Reproductive Disorders PDF

Pathophysiology (2) (MBS 214) Reproductive System Disorders Textbook; Pathophysiology for the Health Professions, 4th edition, 2011 Chapter 28 (p.613-642)  Reproductive System Disorders lecture outline Disorders of the Female Reproductive System Disorders of the Male R...

Pathophysiology (2) (MBS 214) Reproductive System Disorders Textbook; Pathophysiology for the Health Professions, 4th edition, 2011 Chapter 28 (p.613-642)  Reproductive System Disorders lecture outline Disorders of the Female Reproductive System Disorders of the Male Reproductive System Lecture objectives :After studying this lecture, the student is expected to: Compare the common menstrual disorders. Describe endometriosis and its complications. Explain pelvic inflammatory disease Describe the common sexually transmitted diseases Describe the causes of infertility. Describe the common congenital abnormalities in males and females. Compare benign prostatic hypertrophy with cancer of the prostate. Describe testicular cancer.  Disorders of the Female Reproductive System  Structural Abnormalities  Menstrual Disorders  Infections & Sexually Transmitted Diseases  Infertility  1- Structural abnormalities of the uterus Abnormal uterine positions Uterine prolapse Cystocele Rectocele  A-Abnormal uterine positions The normal position of the uterus is ; slightly anteverted (tipped forward) with respect to the vagina and anteflexed (bent forward ) the location of the fundus with respect to the cervix. The abnormal position; – Retroverted uterus is tipped backward – Retroflexed (bent backward, flexed the uterus normally lies immediately postero- posteriorly) superior to the bladder, and anterior to the rectum. Forward: towards the anterior surface of the body  A. Abnormal uterine positions Factors predisposing patients to this condition include: – difficult childbirth – multiple births, – birth of a large baby, – repeated pregnancies – aging or excessive stretching or trauma, The supporting ligaments, fascia, and muscles for the uterus, bladder, and rectum may become weakened (pelvic relaxation), and these organs may shift out of their normal position in the pelvis. Manifestations : Often malposition does not cause any symptoms. In some cases, infertility may result if the cervix is not positioned appropriately to facilitate the passage of sperm. Marked retroversion may cause back pain , dysmenorrhea (painful menstruation), and dyspareunia (painful intercourse).  B. Uterine prolapse  Uterus descends into the vagina to varying degrees Prolapse is classified as: First degree; the cervix drops into the vagina Second degree ; the cervix lies at the opening to the vagina and the body of the uterus is in the vagina Third degree if the uterus and cervix protrude through the vaginal orifice Manifestations: – early stage of prolapse may be asymptomatic, – advanced stages cause discomfort , infection in the cervix and decrease  Cause is weakness of ligaments mobility.  Common occurs in old women over 50, have many children  C. Cystocele and Rectocele A cystocele is a protrusion of the bladder into the anterior wall of the vagina – May cause UTIs. A rectocele is a protrusion of the rectum into the posterior wall of the vagina. – May cause constipation and pain  2- MENSTRUAL DISORDERS 1. Menstrual Abnormalities 2. Endometriosis 3. Menopause  Menstrual cycle A monthly series of changes include ovaries, uterus and hormones (FSH and LH of anterior pituitary and estrogen and progesterone of the ovaries) Each month, one of the ovaries releases an egg — a process called ovulation. At the same time, hormonal changes prepare the uterus for pregnancy. The four phases of the menstrual cycle are menstruation, the follicular phase, ovulation and the luteal phase  1-MENSTRUAL DISORDERS Menstrual Abnormalities – Amenorrhea – Dysmenorrhea – Abnormal menstrual bleeding Menorrhagia Metrorrhagia Polymenorrhea Oligomenorrhea – Premenstrual syndrome (PMS)  Menstrual Abnormalities- Amenorrhea Absence of menstruation, no menses Types : Primary condition, menarche has never occurred. – May be genetic or Congenital defects Secondary amenorrhea is the cessation of menstruation in an individual who previously experienced cycles. – Is usually a result of hormonal imbalance  Menstrual Abnormalities- Dysmenorrhea Refers to painful menstruation or excessive pain during menstruation May be primary or secondary. Primary dysmenorrhea – is due to excessive release of Prostaglandins as a result of endometrial ischemia – Usually begins a few days