Reproductive Flashcards
(150 cards)
1
Q
dysmenorrhea occurs due to the release of:
A
prostaglandins
2
Q
abnormal uterine bleeding can be attributed to the lack of corpus luteum that produces:
A
progesterone
3
Q
dermoid cysts contain:
A
all 3 embryo layers
4
Q
simple cysts have ______:
A
clear
5
Q
dermoid cysts are potentially:
A
cancerous
6
Q
vaginal prolapse of posterior bladder due to weakening of vaginal wall
A
cystocele
7
Q
prolapse of the rectum into the posterior vaginal wall
A
rectocele
8
Q
ovarian cancer has often ________ prior to diagnosis
A
metastasized
9
Q
The epithelial, stromal, adipocytes, or vascular parts of the breast may be affected by _______
A
benign breast disease
10
Q
ovarian cancer has often ________ prior to diagnosis
A
metastasized
11
Q
Changes that occur in \_\_\_\_\_\_ breast disease: ● Irregular lumps ● Cysts ● Sensitive nipples ● Itching
A
Benign
12
Q
Common Reported Symptoms of _______:
pain
palpable mass
nipple discharge
A
benign breast disease
13
Q
Examples of ________:
▪ Simple cysts
▪ Fibrocystic changes
▪ Simple fibroadenomas
A
benign breast lesions
14
Q
Most common non-proliferative breast disease that are fluid-filled sacks occuring in women in 30s, 40s, and early 50s
***feel “squishy” when they appear closer to the breast, but feel firm when they are deep in the breast tissue
A
Simple cysts
15
Q
excessive hair growth
A
hirsutism
16
Q
pelvic inflammatory disease is caused by ______
A
multiple different microbes
17
Q
prolonged ROM in mothers with gonorhhea, the babies need to be treated to prevent _______
A
blindness
18
Q
what STD will cause pneumonia in newborns passed through birth?
A
chlamydia
19
Q
o Physiologic nodularity – Terms such as fibrocystic changes (FCCs) (or physiologic nodularity and cysts), fibrocystic disease, chronic cystic mastitis, and mammary dysplasia refer to non-proliferative lesions that are not clinically definitive b/c they encompass a heterogeneous group of diagnoses.
o Incidence probably r/t systemic factors such as hormonal changes, will see in clients right before they are due to get their period – after they begin menstruating, symptoms will dissipate.
o Symptoms influenced by genetic background, age, parity, hx of lactation, caffeine consumption, use of exogenous hormones
A
Fibrocystic Changes in Breast
20
Q
o Benign, solid lumps or masses composed of stromal and glandular tissue
o Well-defined mobile solid mass upon US
o Smooth/hard like a marble on physical exam
o Common, common ages 15-35 years, can occur at any age (older women receiving hormone therapy possibly)
o Etiology is unknown, hormonal role is likely b/c they persist thru reproductive years, increase in size during pregnancy or estrogen therapy and usually regress after menopause
o Increase in size
o No increased risk of breast cancer in majority of women
A
Simple Fibroadenomas
21
Q
cysts that may occur at any time during lifespan – most commonly occur during reproductive years (at the extremes of those years)
o An increase occurs when there are hormonal imbalances
▪ More likely during puberty & menopause
o Can occur during fetal development and throughout childhood
o 4th leading diagnosis for gynecologic hospital admissions
A
Benign Ovarian Cysts
22
Q
The 2 common causes of benign ovarian enlargement in ovulating women:
● These cysts are functional cysts – result of variations of normal physiologic events and are
● Often asymptomatic
● Usually unilateral 5-6cm diameter as large as 8-10 cm
● Produced when a follicle or number of follicles are stimulated but no dominant follicle develops and completes maturity process.
A
Follicular Cysts & Corpus Lutetium Cysts
23
Q
These cysts can be caused by a transient condition in which the dominant follicle fails to rupture or one or more of the nondominant follicles fails to regress.
o A type of functional cyst
o 5-6cm diameter as large as 8-10 cm
o Every month about 120 follicles are stimulated, but in most cycles only 1 follicle results in a mature ovum
o During the early follicular phase of the menstrual cycle, follicles of the ovary respond to hormonal signals from the pituitary gland.
o A small cyst on the ovary during the follicular phase is normal
o After several subsequent cycles when hormone levels follow a regular cycle & progesterone levels are restored, cysts usually are absorbed or regress.
o Follicular cysts can vary in size & symptoms from one episode to the next & can often recur
o Most are fluid-filled
o The more solid, the greater chance of being malignant
A
Follicular Cyst
24
Q
CM of ______:
bloating
swollen/tender breasts
heavy or irregular menses
A
Follicular Cyst
25
Cysts formed by the granulosa cells left behind after ovulation
o Highly vascularized cyst that spontaneously regresses as part of normal menstrual cycle
o An abnormal or hemorrhagic cyst may develop b/c of a hormonal imbalance
o Low luteinizing hormone (LH) and progesterone levels cause an inadequate development of the corpus luteum
o Large cysts can rupture, causing hemorrhage & excruciating pain
o Usually resolve spontaneously in non-pregnant women; a persistent corpus luteum cyst is a normal finding within first trimester of pregnancy since it produces progesterone to support pregnancy until placenta is established
o Less common than follicular cysts, but typically cause more symptoms, esp. if they rupture
Corpus Luteum Cyst
26
CM of _______:
dull, unilateral pelvic pain
amenorrhea or delayed menstruation
followed by irregular or heavier than usual bleeding
Corpus Luteum Cyst
27
```
Ovarian teratomas that
o contain elements of all three germ layers;
o they are common ovarian neoplasms.
o May contain:
▪ Skin
▪ Hair
▪ Sebaceous & sweat glands
▪ Muscle fibers/cartilage
▪ Teeth/bone
o Usually asymptomatic
o Found incidentally on pelvic exam
o Should be carefully evaluated for removal b/c of malignant potential
```
Dermoid Cyst
28
o Benign smooth muscle tumors in the myometrium (the smooth muscle tissue of the uterus)
o Most common benign tumors of uterus and affect as many as 70-80% all women
o Asymptomatic usually & clinically insignificant
o Prevalence increases in women ages 30-50 but decreases w/menopause
o Incidence in black/Asian women is 2-5x higher than in white women & age of onset 10 yrs earlier
o Complications r/t leiomyomas are primary reason for gynecologic hospitalizations & account for 30% of all hysterectomies in women less than 40
o Size appears to be r/t estrogen, progesterone, & growth factors but etiology unknown.
o Possibly genetic component
o Not seen before menarche
o Those that develop during reproductive years decrease in size after menopause
o B/c they occur at times of estrogen exposure, tumors may enlarge rapidly but often decrease in size after the end of pregnancy
Leiomyomas aka Myoma or Uterine Fibroids
29
```
Risk Factors for ______:
nulliparity
obesity
PCOS
African American race
postmenopausal hormone use
HTN
```
Leiomyomas aka Myoma or Uterine Fibroids
30
Patho of _______:
Most occur in multiples in the fundus of the uterus, although may occur singly & throughout uterus
▪ Classified according to their location within layers of uterine wall:
● Subserous
● Submucous
● Intramural
▪ Usually firm & surrounded by connective tissue later
▪ Unlike cancer, unable to cause blood vessel proliferation to promote their growth. When it outgrows its blood supply, it degenerates & the subsequent tissue necrosis does cause severe pain for woman
Leiomyomas aka Myoma or Uterine Fibroids
31
CM of ______:
▪ Abnormal uterine bleeding
▪ Pain (not an early symptom, but if it degenerates, will experience excruciating pain)
▪ Pressure symptoms (on bladder – frequency, urgency, dysuria; constipation)
▪ May distort the uterine cavity and increase the endometrial surface area. This increase may account for the increased menstrual bleeding that is associated with leiomyomas.
