalopathy - due to ammonia build-up

Primary vs Secondary Hepatic Cancer

• Primary - starts in the liver

  • hepatocellular carcinoma most common

• Secondary (metastatic) - starts elsewhere

  • Often arises from areas served by the hepatic portal veins or that spread along the peritoneal membranes

Pancreatic cancer

• Adenocarcinoma

• Very deadly (mortality about 95%)

• Associated with

  • Smoking

  • Diabetes

  • Obesity

• S/S: location dependent

  • Often: pressure on the duodenum and common bile duct cause early signs of obstructive jaundice

• Males (60%)

• blacks>whites

• Pancreatic head in 66%

• Infiltrates locally, obstructs ducts & encases vessels

• Mets to liver, local nodes

Pancreatitis

• Lots of swelling and inflammation around the pancreas

• Digestive enzymes in pancreas begin to ‘eat self’ (autodigestion)

  • Normally pancreatic enzymes become active in the intestines

  • Causes enzymatic necrosis

• Acute pancreatitis

  • S/S

    • Pain [moderate to severe] in the abdomen that is felt through the back (acute abdomen)

    • Rigidity [guarding]

    • nausea/vomiting

    • BP decreases

    • HR increases

    • Cold extremities

    • Possible LOC

  • Digestive effects

    • Maldigestion

    • Malabsorption

  • Most severe - acute hemorrhagic pancreatitis

Autodigestion (or autolysis)

Tissue destruction by an organ’s own secretions

Enzymatic necrosis

Tissue death brought on by enzymes

Pancreatic insufficiency

• Often associated with chronic alcoholisms

• Destruction of exocrine/endocrine glands

• Gradual loss of normal function

  • Called pancreatic insufficiency

• Permanent malabsorption and diabetes

• Fats not absorbed

  • Steatorrhea

    • Fat-rich, foul smelling stool

Steatorrhea

Fat-rich, foul smelling stool

Celiac Disease

• Aka sprue

• Probably genetic etiology

• Enzyme defect

  • Cant digest gliadin

    • Break down product of gluten

  • Toxic effect on villi

    • Malabsorption results

  • Signs and symptoms: steatorrhea, muscle wasting, failure to gain weight

Ulcerative Colitis - Chronic inflammatory bowel disease

• Large intestine

• Idiopathic

• Ulceration, mucosal atrophy, polyps, adhesions, only lining of colon

• 30% lead to cancer

Crohn’s Disease - Chronic inflammatory bowel disease

• Crohn’s disease

• Small intestine

• Idiopathic (genetic or autoimmune)

• Entire wall thickening, fibrosis, lumen, stenosis, adhesions

Acute appendicitis

• Fecalith (usually) obstructs opening

• inflammation/swelling

• Necrosis in wall

• Bacteria leak into peritoneum

  • Localized peritonitis

  • Possible greater omentum abscess

• May rupture

  • General periodontitis

Diverticular Disease - Know the difference between diverticula, diverticulosis, and diverticulitis

• Diverticula - Large Intesine

  • Outpouchings of large intestine

  • Weakening of wall (straining, low fiber diet)

  • Fill up with feces and other debris → inflammation

  • Diverticulosis v diverticulitis

• Diverticulosis

  • Asymptomatic or mildly symptomatic condition of having these pouches

• Diverticulitis

  • Occurs when these pouches become inflamed or infected, causing severe abdominal pain, fever, and requiring medical treatment

  • Does not produce signs

  • Diverticulitis: 

    • Abdominal pain

    • Tenesmus

    • Bloody stool

Diverticula and colonic polyps

• Innie versus outie

• Diverticula = pouch

• Colonic polyps = growth

Colorectal cancer

• Adenocarcinoma

  • Described as an apple core lesion

  • Lumen is narrowed due to constricting lesion

  • Common and surgically resectable

• 3rd leading type of cancer, 2nd leading cause of cancer death

• Etiology: probably genetics, diet

• Benign: polyps (though can predispose to cancer)

