Reproductive pathologies Flashcards
(87 cards)
1
Q
What is menopause?
A
cessation of menses for 12 consecutive months
2
Q
What is the physiology of menopause?
A
- •As ovarian follicles diminish with age, so too does the amount of oestrogen produced by granulosa cells
- •BecauseLH secretion isdependent on oestrogen levels, menopause is preceded by ~5 years of increasingly anovulatory cycles (referred to as the climacteric)
- •Eventually, menstruation ceases due to reduced number of follicles & reduced responsiveness to FSH
- •Average age for cessation of menses: 51 years
3
Q
What are the clinical features of menopause?
A
Non-specific - hot flushes, hight sweat, fatigue, lethargy
reproductive: reduction fo breast size, vaginal dyspareunia, UTI
Neurological: changes mood and memory, headache, dizziness
Musculoskeletal: osteoporosis, arthralgia, myalgia
cardiovascular: HBP, AMI
4
Q
what is the climacteric period?
A
period with irregular menses before complete cessation of menstruation
5
Q
What are the advantages and disadvantages of hormone therapy?
A
ADVANTAGES
- •Relieves symptoms of menopause
- •Prevents early menopausal bone loss – reductionin #risk
DISADVANTAGES
- •‘Premenstrual-like’ symptoms e.g. bloating & fluid retention, breast tenderness, irritability
- •Increased risk for:
- •Thromboembolic disease
- •Cardiovascular disease: stroke
- •Cancer: breast, endometrial (oestrogen-only HT)
- •Gall bladder disease
6
Q
What is Polycystic ovarian syndrome?
A
Inappropriate secretion of gonadotrophins
Diagnostic criteria
- menstrual irregularity
- clinical hyperandrogenism
- polycystic ovaries
7
Q
What is the correlation between PCOS and Chronic disease?
A
Hyperinsulanemia
8
Q
What is the pathophys behind PCOS?
A
- •Follicular growth is continuously stimulated, but not to full maturation
- •Hyperinsulinaemia suppresses normal follicular apoptosis – this permits the survival of follicles that would normally disintegrate
- •The net result is anovulation and enlargement of the ovaries with cyst formation
9
Q
What are the clinical features of PCOS?
A
- •Menstrual disturbance: oligomenorrhoea, amenorrhoea
- •Infertility
- •Hyperandrogenism: acne, hirsutism, male pattern baldness
- •Obesity (38% of cases)
- •Asymptomatic (20% of cases)
- •Increased risk for: Type 2 diabetes, cardiovascular disease, endometrial cancer
10
Q
Management of PCOS?
A
combined oral contraceptive
anti-androgen agents
Insulin sensitisers
11
Q
What is Pelvic inflammatory disease (PID)?
A
ANy infection in the genitourinary tract which was not treated.
12
Q
WHat are the risk factors for PID?
A
Sexually active women
Inadequately treated chlamydia or gonorrhea
surgical procedure: IUD, Abortion, C-section
13
Q
What are the clinical features for PID?
A
Low abdominal pain
irregular bleeding
mucopurulent discharge
14
Q
What are the complications fro PID?
A
- infertility
- •Pelvic adhesions
- •Abscess formation
- •Ectopic pregnancy
- •Chronic pain
15
Q
What is the management for PID?
A
antibiotics
Surgery
16
Q
what is endometriosis?
A
deposits of endometrial tissue found anywhere except the uterine mucosa.
related to vicarious bleeding
17
Q
Where are the posible sites for vicarious bleeding related to endometriosis?
A
Common:
- uterine tube
- uterus
- bowel
- bladder
- ureters
Post surgery: vagina, perineum
Rare: umbilicus, inguinal canal
very rare; pleura, diaphragm, nose
18
Q
What are the 3 possible pathophys mechanisms for endometriosis?