▪ Slow-growing, making symptoms slow to develop
▪ May contribute to infertility and subfertility
Leiomyomas aka Myoma or Uterine Fibroids
32
The presence of endometrial tissue within the uterine myometrium
o Endometrial cells migrate into the myometrial layer thru unknown mechanisms
▪ Estrogen and progesterone likely play a role
o Unlike endometriosis, this tissue does not respond to cyclic hormone changes
o Found during late reproductive years
o Usually diagnosed after hysterectomy
o Women diagnosed are usually not of childbearing age
▪ Those with this that become pregnant are at risk for poor outcomes:
● Preterm labor
● Preterm premature rupture of membranes
● Low birth weight
Adenomyosis
33
Risk Factors for ______:
Parit
History of uterine surgery.
Adenomyosis
34
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CM of ______:
***may be asymptomatic
▪ Abnormal menstrual bleeding
▪ Dysmenorrhea (menstrual cramps)
▪ Dyspareunia (painful intercourse)
▪ Uterine enlargement
▪ Uterine tenderness during menstruation
▪ Chronic pelvic pain
▪ Infertility
▪ Secondary dysmenorrhea becomes increasingly severe as disease progresses
o Pelvic exam: uterus is diffusely enlarged (2-3x expected size), globular, & most tender just before or after menstruation.
```
Adenomyosis
35
The presence of functioning endometrial tissue or implants outside the uterus
o Like normal endometrial tissue, the ectopic (out of place) endometrium responds to the hormonal fluctuations of the menstrual cycle
o Incidence: Primary affects younger or premenopausal women peak incidence in 30s. However,
▪ Overall incidence is difficult to determine particularly in asymptomatic adolescent and fertile women
▪ 11% asymptomatic women have it;
▪ 50% of women evaluated for pelvic pain, infertility, or a pelvic mass are diagnosed w/this
o 3rd most common reason for hysterectomy
o Women are at higher risk for cancer, esp. ovarian cancer
o Common sites of implantation include the pelvic peritoneum, ovaries, & uterosacral ligaments
Endometriosis
36
Theories of Etiology of _______:
▪ Impaired cellular and humoral immunity
▪ Endometrial cells may spread outside the uterus during fetal organogenesis
▪ Genetic predisposition
▪ Disruption of gene expression during embryogenesis that is responsible
▪ Transportation
▪ Autoimmune response
Endometriosis
37
Patho of ________:
Endometrial implants can occur throughout the body but generally occur in the pelvic and abdominal cavities
▪ Most common sites of implantation: ovaries, uterine ligaments, rectovaginal septum, pelvic peritoneum
▪ Other sites include: sigmoid colon, small intestine, rectum, appendix, bladder, uterus, vulva, vagina, cervix, lymph nodes, extremities, pleural cavity, lungs, laparotomy scars, hernial sacs.
▪ The growth of endometrial lesions depends on estrogen exposure.
▪ Endometrial lesions are affected by ovarian hormones in the same manner as endometrial tissue within the uterus, w/exception of marked progesterone resistance of the endometriosis cells.
▪ Cyclic changes depend on vascularity/blood supply of the lesion and the presence of glandular and stromal cells.
▪ If blood supply sufficient: ectopic endometrium proliferates, breaks down, and bleeds with the normal menstrual cycle
▪ Bleeding causes inflammation, triggering a cascade of cellular inflammatory mediators including cytokines, chemokines, growth factors, and protective factors such as secretory leukocyte protease inhibitor and superoxide dismutase.
▪ The inflammation may lead to fibrosis, scarring, adhesions, and pain
Endometriosis
38
CM of _________:
can mimic other disease processes (PID, IBS, ovarian cysts)
▪ Symptoms variable in frequency/severity
● Pain
Infertility (25-40% of women)
▪ Dysmenorrhea
▪ Dysuria (painful urination)
▪ Dyschezia (pain on defecation)
▪ Dyspareunia (pain on intercourse)
▪ May also report constipation & abnormal vaginal bleeding
▪ If implants are located within pelvis, may cause asymptomatic pelvic mass & have irregular, movable nodules and a fixed, retroverted uterus
▪ Link w/ infertility is strong, but degree of disease and infertility is not as closely associated
Endometriosis
39
Reasons for Infertility w/ _________:
may result from mechanical interference w/ovulation or ovum transport thru fallopian tube b/c of adhesions & the effects of inflammation & cytokine activity
● Infertility could be result of autoimmune disorder that caused endometriosis
● Conflicting reports re: effect of endometriosis on sperm activity
o Increased phagocytosis of spermatozoa by macrophages has been observed
● Uterine endometrium in women w/endometriosis appears to have an overactive response to estrogen and an underactive response to progesterone, impairing the endometrial receptivity to blastocyst implantation, decreasing the chance of successful pregnancy
● Women w/endometriosis who achieve pregnancy naturally or thru IVF seem to be at higher risk for poor obstetric outcomes: preterm birth, small-for-gestational-age babies, placental complications
Endometriosis
40
the line where squamous epithelium & columnar epithelial cells meet that is very vulnerable to the oncogenic effects of HPV, & where carcinoma in situ is likely to develop
Transformation Zone
41
CM of _______:
***predominantly asymptomatic
▪ Bleeding is variable and may occur after intercourse or between menstrual periods
▪ Vaginal discharge is a less common presenting symptom and may be serosanguinous or yellowish with a foul odor.
