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BioMed S2 > 12. Reproductive System - Pathologies > Flashcards

12. Reproductive System - Pathologies Flashcards

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1
Q

What is in-vitro fertilisation (IVF)?

A

Artificial fertilisation of the ovum by sperm outside the body

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2
Q

What does the IVF process entail?

A
  1. The drug Clomiphene causes oocytes to develop
  2. Ova are retrieved from ovaries, examined and incubated with sperm on a petri dish to allow fertilisation (or sperm injected into ovum)
  3. Embryo is transferred to uterus
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3
Q

Amenorrhoea: definition

A

Absence of periods

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4
Q

Primary amenorrhoea: definition

A

Failure to have a period by aged 16/17 (expected onset)

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5
Q

Secondary amenorrhoea: definition

A

Lack of menstruation for 3 months in previously menstrual woman

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6
Q

Primary amenorrhoea: aetiology

A

Congenital defects: failure of the ovarian follicles to develop
(Turner’s syndrome)

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7
Q

Secondary amenorrhoea: aetiology

A

Excessive exercise (endorphins inhibit GnRH)
Stress (cortisol inhibits GnRH)
Anorexia (neuropeptide Y surpresses GnRH)
Pregnancy!
Pituitary tumour
PCOS (increased testosterone promoting male functions not female)
Uterine obstruction
Hypothyroidism
Medications (e.g. antipsychotics)

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8
Q

Dysmenorrhoea: definition

A

Painful periods

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9
Q

Primary dysmenorrhoea: definition

A

Excessive release of uterine prostaglandins during menstruation, causing the myometrium to contract

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10
Q

Primary dysmenorrhoea: aetiology

A

Raised prostaglandins may be due to low progesterone before menses
No association with identifiable pelvic disease

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11
Q

Secondary dysmenorrhoea: aetiology

A

Associated with specific pelvic or systemic pathologies such as endometriosis, fibroids, pelvic inflammatory disease

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12
Q

When does primary dysmenorrhoea usually occur?

A

6-12 months after menarche

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13
Q

Dysmenorrhoea: allopathic treatment

A 
Contraceptive pill (inhibits ovulation)
NSAIDs
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14
Q

Premenstrual Syndrome (PMS): definition

A

Physiological, psychological and behavioural changes during the luteal phase (post-ovulatory phase of menstrual cycle)

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15
Q

Premenstrual Syndrome (PMS): aetiology

A

Variable: definitive cause unknown

Hormone imbalance - rapid shifts in levels of oestrogen and progesterone which can influence neurotransmitters

Drop in progesterone in the luteal phase of cycle

Increase in prostaglandins

Serotonin deficiency is thought to be a key neurotransmitter relationship

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16
Q

Premenstrual Syndrome (PMS): signs and symptoms

A

Over 150 symptoms have been attributed to PMS

Tension, anxiety, reduced concentration, depression, fatigue, palpitations
Headache, bloating, backache, pelvic pain, aching legs, sweating, fluid retention, hot flushes
Low blood sugar, cravings, increased appetite, greasy skin/hair

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17
Q

Premenstrual Syndrome (PMS): allopathic treatment

A

Oral contraceptive pill

Counselling

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18
Q

Pelvic Inflammatory Disease (PID): definition

A

Infectious and inflammatory disorder of the upper female genital tract including the uterus, fallopian tubes and ovaries

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19
Q

Pelvic Inflammatory Disease (PID): aetiology

A

Spread of bacteria ascending from the cervix
Sexually transmitted infective causes include gonorrhoea and chlamydia
Insertion of intra-uterine device (IUD) e.g. coil
Abortion
Delivery under non-sterile conditions

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20
Q

Pelvic Inflammatory Disease (PID): signs and symptoms

A

Lower abdominal pain (gradual or sudden/severe) - may increase with walking
Deep dyspareunia
Purulent discharge - pus/foul odour
Occasional dysuria, fever, nausea, vomiting

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21
Q

Pelvic Inflammatory Disease (PID): complications

A

Ectopic pregnancy
Infertility
Peritonitis, abscesses
Septicaemia

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22
Q

Pelvic Inflammatory Disease (PID): allopathic treatment

A

Antibiotics

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23
Q

Endometriosis: definition

A

Endometrial tissue found outside uterine cavity

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24
Q

Endometriosis: pathophysiology

A

Ectopic endometrial tissue follows the menstrual cycle but there’s no exit point for that blood that accumulates during menstruation

