Pathophysiology - Chapter 20 - Female Reproductive System

What happens to the follicle?

follicle becomes the corpus luteum, produces progesterone

If implantation does not occur to corpus luteum,

-corpus luteum atrophies

-uterine muscle contracts -> ischemia

-endometrium degenerates

What happens to corpus luteum during 25-26 days after ovulation?

progesterone decreases and corpus luteum atrophies

Structure abnormalities of uterus

-retroversion

-retroflexion

-retrocession

-anteflexion

What is first-degree prolapse?

First-degree prolapse occurs if the cervix drops into the vagina.

What is second-degree prolapse?

Second-degree prolapse occurs if the cervix lies at the opening to the vagina and the body of the uterus is in the vagina.

What is third-degree prolapse?

Third-degree prolapse occurs if the uterus and cervix protrude through the vaginal orifice.

What are the symptoms of early stages of uterine prolapse?

Early stages of prolapse may be asymptomatic.

What are the symptoms of advanced stages of uterine prolapse?

Advanced stages cause discomfort, infection, and decreased mobility.

Rectocele

-protrusion of the rectum into the posterior vagina

-may cause constipation and pain

Cystocele

-protrusion of the bladder into the vagina

-may cause UTIs

Severe cystocele and rectocele

conditions are treated with surgically to increase the support of the pelvic ligaments

Amenorrhea

absence of menstruation

primary amenorrhea

genetics or hysterectomy

secondary amenorrhea

hormonal imbalance or weight loss

Dysmenorrhea

painful menstruation caused by excessive release of prostaglandins

Premenstrual Syndrome

syndrome involving physical and emotional symptoms occurring in the 10 days before menstruation

Menorrhagia

increased amount and duration of flow

Metrorrhagia

bleeding between cycles

Polymenorrhea

Short cycles of less than 3 weeks

Oligomenorrhea

Long cycles of more than 6 weeks

What is endometriosis?

Endometrial tissue located outside the uterus.

How does ectopic endometrium respond?

Ectopic endometrium responds to cyclical hormone changes.

What are the consequences of bleeding in endometriosis?

Bleeding leads to inflammation and pain.

What complications can arise from fibrous tissue in endometriosis?

Fibrous tissue may cause adhesions and obstructions of the involved structures.

What is a potential cause of endometriosis?

The cause may be congenital.

tx for endometriosis

-surgical removal of ectopic tissue

-hormonal suppression (hormone therapy)

Candidiasis

-yeast infection

-caused by fungus candida albicans

-opportunistic infection (pt get it after being on antibiotics)

s/s of candidiasis

-red and swollen

-intensely pruritic mucous membranes

-thick, white, curdlike discharge

tx for candidiasis

antifungal treatment

What is the average age for menopause?

51

What hormone initiates menopause?

low estrogen

How long must a women go without menstruating for it to be considered menopause?

over 12 months

Number one complaint of women going through menopause?

Heat flashes

Benefits of hormone replacement therapy

-decrease hot flashes

-prevents/treats osteoporosis and hip and vertebral fx

-prevents/treats urogenital atrophy

Risks of hormone replacement therapy

-increased risk for venous thrombosis and embolism

-increased risk for breast cancer with prolong use

-increased risk for endometrial cancer with ET

Pelvic Inflammatory Disease (PID)

Infection of uterus, fallopian tubes, and/or ovaries

What kind of infection is PID?

infection usually originates as an ascending infection from lower reproductive tract

scarring of tubes increase risk of what when someone has PID?

scarring of tubes increases risk of infertility and ectopic pregnancy

What experience will women have once they have PID?

Approximately 25% of women with a single episode of PID will experience sequelae, including ectopic pregnancy, infertility, or chronic pelvic pain

Tubal infertility and PID

tubal infertility occurs in 50% of women after three episodes of PID

s/s of PID

-hyperthermia

-guarding

-N/V

-Leukocytosis

-Purulent discharge may be present

tx for PID

aggressive antibiotic therapy in hospital

Leiomyoma

benign tumor of myometrium (smooth muscle)

Ovarian cyst

-lasts about 8 to 12 weeks and disappear without complications

-usually multiple, small, fluid-filled sacs

dx test for ovarian cyst

US or laparoscopy

What is Polycystic Ovary Syndrome (PCOS)?