▪ Bleeding and discharge are subtle and are likely to be disregarded by premenopausal women (they are more likely to seek tx if these signs appear)
▪ Advanced disease may cause urinary or rectal symptoms & pelvic or back pain along with anemia
Cervical Cancer
42
Carcinomas that arise within the glandular epithelium of the uterine lining
o Occurs mostly in postmenopausal women w/peak incidence in late 50s & 60s
o Women have a 3% lifetime risk of developing uterine cancer
o Mortality rates in black women > white women
Endometrial Cancer
43
Risk Factors for ________:
prolonged exposure to estrogen without the presence of progesterone(unopposed estrogen) – Exposure includes:
▪ Estrogen-only hormone replacement therapy
▪ Tamoxifen use
▪ Early menarche
▪ Late menopause
▪ Never having children
▪ Failure to ovulate
▪ PCOS & anovulatory cycles typical of the late reproductive years
o Obesity is another risk factor (known source of endogenous estrogen)
-couldn’t really find patho or genetics – although women w/family hx of colon, endometrial, or ovarian cancer may wish to explore genetic testing & more aggressive screening
Endometrial Cancer
44
CM of _______:
abnormal vaginal bleeding caused by disruption of the endometrial surface by neoplastic processes
Pain and weight loss are late signs
Endometrial Cancer
45
Screening for ______:
Transvaginal ultrasound (TVUS) may be used (if endometrium is abnormally thick, further testing warranted)
▪ PAP are not effective at detecting
Endometrial Cancer
46
Screening for ______:
Transvaginal ultrasound (TVUS) may be used (if endometrium is abnormally thick, further testing warranted)
▪ PAP are not effective at detecting
Endometrial Cancer
47
Risk Factors for _______:
increased ovulation over the lifetime, such as early menarche, late menopause, & nulliparity
▪ Hx of endometriosis
▪ Genetic component – BRCA1 & BRCA2 mutation have 40-60% lifetime risk. Women with this gene tend to be diagnosed approximately 10 years before women w/out genetic predisposition
▪ Factors that suppress ovulation decrease the risk and include:
● Pregnancies
● Prolonged lactation
● Use of hormonal contraceptives that limit ovulation (including birth control pill)
▪ Tubal ligation and hysterectomy and specifically retrograde menses around the ovary
Ovarian Cancer
48
Patho of _______:
Controversy about pathogenesis
▪ Great majority are sporadic and not associated w/a known pattern of inheritance
▪ Of the 20% of cancers that are familial, the majority are associated w/ the BRCA1 and smaller # w/mutations of BRCA2
Ovarian Cancer
49
CM of _______:
is commonly asymptomatic until the tumors have grown very large
▪ There is no sensitive and specific test and screening for low-risk women & routine screening of women w/out risk factors has not been shown to be beneficial, & may cause harm b/c more women may have unnecessary surgical prodcedures
▪ Common first symptoms are vague &include:
● Persistent abdominal distention
● Loss of appetite due
● Pelvic pain
▪ Symptoms of advanced disease include:
● Pain
● Abdominal swelling from the primary ovarian mass
● Ascites
● Abdominal distention
▪ GI manifestations include:
● Dyspepsia
● Vomiting
● Alterations in bowel habits caused by mechanical obstruction
*** The disease is most commonly diagnosed after metastasis has occurred
Ovarian Cancer
50
● Irritation of the vagina
● Caused by variety of micro-organisms, irritants or pathogens, or disruption of normal flora
● When looking at discharge with normal saline prep, we see an increase in WBC or abnormal foreign cells or both
● Most common are BV (Bacterial vaginosis) and yeast
Vaginitis
51
```
Clinical manifestations of ________:
vaginal irritation
odor
itching
abnormal discharge.
```
Vaginitis
52
Causes of ______:
● The majority of causes are overgrowth of normal flora, STDs, or infection, and vaginal irritation from low estrogen during menopause.
● Changes in vaginal pH may predispose women to infection. Substances and conditions that alter pH include: soaps, spermicide, douches, feminine hygiene sprays, deodarants, semen, menstrual pads and tampons.
Conditions that are associated with increase glycogen content of vaginal secretions such as pregnancy and DM contribute to inflammation.
● Abx can cause disruption with normal flora and allow overgrowth of candida albicans that then causes yeast infection.
Vaginitis
53
common vaginal infection caused by Gardnerella vaginalis, Mobiluncus species, or mycoplasma hominis……
mostly see a thin gray malodorous discharge with a pH of 5 to 5.5 or greater. Some describe as a fishy odor
Bacterial Vaginosis
54
flagellated, anaerobic protozoan that causes vaginitis.
Trichomonas Vaginalis
55
Inflammation of 1 or both of the ducts that lead from the introitus or vaginal opening to the Bartholin or greater vestibular glands.
● The usual cause is microorganisms that affect the lower female reproductive tract such as streptococci, staph and STDs.
● Infection or trauma causes inflammation that causes narrowing of the distal part of duct that leads to stasis and obstruction of glandular secretions.
● The cyst varies from 1-8cm in diameter. Located in posterior-lateral portion of the vulva. Cyst may be reddened and painful and puss may be visible at the duct. Exudate should be tested for Gonorrhea and chlamydia. Women may experience symptoms of the initiating infection such as fever and malaise.
● Diagnosis is based on clinical manifestations and identification of infectious organism. Most are asymptomatic and require no treatment in women <40 years
Bartholinitis aka Bartholin cyst.
56
acute inflammatory process caused by infection and effects approximately 800k-1 million women per year and may involve any or all organs in upper genital tract-uterus, fallopian tubes, and ovaries. In it’s most severe form, the entire peritoneal cavity
Pelvic Inflammatory Disease (PID)
57
Inflammation of the fallopian tubes
salpingitis
58
Inflammation of the ovaries
oophritis
59
Patho of _______:
o Most pathogens migrate from vagina to the uterus to the fallopian tubes to the ovaries
o It has immediate and long term complications for women. Upper reproductive tract infections cause change to the delicate cells of the uterine and fallopian tubes which can effect fertility and increase chance of ectopic pregnancy.
o Caused when defense mechanisms fail. Virulence of organism, size of inoculum, and defense status of woman determine if infection results.
o Anaerobic bacteria have been implicated in increasing risk because they alter the pH of the vaginal environment and may cause decrease in the integrity of the mucous blocking the cervical canal.
o Bacterial vaginosis is present in up to 66% of cases
o E-Coli may contribute for older women.
o Although Chlamydia and Gonorrhea are the main pathogens, the disease is really poly-microbial. Treated with broad spectrum abx.
Pelvic Inflammatory Disease (PID)
60
CM of _______:
vary from sudden to severe abdominal pain with fever to no symptoms.
o Asymptomatic cervicitis with or without discharge may be present before development
o The first sign may be the onset of low bilateral abdominal pain… characterized as dull and achy with gradual onset
Symptoms usually develop during or after menstruation.
o Increased pain with walking, intercourse, or other activities involving movement.
o May have dysuria
dyspareunia (pain with intercourse)
irregular bleeding.
