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UNIT 8 CH 34 – STI Neisseria Gonorrhea Patho o Gram neg diplococcus N. Gonorrhea o Attach and penetrate columnar epithelium o Can occur/spread through lymphatic system Etiology o Contact w/ mucous membranes of infected person o Females🡪...

UNIT 8 CH 34 – STI Neisseria Gonorrhea Patho o Gram neg diplococcus N. Gonorrhea o Attach and penetrate columnar epithelium o Can occur/spread through lymphatic system Etiology o Contact w/ mucous membranes of infected person o Females🡪 found in cervix, urethra, skene, Bartholin glands o Skene gland🡪 causes scarring in urethra, oviducts, epididymis DX o Urine culture, discharge sample CM o Discharge, dysuria (inflammatory response in columnar epithelium), infertility o Females🡪 asymptomatic, but may have ↑ o Males🡪 urethritis, redness, swelling Nongonococcal C. trachomatis/Chlamydia Patho o C. trachomatis act on columnar epithelium similar to gonorrhea DX o Screening for sexually active patients CM o s/s less severe than gonorrhea Syphilis Patho o Systemic infection of vascular system o Changes in vascular system o Inflammatory response causes infiltration of lymphocytes and plasma cells o Terminal arterioles and small arteries are obliterated and no longer functional o Long term inflammation results in fibrous thickening in blood vessels🡪 eventually tissue necrosis Etiology o Caused by Treponema pallidum o Penetrates intact mucous membranes during sex o Pathogens migrate to regional lymph nodes w/in hours o During incubation🡪 T. pallidum is disseminated throughout body and can invade/multiply in any organ system DX o Serologic screening, rapid plasma test CM o Incubation 10-90 days  o Primary🡪 painless chancre ▪ Untreated resolves 3-6 weeks o Secondary🡪 untreated chancres resolve, followed by cutaneous rash, flu-like s/s ▪ Spreads throughout bloodstream and lymphatic system o Latent🡪 no s/s present, early latent = contagious, lasts up to 40 yrs o Tertiary🡪 cardiovascular and nervous systems at risk ▪ Aortic necrosis and aortic insufficiency ▪ Damage to CNS🡪 paresis, blindness, mental deterioration Genital Herpes Patho o Virus in ganglion neurons Etiology o Self-limiting infection o Virus stored in ganglion neurons🡪 stress triggers reactivation DX o Cell culture CM o Fluid filled vesicles after 3-7 day incubation, lesions recur at site of initial occurrence o Females🡪 cervix o Males🡪 glans penis, foreskin, shaft NI o Prevention education🡪 asymptomatic shedding of virus HPV Patho o Epithelial lesions of anogenital region o Infects single epithelial cells🡪 divide and proliferate o Incubation 1-20 months Etiology o Epithelial lesions🡪 genital warts (condylomata acuminate) DX o Pelvic exam CM o Period of communicability unknown, thought to last as long as lesions persist and possibly even after removal o Single or multiple lesions o Soft pink to brown, small-large, raised or flat o Pruritic, painful, bleed easily o Females🡪 vagina and cervix, anogenital area ▪ Cervical cancer observed w/ some types of warts o Males🡪 urethra, anogenital area UNIT 8 CH 31 – DISORDERS OF MALE GENITALIA & REPRODUCTIVE Epididymitis Patho o Bacterial cause w/ STDs ▪ C. trachomatis ▪ E. coli Etiology o Inflammation of the testis DX o Urine culture, WBC (↑) CM o Enlarged scrotum, red, tender, fever, pain along spermatic cord Fournier Gangrene Patho o Gangrenous necrosis of scrotum Etiology o Alcoholism, DM o Other sources of infection ▪ Perforated urethral diverticulum ▪ Non-urinary tract source🡪 perirectal abscess ▪ Extravasation of infected urine from urethral trauma DX o CT, MRI, history CM o s/s shock (high fever, ↓ BP, ↑ HR), sepsis, pain, swollen genitalia Benign Prostatic Hyperplasia Patho o Hyperplasia of glands, compresses urethra o Changes in endocrine system Etiology o Unknown o BPH does not predispose pt to prostate cancer DX o PSA, rectal exam, CT, u/s, urethral catheterization CM o s/s of obstruction ▪ ↓ urine stream, force ▪ Hesitancy ▪ Difficulty initiating stream ▪ Interruption of stream ▪ ↑ risk for UTI due