Week 8 Lecture PDF - Applied Pathophysiology

Lecture Material is adapted from © 2022 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 14: Altered Reproductive Function Module 2: Altered Reproductive Function Dr. Romeo Batacan Jr. MPAT12001 Medical Pathop...

Lecture Material is adapted from © 2022 Wolters Kluwer Health, Lippincott Williams & Wilkins Applied Pathophysiology: A Conceptual Approach to the Mechanisms of Disease Chapter 14: Altered Reproductive Function Module 2: Altered Reproductive Function Dr. Romeo Batacan Jr. MPAT12001 Medical Pathophysiology Lecture Series Copyright © 2017 Wolters Kluwer Health | Lippincott Williams &Wilkins  Altered Reproductive Function Hormonal imbalance Absent, infrequent ovulation, impaired oocyte development Motility impairment Adhesion or obstruction in the pathway from the cervix to ovary Problems with transit and joining of sperm and egg cell Inhospitable cervical mucus that blocks sperm from entering Previous infection leading to adhesions Leiomyoma (fibrous tumor in the uterus) distorts the endometrial cavity Immune problems Antibodies to male sperm, destroying sperm quickly General manifestations of Altered Reproductive Function Infertility: inability to conceive Pain: sign of infection, inflammation, structural problems Amenorrhea: hormone alterations Male contribution topregnancy the male must be able to provide sperm in sufficient quantity deliver to the upper end of the vagina with adequate motility to traverse the female reproductive tract contribution to this process is assessed by: semen analysis: evaluates volume of semen (normally 2 to 5 mL) sperm density (15 to 39 million/mL) motility (>32% good and progressive, swimming forward) viability (>58% are alive) morphology (>4% normally shaped) viscosity (full liquefaction within 20 minutes) Female contribution to pregnancy The female contribution to pregnancy is complex: requires production and release of a mature ovum capable of being fertilized production of cervical mucus that assists in sperm transport and maintains sperm viability in the female reproductive tract patent fallopian tubes with the motility potential to pick up and transfer the ovum to the uterine cavity development of an endometrium that is suitable for the implantation and nourishment of a fertilized ovum uterine cavity that allows for growth and development of a fetus vagina without obstructions, malformations Sexual response physiology Neurological and vascular controls: Same for male and female 4 phases 1. Excitement 1. Vasocongestion: swelling of genitals with blood 2. Myotonia: muscle tension 3. Increased heart rate, blood pressure, pulmonary ventilation 4. Glands secrete their fluid 2. Plateau 1. Variables are sustained at a high level or rise slightly 2. Last few seconds to few minutes before orgasm 3. Vasocongestion and myotonia may increase further Sexual response physiology 3. Orgasm/climax 1. Short, intense physiological reaction, 3‐15 sec 2. Heart rate ~180beats/min, respiratory rate 40 breaths/min 3. Male: ejaculation Emission: sperm into urethra Expulsion: from urethra 4. Female: orgasmic platform contractions Cervix plunges rhythmically into vagina (and semen) Uterus: peristaltic waves 4. Resolution 1. Cardiovascular and respiratory functions return to normal Male: refractory period: no other erection and orgasm Female: no refractory period, multiple orgasms Sexual response physiology Saladin K. Anatomy and Physiology: The Unity of Form and Function. 4th ed. New York, McGraw‐Hill; 2007 Saladin K. Anatomy and Physiology: The Unity of Form and Function. 4th ed. New York, McGraw‐Hill; 2007 Infertility Inability to conceive after 1 year of unprotected intercourse Primary infertility: situations in which there has been no prior conception Secondary infertility: occurs after one or more previous pregnancies Sterility: inability to father a child or to become pregnant because of congenital anomalies, disease, or surgical intervention The causes of infertility are almost equally divided between male factors (30% to 40%) female factors (30% to 40%) and combined factors (30% to 40%) ~10% to 25% of infertile couples, the cause remains unknown common causes Infections, inflammation, endocrine disorders, autoantibodies to sperm, environmental and lifestyle factors Male Altered ReproductiveFunction Causes of male infertility Varicocele (10‐15% of males, dilated veins, reduced blood flow, interfering with spermatogenesis) Hormonal (hyperprolactinemia, hypogonadotropic hypogonadism) Infection and immunologic problems (antisperm antibodies) Obstruction and congenital anomalies Ejaculatory dysfunction Treatment depends on the cause Craft AJ, Gordon C, Tiziani A. Understanding pathophysiology. 