Pelvic Inflammatory Disease (PID)
61
```
Most common causes of _______:
▪ chromosomal abnormalities,
▪ hypothalamic dysfunction,
▪ polycystic ovary syndrome,
▪ hyperprolactinemia,
▪ hypothyroidism,
▪ malnutrition,
▪ ovarian failure
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Amenorrhea
62
_______ Failure of Menarche
o Age 13 with no secondary sex characteristics
o Age 15 regardless of sex characteristics
Primary
63
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Causes of _______ Amenorrhea:
▪ hypothalamic disorders where the hypothalamic-pituitary-ovarian (HPO) access is dysfunctional and the hypothalamus is unable to synthesize gonadotropin releasing hormone....pituitary then fails to secrete gluttonizing hormones and follicle stimulating hormones and the ovary does not receive the hormonal signals needed to stimulate estrogen production and ovulation and menstruation does not occur.
● Hypothalamus dysfunction can include:
Malnutrition from anorexia
stress
meningitis
syphilis
TBI
▪ Disorders of the anterior pituitary gland include tumors that prevent the ovaries from receiving the necessary signals and ovulation and menstruation do not occur ...These can affect pituitary gland also:
-Autoimmune disease
-Hyperprolactinemia
-Meds
▪ Disorders that involve the ovaries and are often linked to chromosome disorders such as
-Turners syndrome
-androgen sensitivity syndrome.
▪ Women who do not have uterus or vagina usually have normal ovarian function so skeletal growth occurs and secondary sex characteristics develop in proper sequence but menstruation does not occur because uterus is too small or not substantial endometrium to have menses
```
Primary
64
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Causes of ______ Amenorrhea:
o Most common causes after pregnancy:
sThyroid dysfunction
Hyperprolactinemia
HPO interruption secondary to excessive exercise
Stress
Weight loss
polycystic ovarian syndrome (PCOS)
o High levels of prolactin are physiologic in lactation because it helps produce milk and suppresses ovulation, thus decreasing closely spaced pregnancies. If high levels of prolactin occur outside of lactation it disrupts menstruation.
```
Secondary
65
Causes of _______ Amenorrhea:
o Birth control methods
o Lactation
Physiologic
66
absence of menses 3 months or irregular menses for 6 months
Secondary Amenorrhea
67
Vaginal bleeding that is abnormal in duration, volume, frequency, or regularity that has been present for the majority of the previous 6 months
Abnormal Uterine Bleeding (AUB)
68
PALM COEIN
```
---PALM-tissues or structures that are causing bleeding
Polyp
Adenomyosis
Leiomyoma
Malignancy
Hyperplasia
---COEIN-non structural causes of AUB
Coagulopathy
Ovulatory Dysfunction
Endometrial
Iatrogenic
Not yet classified
```
69
majority of AUB is due to:
anovulation (lack of )
70
_________ occurs most of the time in adolescents and peri-menopausal women because these women are on the edge of reproductive years and are more likely to ovulate irregularly
Anovulation
71
Patho of _____:
As the follicle forms it produces estrogen which causes the proliferation of the endometrium… following ovulation the remaining portion of the follicle known as the corpus luteum release progesterone. The progesterone limits growth and changes vasculature of endometrium thus limiting the bleeding that occurs in endometrial shedding. If a follicle forms but never releases the ovum the follicle may continue to produce estrogen, encouraging endometrial proliferation beyond the normal 14 day time window. In addition the lack of progesterone causes the thickened endometrium to be able to shed in a predictable fashion without excessive blood loss.
Menses
72
o Painful menstruation associated with the release of prostaglandins in ovulatory cycles
o Not associated with pelvic disease
o Usually begins with the onset of ovulatory cycles with the prevalence highest in adolescent period
Primary Dysmenorrhea
73
o Painful menstruation that results from pelvic disorders such as ovarian cyst, adenomyosis, endometriosis
o Usually manifest in later years but can occur anytime during menstrual cycle
o Endometriosis is most common cause… endometritis (infection in the uterus), endomyosis, Pelvic inflammatory disease, obstructive uterine or vaginal anomalies, uterine fibroids, polyps, pelvic congestion syndrome, tumors, ovarian cysts, non hormonal inter-uterine devices (paraguard IUD)
Secondary Dysmenorrhea
74
Women with painful periods produce 10x more ________ which is potent myometrial stimulant and vasoconstrictor.
prostaglandin F
75
Elevated levels of ________ cause uterine hyper contractility, decreased blood flow to the uterus, and increase nerve hypersensitivity that results in pain.
prostaglandin
76
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CM of _______:
Pelvic pain on onset of menses that may radiate to groin
Backache
vomiting
anorexia
diarrhea
syncope
insomnia
headache
```
Dysmenorrhea
77
Syndrome which anovulation is the most common cause
● 2 of the 3 features:
o Irregular ovulation,
o Elevated levels of androgens
o Appearance of polycystic ovaries on ultrasound
● Associated with metabolic dysfunction and includes dyslipidemia, insulin resistance, and obesity
● Leading cause of infertility
● Genetic component
● Frequency, expression and timing of symptoms makes it very confusing…. s/s may change over time.
● May be associated with Cushing’s syndrome, premature ovarian failure, obesity, congenital adrenal hyperplasia, thyroid disease, androgen producing adrenal tumors or ovarian tumors and syndromes with hyperprolactinemia
PCOS
78
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CM of ______:
(usually present within 2 years of puberty but may present after a variable time of regular menstrual function)
o Presenting Signs and symptoms
▪ Obesity
▪ Menstrual disturbance
▪ Oligomenorrhea
▪ Amenorrhea
▪ Hyperandrogenism
▪ Infertility
o Hormonal disturbances
▪ Increase insulin
▪ Decreased SHBG
▪ Increased androgens
▪ Increased DHEA
▪ Dyslipidemia
▪ Diabetes Mellitus
▪ Cardiovascular disease
```
PCOS
79
The descent of one of more of the following into the vaginal space:
o Vaginal wall
o Uterus
o Apex of the vagina (after a hysterectomy)
● Up to 50% of women have some version on physical examination
● Common clinical indicator for significant = Bulging of the organs beyond the hymenal ring or vaginal entrance
Pelvic Organ Prolapse
80
Risk Factors for ______:
o Menopause (aging & hypoestrogenism)
o Chronically increased intraabdominal pressure (pregnancy, coughing/lung disease, constipation, obesity, prolonged lifting or standing)
o Pelvic floor trauma (vaginal childbirth, hysterectomy)
o Genetic factors (connective tissue disorders, spina bifida)
Pelvic Organ Prolapse
81
Prolapse description is based on physical examination findings (anterior vaginal wall, apical vaginal wall, posterior vaginal wall, cervical, perineal, and/or rectal) and uses a grading system to describe the extent of the prolapse
o Grade 0: normal, no prolapse
o Grade 1: is minimal and rarely requires correction
o Grade 2: moderate symptoms
o Grade 3: severe; the uterus is so low that the cervix protrudes from the vagina
o Grade 4: maximum possible descent for each site
Pelvic Organ Prolapse
82
CM of _______:
o Urinary: sensation of incomplete emptying of bladder, urinary incontinence, urinary frequency/urgency, bladder “splinting” to accomplish voiding
o Bowel: constipation or feeling of rectal fullness or blockage, difficult defecation, stool or flatus incontinence
o Urgency: manual “splinting” of posterior vaginal wall to accomplish defecation
o Pain & Bulging: vaginal, bladder, rectum, pelvic pressure/bulging/pain, lower back pain
o Sexual: dyspareunia, decreased sensation/lubrication/arousal
Pelvic Organ Prolapse
83
▪ Rates of gonorrhea, chlamydia, vaginitis, cervical condyloma, genital warts, and PID are highest in ________
aldolescence
84
________ women are at greater risk of STI d/t the position of susceptible cells on the surface of their cervix
Young
85
STI caused by gonococci which are microorganisms of the species Neisseria gonorrheoeae
● Risk of developing from intercourse with an infected male partner is 50-80% for women and with an infected female partner is 20-30% for men.