to bladder retention Prostatitis Patho o Inflammation of prostate Etiology o Bacterial prostatitis🡪 E. coli DX o Urine culture CM o Acute🡪 fever, chills, low back pain, dysuria o Chronic🡪 voiding symptoms, localized pain, harder to treat Urethral Strictures Patho o Fibrotic narrowing of urethra caused by scar tissue Etiology o Prior infection🡪 gonorrhea, trauma, straddle injuries DX o Retrograde urethrogram CM o Urine retention o ↓ urinary stream, discharge, infection Erectile Dysfunction Patho o Inability to achieve or maintain erection Etiology o Arterial insufficiency o Result from excessive venous drainage from penis o ↓ secretion of LH (luteinizing hormone) RF o HTN, ↑ cholesterol, trauma, DM, metabolic syndrome, smoking, obesity o Antidepressants and antihypertensives DX o Labs🡪 testosterone levels, serum glucose, physical CM o Priapism🡪 painful, persistent erection o Inability to maintain erection Neoplasms of Penis Patho o Rare o Phimosis of foreskin🡪 too tight to be pulled back over head Etiology  o Squamous cell carcinoma o Chronic inflammation of penis DX o None CM o Pain, bleeding, urethral discharge o Ulcerative, fungating lesions Neoplasms of Testis Patho o Nongerminal🡪 tumors originate from Leydig cells o Germinal🡪 derived from germinal cells Etiology o Cause is uncertain o Peak incidence is in late adolescence to early adulthood (18-26 yo) o Cryptorchidism🡪 undescended testes DX o Exam, u/s CM o Self-testicular exam Prostate Cancer Patho o Adenocarcinomas w/ abnormal proliferation Etiology o Rarely occurs in men 10,000, abscess or inflammatory mass, purulent vaginal discharge ▪ Can cause infertility, ectopic pregnancy, chronic pelvic pain Vaginitis (Vulvovaginitis) Patho o Inflammation of vulva and vagina due to overgrowth of bacteria Etiology o Candida albicans, trich, N. gonorrheae, DM, pregnancy, oral contraceptives, abx DM o Pelvic exam, mucous culture CM o Thick/white discharge, red, itching, malodorous/purulent discharge, painful urination and sex Bartholinitis Patho o Inflammation of Bartholin glands due to bacteria🡪 gonorrhea Etiology o Bacteria/abscess formation DX o Culture of drainage CM o Tender and swollen, edema at vaginal opening, purulent drainage at duct orifice, fever, malaise Uterine Leiomyomas (fibroids) Patho o Benign fibroid growth Etiology o Estrogen and HGH influence tumor formation o Most common in premenopausal women DX o Pelvic u/s CM o Abd pain and pressure, vaginal bleeding and discharge, backache, constipation, urinary frequency/urgency, prevent pregnancy and carrying to term Ovarian Cysts Patho o Sacs on ovary containing fluid or semisolid material  Etiology o Idiopathic DX o Pelvic u/s CM o Can be asymptomatic, commonly seen in reproductive years o May increase or decrease in size w/ menstrual cycle o Larger cysts can cause pain, can rupture and bleed Endometriosis Patho o Endometrial tissue outside lining of uterus o Endometrium implants w/in pelvis, most common in ovary, oviduct, peritoneum of cul-de-sac Etiology o Transportation🡪 endo tissue backflows during period o Metaplasia🡪 inflammation triggers tissue to convert o Induction🡪 combo of both. *most likely* DX o Pelvic exam, u/s CM o Dysmenorrhea, abd pain into vagina, posterior pelvic, back, dyspareunia, painful defecation Cervical Cancer Patho o Growth in cervical area Etiology o HPV o Sex at young age or multiple partners o Multiple pregnancies o HSV 2 or other STDs DX o Pelvic exam w/ PAP smear CM o Vaginal bleeding, persistent vaginal discharge, pain/bleeding after sex o Prevention🡪 Gardasil vaccine Endometrial Cancer Patho o Cancer in endometrial lining Etiology o Abnormal or cancerous cells in endometrial lining DX  o Pelvic exam, tissue sample, u/s CM o Bleeding between periods, postmenopausal bleeding ▪ RF🡪 obesity, DM, infertility, late menopause, HTN, long term estrogen use ▪ unopposed estrogen🡪 estrogen therapy alone w/out progesterone Vaginal Cancer Patho o Cancer in vagina Etiology o Cancer cells in vagina DX o Pelvic exam, tissue biopsy CM o Vaginal spotting, discharge, pain, groin