prior to menses and last a few days after onset – NSAIDs offer relief Secondary dysmenorrhea : – results from pelvic disorders such as endometriosis, uterine polyps or tumors, or pelvic inflammatory disease  Menstrual Abnormalities- Abnormal menstrual bleeding Include: Menorrhagia (increased amount and duration of flow) Metrorrhagia (bleeding between cycles) Polymenorrhea (short cycles of less than 3 weeks) Oligomenorrhea (long cycles of more than 6 weeks) The usual cause is lack of ovulation Hormonal imbalance in the hypothalamic pituitary –ovarian axis may be a factor  Menstrual Abnormalities-Premenstrual syndrome PMS is a condition that begins a week or so before the onset of menses and ends with the onset of menses. The cause is not completely understood In most women PMS causes symptoms such as: – breast tenderness, – weight gain, – abdominal distention or bloating, – irritability, emotional lability, sleep disturbances, depression, headache, and fatigue. Treatment measures are tailored to the individual and may include – hormonal therapy – the use of diuretics or antidepressants as necessary.  2- Endometriosis Presence of endometrial tissue outside the uterus The ectopic endometrium responds to cyclic hormone changes Bleeding leads to inflammation and pain Fibrous tissue may cause adhesions and obstruction of involved structures, such as urinary bladder, colon and ovary Treatment measures include; – hormonal suppression of the endometrial tissue – surgical removal of the ectopic endometrial tissue – Endometriosis is usually a long-lasting (chronic) disease, which means there is no cure. Possible ectopic sites  3-Menopause The term is given to the change that occurs in women at around age 50, when the ovaries cease to respond to FSH and LH, resulting in ; – lack of ovulation, – Cessation of the menstrual cycle, – decrease estrogen and progesterone levels (sex hormones ) Manifestations :either  Reproductive system : – Thinning of the mucosa, loss of elasticity, and decreased glandular secretions in the vagina and cervix causing inflammation and dyspareunia, or painful sexual intercourse. The effects can be minimized by topical (local) administration of estrogen creams. – The pH of the vaginal secretions becomes more alkaline, thus predisposing older women to recurrent vaginal infections. – Breast tissue also decreases in volume.  Systemic signs : “hot flashes,” which involve periodic sweating or vascular disturbances. headaches, irritability, and insomnia are common manifestations.  INFECTIONS – Candidiasis – Pelvic Inflammatory Disease – Sexually transmitted diseases (STDs)  Candidiasis (Monilia) One form of vaginitis – It is a yeast infection caused by Candida albicans – occurs as an opportunistic superficial infection of mucous membranes or skin Manifestation of vaginal candidiasis – red and swollen pruritic mucous membranes – thick, white discharge. – White patches may adhere to the vaginal wall. – Dysuria (painful urination) – Dyspareunia (painful intercourse) may be present. An antifungal agent such as nystatin is effective treatment  Pelvic Inflammatory Disease (PID) Infection of uterus, fallopian tubes and ovaries. The infection may be acute or chronic. Infection usually originates as an ascending infection from lower reproductive tract May occur due to bacteremia Majority of infection arise from sexually transmitted diseases, non sterile abortions or postpartum.  Pelvic inflammatory disease (PID) Manifestations; Signs and symptoms Pelvic pain is usually the first sign – Fever and leukocytosis depend on which causative organisms. – Nausea and vomiting – Purulent discharge is evident at the cervical os – Tenderness is common during pelvic examination. – Abdominal distention and rigidity indicate peritonitis Potential acute complications: Peritonitis Pelvic abscess Septic shock Scarring of tubes increases risk of infertility and ectopic pregnancy. Treatment: Aggressive treatment with appropriate antimicrobials  SEXUALLY TRANSMITTED DISEASES Formerly called Venereal diseases, infectious diseases that are spread by sexual contact. BACTERIAL INFECTIONS – Chlamydial Infection – Gonorrhea – Syphilis VIRAL INFECTIONS – Genital Herpes – Genital Warts PROTOZOAN INFECTION – Trichomoniasis  A summary of sexually transmitted diseases(STDs) Most common ophthalmia neonatorum. ulcer Chancre; a painless, firm, ulcerated nodule at oral cavity,anus,genital region ulcer risk for cancer of the cervix and vulva. Yearly Pap smears is essential for early detection copious yellowish, foul-smelling