● Men who have sex with infected men have a greater risk of contracting if they are the receptive partner
● Transmission of gonococcal infection generally requires contact of epithelial (mucosal) surfaces (vaginal, oral, or anal intercourse) and infection in adults can be maintained in the vagina, rectum, oropharynx, or urethra
● A pregnant woman also can transmit to her fetus through infected cervical and vaginal secretions contacting the babies mucosal surfaces during birth
Gonorrhea
86
Patho of ________:
o Humans are the only natural hosts for this infection, an aerobic non-spore forming, oxidase positive, Gram negative coccal (round) Micro organism that usually appears in pairs (diplococci), with adjacent slightly flattened sides.
o Hair-like filaments, called pili, appear to help the microorganisms attach themselves to host cells: the epithelial cells of mucous membranes
o In women, the endocervical canal (inner portion of the cervix) is a common site of initial infection, although urethral colonization and infection of glands (paraurethral [Skene] glands and greater vestibular [Bartholin] glands) near the urethra and vagina also are common.
o Several factors facilitate ascent into the uterus and the Fallopian tubes, where they can cause PID.
o In men, the it typically infects the urethra or rectum
Gonorrhea
87
CM of _______:
o Can be categorized as local or systemic and uncomplicated or complicated
o Uncomplicated local infections include urethral infections in men and urogenital infections in women
o The majority of infected men will develop painful urination or purulent penile discharge, or both, within a week of infection
o Some men only have a little discharge or urethral itching (pruritis) but If left untreated, can cause penile abscesses fistula and structures
o In women, the incubation period varies that those who develop symptoms usually manifest within 10 days of exposure or 1 to 2 days after the next menstrual period.
o More than half of Gonorrhea infections in women are initially asymptomatic
o Symptoms often do not appear until the infection has spread to the upper reproductive tract (uterus, fallopian/ uterine tubes, and ovaries).
o Symptoms can include dysuria, increased vaginal discharge, abnormal menses (increased flow or dysmenorrhea), dyspareunia, lower abdominal/ pelvic pain, and fever.
o Physical examination may disclose cervical friability & erythema (redness) and mucopurulent discharge from the cervical os
Gonorrhea
88
A disease with local and systemic manifestations that stretch over years
● Causative organism: Treponema pallidum
● Incidence:
o With the advent of antibiotics and intensive public health efforts during and after World War II, the prevalence has declined sharply
o Rates reached a record low in 2000 however the rate in the United States has since doubled to 5.3 cases per 100,000
o Men account for nearly 91% of all new cases, where as rates between sexes were equivalent two decades ago
o Data suggests this increases driven by transmission among MSM accounts for over 89% of new cases
● Congenital cases, caused by vertical transmission of the spirochete, also has experience resurgence in the US
o The rate of congenital cases increased by 38% between 2012 and 2014 11.6 per 100,000 births
o During pregnancy, untreated cases result in perinatal death in as many as 40% of cases and may lead to perinatal complications in more than 70% of cases because the spirochete can cross the placental membrane to infect the fetus
o All pregnant woman should be screened at their first prenatal visit, and women at risk should be screened again in the third trimester and at the time of delivery bc treatment with penicillin is 98% effective at preventing vertical transmission
Syphillis
89
Patho of _______:
o Treponema pallidum, the cause, is an anaerobic spirochete bacterium that can grow in any human organ or tissue but cannot be cultured in vitro
o Treponema resembles a corkscrew, with regular, tight spirals and a rotary motion
o Because the bacterium is present in exudate from moist mucosal or cutaneous lesions, the spirochete is usually transmitted to others during the first few years of infection
o Transmission generally occurs through minor abrasions during sexual intercourse and become systemic shortly after infection and can be transmitted from pregnant women to fetus as early as the ninth week of gestation
Syphillis
90
Stage ___ of Syphillis:
● Local infection
● Begins at the sight of bacterial invasion where T. pallidum multiplies and epithelial produces a granulomatous tissue reaction called a chancre
● Lymph-containing microorganisms drain into adjacent lymph nodes and stimulate immune responses
1
91
Stage ___ of Syphillis:
● Is systemic.