masses, urinary pattern changes ▪ RF🡪 early to mid-fifties Vulvar Cancer Patho o Abnormal or cancerous cells in vulva CM o Leukoplakic changes o Vulva masses Ovarian Cancer Patho o Leading cause of genital cancer o Cancer in ovaries DX o Difficult to dx bc they are so deep in pelvis ▪ Mortality rate is high o Carriers of BRCA1 and BRCA2 mutations🡪 prophylactic oophorectomy or salpingo-oophorectomy recommended CM o Increased abd girth, wt loss, abd pain, dysuria, constipation o Symptoms are not found until late in disease ▪ RF🡪 peak incidence 60-80 yo Fibrocystic Breast Diseases Patho o Group of lesions in breast Etiology o Hormonal imbalance in reproductive years DX  o Breast exam, mammogram, u/s w/ biopsy CM o Firm, regular shape, mobile mass, painful and tender Specific Benign Neoplasms Patho o Encapsulated mass and freely movable mass o Fibroadenomas, adenomas, papillomas Etiology o Abnormal cells DX o Breast exam, u/s, mammogram CM o Freely movable and palpable Breast Cancer Patho o Hormonal changes Etiology o Abnormal cells begin in glandular ducts and invade breast tissue o Occur in the upper outer quadrant bc it’s so close to lymph nodes DX o Breast exam, mammogram, u/s CM o Palpable, painless, hard, poorly movable lump ▪ Advanced🡪 dimpled skin, inverted nipple, changes in breast contour, bloody discharge from nipple ▪ RF🡪 hormonal influences, early onset menses, 40+ yrs of menses, postmenopausal hormone replacement therapy, giving birth >35, increased fat in diet, family hx, age, radiation exposure, hx of cancer, lack of access to healthcare UNIT 10 – CONCEPTS OF AGING Decline in functional reserve Inability to adapt to environmental demands Cardiovascular ↓ vessel elasticity, heart muscle fibers, capacity, stroke volume, baroreceptor sensitivity Tissue calcifies, venous stasis occurs due to vascular fragility Respiratory ↓ cough reflex, elasticity Enlarged alveoli🡪 ↓ alveolar fx and service area Costal cartilage calcifies🡪 ↓ capacity Renal/Urinary ↓ glomerular filtration, ability to concentrate urine, excretion of hydrogen ions Fx nephrons ↓, less renal reserve o more susceptible to fluid/electrolyte imbalances and renal damage o very susceptible to kidney damage, drug toxicity o run BUN and creatinine labs during drug therapy ↓ sphincter tone and bladder capacity o Causes residual volume and difficulty starting urinary stream Nocturia GI ↓ contraction strength, peristalsis, enzyme secretion, ability to maintain mucosal integrity, absorption of lipids, aa, glucose, calcium, iron Neuro Atrophy and degeneration of nerves and neurons ↓ neurotransmitters, nerve impulse conduction, reaction time (myelin sheath ↓) Brain atrophy and ↓ in brain weight Hearing Ankylosis of ossicles🡪 ↓ sound to inner ear Hair cells deteriorate🡪 ↓ pitch discrimination (can’t hear high tones) Musculoskeletal ↓ mass, ↓ estrogen leads to osteoporosis, risk for fractures, unsteady gait Intervertebral cartilage disks dehydrate and ↓ height ↑ joint degeneration Immune ↓ inflammatory response Integumentary ↓ subq fat, elasticity, temp regulation, circulation, vascularity (↑ vascular fragility) CH 6 – CONCEPTS OF GENETICS Phenotypes- physical traits Genotypes- genetic makeup Chromosomes- 23 pairs o 22 homologous autosomes o 1 pair sex hormones Mitosis- one cell into 2 cells Meiosis- cell division results in haploid germ cells; ½ the normal # of chromosomes  Crossing over- in meiosis, homologous chromosomes form a pair and exchange sections of DNA Alleles- 2 alleles for each gene o 2 different = heterozygous (Aa) = dominant gene ▪ carriers of recessive o Both alleles are recessive = homozygous o Codominant- not clearly dominant or recessive (blood types) Polygenic- heritable traits, affected by environmental factors o Multifactorial- height, weight, BP, heart disease, asthma, DM, cancer Mutagens- mutations occur by exposure to radiation, chemicals, viruses GENETIC ASSESSMENT PRENATAL DX AND COUNSELING Maternal age >35 Chromosomal disorder in previous pregnancy Known family hx of x-linked or inborn