Ileus

• Blockage of intestine (ileus) due to:

  • Mechanical

  • Paralytic (lack of normal peristalsis)

    • Hirschsprung’s disease

  • Back up, increased pressure (infarction/pressure necrosis)

    • Can lead to gangrene

    • Rupture

    • Contents spill into peritoneum (peritonitis)

Mechanical Ileus

• Inguinal hernia

• Volvulus 

  • Twisting of the bowel

  • Imagine the impact on GI function as well as blood supply

  • It actually looks like a corkscrew

• Infussuception

  • Telescoping of bowel into itself

  • Common in children

  • Can be reduced (fixed) with a barium enema

• Tumor

• Divertilitis

• hernia

Paralytic (lack of nerve stimulation or exterior stifling of peristalsis)

• Caused by

  • Severe pain - internal sphincters respond by spasm and restrict contents

  • Peritonitis - pus surrounds intestine and prevents peristalsis

  • Sever enteritis - inflammation neuromuscular transmission

  • Spinal cord trauma - portions of intestine are denervated

  • Effects of general anesthesia

  • Hirschprung’s disease (congenital megacolon)

    • Lack of PNS innervation

Peritonitis

• Inflammation of peritoneal cavity

  • Infectious

    • Bacteria - often from GI tract

  • Chemical irritation

    • AKA sterile peritonitis

    • Bile in peritoneum

    • Pancreatic enzymes

    • Surgical materials

Ascites

• Excess fluid in the peritoneal cavity

• 3 kinds

• Transudate

  • Cirrhosis - from liver

  • Nephrotic syndrome - from kidneys

  • CHF - causes back-pressure in liver

• Bloody exudate

  • Usually from metastatic cancer to the peritoneum

• Chyle

  • Milky fat-containing fluid from blocked lymph flow

Ischemic bowel disease and its complications

• Infarction

  • Atherosclerosis

  • Thrombosis

  • Shock - systemic hypotension

  • CHF - systemic hypoperfusion and hypotensive episodes

• signs/symptoms

  • Intestinal angina (rigid abdomen due to pain)

  • Bloody diarrhea

  • Weight loss (from malabsorption)

• Mild

  • Edema, some hemorrhaging, but heals with minimal fibrosis

• Moderate

  • Scarring, cicatrization, stenosis or stricture

• Severe

  • Can lead to infarction, necrosis, gangrene, and finally a strong possibility of rupture and death

Hernias

• Tissue where it should not be

  • Inguinal - protrusion of abdominal tissue through a weak spot in the lower abdominal wall

  • Hiatal - occurs when the upper part of the stomach pushes through a weakened diaphragm into the chest cavity

  • Umbilical - soft bulge near the belly button caused by intestine or fatty tissue pushing through a weak spot in the abdominal wall

Congenital anal atresia

Congenital defect where a baby is born with a missing, blocked or mispositioned anal opening, preventing normal stool passage

Hemorrhoids

Varicose veins of rectum

Irritable bowel syndrome

• Very common (up to 20% of the population in U.S)

• Overactive large bowel

• Peristaltic disturbance

• Cramping, diarrhea, gas

• Sometimes alternating diarrhea/constipation

Peyronie’s Disease

• Condition resulting from development of fibrous scar tissue on the penis causing a significant bend during erection

• Considered a form of erectile dysfunction (ED)

• Can lead to painful/difficult intercourse

• Cause is not fully understood but may be hereditary or through repeated injury to penis as well as possible connective tissue disorders

Cryptorchidism

• Maldescent/failure of one or both testicles to descend into scrotum from abdomen in developing fetus

• Congenital disorder

• Cause not fully understood

• Infertility results if both fail to descend

• Increased risk for testicular cancer

Hydrocele

Excessive fluid collects in the potential space between the layers of the tunica vaginalis (layer of scrotum), may be a congenital defect