● Blood borne bacteria spreads all major organ systems
● Immune system suppresses infection and symptoms regress spontaneously
2
92
Stage ___ of Syphillis:
● Silent infection
● Transmission of infection possible even though there are no clinical signs infection
3 (Latent)
93
Stage ___ of Syphillis:
● Noninfectious disease
● Significant morbidity and mortality occur
● Destructive skin, bone, and soft tissue lesions, or gummas, results from severe hypersensitivity
● Cardiovascular complications (aneurysms, heart valve insufficiency, heart failure) and neurosyphilis develop
4 (Tertiary)
94
CM of Stage ____ Syphillis:
▪ A sore, or hard chancre, develops at the site of treponemal entry
● Typically the chancre is an eroded, painless, firm, & indurated (hard) ulcer up to 2 cm in diameter
● Firm, enlarged, and nontender regional lymph nodes accompany chancres
● Chancres are not always typical and disease should be considered in the presence of any open lesion
● The chancre heals in 2-8 weeks and it spontaneously disappears, usually without leaving a scar
1
95
CM of Stage ___ Syphillis:
▪ Usually developed six weeks after the first appearance of the chancre but may overlap stages
▪ Systemic symptoms are variable and can include low-grade fever, malaise, sore throat, hoarseness, anorexia, generalized adenopathy, headache, joint pain, and skin mucous membrane lesions or rashes
▪ Cutaneous rashes are generally papulosquamous (raised and scaly), but any variation or combination of macular (flat), papular (raised), and pustular (pus-filled) lesions maybe seen
▪ Lesions are often widespread and bilateral, appearing on the palms and soles
▪ Condylomata lata- lesions that become hypertrophied, flat, moist, and wartlike or vegetative (ex. cauliflower-like)
● Are highly contagious and developed on the perineum, vulva, and groin of women
● Also around the inner thigh and anal area in men and women
▪ Besides skin sores, oral mucous membrane lesions (known as mucus patches), lymphadenopathy, pruritis, and alopecia are common
▪ Regardless of treatment, cutaneous lesions generally heal in 2 to 10 weeks
▪ Within the CNS, the presence of T. pallidum in cerebrospinal fluid may cause the manifestations of neurosyphilis, including altered mental status and meningitis, which can occur within any stage of infection but are more common in early stages
2
96
CM of ____ Stages of Syphillis:
▪ Maybe as short as one-year or as long as a lifetime
▪ May present with gummas, cardiovascular lesions, and neurosyphilis manifestations, including tabes dorsalis & general paresis
▪ Rare because of the widespread availability of antibiotics
3 and 4 (Latent and Tertiary)
97
Syphillis caused by the passage of the spirochete across the placental membrane to affect any or all fetal tissues
▪ Can cause fetal death or growth abnormalities, including changes in the fetal bones, teeth, and neurologic system
▪ Variety of manifestations of the disease, including growth abnormalities, rashes, hepatic splenomegaly, jaundice, and CNS involvement, including blindness and deafness
▪ A classically reported late manifestation of notched incisors
Congenital Syphillis
98
● Common name for infections caused by chlamydia trachomatis (CT) IT is responsible for variety of syndromes, including acute urethral syndrome, non-gonococcal urethritis (NGU), mucopurulent cervicitis, & PID
● Most common reportable STI in the US & it is a leading cause of preventable infertility and ectopic pregnancy
● The majority of reported cases are in people younger than 26 years old, but the incidents in older adults is increasing
o Up to 90% of women with infection are asymptomatic, which can delay diagnosis and increase the risk of long-term health sequelae
● Without timely treatment, 10-20% of women will have the infection spread to the uterus and uterine tubes
Chlamydia
99
```
Ris Factors for ______:
Age < 26
Recent new sexual partner
Drug use or other risky behaviors
Infection can be transmitted from mother to infants during birth and can cause eye infections and pneumonia in affected newborns
```
Chlamydia
100
Patho of ______:
o C. trachomatis is an obligate, gram-negative intracellular bacteria that lacks the ability to reproduce without a host cell
o It is differentiated from other bacteria both unique two-part growth cycle
▪ The first part consists of an elementary body that is small and resilient and is able to survive extracellularly. Once this elementary body attaches itself to a receptor host cell, it is able to enter by endocytosis
▪ Once inside the cell, the second part of the cycle begins and the microorganism becomes a metabolically active parasite, reproducing within the cell until the cell is destroyed and ruptures, disseminating up to 1000 new elementary bodies
o C. trachomatis produces an inflammatory reaction that results in permanent scarring of tissues
o Microorganisms are always pathogens; they’re not part of the normal flora of the urogenital tract, despite the fact that infection is often asymptomatic
Chlamydia
101
CM of ______:
o Urogenital infections closely parallel sgonorrhea
o Both microorganisms infect superficial genital tract tissues, such as mucosa of the urethra and cervix, and both can invade the epididymis, the Fallopian/uterine tubes, and rarely the hepatic capsule
o Men and women have different responses to the infection
o Although most men do not have symptoms even while contagious, infection can cause non-gonococcal urethritis
o Clinically, urethritis cannot be differentiated: both have a 7 to 21 day incubation period and cause dysuria
o Although urethral discharge in men maybe similar in the two infections, this discharge tends to be more clear and gonococcal discharge more purulent
o Men might note a clear, mucus discharge or mild burning with urination
o epididymitis can accompany urethritis in men and is characterized by fever and a unilaterally painful, swollen scrotum
o Women with chlamydial cervicitis maybe asymptomatic or may have a yellow mucopurulent discharge from the cervical os and a hypertrophic, edematous, friable, of cervical ectopy
o The woman may also report intermenstrual or postcoital spotting
o Although ectopy alone does not indicate a pathologic condition, an erythematous, raw, friable cervix is suggestive of chlamydial cervicitis
Chlamydia
102
HSV Type ___ outbreaks are more frequent and more severe
2
103
_____ may have a role in development of HSV— longer than >4 hours increase risk of transmission
ROM
104
______ Episode of ______ HSV Genital Infection
a. Occurs when the individual has no antibodies to HSV 1 and HSV 2
b. Many primary infections with HSV infection are asymptomatic or the symptoms are not severe enough to warrant medical attention
c. If symptoms do occur, the person may have small, there are 1-2 mm multiple vesicular lesions at the site of the infection
i. These appear on the labia minora, fourchette, penis or mouth OR cervix, buttocks, thighs--Often painful and pruritic
ii. Lesions usually last 10-20 days
iii. Lesions of HSV 1 and 2 can be very small and almost indistinguishable to the naked eye or fairly large and clustered into raw areas
1. These wet lesions actively shed virus for 10-14 days
2. After they heal by re-epithelization
3. Small lesions may coalesce into larger ulcers and become secondarily infected
First/ Primary
105
```
CM of _____ Primary HSV Genital Infection:
systemic typically
fever
malaise
myalgia
lymphadenopathy
urinary retention
pharyngitis
aseptic meningitis
hepatitis
```
First
106
_______ Episode of _______ HSV Genital Infection:
a. Occurs in individuals who have preexisting antibodies
b. For some, primary infection may not have any clinical manifestations, but HSV has become latent in the nerve root and can reactivate later in life
c. Often milder with fewer lesions that are less painful & heal faster
First/ Non-Primary
107
CM of Episode of _______ HSV Genital Infection:
fewer systematic manifestations occur
viral shedding shorter duration
HOWEVER symptoms may be severe if the second infection occurs during a period of immunocompromised health status
First/ Non-Primary
108
_______ HSV Infection:
a. Usually produce mild local symptoms
b. Number of lesions is greatly reduced and the lesions are less painful
c. Lesions are often unilateral with crusting within 4 to 5 days
d. Recovery and healing are usually complete within 10 days
e. Asymptomatic viral shedding can occur with both HSV 1 or 2, but more common with HSV 2
● ***Individuals affected with HSV 2 are more likely to experience this!!