errors of metabolism Known carrier of recessive genetic disorder GENETIC AND CHROMOSOMAL DISORDERS Aneuploidy- abnormal number of chromosomes caused by nondisjunction Nondisjunction- chromosomes fail to separate normally o Trisomy 21 Duplication- extra copies Polysomy- too many Monosomy- not enough Translocation- abnormal gametes AUTOSOMAL Trisomy 21 o Extra copies of 21 o RF🡪 AMA Trisomy 18 (Edwards) and Trisomy 13 (patau) o Less common than trisomy 21 o Most pregnancies lost before term, infants don’t survive long Cri du Chat o Deletion of part of short arm chromosome 5 o Severe mental retardation, round face, congenital heart abnormalities o Laryngeal malformation causing cat-like cry o Some live to adulthood, thrive better than those w/ trisomies SEX CHROMOSOME DISORDERS Klinefelter Syndrome  o Male has extra copies of X chromosome o Dx in puberty o Low testosterone, hypogonadism, infertility o Feminine hair distribution, gynecomastia o Tall stature, long arms and legs Turner’s o Monosomy X (paternal) o Only one normal X, no Y o Female phenotype o Ovaries fail to develop, short stature, webbed neck, wide chest Multiple X Females, Double Y Males o Extra X in females o Extra Y in males o Appear normal, few physical probs Mendelian Single Gene Disorder o Mutations in single genes AUTOSOMAL DOMINANT DISORDERS Males and females equally affected Affected person usually has affected parent Offspring of one affected parent have 50% chance of inheriting disease Marfan Syndrome o Disorder of connective tissues o Tall, slender, long/thin arms and legs🡪 spider fingers o Cardiovascular lesions *most life threatening* o Dysfunction of heart valves Huntington Disease o Affects neuro fx o Mental deterioration and involuntary arms/legs movements o Appears >40 yo o Degeneration of nerve cells AUTOSOMAL RECESSIVE DISORDERS Both alleles are mutated Associated w/ consanguinity (mating of related individuals) 2 carriers = 25% of affected offspring and 50% chance of offspring who carries disease Albinism o Lack of pigmentation o Disruption of melanin synthesis o Risk for sunburn and skin cancer PKU o Unable to metabolize phenylalanine  o Overly irritable, phenyl ketones in urine, infants have musty odor o Cannot bf baby w/ PKU bc bm contains phenylalanine o Managed w/ low-phenylalanine diet ▪ Very early tx to prevent mental retardation Cystic Fibrosis o Defect in chloride ions being transported o Lung bronchioles and pancreatic ducts affected ▪ Causes thick secretions, coughing o Newborn screening for early management SEX-LINKED DISORDER Hemophilia A o Bleeding disorder🡪 factor VIII (necessary for clotting) o Mom is carrier, expressed only by males NON-MENDELIAN SINGLE GENE DISORDERS o Triplet repeat mutations🡪 Fragile X o Mitochondrial DNA mutations o Genomic imprinting Triple Repeat Mutations o Fragile X o Long repeating sequence of 3 nucleotides on X chromosome o More than 200 to >2000 (normal is 29) o Mental retardation o Males more severely affected Mitochondrial Gene Mutations o Cause dysfunction in tissues w/ high use of ATP ▪ Nerve, muscle, kidney, liver o Mothers to all children o Father does not pass mitochondria Genomic Imprinting o Maternal and paternal chromosomes marked differently o 2 diff syndromes from same mutation ▪ Maternal🡪 Angelman syndrome ▪ Paternal🡪 Prader-Willi syndrome Polygenic and Multifactorial o Runs in families o Environmental o Multifactorial disorders: High BP, cancer, DM o Multifactorial traits: height, weight, intelligence ENVIRONMENTAL INDUCED CONGENITAL DISORDERS Teratogens o Chemicals, radiation, viral infections  ▪ Thalidomide, alcohol, anticonvulsants, warfarin, folate antagonists, androgenic hormones, angiotensin-converting enzyme inhibitors, organic mercury o TORCH ▪ Toxoplasmosis, Others, Rubella, Cytomegalovirus, Herpes Periods of Fetal Vulnerability o Before 3rd week🡪 embryo can’t survive o 3-9th week🡪 embryo very susceptible to teratogenesis ▪ Esp 4th and 5th weeks during organ development o After 3rd month, affect growth or injury to already formed organs