Inguinal Hernia

Opening in processus vaginalis allows for a loop of intestine to pass through the abnormal opening, leads to intestinal obstruction

Spermatocele

Abnormal cyst of fluid/sperm that develops between the testis and epididymis outside the tunica vaginalis

Varicocele

Dilated vein in spermatic cord usually on left side, frequently develops after puberty and results from lack of valves in the veins, varicose veins in spermatic cord

Testicular Torsion

When testis rotates on the spermatic cord, compressing the arteries and veins, ischemia develops, hospitalization needed, cuts off blood supply, leads to sterilization

Prostatitis

• Has 4 categories: 

  • 1 - acute bacterial

  • 2 - chronic bacterial

  • 3 - nonbacterial

  • 4 - asymptomatic inflammatory

• Considered an ascending infection or inflammation with multiple causes

• Pressure in lower abdomen

• Usually seen in older men with incomplete bladder emptying

• Fibrosis/inflammatory enlargement can lead to urethral obstruction

• Signs include:

  • Burning urination

  • Pain

  • White blood cells in urine

  • Pus in urine/around urethra

  • Fever

  • Chills

Balanitis

• Fungal infection of glans penis that can be sexually transmitted

• Caused by candida albicans

• Seen mostly in uncircumcised men

• Vesicles develop into patches

• Severe burning and itching

Pathophysiology and complications of benign prostatic hypertrophy (or hyperplasia) (BPH)

• Actually hyperplasia not hypertrophy

• Not cancer, common in older men (50% of those over 65 years)

• Can vary from mild to severe

• Hormonal change associated with aging

• Prostate goes from smooth to bumpy, irregular, and enlarged

• Some fibrosis

• Losing testosterone

• With frequent but difficult and possibly painful urination

Pathophysiology of prostate cancer and its complications

• Common in men 50+ years of age

• High cause of cancer related deaths

• 5-10% of prostatic cancers are caused by inherited mutations in the HPC1 gene

• Most tumors are adenocarcinomas arising from the tissue near the surface of the gland

• Invasive to regional tissues and metastatic to bone

• Tumors vary in degree of cellular differentiation

• Silent grower

• Spreads quickly in prostate but slow to metastasize

• Confined to posterior part of prostate

• Signs come late

• Treated with surgery and radiation

Seminomas

• Malignancy of seminiferous tubules

• Most common form

• Does not metastasize

• 90% 5 year survival rate

Teratomas

• Worse in men

• Malignancy of germ cell

• Metastasizes through blood and lymph to lungs, liver, and brain

• Survival rate for 5 years is less than 50% if metastasis is present

Pathophysiology and prognoses for male breast cancer

• Extremely rare (about 1% of breast cancer cases)

• Similar to female breast cancer, usually detected very late because of no routine screening

Uterine Prolapse

• AKA displacement

• Descent of the cervix/uterus into the vagina, has 3 degrees: 

  • 1st degree - cervix drops into vagina

  • 2nd degree - cervix lies at opening to the vagina and the body of the uterus is in the vagina

  • 3rd degree - aka procidentia, if the uterus and cervix protrude through vaginal orifice

Cystocele

Protrusion of urinary bladder into the anterior wall of vagina

Rectocele

Protrusion of rectum into posterior wall of vagina

Amenorrhea

Lack of period 

• Primary: Never had a period, no menstruation at puberty, may result from genetic or congenital disorder, ovarian problem, hormonal development off  

• Secondary: Cessation of a period from someone who’s had them, confirmed after 12 months no period, hormone imbalance, pituitary disease, ovarian disease, endometrial disease, may be psychosomatic

Menorrhagia

Excessive bleeding (amount and duration)

Dysmenorrhea

Painful menstruation 

• Primary: No organic foundation, develops when ovulation commences 

• Secondary: Results from pelvic disorders

Premenstrual Syndrome (PMS)

Condition that begins a week before menstruation and ends with end of menstruation, cause is unknown but likely hormonal, if severe symptoms (3-8% of women), then it is premenstrual dysphoric syndrome