● occur on average of 5 to 8 times per year but may be more frequent in the first few years of infection
Recurrent
109
CM of _______ HSV Infection:
● may experience prodromal symptoms (pruritis, tingling, dysesthesias) a few hours to 2 days before the eruption of lesions
● women may experience a vaginal discharge and dysuria
44% of men have dysuria
● range from a local infection of the eyes, skin, or mucous membranes to a severe disseminated infection with CNS involvement—including seizures and its associated with mortality of more than 50% and extensive neurologic sequelae in survivor
Recurrent
110
HSV Infection of _______:
○ may occur any time in the 1st month of life
● 70% present with skin lesions
Newborns
111
______ transmission in utero and during _____ birth is possible with HPV
vertical/ vaginal
112
HPV associated with benign genital lesions or warts: condylomata acuminata of the vulva, vagina, penis, and perianal area
low risk serotypes of HPV
113
HPV serotype ___ and ___ are associated with 90% of genital warts
6 and 11
114
```
influencing factors for ____ transmission:
number of exposures
type
location of lesions
cellular immunity response
```
HPV
115
HPV serotype ____ and ____ are the most common oncogenic / high risk types
16 and 18
116
_____ causes 70% of anogenital cancers and highly associated with oropharyngeal cancers
HPV
117
STRONGLY correlated with persistent ______:
ETOH
smoking
HIV
HPV infection
118
Patho of _____:
non-enveloped circular double stranded DNA virus, one of the papovaviruses
○ transmission through close physical contact with infected skin, mucosa, or fluids
○ HOWEVER; the exact transmissibility of the virus into the cell is unknown
● initial infection follows trauma to the epithelium that allows the virus to reach and infect the basal cells of the epithelium, which appear to be supportive of the viral propagation
○ the minor trauma may occur after sexual intercourse
● ***may enter the nuclear DNA and change the expression of cell proteins, leading either to increased but noncancerous cell growth (warts) OR to unchecked cell growth (cancer)
HPV
119
CM of _____:
● genital warts OR condylomata acuminate are soft, skin-colored, whitish pink to reddish brown discrete growths
○ *may occur singular or in clusters
○ *may be broad at base or pedunculated
○ *may be feathery or smooth
● sometimes enlarge to form cauliflower like masses on the male frenulum, glans, foreskin, urinary meatus, shaft, scrotum, or anus OR female labia, clitoris, perineum, vagina or anus
● not usually painful, but can cause dyspareunia (painful intercourse) and may be friable and bleed easily
● some individuals complain of pruritis
● Common locations: vaginal introitus, shaft of penis, and under foreskin
● they can be found in any location infected along the reproductive tract, anus, and oropharynx
● laryngeal papillomas can occur in infants and children whose mothers had it at the time of delivery
HPV
120
parasitic STI that is anaerobic, unicellular, flagellated parasitic protozoan adhering to & damaging squamous epithelial cells
○ affects more than 3.5 million people in US
○ 11% of women older than 40
○ most common NON-VIRAL STI in US
○ high rate of asymptomatic infection aids the spread
○ male-female vaginal intercourse is the most common route of transmission
○ sexual is the most common form of spread—fomites is theoretically possible
Trichomoniasis
121
CM of _____:
○ range from none to severe
○ up to 85% infected have minimal or no symptoms
○ vaginal discharge and internal pruritis is most common
○ dyspareunia and dysuria is also fairly common
○ Women report an increase in symptoms immediately after menses
○ vaginal secretion can be copious, frothy, malodorous, & yellow-green to gray-green
○ on exam—vaginal walls may appear erythematous and sore
● small, punctae red marks sometimes called STRAWBERRY SPOTS can be visible on the vaginal walls & cervix
● most men are asymptomatic but can have scant intermittent discharge, slight pruritis, and mild dysuria
Trichomoniasis
122
sexually associated condition, but not necessarily a STI
● associated with sexual contact, including genital touching and digital penetration, oral sex, and penile penetration
● etiology is unknown, but thought to be dysbiosis of normal vaginal flora that is associated with sexual contact
● mostly effects sexually active women of reproductive age, it can effect women that are menopausal and aren’t sexually active
Bacterial Vaginosis aka
| Haemophilus, Corynebacterium, Gardnerella
123
Patho of _______:
● GARDNERELLA vaginalis and various anaerobes, including MYCOPLAMA HOMINIS, BACTEROIDES and MOBILUNCUS—interact and proliferate when lactobacilli (normal predominal vaginal flora) are decreased or absent
● bacteria adhere to vaginal epithelium and form a scaffolding-like biofilm to which other bacteria can adhere, facilitating their proliferation and causing a noninflammatory response in the surrounding tissues
○ as vaginal microbiome changes—catabolic enzymes degrade proteins into amines
○ amines elevate the vaginal pH and produce the fishy smell
● ***implicated in PID, chorioamnionitis, preterm labor, and postpartum endometriosis
● ***can increase risk for other STIs like HIV
Bacterial Vaginosis aka
| Haemophilus, Corynebacterium, Gardnerella
124
CM of _______:
● thin, gray, homogeneous, and malodorous discharge that adheres to vaginal walls, but often copious enough to drain from the vagina
● strong fishy odor—strong, foul, fishy vaginal odor especially after intercourse and during menses
○ odor is intensified by contact with alkaline secretions (semen and menstrual discharge)
● occasionally discharge is bubbly or frothy
● vaginal pH is usually 5-5.5
● male and female partners of infected women may harbor the microorganisms but have no signs or symptoms
Bacterial Vaginosis aka
| Haemophilus, Corynebacterium, Gardnerella
125
can generally diagnose this during speculum exam and odor—do a wet mount!!