A
Retrograde menstruation
embryonic cells
endometrial emboli
19
Q
Clinical features related to endometriosis
A
•Pain: pelvic pain, dysmenorrhea, dyspareunia
•Bleeding: menorrhagia, irregular periods, spotting
•Bowel or bladder symptoms: dysuria, dyschezia, ‘cyclical’ IBS symptoms
•Reduced fertility
•Systemic: fatigue, lethargy, depression
20
Q
what is the management of endometriosis?
A
- Analgesia
- Suppression of ovulation e.g. COCP
- Laparoscopic ablation of ectopic tissue, adhesions
looks to restore fertility and reduce spread of tissue
21
Q
What is a uterine fibroid (leiomyoma)?
A
A common, benign tumour arising from the smooth muscle cells of myometrium
22
Q
What is the pathophys behind uterine fibroids?
A
- Myomas are usually spherical
- Some extend out on stalks (pedunculated)
- There may be multiple (in some cases up to 200!)
- The fibroid develops in the myometrium and can remain there
- Alternatively, it can protrude into the uterine cavity (submucosal fibroid) or out of the perimetrium (subserosal fibroid)
23
Q
What are the clinical features of fibroids?
A
- •Bloating,
- palpable mass,
- protruding belly,
- sensation of abdominal heaviness
- •Dysmenorrhea or menorrhagia (can lead to iron deficiency anaemia)
- Pressure on surrounding organs
24
Q
What are the complications of fibroids?
A
- Torsion: twisting on their stalks (pedicles)
- Ulceration & bleeding
- Small risk of malignant change (to uterine sarcoma)
25
What is the most common type of uterine cancer?
adenocarcinoma: •Develops from the secretory epithelium of the endometrium
26
What are the risk factors for uterine cancer?
Exposure to oestrogen
Obesity
family Hx
previous pelvic radiation for cancer
27
What are the clinical features for uterine cancer?
irregular vaginal bleeding
vaginal discharge: watery brown
lower abdominal pain
spread of tumour
28
What are the types of ovarian cancer?
epithelial type: arise from a germ cell type.
rarely primary tumour mostly arise from breast cancer.
29
What are the risk factors for ovarian cancer?
Age
family Hx
Oestrogen
30
What are the clinical features of ovarian cancer?
Pain or pressure on the back, abdomen and pelvis
abdominal bloating
indigestion/ nausea
urinary frequency and urgency
hormone-secreting tumour
31
What are the types of cervix cancer?
squamous cell carcinoma
32
What are the clinical features fro vaginal cancer?
Asymptomatic
vaginal discharge with a foul odour
abnormal bleeding
pelvic pain
symptoms of compression of bladder discomfort.
33
What are the possible spread sites if vaginal cancer is not detected?
* Direct spread: Through the uterine/vaginal walls to adjoining organs
* Lymphatic spread: To pelvic, inguinal, iliac and aortic nodes
* Blood spread: to the liver, lungs and bone
34
What is the management of vaginal cancer?
Early vaccination
HPV test - if positive do Pap smear
35
What is the two-tiered classification system of the squamous intraepithelial lesion (vaginal cancer)r?
* CIN 1 was renamed Low-grade Squamous Intraepithelial Lesion (LSIL)
* CIN 2 & CIN 3 were renamed High-grade SILs (HSIL) -- Surgery
36
What is a venerial disease
STI
37
What are the female defences against infections
1. •Normal defences of the female GUT include:
2. •Oestrogen & lactobacilli
3. •Thick vaginal epithelium
4. •Cervical mucus plug
5. •Regular shedding of endometrium
38
WHat are the defenses of the male reproductive tract?
1. •Normal defences of the male GUT include:
2. •Prostatic secretions
3. •Confer a degree antimicrobial activity
4. •Increasedlength of the male urethra
5. •A drier peri-meatalenvironmentcompared to women
39
What are the complications of STI?
* •Malignancy,
* Infertility,
* Ectopic pregnancy,
* PID,
* Neonatal morbidity
* mortality
40
What are the contributing factors for increased incidence of STI?
* Sexual freedom
* change in perceived sexual risk
* increased travel
* use of recreational drugs
* less barriers for contraception
41
What is Chlamydia?