A condition in women characterized by endocrine dysfunction, specifically abnormal androgen production and metabolism.

What hormone is typically in excess in women with Polycystic Ovary Syndrome?

LH (Luteinizing Hormone)

What is the level of FSH (Follicle Stimulating Hormone) in women with Polycystic Ovary Syndrome?

Low and tonic

What is a common feature of the ovaries in women with Polycystic Ovary Syndrome?

Enlarged and/or polycystic ovaries

What is hypersecretion of androgens?

A condition often seen in women with Polycystic Ovary Syndrome.

s/s of polycystic ovarian disease

-fibrous capsule thickens around follicles of ovary

-may be hereditary

-absence of ovulation and infertility

-hormonal imbalance

-amenorrhea

-hirsutism

tx for polycystic ovarian disease

surgical wedge resection or pharmacology

What are the breast changes associated with Fibrocystic Breast Disease?

Increased density of breast tissue

What is a cyclic occurrence in Fibrocystic Breast Disease?

Nodules or masses in breast tissue

What is the risk of breast cancer in Fibrocystic Breast Disease?

Increased risk if atypical cells are present

How does increased density in Fibrocystic Breast Disease affect self-examination?

Makes breast self-examination difficult

What effect does caffeine intake have on Fibrocystic Breast Disease?

Increased cystic masses

What age group has the most cases of breast carcinoma?

Women between ages 50 and 69 years

Are most breast carcinoma tumors unilateral or bilateral?

Most tumors are unilateral

What is the association between earlier onset of breast carcinoma and tumor growth?

Earlier onset is associated with more aggressive growth

From which cells do most breast carcinomas arise?

Ductal epithelial cells

How does metastasis occur in breast carcinoma?

Metastasis occurs via lymph nodes early in the course of the disease

What influences the treatment of breast carcinoma?

The presence of estrogen or progesterone receptors on tumor cells

What is a predisposing factor for carcinoma of the breast related to family history?

First-degree relative with the disease

Which genes are associated with a strong genetic predisposition to breast carcinoma?

BRCA1 and BRCA2

What hormonal exposure is a risk factor for breast carcinoma?

Longer and higher exposure to estrogen

What is a reproductive factor that increases the risk of breast carcinoma?

Nulliparous or late first pregnancy

How does physical activity relate to breast carcinoma risk?

Lack of exercise is a predisposing factor

What lifestyle choice is a risk factor for breast carcinoma?

Smoking

What type of diet may increase the risk of breast carcinoma?

High-fat diet

What previous medical treatment can be a risk factor for breast carcinoma?

Radiation therapy to the chest

Which cancers are associated with an increased risk of breast carcinoma?

Cancer of the uterus, ovaries, or pancreas

s/s of carcinoma of the breast

-change on mammogram

-initial sign (single, small, hard, painless nodule)

dx test for carcinoma of the breast

US or bx

Metastasis occurs by the time the tumor grows how much in diameter?

1 to 2cm

tx for carcinoma of the breast

-surgery may be a lumpectomy or removal of the breast

-lymph nodes may be removed

-tissue bx to determine drug tx and chemotherapy

-radiation therapy may be done

Carcinoma of the cervix

malignant cells within the cervix

What causes cervical cancer typically?

human papillomavirus (HPV) (a STD)

Why are routine pap smear important?

routine pap smears of cervical cells are important in identifying early, treatable stages of the disease

Course of carcinoma of the cervix

Early dysplasia of cells; abnormal cells showing less differentiation

Risk factor of carcinoma of the cervix

-age > 40 years

-strongly linked to HPV

-multiple partners

-sexual intercourse beginning in early teenage years

-smoking

-hx of prior STDs

What is the most common demographic for carcinoma of the uterus?

Postmenopausal women

What is an early indicator of carcinoma of the uterus?

Painless vaginal bleeding or spotting

Does a Pap smear detect carcinoma of the uterus?

No, it does not detect this cancer

From what type of tissue does carcinoma of the uterus usually arise?

Glandular epithelium

How is carcinoma of the uterus characterized in terms of growth?

Relatively slow-growing but is invasive

What is the basis for staging carcinoma of the uterus?

Degree of localization

What are the common treatments for carcinoma of the uterus?

Surgery and radiation

Ovarian Cancer

-no reliable screening available

-considered a silent tumor

-varies in aggressiveness

-blood test CA125 is way too sensitive