Alterations of the Reproductive Systems

Vaginitis

Infection of the vagina caused by sexually transmitted bacteria and candida albicans

Any change in the vaginal discharge may signify a problem

Diagnosis based on hx, physical exam, and lab exam of discharge

Leiomyomas

• Benign tumors that develop from smooth muscle cells in the myometrium

• Most common tumour of the uterus, most remain small and asymptomatic

• Cause is unknown but related to estrogen increase during pregnancy

• Classification according to location in the uterus linings

• Degenerative changes may happen when a tumour outgrows its blood supply

Leiomyomas

Pathology of ___________ includes abnormal uterine bleeding, pain, and symptoms r/t bleeding, pain, and symptoms r/t pressure (e.g. dysuria, urinary pressure (e.g. dysuria, urinary frequency and urgency) frequency and urgency. Often found when examination reveals hard and lumpy uterus

Leiomyomas

Treatment of __________ includes watchful waiting, NSAIDs, Hormones (BCP, IUD, GnRH agonists, selective progesterone receptor modulators, ulipristal (fibristal) now discontinued. Embolization, Myomectomy , Hysterectomy.

Endometriosis

- Presence of functioning endometrial tissue outside of the uterus

- Responds to the hormonal cycle

- Presence increases risk for endocrine cancers

- Cause unknown but several theories including genetic predisposition

- Bleeding causes inflammation, pain in surrounding tissues, may cause fibrosis, scarring and adhesions

Endometriosis

Pathology of _________ : Variable in frequency and severity, usually cause infertility and pain. Laparoscopy required for definitive dx

Laparoscopy

Procedure used to check the organs in the belly (abdomen)

Endometriosis

Treatment for _______ includes

- NSAIDs

- Hormones – BCP, Progestins, GnRH agonists, Aromatase inhibitors

- Surgery

Cervical Cancer

Risks for ______________ include:

- Infection with HPV before the age of 16

- Multiple partners or a partner with multiple partners

- Smoking

- Poor nutrition

- HIV

Cervical Epithelial Neoplasms

First stage of cervical cancer histology

- Asymptomatic

- Must have screening tests – 90% detected early

- Graded as mild (CIN 1), moderate (CIN 2), severe (CIN 3)

Carcinoma in Situ

Second stage of cervical cancer histology

- Underlying tissues are not affected but all other cells are affected

- Cells changing from carcinoma in situ back to intraepithelial neoplasia (CIN 1) is uncommon

Invasive Carcinoma of the Cervix

Third stage of cervical cancer histology

- Direct invasion into adjacent tissues and metastasis

-  Affects the uterus and pelvic wall

-  Travels through the lymph

Ovarian Cancer

Cause presently unknown, risk increases with 1^st degree relatives with the disease or breast cancer.

Inc parity may decrease risk.

Other risks include use of fertility drugs and HRT or diet low in fruits + veggies and high in fat.

Good survival rate if caught early, but only 25% caught early

Often considered a silent disease, can have diverse S & S

Most obvious symptoms are pain and abdominal distension

Usually advanced by the time tx is sought

May use radiation and chemo

Breast Cancer

Most common cancer of women

Disease of the glandular epithelium

50% occur in the upper outer quadrant of the breast (most glandular tissue found there)

First sign is a painless lump

Mammography and biopsy are used to dx

Biopsy used to determine receptor status

Breast Cancer

Diagnosis of ___________ includes mammogram, physical examination, needle localized biopsy, excisional biopsy

Breast Cancer

Treatment of __________ includes:

Surgery - Lumpectomy or mastectomy

Chemotherapy depending on receptors

Radiation

Hormone therapy

Bone marrow transplantation for very serious cases

Infertility

-       Inability to conceive after 1 year of unprotected intercourse

-          Affects 15% of couples

-          May be d/t issues with male or female or both

-          Tx aimed at correcting the problem

-          Best Tx is prevention – especially STD infections

Infertility

Male ________ includes:

-          Diminished quantity/production of sperm

-          Diminished quality of sperm

-          Anatomical anomalies

Infertility

Female _________ includes:

-          Malfunctions of the fallopian tubes, ovaries, or reproductive hormones

-          Adhesions from pelvic infection

-          Disruption of ovulation or implantation

-          Endometriosis

Fertility

__________ testing for males includes looking at the amount, structure, and motility of sperm and obstruction of the reproductive tract

Fertility

___________ testing for females includes looking for patency of reproductive tract, normal ovulation, normal endometrial response to hormones and lack of tumours or infections

Epididymitis

-       Inflammation of the epididymis

-          Generally occurs in young sexually active men

-          Most common cause is gonorrhea or chlamydia

-          Pathogen reaches epididymis by ascending the vas deferens

-          Inflammation process begins

-          Pain is the main symptom

-          Difficulty urinating, urethral discharge, red edematous scrotum

Epididymitis

Complications of _____________ include:

-  Abscess

-  Infarction

-  Infection

-  Infertility

Epididymitis

Diagnosis of _________________ include:

- Hx of recent UTI or urethral discharge

- Urethral swab for C&S and gram stain

Epididymitis

Treatment of _____________ include:

-  Relief of pain

-  Abx

-  Bedrest

-  Elevation of testes

-  Antibiotics are 10-14 days minimum

Torsion of the Testes

- Testes rotates on its vascular pedicle interrupting the blood supply

- Common in neonates and pubertal adolescents

- Spontaneous onset or after physical activity or trauma

- Ischemia develops causing scrotal swelling or pain

- Tender, high-rising testes

Torsion of the Testes

Dx and Tx of __________ includes:

-  Ultrasound of the testes

-  If the torsion cannot be reduced manually, emergency surgical intervention within 6 hours after onset of symptoms to preserve normal testicular function

- Surgery includes untwisting the spermatic cord and anchoring testes into correct position

Benign Prostatic Hyperplasia

Enlargement of the prostate gland

Commonly occurring phenomenon, begins at age 40-45

Becomes problematic when the urethra is compressed

80% of men will have it by their 80^th year

Urine retention becomes chronic

Benign Prostatic Hyperplasia

Signs and Symptoms of __________ include:

1.       Obstruction

-          Incomplete emptying

-          Weak stream

-          Prolonged voiding

2.       Irritative

-          Frequency

-          Nocturia

-          Incontinence

Acute Bacterial Prostatitis

Ascending infection of the urinary tract

Infection stimulated inflammation in the prostate

May follow cauterization or cystoscopy

Acute Bacterial Prostatitis

CM similar to acute cystitis or pyelonephritis:

- Malaise, low back and perineal pain, high fever, chills, dysuria, inability to empty fever, chills, dysuria, inability to empty bladder nocturia, bladder nocturia

Acute Bacterial Prostatitis

Treatment of ____________ includes:

Acutely ill and look toxic – treat causative organism - long-term broad causative organism - long-term broad spectrum antibiotics spectrum antibiotic

Complications can include bacteremia and septic shock

Same Rx as UTI and epididymitis

Usual UTI antibiotics – Longer courses (4-6 weeks minimum)

Nonbacterial Prostatitis

Most common of the prostatitis syndrome

No evidence of bacterial infection

May complain of continuous or spasmodic pain or dull ache – prostate gland feels normal on palpation

Diagnosis by exclusion

Prostate Cancer

Most commonly diagnosed malignancy, second leading cause of death in men

Cause is poorly understood – disease of the aging

Rarely occurs in men < 40 years

Many contributing factors including:

-          Dietary

-          Hormones

-          Vasectomy

-          Familial

Prostate Cancer

___________ pathology includes

- More than 95% are adenocarcinomas, occur in the periphery of the prostate

- Aggressiveness of cancer depends on differentiation rather than the size of the tumour

- Little is known about hormone involvement

- Major hormone is testosterone

Prostate Cancer

Clinical manifestations of ____________ include:

- Often causes no symptoms until far advanced

-  Look for bladder outlet obstruction, than perhaps rectal obstruction

-  Late symptoms include pain at sites of bone metastasis, edema at the lower extremities, liver enlargement, pathologic bone fractures, mental confusion.

Gonorrhea

-  Caused by gonococci

-  Endocervical canal usual site of original infection in women

-   Infect the urethra in males

Gonorrhea

Incubation period of _____________ in men is 3-10 days (dysuria is often the first sign). 30% chance for men to contract from women

Gonorrhea

Incubation period of ____________ in women is up to 10 days, or just before next period. 80% chance for women to contract from men. From mom to babe Treatment: Ceftriaxone IM

Gonorrhea

Ceftriaxone IM is an injected antibiotic used to treat _____________

Chlamydia

- Most common STD

-  Reportable disease

-  Highest in women under the age of 20

-  Rarely seen in the sexually inexperienced

- Obligate, gram negative intracellular bacteria and lacks the ability to reproduce independently

Chlamydia

Signs and symptoms of ________ include:

-  Urethral symptom

-   Mucopurulent cervicitis

-   PID

-    Asymptomatic chlamydia common

-    Gonorrhea & chlamydia often occur together

Chlamydia

Diagnosis and treatment of _____________ includes:

Dx.

-          Tissue culture immunoassay

-          DNA test from same tissue culture

Tx.

-          Abx for affected person and partners.

-          Azithromycin

Pelvic Inflammatory Disease

Severe infection of female reproductive organs, often caused by ascending sexually transmitted microorganisms.

Key points include polymicrobial nature, risk factors involving virulence and individual defense status, and complications such as infertility and chronic pain (15-25% incidence).

Mortality is around 8-9%, primarily from septic shock. Symptoms range from severe fever to asymptomatic, with pain worsening during intercourse or physical activity.

Diagnosis relies on history, abdominal tenderness, and lab tests. Treatment involves bed rest, abstinence from intercourse, antibiotics, and partner treatment.

Genital Herpes

-  Blisters (cold sores) to genital areas

-  Can be from 2 different viruses: – HSV -1HSV -1– HSV -2HSV -2

-  Not a reportable disease

-  Spread through intimate contact by a person shedding the virus in secretion or person shedding the virus in secretion or from a peripheral lesion or mucosal surface

Genital Herpes

Reactivation of ____________ can be caused by

- Physical

- Hormonal

- Immunologic stimuli

- Stress

- Sun exposure

During Reactivation the virus travels up the peripheral sensory nerves back to the dermal surface

Occur an average of 5-8 times a year but may be as frequent as every month or as rare as many years

Vaginal discharge and dysuria

Can be serious for infants

-          CNS involvement including seizures

-          50% mortality

Genital Herpes

Diagnosis and treatment of ____________ includes

- Pap smear

-  Non curative treatment

-  Oral medications are used for outbreaks to prevent reoccurrence

-  Can be transmitted during latent periods

-  Condoms

Genital Herpes

Medications used to treat ____________ include

-  Acyclovir

-  Valacyclovir

-  Famciclovir