1st ed. Chatswood, Mosby;2011 Surgery Medication Artificial insemination to deliver more concentrated specimen directly Artificial insemination with donor sperm Female Altered Reproductive Function Anatomical location Type of cause Examples Hypothalamus‐ Ovulatory and uterine dysfunction Hypopituitarism, hyperprolactinemia pituitary Polycystic ovary syndrome, Anovulation, Ovaries Ovulatory dysfunction Ovarian cancer Pelvic inflammatory disease, Fallopian tubes Tubal obstruction Endometriosis, Tubal adhesions Uterine fibroids, cervical stenosis, hostile Uterus Uterine dysfunction cervical mucus, antisperm antibodies Vagina Vaginal obstruction Vaginal malformations  Sexually Transmitted Infections (STIs, STDs) Single most important cause of reproductive disorders Reporting not mandatory for all types 70,000 reported cases per year in Australia Preventable with barrier contraception Latex male condom and female femidom help prevent spread  STI Treatment Easy Parasitic/Protozoa Trichomoniasis Bacterial Chlamydia Gonorrhoea Syphilis Viral Hepatitis Herpes simplex (genital herpes) Human papilloma (genital wart) HIV Difficult Hormonal and menstrual alterations Dysmenorrhoea: painful menstruation Primary dysmenorrhoea Painful menstruation associated with prostaglandin release in ovulatory cycles Related to the duration and amount of menstrual flow Secondary dysmenorrhoea Painful menstruation related to pelvic pathology Can occur any time in the menstrual cycle Amenorrhoea: absence of menstruation Primary amenorrhoea Absence of menstruation by age 14 (or age 16 regardless of the presence of the development of secondary sex characteristics) Secondary amenorrhoea Absence of menstruation for a time equivalent to three or more cycles or 6 months in women who have previously menstruated Premenstrual syndrome (PMS) Distressing cyclical pain and mood swings in the luteal phase of the ovarian cycle 5–10% of menstruating women have severe to disabling symptoms Familial predisposition More than 200 physical, emotional and behavioural signs and symptoms Amenorrhea Ovarian hormones: estrogen & progesterone McCance KL, Huether S. Pathophysiology. 7th ed. N.S.W, Mosby; 2015  Benign growths and proliferativeconditions Benign ovarian cysts: common Functional cysts: caused by variations of physiologic events Follicular cysts: more common, dominant follicle fails to rupture Corpus luteum cysts: less common, granulosa cells develop into cyst after ovulation, may regress spontaneously as part of menstrual cycle McCance KL, Huether S. Pathophysiology. 7th ed. N.S.W, Mosby; 2015 Endometrial polyps Benign mass of endometrial tissue Intermenstrual, and excessive bleeding can occur Leiomyomas Commonly called uterine fibroids Benign tumours of smooth muscle cells in the myometrium Cause abnormal uterine bleeding, pain and symptoms related to pressure on nearby structures McCance KL, Huether S. Pathophysiology. 7th ed. N.S.W, Mosby; 2015 Benign growths and proliferative conditions(cont’d) Adenomyosis Islands of endometrial glands within the myometrium Asymptomatic, or abnormal bleeding, dysmenorrhoea, uterine enlargement and tenderness Endometriosis Presence of functioning endometrial tissue or implants outside the uterus Endometrial cells may enter pelvic cavity by retrograde menstruation Responds to hormone fluctuations of the menstrual cycle Can cause infertility and pain McCance KL, Huether S. Pathophysiology. 7th ed. N.S.W, Mosby; 2015  Detecting Altered ReproductiveFunction History and physical examination Sperm analysis Determination of ovulation observing cervical mucus changes, basal body temperature changes LH surge measurement Laboratory hormone levels, antibodies Patency of reproductive structures: imaging studies – hysterosalpingogram injecting a radiopaque material into the uterus and fallopian tubes using a fluoroscope and radiograph to determine the presence of obstructions Laparoscopy: scope placed through an incision in the abdomen view peritoneal and abdominal structures outside of the uterus and fallopian tubes Genetic testing  Laparoscopy Hysterosalpingogram Anteroposterior radiograph of the female pelvis after injection of radiopaque compound into the uterine cavity (hysterosalpingogram). Thibodeau GA, Patton KT. Anatomy and Physiology. 6th ed. Chatswood, Mosby;2007  Treating Altered Reproductive Function Supportive counseling and education Dependent upon cause Infection Hormone imbalance Motility problems Immune problems Contraception Behavioral Hormonal 1 Barrier Hormonal 1 Constant blood level of ovarian hormones (estrogen, progesterone) Follicles do not develop Ovulation ceases Tricking the hypothalamic‐pituitary‐gonadal axis Hormonal 2 High hormone concentration: postcoital contraception Interferes with normal hormone signals Prevent fertilized egg from implanting, or fertilization altogether Hormonal 3 Hormonal 2 Progestin only Thicken cervical mucus enough to block sperm entry Hormonal 3 Decrease frequency of ovulation Make inhospitable endometrium Marieb EN, Hoehn KN. Human Anatomy & Physiology. 9th ed. Boston, Pearson Education; 2013 Saladin K. Anatomy and Physiology: The Unity of Form and Function. 4th ed. New York, McGraw‐Hill; 2007 Assisted Reproductive Technology Surgical removal of oocytes following hormone stimulation Fertilization of oocytes Return of fertilized oocytes to woman's body Disadvantages: costly, emotionally draining, painful for oocyte donor In vitro fertilization (IVF) Oocytes and sperm incubated in culture dishes for several days Embryos (two‐cell to blastocyst stage) transferred to uterus for possible implantation