This leads to irritation, inflammation and pain

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25
Endometriosis: aetiology
Altered immune surveillance in pelvic cavity affecting the body's ability to recognise ectopic endometrial tissue Oestrogen dominance, causing endometrial tissue (wherever it is) to proliferate Retrograde menstruation - migration of endometrial tissue back through fallopian tubes/transplant of tissue during surgery Primordial cells lining other body cavities or organs differentiate into endometrial cells Transfer of tissue through blood/lymph
26
Endometriosis: signs and symptoms
``` Dysmenorrhoea Menorrhagia Pelvic pain occurring around menstruation and lessening after Dyspareunia Bloating Lower back pain Bowel changes e.g. diarrhoea Infertility ```
27
Endometriosis: diagnostics
Ultrasound | Laparoscopy
28
Endometriosis: complications
Recurrent inflammation = formation of fibrous tissue = adhesions Adhesions = obstruction of uterus/fallopian tubes = infertility Chocolate cysts - sac containing old blood
29
Endometriosis: allopathic treatment
Combined oral contraceptive pill Surgery to remove ectopic tissue (45% grows back within a year)
30
Where does endometriosis commonly affect?
``` Ovaries Fallopian tubes Utero-sacral ligaments Pelvic cavity Intestines ```
31
Which women are at risk of developing endometriosis?
Family history Women who haven't given birth Periods longer than 7 days
32
Fibroids: definition
Benign tumours of the uterus myometrium | Can vary significantly in number and size
33
Fibroids: aetiology
Development is linked to levels of oestrogen and progesterone Increased risk with obesity (excess oestrogen) Earlier menses (more oestrogen) Family history Contraceptive pill (more oestrogen!)
34
Fibroids: signs and symptoms
50-80% are asymptomatic Menstrual changes - menorrhagia, prolonged menses, spotting/mid-cycle bleeding Leading to iron deficient anaemia Urgent/frequent urination, constipation Bloating, heaviness in abdomen Infertility - 2-10% of infertility cases
35
Fibroids: diagnostics
Ultrasound
36
Fibroids: complications
Large fibroids can occlude their blood supply causing necrosis They can calcify which causes pain
37
Fibroids: allopathic treatment
NSAIDs Hormonal therapies (inc oral contraceptive pill) Surgery (myomectomy or hysterectomy)
38
What do fibroids consist of?
Smooth muscle cells | Connective tissue
39
When are women more likely to develop fibroids?
More common in reproductive years, tending to subside post-menopause
40
Ovarian Cysts: definition
Fluid-filled sac within the ovary
41
Ovarian Cysts: signs and symptoms
Often asymptomatic (and often harmless) Dull ache Sudden sharp/severe pain if ruptured (if on rhs could present as appendicitis) Large cysts may affect bladder function
42
Ovarian Cysts: diagnostics
Ultrasound Laparoscopy
43
Ovarian Cysts: allopathic treatment
Surgery (if >5cm)
44
What is the most common type of ovarian cyst?
Follicular cyst - failure to ovulate and instead fills with fluid
45
Polycystic Ovarian Syndrome (PCOS): definition
An endocrine metabolic condition associated with menstrual dysfunction, ovulatory dysfunction, hyperandrogenism and metabolic disturbances e.g. hyperinsulinemia
46
Polycystic Ovarian Syndrome (PCOS): pathophysiology
Dysfunction of the hypothalamic-pituitary (HPA) axis - LH:FSH imbalance High circulating LH promotes increase in ovarian androgen formation
47
Polycystic Ovarian Syndrome (PCOS): aetiology
Genetic links - increased risk with first degree relatives
48
Polycystic Ovarian Syndrome (PCOS): signs and symptoms
Amenorrhoea/oligomenorrhoea, lack of ovulation, infertility, hirsutism, acne/oily skin, weight gain/difficulty losing weight, increased risk of miscarriage (all due to increased testosterone) Acanthosis nigricans - sign of insulin resistance Alopecia/baldness Anxiety/depression
49
Polycystic Ovarian Syndrome (PCOS): diagnostics
Blood tests - increased androgens, low sex hormone binding globulin (SHBG), high LH, low/normal FSH, hyperinsulinemia, elevated blood glucose levels Ultrasound Laparoscopy
50
What criteria must be present for a PCOS diagnosis?
Oligo/anovulation AND/OR polycystic ovaries Clinical or biochemical signs of hyperandrogenism (hirsutism, acne, elevated testosterone) Exclusion of other causes of hormonal and metabolic dysfunction (androgen secreting tumours, Cushing's)