discharge  INFERTILITY Cause may be male conditions, or female conditions, or combination of both A couple is considered infertile after a year of unprotected intercourse fails to produce a pregnancy. Causes : – Associated with hormonal imbalance – Age of parents – Structural abnormalities – Infections, Abnormal vaginal pH – Chemotherapy – Environmental factors, Cigarette smoking – Workplace toxins – Idiopathic  DISORDERS OF THE MALE REPRODUCTIVE SYSTEM 1. Congenital Abnormalities of the Penis Epispadias and Hypospadias 2. Disorders of the Testes and Scrotum Cryptorchidism Hydrocele, Spermatocele, and Varicocele 3. Inflammation and Infections Prostatitis 4. Tumors Benign Prostatic Hypertrophy Cancer of the Prostate Cancer of the Testes  1- CONGENITAL ABNORMALITIES OF THE PENIS Epispadias ; – urethral opening on the dorsal (upper) surface of the penis, proximal to the glans.. Hypospadias ; – urethral opening on the ventral (under) surface of the penis  Either condition may result in incontinence or infection  Surgical reconstruction  2- DISORDERS OF THE TESTES AND SCROTUM Cryptorchidism – Undescended testes: testes fail to properly descend into scrotum Complications of undescended testes: – Degeneration of seminiferous tubules, – Spermatogenesis is impaired, – Increased risk of testicular cancer significantly if treatment is not done by age of 5 Therefore, surgical positioning of the testes in the scrotum before age 2 is advisable. Ectopic testis : testis positioned outside the scrotum.  DISORDERS OF THE TESTES AND SCROTUM Hydrocele excessive fluid collects between the visceral and parietal layers of the tunica vaginalis Spermatocele Cyst containing fluid and sperm, that develops between the testis and the epididymis outside the tunica vaginalis. Torsion of the testis the testis rotates on the spermatic cord, compressing the arteries and veins. Ischemia and infarction may develop in testis  DISORDERS OF THE TESTES AND SCROTUM Varicocele: Dilated veins in the spermatic cord; – Results from a lack of valves in the veins, allows backflow of blood and increased pressure in the veins. – If it is extensive, causes impaired blood flow to the testes and decreased spermatogenesis and infertility. – Surgical treatment of the abnormal veins is necessary.  3- INFLAMMATION AND INFECTIONS Prostatitis: Infection or inflammation of the prostate gland. Four recognized categories of prostatitis: Acute bacteria Chronic bacterial Non-bacterial Asymptomatic inflammatory prostatitis. Acute bacterial prostatitis is caused primarily by : – Escherichia coli in young men occurs with UTIs, in old men with benign prostatic hypertrophy – Association with sexually transmitted diseases (STDs) such as gonorrhea/ – With instrumentation such as catheterization – Bacteremia (through the blood) Signs and symptoms: dysuria, urinary frequency, and urgency and low back pain. Gland is tender and swollen – Severe inflammation may cause: obstruct urinary flow, hesitancy in initiating urination, increased frequency and urgency. Chronic prostatitis: repeated infection by E. coli., gland only slightly enlarged with dysuria and urinary frequency.  TUMORS Benign Prostatic Hypertrophy Cancer of the Prostate Cancer of the Testes  Benign Prostatic Hypertrophy (BPH) Occur in up to 50% of men over age 65 Hyperplasia of the prostatic tissue which is related to estrogen- testosterone imbalance.  Prostatic cancer Most common cancer in men over age 50 (1 in 6) Most are adenocarcinomas arising near surface of the gland. Many tumor are androgen dependent Signs and symptoms: – Hard nodule felt on the periphery of the gland on rectal examination. – Signs of urinary obstruction; Hesitancy in urination Decreased urine stream Frequent urination Recurrent UTIs  Prostatic cancer Diagnosis: – Serum markers; prostate specific antigen (PSA) and prostatic acid phosphatase – Ultrasonography – Biopsy – Bone scans to detect metastasis (prostatic cancer often metastasizes mainly to bones) Treatment: Removal of testes may be suggested to reduce hormonal effects on androgen- sensitive tumors.  Testicular cancer Majority of testicular tumor are malignant Most common solid tumor in younger men ages 20-40 years old. Testicular self examination is essential for early detection. Signs and symptoms: – Hard, painless, usually unilateral mass – Enlarged or heavy testes – Dull aching pain in the lower abdomen – Hydrocele or epididymitis and gynecomastia if the tumor is hormone secreting Treatment: Includes a combination of surgery, radiation and chemotherapy.