Bacterial STI caused by Chlamydia trachomatis bacteria.
lives and multiply within cell
incubation for 14 days
42
What is the pathophys of clamydia?
WOMEN:
* •Cervix affected more than vagina
* •Chronic cervicitis, even salpingitis can develop
* •Complications: ectopic pregnancy, infertility
MEN:
* •Typically develop urethritis
* •Women & MSM who engage in receptive anal intercourse may develop an infection in the rectum
* •It is possible for the conjunctivae\* and oropharynx to be infected through direct inoculation
* •\*Leading cause of infectious blindness in the world
43
What are the clinical features of clamydia?
WOMEN:
* •Vaginal discharge,
* bleeding,
* abdominal pain,
* bloating,
* dyspareunia
MEN:
* •Dysuria is more common,
* there may be a penile discharge
OTHER SITES OF INFECTION:
* •Proctitis,
* pharyngitis,
* conjunctivitis
8% of patients develop a reactivearthritis
44
What is gonorrhoea?
STI bacteria caused by Neisseria gonorrhoeae
3-7 incubation day
45
What are the clinical features of gonorrhea?
•R**ectal infection**
* •Proctitis:rectal pain
* tenesmus,
* anal discharge
* •Asymptomatic
**•Pharyngealgonorrhoea**
* •Most commonly asymptomatic
* •+/- cervical lymphadenopathy
**•Conjunctivitis:**
* •Copious amounts of exudate, bright red or “beefy” conjunctivae
* •Serious complications: cornealulceration and visual deterioration
* Mother-to-child transmission during vaginal delivery can occur
46
What is reactive arthritis?
a complication of chlamydial & gonorrhoeal infection related too
oligoarthritis on •knees, SIJs, interphalangeal joints, LBP
may affect Aquiles tendon
47
What are the clinical features for the 3 types acquired syphilis?
**Primary syphilis:**
* Symtoms 2-4 weeks
* chancre in: penis, cervix, vagina, anus, oropharynx
* chancrea may heal without treatment
**Secondary syphilis**
* 6-8 weeks
* rash
* wart like lessions
* silvery gray lesions
* systemic symptoms
* lymphadenopathy
**Tertiary syphilis**
* 10 to 25yr
* Gummas: skin, mucous membranes, bone
* neurosyphilis:
* •Mild symptoms: Headaches, photophobia, dizziness, blurred vision, poor concentration •Severe symptoms: Meningitis, seizures, paraplegia, psychosis, cognitive decline
* cardiovascular features: Gummas in the myocardium
48
WHat is the causitive agent of genital herpes?
Herpes simplex type 2
transmitted through genital or oral contact
becomes active 2-3 times a year
49
clinical features of herpes simplex?
* Group tender vesicles at •penis, labia, perianal skin, buttocks
* •Intense burning
* stinging
* •Fever, lethargy
* HVS nerve root
**progression**
* •First attack:lasts 2-4/52 before lesions crust and disappear
* •There may be recurrences, which typically last for 7-10 days
50
What is vaginal Thrush?
overgrowth of the fungus Candidaalbicans
Arises from disordered local ecology that allows the overgrowth of the yeast
•Factors that can change vaginal microbiome:
* •Pregnancy,
* diabetes,
* antibiotic therapy,
* some types of OCP
51
What is toxic shock syndrome?
a form of septic shock (circulatory failure), secondary to bacterial infection and toxin release
Causative agent: •Staphylococcal aureus +, Streptococcus pyogenes
Cause: tampons + low menstrual flow while using tampons may cause vaginal lesions
52
What are the clinical features and complications of septic shock?
**Clinical features**
* •Abrupt onset: high fever, vomiting, diarrhoea
* •Also common: sore throat, myalgia, headaches, skin rash
**Complications**
* septic shock
53
What is acute prostatitis and its classifications?
acute inflammation of the prostate
## Footnote
Non-bacterial prostaitis: trauma, infection
Bacteria prostaitis: E coli, clamydia, gonorrhea
54
what is the clinical presentation of prostatitis?