Endometriosis

The presence of endometrial tissue on the outside of the uterus on structures such as the ovaries, colon, and ligaments, ectopic tissue responds to hormones, dysmenorrhea is a common sign, adhesions/fibrous formation/blood filled cysts may result in infertility 

Vaginitis

Inflammation of vagina, usually the result of infection or imbalance of normal bacteria flora

Cervicitis

Inflammation of cervix, usually caused by STDs but can also be  imbalance of normal bacteria flora

Pelvic Inflammatory Disease

• Infection of reproductive tract, particularly fallopian tubes and ovaries

• Follows ascending path through vaginal entry

  • Can be caused by STDs/bad abortion or delivery practices

  • Originates as vaginitis or cervicitis and is often polymicrobial

  • Can cause lower abdominal pain/fever/vaginal discharge

  • Can lead to abdominal abscess and peritonitis, septic shock, death, adhesions/fallopian scarring causing infertility, ectopic pregnancy due to obstructed fallopian tube from scarring

Leiomyoma

• Benign estrogen dependent tumor of myometrium (uterine muscle)

• Unknown cause

• Common in women during reproductive years (more than 30% of women)

• Usually small but can enlarge, shrink after menopause (become fibroid mass)

• Can cause pressure damage

Ovarian Cysts

• Fluid filled enlarged corpus luteum or unruptured follicle

• May become large enough to cause irritation

• Bleeding may cause surgical intervention

• Insufficient FSH and LH leads to polycystic ovary syndrome (AKA Stein-Leventhal Syndrome)

Teratoma

• AKA terrible growth and dermoid cyst

• Germ cell (ovum) contains DNA for all body tissues

• Needs DNA from sperm to make complete set to form a human being

• Develop on ovaries during reproductive years

Fibrocystic Breast Disease

• AKA benign breast disease/fibrocytic change

• Inappropriate response to estrogen/progesterone

• Multiple cysts develop and accumulate fluid

• Presence of nodules or masses in the breast tissue that change during the menstrual cycle in response to fluctuating hormone levels

• Scar tissue surrounds cysts, has 3 categories based on risk

Fibroadenoma

• First category of fibrocystic breast disease

• Not considered precancerous

• They are specific benign tumors that appear as single, moveable masses that are excised

Pathophysiology and complications of malignant breast carcinoma

• Common malignancy and cause of death in women

• 20-40% of masses that become cancerous are not palpable

• Mammography could prevent 30% of breast cancer deaths

• Malignant tumors develop in upper outer quadrant of breast in about half of all cases, with the central breast being the next most common location, most tumors are unilateral, most carcinomas arise from cells of ductal epithelium, malignant cells spread at early stage to lymph nodes and blood then metastasize to bone, liver, lungs, and brain, most cases are in women 50 years of age and older, usual initial sign is small moveable nodule but becomes fixated after invading surrounding tissue, treatment is done with surgery/chemo/rad therapy, can be spread through genes (BRCA 1 and 2), hormonal influence, chemical, oncogenic viruses, radiation, history of other estrogen linked cancers

Cervical Carcinoma

Death rate has decreased by 74% with pap smear screenings, average onset for it in situ is 35 years of age, graded from 1-3, staged from 0-4, early changes consist of dysplasia which progresses from mild to severe, strongly linked to oncogenic STDs (HSV2 and HPV), is asymptomatic in early stage

Endometrial Carcinoma

AKA uterine cancer, most common reproductive tract cancer (not including breast), derived from connective tissue/muscle and termed leiomyosarcomas, poor prognosis, increased estrogen exposure leads to a higher incidence, graded from 1-3, majority are adenocarcinomas arising from glandular epithelium, relatively slow growing, unusual painless bleeding is an early warning sign, most commonly affects post menopausal women

