patho W 9 (mine)

Introduction

• This lecture covers health issues related to individuals with a penis and those with a uterus. Focus will primarily be on uterine issues due to the extensive variety of conditions associated.

Prostatitis

• Definitions:

  • Prostatitis: Inflammation of the prostate gland.

  • Commonly misunderstood as synonymous with infection.

• Acute Bacterial Prostatitis:

  • Accounts for approximately 10% of prostatitis cases.

  • Primarily affects younger individuals and the elderly.

• Types of Infection Spread:

  • Contiguous: Spread from nearby structures, e.g., bladder to prostate.

  • Hematogenous: Spread through blood.

  • Lymphatic: Spread through lymphatic system.

  • Direct inoculation: Infection introduced directly into the body.

• Risk Factors for Prostatitis:

  • Benign Prostatic Hyperplasia (BPH, preferable terminology: hyperplasia).

  • Sexual behavior, phimosis (narrowing of the foreskin).

• Symptoms:

  • Pain referred to various pelvic areas (rectal, perineal), pain with ejaculation.

• Diagnosis and Treatment:

  • Urinalysis, monitoring trends, antibiotic therapy, hydration, pain control, and antipyretics.

• Long-term Outlook:

  • Prostatitis does not lead to cancer, but pain can be debilitating and often remains untreated.

Benign Prostatic Hyperplasia (BPH)

• Definitions:

  • Hyperplasia: Increase in the number of cells (distinguished from hypertrophy).

• Epidemiology:

  • Affects 8% of males in their 30s, 30-40% in their 40s, and 70-80% in older males.

• Theories of Etiology:

  • Linked to hormonal changes, specifically decreasing testosterone and increasing DHT (dihydrotestosterone).

• Symptoms:

  • Urinary urgency, difficulty urinating, potential bladder distension requiring catheterization.

• Management:

  • Symptom management, lifestyle changes, patient education on fluid intake and diuretics.

Endometriosis

• Definitions:

  • Endometrial tissue found outside of the uterus, responds to hormonal cycles leading to hyperplasia and inflammation.

• Theories on Causes:

  • Retrograde menstruation, hematogenous spread, iatrogenic spread post-surgery, and embryonic rest theory.

• Manifestations:

  • Pelvic and back pain, dyspareunia (painful intercourse), dyschezia (pain with bowel movements), and infertility.

• Diagnosis and Treatment:

  • Difficult to diagnose due to symptom variability. Common treatments include NSAIDs, hormonal treatments, and surgery (laparoscopy) for severe cases.

Pelvic Inflammatory Disease (PID)

• Overview: Infection that ascends through the reproductive tract, commonly caused by STIs (Chlamydia and Gonorrhea).

• Risk Factors:

  • Age (especially under 25), nulliparity, multiple partners, IUD insertion.

• Symptoms:

  • Abdominal pain, dyspareunia, back pain, fever.

• Diagnosis and Treatment:

  • Diagnosed using clinical criteria (adnexal tenderness, cervical motion tenderness, blood tests), treated with broad-spectrum antibiotics.

• Complications:

  • Infertility and ectopic pregnancy risks due to scarring from infections.

Ectopic Pregnancy

• Definition: Occurs when a fertilized egg implants outside the uterus, commonly in the fallopian tube.

• Clinical Risk Factors:

  • Previous ectopic pregnancies, tubal surgeries, PID, advanced maternal age, and smoking.

• Symptoms:

  • Early signs of general abdominal discomfort, localized pain as pregnancy progresses, potential for first trimester vaginal bleeding, and syncope (fainting).

• Diagnosis and Treatment:

  • Confirmed through urine tests (hCG), ultrasound, and possibly laparoscopy. Treated surgically or via methotrexate in early cases.

• Complications:

  • Hemorrhage, risk of maternal mortality if ruptured, and potential for infertility.

Pelvic Organ Prolapse

• Overview: Refers to a condition where pelvic organs drop due to weakened pelvic support tissues (could involve cystocele, rectocele, uterine prolapse).

• Risk Factors:

  • Age, pregnancy history, BMI, and chronic cough.

• Symptoms:

  • Vary widely, affecting sexual health and quality of life.

• Diagnosis and Management:

  • Diagnosed through pelvic exams. Treatment options range from conservative measures like lifestyle changes and pelvic floor exercises to surgical interventions.

Preeclampsia and Eclampsia

• Definitions:

  • Preeclampsia: New-onset hypertension after 20 weeks coupled with other organ involvement indicators.

  • Eclampsia: Progression of preeclampsia to seizures or coma.

• Risk Factors:

  • Previous preeclampsia, chronic hypertension, diabetes, and advanced maternal age.

• Pathophysiology:

  • Theories point to poor placentation leading to hypertension due to vascular issues.

• Symptoms and Management:

  • High blood pressure assessment, proteinuria, potential organ dysfunction. Management includes bed rest, magnesium for seizure prevention, antihypertensives, and monitoring.

Miscarriage

• Overview: Defined as a spontaneous abortion occurring before 20 weeks of gestation.

• Epidemiology:

  • Approximately 10-15% of all pregnancies end in miscarriage.

• Causes:

  • Can stem from chromosomal abnormalities, immune factors, or hormonal imbalances.

• Symptoms:

  • Signs include bleeding, pelvic pain, and an opened cervix.

• Diagnosis and Treatment:

  • Ultrasounds and blood tests used for assessment. Treatments may include monitoring, medication, or surgical intervention for complications.