Pain
dysuria
obstructive voiding
irritative voiding
\*\*\*Infective prostatitis: fever, chills
55
What is benign prostate hyperplasia BPH?
hyperplasia of stroma
affects transition zone
affects old men
56
what is the enzyme related to BPH?
**5a reductase** (an enzyme that converts testosterone to DHT)
responsible Dihydrotestosterone DHT
57
What area of the prostate does BPH affect?
transitional zone
58
what are the clinical features of BPH?
Obstructive symptom (affect urine flow and stream)
Irritative symptoms (affect urine urgency, frequency, night pee)
59
# 3 B's
what are the complications fo BPH?
Bacterial infection
bladder stones
bladder diverticuli
60
What are the managements for BPH?
Meds: 5-alpha-reductase inhibitor
surgery
61
What is the pathogen responsible for Prostate cancer?
adenocarcinoma
62
what is the aetiology of prostate cancer?
Old, obese, male smoker with diabetes
loves BBQ
works with chemicals
genetics
Hormonal factors
63
Where is the first spread zone for prostate cancer and how?
spine via blood and lymphs
64
how do prostate cancer tumours affect bones different to other cancers
(tumours in bones)
cause secondary osteoblastic that are dense and easy to detect in x-ray
This is the only detectable site of metastasis
65
What are the clinical features for prostate cancer?
asymptomatic
Obstructive and irritative symptoms
Others
* hematuria
* pain
* systemic
* DRE
* Bone #
66
What is TURP?
removal of the prostate via rectum
transurethral resection of prostate
67
Management for prostate cancer?
Surgery (TURP or Open)
Radiation (needle vs seed brachytherapy)
68
what is an inguinal hernia and how is it classified?
protrusion fo abdominal content into inguinal canal
indirect - inside canal via deep inguinal ring
direct - posterior wall of canal (weakness in transversalis fascia
69
what is the risk of getting an inguinal hernia?
male 27%
female 3%
Profile
* old man, tradie/ athlete, smoker with high BMI
70
what are the clinical features
lump in groin and discomfort in abdomen
71
72
Define Hydrocele?
accumulation of fluid in Tunica vaginal
73
how are hydrocele classified?
Primary hydrocele: fluid not reabsorved
Secondary: excess fluid from infection
congenital: conection between vaginalis and abdomen not closed
74
What is Cryptorchidism?
failure of testicles to descend from abdo to scrotum.
75
Where is the most common arrest site of testes in cryptorchidism?
inguinal canal
76
what are the complications in cryptorchidism?
inguinal hernia
infertility
testicular cancer
77
What is the management for cryptorchidsm?
surgery - orchiopexy
78
What is the venous drainage for the testes and epididimis?
pampinfon plexus
drains into testicular vein in abdo
79
What is varicocele and how are they classified?
varicosity of the testicular and pampiniform plexus
primary: incompetent valves
Secondary: pathological condition
80
What is testicular torsion?
twisting of sperm cord
\*\*\*its a medical emergency\*\*\* may lead to infarction, must be fixed 6 hours after onset to avoid ischaemic necrosis
81
what is the most common cause of testicular torsion?
congenital malformation of tunica vaginalis
"bell-clapper abnormality"
82
Who is the most affected population with testicular torsion?
Adolescents
83
What are the 2 main varieties of testicular cancer ?
seminomas: cancer in seminiferous tube - common
non semionmas: mixed germ cell - aggressive
84
What is the incidence and risk factors of testicular cancer ?
seminomas: adult 25+
non-seminoma: young adult 20's
Risks
* family Hx
* cryptorhidism
85
what are the clinical features for testicular cancer?
large testicles
sensation of "heavy" scrotum"
asymptomatic
metastatic disease
secondary hydrocele
gynaecomastia (large man bobs')
86
what is the management for testicular cancer
surgery - radial orchiectomy
87