Bacterial Vaginosis
126
uncommon condition of prolonged penile erection
● persistent and painful erection lasting longer than 4 hours without sexual stimulation
● Etiology: idiopathic in 60% of cases, and the remaining 40% of cases are associated with spinal cord trauma, sickle cell disease, leukemia, pelvic tumors or infections, or penile trauma
● also use of erection enhancing drugs (Viagra) or secondarily co-morbidities
● has been associated with cocaine use
● prolonged sexual stimulation often associated with initial development of the idiopathic type
● a urologic emergency, and generally requires an ER visit and treatment
Priapism
127
condition which the foreskin cannot be retracted back over the glans that can occur at any age and is caused most commonly by poor hygiene and chronic infection
phimosis
128
inflammation of the glans and prepuce that predisposes older diabetic men to phimosis (rare with normal foreskin)
chronic balanoposthitis
129
```
CM of _____:
edema
erythema
tenderness of the prepuce
purulent discharge
inability to retract the foreskin is a less common complaint
```
phimosis
130
the foreskin is retracted and cannot be moved forward (reduced) to cover the glans
● the inability to retract the foreskin is normal in infancy and is caused by congenital adhesions
● although most cases occur in uncircumcised males, stenosis and resultant phimosis can occur in males with excessive skin remaining after circumcision
- can restrict the penis—causing edema of the glans
● if edema if such that the foreskin cannot be reduced manually, surgery MUST be performed in order to prevent necrosis of the glans caused by constricted blood vessels
Paraphimosis
131
fibrotic condition of the tunica albuginea of the penis resulting in varying degrees of curvature and sexual dysfunction
● underdiagnosed condition with prevalence in the male population as high as 9%
● develops slowly and is characterized by tough, fibrous thickening of the fascia in the erectile tissue of the corpora cavernosa
● dense fibrous plaque is usually palpable on the dorsum of the penile shaft
● problem usually affects middle-age men and is associated with painful erection, painful intercourse (for both partners), and poor erection distal to the involved area
● Etiology: exact cause is unknown, local vasculitis-like inflammatory reaction occurs and decreased tissue oxygenation results in fibrosis and calcification
Peyronie disease
132
collection of fluid within the tunica vaginalis
● most common cause of scrotal swelling
● occur in 6% of male newborns and are CONGENTIAL malformations (patent processus vaginalis)-that often resolve spontaneously within 1st year of life
○ ***surgical ligation recommended if not resolved in 1st year
● may be caused by an imbalance between the secreting and absorptive capacities of scrotal tissues
○ range in size from slightly larger than the testes to the size of grapefruit or larger
○ can be flaccid or tense
● compression of testicular blood flow may lead to atrophy
● Etiology: unknown for idiopathic development
Hydrocele
133
results from trauma or infection of the testis or epididymis or from a testicular tumor
Secondary Hydrocele
134
testicular maldescent—testicles do not descent USUALLY unilaterally, but occasionally both testicles may remain in the abdomen
● common pathological condition that occurs in about 3% of full term newborns, and it decreases to 0.8-1.2% at 1 year old
● Etiology: multifactorial (genetic, maternal and environmental), most often as an isolated disorder with no obvious cause
● risk of testicular cancer is 35-50 times greater for men with this or a history of it than the general male population
● in men with a history of UNILATERAL, neoplasms develop more commonly in the contralateral (opposite) testis---this suggests it affects the testes and is a process more significant than simply the position of the testes in childhood
Cryptorchidism
135
rotation of the tests, which twists the blood vessels in the spermatic cord
● twists the arteries and veins in the spermatic cord, reducing or stopping circulation to the testis
○ vascular engorgement and ischemia develop, causing scrotal swelling and pain
● causes an acute scrotum—testicular pain and swelling
○ dx by physical exam and history
● ***most common among neonates and pubertal adolescents, but can happen in any age
● onset can be spontaneous or follow physical exertion or trauma
● ***symptoms are NOT relieved by scrotal elevation (PREHN sign), rest or scrotal support
Testicular Torsion
136
```
CM of _____:
tender high-riding testis
thickened spermatic cord
absent cremasteric reflex
epididymis cannot be differentiated from the testis
```
Testicular Torsion
137
_____ is surgical emergency
Testicular Torsion
138
inflammation of the epididymis, generally occurs in sexually active young males (younger than 35)
● rare before puberty
● young men-usual cause-STI such as gonorrhoeae or trachomatis
● ***men who practice unprotected anal intercourse—may acquire via e.coli, Hemophilus influenzae, tuberculosis, cryptococcus, or brucella
● ***in men GREATER than 35—Enterobacteriaceae (intestinal bacteria) and pseudomonas associated with UTI and prostatitis may be the cause
● Etiology: besides infectious, may result from a chemical inflammation caused by the reflux of sterile urine into the ejaculatory ducts
● associated with urethral structures, congenital posterior valves, and excessive straining in which the increased abdominal pressure is transmitted to the bladder
Epididymitis
139
CM of ______:
pain is main symptom
○ scrotal or inguinal pain is caused by inflammation
○ pain is usually acute and severe
○ ***flank pain may occur if, as the urethra passes of the spermatic cord, edematous swelling of the cord obstructs the urethra
○ can have pyuria and bacteriuria and history of urinary symptoms including urethral discharge
○ scrotum on involved side is red and edematous as a result of inflammatory changes
● tail near the lower pole of the testes usually swells first—then swelling ascends to the head
○ spermatic cord may be swollen and tender
Epididymitis
140
enlargement of the prostate gland
● major prostatic changes are due to hyperplasia NOT hypertrophy
● prostatic tissue compresses the urethra, where it passes through the prostate, resulting in frequent lower urinary tract symptoms
● US men >60=50% and men >70=90%
***AGING BIGGEST RISK FACTOR
● aging and circulating androgens are associated
Benign Prostatic Hyperplasia (BPH)
141
CM of ______:
urge to urinate often
delay in starting urination
decreased force of urinary stream
● as obstruction progresses—the bladder cannot empty all the urine and the increasing volume can then lead to long term urine retention
● volume of urine contained may be great enough to produce an uncontrolled “overflow incontinence” with any increase in abdominal pressure
BPH
142
an ascending infection of the urinary tract that tends to occur in men b/w the ages of 30-50, but also associated with BPH in older men
● infection stimulates an inflammatory response to which the prostate becomes enlarged, tender, firm, or boggy
● onset may be acute and unrelated to previous illnesses or it can follow a catheterization or cystoscopy
● usually associated with bladder infection caused by the same microorganism—Do urine cultures!!!
Acute Bacterial Prostatitis
143
```
same as UTI or pyelonephritis
● sudden onset of
malaise
low back
perineal pain
high fever (up to 104)
chills
dysuria
inability to empty bladder
nocturia
urinary retention
● symptoms of lower urinary tract obstruction—slow, small, narrowed urinary stream—MEDICAL EMERGENCY
● can compress urethra causing urinary obstruction
● SYSTEMIC s/s of infection—sudden onset of high fever, fatigue, arthralgia, myalgia
● prostatic pain may occur when upright because pelvic floor muscles tighten with standing and prostate gland is compressed
● some have
low back pain
painful ejaculation
rectal pain
● palpation—enlarged, extremely tender and swollen prostate that is firm, indurated, warm to touch
```
Acute Bacterial Prostatitis
144
● highly treatable, usually curable cancer
● most often in young and middle-aged men
● most common form of cancer in men 15 to 35, but still rare
● tumors are slightly more common the right side than the left—a pattern that parallels cryptorchidism
Testicular Cancer
145
Patho of ____:
| 90% are germ cell tumors that arise from the male gametes
Testicular Cancer
146
CM of _______:
painless testicular enlargement is USUALLY the first sign
usually gradual, and may be accompanied by a heaviness or dull ache in the lower abdomen
Testicular Cancer
147
most commonly diagnosed non-skin cancer in men with a current lifetime risk of 15.9%
● more than 95% are histologically similar to adenocarcinomas and relay on androgen signaling for their development and progression
Prostate Cancer
148
```
CM of ________:
○ causes no symptoms until it is far advanced
● first symptoms:
bladder outlet obstruction
slow urinary stream
hesitancy
incomplete emptying
frequency
nocturia
dysuria
○ symptoms progressive and do not remit like BPH
```
Prostate Cancer
149
● 1% of all male cancers
○ mean diagnosis between 60-70 years
○ men of all ages can be affected
● DUCTAL CARCINOMA most common type
Male Breast Cancer
150
```
Risk Factors for ________:
radiation
estrogen administration
diseases associated with hyperestrogenism (cirrhosis)
Klinefelter Syndrome
female relatives with breast cancer
BRCA2 mutations
```
Male Breast Cancer