51
Polycystic Ovarian Syndrome (PCOS): complications
Infertility Amenorrhoea (increases risk of endometrial cancer) Increased risk of T2D and cardiovascular disease
52
Polycystic Ovarian Syndrome (PCOS): allopathic treatment
Oral contraceptive pill Metformin (to deal with insulin resistance, but causes nausea and increases levels of an amino acid when in excess (homocysteine: which can lead to atherosclerosis) Anti-androgen topical creams Clomiphene = stimulates ovulation
53
Ectopic Pregnancy: definition
When a fertilised egg implants outside of the uterine cavity
54
Where can an ectopic pregnancy occur?
``` Fallopian tube (97%) Ovary Cervix Abdomen ```
55
Ectopic Pregnancy: aetiology
Increased risk with intra-uterine devices Endometriosis PID
56
Ectopic Pregnancy: signs and symptoms
Initially no symptoms but amenorrhoea Unilateral pelvic pain Vaginal bleeding If ruptures - sudden acute abdominal pain
57
When does an ectopic pregnancy generally occur?
6-8 weeks after ovulation
58
Ectopic Pregnancy: complications
May cause spontaneous abortion, haemorrhage, peritonitis
59
Infertility: definition
Failure to conceive after 1 yr of unprotected intercourse
60
Infertility: aetiology (males)
Low sperm count Poor sperm viability or motility Blocked sperm ducts Undescended testes
61
Infertility: aetiology (females)
``` PCOS Endometriosis (blocked fallopian tubes) Fibroids PID Menopause Hypothyroidism STIs ```
62
Infertility: aetiology (both sexes)
``` Metal toxicity Radiation Malnutrition Body weight Smoking Alcohol Heat Stress ```
63
Infertility: allopathic treatment
Clomiphene (induces ovulation) IVF
64
Balanitis: definition
Inflammation of glans penis
65
Balanitis: aetiology
Infectious - candida albicans, bacterial infection Non-infectious - lichen sclerosus (autoimmune), ezcema, psoriasis, inadequate cleaning under foreskin Phimosis - foreskin narrowing, preventing retraction
66
Balanitis: signs and symptoms
Pain Irritation Dyspareunia
67
Balanitis: complications
Chronic infections can result in foreskin fibrosis
68
Balanitis: allopathic treatment
Antibiotics Surgery Hygiene
69
Undescended Testes: definition
When one testicle fails to descend in late foetal development
70
Undescended Testes: aetiology
Premature birth - affects 30% of premature boys
71
Undescended Testes: complications
Damaged sperm = infertility Testicular cancer
72
Undescended Testes: allopathic treatment
May descend independently a few months after birth hCG injection (acts like LH and increases testosterone) Surgery (6-18 months)
73
Prostatitis: definition
Inflammation of the prostate gland
74
What percentage of men are likely to develop prostatitis?
8%
75
Prostatitis: aetiology
Infectious - bacterial (UTIs or STIs) Non-infectious - trauma, stress
76
Prostatitis: signs and symptoms
Recurrent UTIs - increased urination, urgency, dysuria, nocturia, hesitancy and incomplete voiding Painful ejaculation Fever, malaise
77
Prostatitis: allopathic treatment
Antibiotics | Painkillers
78
Benign Prostatic Hyperplasia (BPH): definition
Enlargement of the prostate tissue leading to compression of the urethra
79
Who is more likely to develop Benign Prostatic Hyperplasia (BPH)?
Men >60 yrs
80
Benign Prostatic Hyperplasia (BPH): aetiology
Risk factors - obesity, genetics, sedentary lifestyle, sympathetic activity, pesticides Increase in 5-alpha-reductase activity
81
Benign Prostatic Hyperplasia (BPH): signs and symptoms
``` Obstructed/poor urinary flow Increased urinary frequency Intermittent urine flow and dribbling of urine Nocturia Cystitis (recurrent) Reduced sexual function ```
82
Benign Prostatic Hyperplasia (BPH): diagnostics
Elevated PSA levels Digital rectal exam (DRE) Ultrasound
83
What is 5-alpha-reductase?
An enzyme that converts testosterone to dihydrotestosterone (DHT) Need this conversion for testosterone to affect the prostate
84
Benign Prostatic Hyperplasia (BPH): allopathic treatment
5-alpha-reductase inhibitors (finasteride) Surgery (when obstruction is severe)
85
What are the success rates of IVF ?
32.3% women under 35 27.7% aged 35–37 20.8% aged 38–39 13.6% aged 40–42

BioMed S2 (34 decks)

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