Presentations of ovarian carcinoma

• Known as a silent killer, only about 25% of cases diagnosed early, 2/3 diagnosed after 55 years of age, prognosis based off tumor type and time of diagnosis, genetic factors have a role in its development

• Cystadenocarcinoma: May be benign or low or high malignancy 

• Endometroid carcinoma: Highly malignant

Chlamydia

One of the most common STDs, leading cause of PID, caused by chlamydia trachomatis, a gram negative obligate intracellular parasite that requires a host cell to reproduce 

• Men: Evident within several weeks as urethritis with whitish discharge from penis, epididymitis, proctitis

• Women: Often asymptomatic until PID develops, sometimes urethritis or other reproductive tract infection

Gonorrhea

Caused by n. gonorrhoeae, a gram negative aerobic diplococcus (gonococcus)

• Men: Most common site of inflammation is in the urethra, resulting in dysuria with purulent discharge and sometimes epididymitis, sometimes asymptomatic 

• Women: Often asymptomatic, may have infection in anus/rectum, involves the endocervical canal, PID, bacteremia and gonococcal arthritis, green/yellow/creamy white discharge

Bacterial STI syphilis

• Caused by treponema pallidum, an anaerobic spirochete, systemic infection with 4 stages and the organism can be isolated from lesions in the first 2

• Stage 1: Primary stage, identified by presence of chancre on genitalia (or cervix) about 3 weeks after exposure, lesion heals spontaneously without treatment within a few weeks and are asymptomatic 

• Stage 2: Secondary stage, the organisms have entered the general circulation by the time the chancre has healed, and if untreated, a widespread symmetrical rash appears on skin along with fever, malaise, sore throat, stomatitis, anorexia 

• Stage 3: Latent stage, may persist for years, skin lesions may recur, person is usually asymptomatic

• Stage 4: Tertiary stage, gumma formation (area of necrosis and fibrosis leading to bone destruction and pathologic fractures), these affect the cardiovascular system by damaging the arterial wall and developing aortic aneurysms, also cirrhosis like liver damage, dementia, and blindness

Genital Herpes (HSV2)

Usually caused by HSV2, sometimes HSV1, blister like lesions appear (vesicles) on genital areas/buttocks/thighs, ruptures after several days and a crust eventually forms over it, and heals in about 3-4 weeks, systemic signs may present in acute stage (fever, headache, lymphadenopathy), then travels up dermatome to the spinal ganglia where it resides until it's triggered again (stress, respiratory infections), the migrated back to the mucosa or skin to replicate, may be transferred to infant during vaginal delivery and cause nervous system damage and even death, places women at high risk for cervical cancer

Human Papilloma Virus (HPV)

Certain types cause genital warts, increasing in frequency, incubation period is up to 6 months, may be asymptomatic, circular, double stranded DNA virus, several types also cause cervical cancer, appearance varies, usually appear on penis in men, found in vagina/on cervix in women, pregnancy promotes growth/spread

STDs

Trichomoniasis

• Caused by trichomonas vaginalis, localized infection, an anaerobic flagellated protozoan, extracellular parasite

• Women: 

  • Vaginal, urethral, and Bartholin’s glands infected, produces inflammation, pruritus, foul smelling yellow discharge, may be subclinical then flare up when microbial balance of vagina shifts 

• Men: 

  • Urethral infection, usually asymptomatic, can lead to other infections

Development and consequences of an ectopic pregnancy

AKA tubal pregnancy, occurs when fertilized ovum is implanted outside the uterus, often in fallopian tube, incidences increased within the past 20 years likely due to pelvic inflammatory disease (PID), may cause spontaneous abortion in early pregnancy, or fetus may continue to develop leading to severe hemorrhage or periodontitis, causes severe abdominal/pelvic pain, considered a medical emergency and requires hospitalization

Gestation

Length of time since the first day of the last menstrual period (LMP) and equals 280 days/40 weeks/10 lunar months

Parity (pregnancy)

Number of pregnancies in which the fetus has reached viability