Reproductive System Diseases and Disorders PDF

Reproductive System Diseases and Disorders Menstrual Variations/Abnormalities Premenstrual Syndrome Discomfort experienced prior to menses due to rapid hormone shifts, vitamin deficiency, stress: Symptoms ________________ Treatments: analgesics, anti-depressants, B6...

Reproductive System Diseases and Disorders Menstrual Variations/Abnormalities Premenstrual Syndrome Discomfort experienced prior to menses due to rapid hormone shifts, vitamin deficiency, stress: Symptoms ________________ Treatments: analgesics, anti-depressants, B6, magnesium, nutrition balance Amenorrhea: =_____________________ no bleeding/ no menstrual cycle Types: primary vs. secondary___________________________ primary- never had period// secondary- period stops despite having cycle before Causes hormonal imbalance, depression, excessive exercise, malnutrition, ovarian tumor, pregnancy Dysmenorrhea= painful periods Etiology: pelvic infections, cervical stenosis, endometriosis, idiopathic Treatment: OCPs, NSAIDS, Heat oral contraceptives Menstrual Variations/Abnormalities Menorrhagia= heavy bleeding may need a hysterectomy Causes: tumor, pelvic inflammatory disease (PID), hormone imbalances Treatment: related to cause (surgery, antibiotic, OCPs to treat hormone imbalances Metrorrhagia= abnormal bleeding between periods pregesterone often issue Causes: hormone imbalance causing abnormal thickening and shedding of endometrial tissue Treatment: D&C  Menopause =natural halting of menstruation Perimenopause: 40-50 yrs old. Periods become ____________ One full year of no irregular periods = _____________. menopause Surgically induced menopause= _____________ uterus + ovaries removed Risk of cardiac disease and osteoporosis increases with menopause d/t _______ decreased levels of _______ estrogen and other hormone shifts Symptoms: Hot flashes, night sweats, and vaginal dryness. Depression, sleep disorders, and decreased libido Diagnosis: History of symptoms and menstrual cycles; labs: FSH level. Treatment: Antidepressants and low dose/shorter term HRT (hormone replacement therapy)  Diagnostic Tests for Females Bimanual examination: allows palpation of vaginal canal, cervix, female organs Pap smear of cervix: sample of cervical cells to test for cellular changes that may indicate early cervical cancer. – For example, ASCUS (atypical squamous cells of undetermined significance). – Add test for for HPV from cervical sample Cervical biopsy: takes tissue from the cervix for evaluation by pathologist Laparoscopy: allows visualization of abdominal and reproductive organs using small incisions instead of large surgical incisions. Breast ultrasound Mammogram- series of X-ray images of breast tissues to evaluate for breast cancer or other changes in breast tissue Breast biopsy  GYN PROCEDURE D&C Dilatation and curettage (D&C): Dilation of the cervix and scraping (curettage) of the uterine endometrial tissue. D&C is commonly used to treat abnormal uterine bleeding and following a miscarriage  Clinical Examples-Female Vaginitis (Inflammation of the vagina) – Types Candida: Fungus or yeast Trichomonas: Parasite Atrophic: Postmenopausal (low estrogen leads to thinning of the vaginal lining) – Symptoms: Vaginal burning, itching, swelling of the vagina and external genitalia pain/ intercourse is painful A white cottage cheese–appearing discharge with Candida Treatment: Antifungal for candida and metronidazole (Flagyl) for trich Estrogen cream for atrophic Abstain from sexual intercourse until healed Clinical Example: Bacterial Vaginosis (BV): Bacterial induced vaginal inflammation. Most common cause of vaginitis! Usually, "good" bacteria (lactobacilli) outnumbers "bad" bacteria (anaerobes) but overgrowth of anaerobic bacteria upsets natural balance of the microorganisms in the vagina & causes BV. Often associated with sexual activity but is NOT a sexually transmitted infection! S/S: thin grey vaginal discharge with “fishy” odor Vaginal itching, dysuria (_________) painful urination Dx: clue cells (epithelial cells with bacteria on them) on microscopic exam. Treatment  Clinical Example: Endometriosis Abnormal growth of endometrial tissue outside of uterus –Common implantation sites: Ovaries Fallopian tubes Abdominal wall Intestines –Implanted endometrial tissue continues to act under the influence of hormones producing cysts, scar tissue, and adhesions  Clinical Example, continued Endometriosis Symptoms: Dysmenorrhea Low back, vaginal, and pelvic cramping Heavy menses Dyspareunia Primary complication is infertility Treatment: Hormones Remission with pregnancy, nursing, and menopause Panhysterectomy  Clinical Example: PID Pelvic inflammatory disease (PID) -Inflammation of some or all pelvic reproductive organs -May include cervicitis, endometritis, salpingitis and oophoritis –Causes: Infection ascending reproductive tract. Chlamydia and Gonorrhea (STIs) most common causes  Clinical Example: PID – Symptoms: Fever, Chills Pelvic pain Leukorrhea Pain during sex Can lead to infertility or ectopic Cervical motion tenderness – Diagnosis: physical exam and culture of vaginal discharge – Prevention: Practicing safe sex with proper use of condoms – Treatment: Antibiotics, analgesics, rest – Comparable infection in men: epididymitis or orchitis  Clinical Example: Ovarian Cyst Ovarian Cyst Fluid-filled sac(s) on or near ovary. –Two types: Physiologic Neoplastic (abnormal type) –Symptoms: Low back pain Pelvic pain Dyspareunia Nausea and vomiting –Treatment: OCPs can sometimes be used to allow resolution of cysts by preventing ovulation –Some need laparoscopic drainage Clinical Example: PCOS Polycystic Ovarian Syndrome Etiology: excess androgen production from ovaries due to excess LH stimulation metabolic/hormonal issue Leads to formation of multiple immature follicles (cysts) in the ovary  Polycystic Ovary Syndrome (PCOS) Clinical Manifestations: Heavy irregular periods or amenorrhea Hirsutism_______________ hair growth + acne Acanthosis nigricans__________ darkening of skin (neck) Infertility (due to anovulation) ----Obesity, HTN, DM, etc. Diagnosed by history + physical Hormone levels Transvaginal ultrasound Treatment: fake periods Birth control pills (decrease androgen production and regulate periods) exercise improves insulin resistance, lowers insulin levels, adjust nutrition- high protein low carb Metformin (lowers insulin levels and improves ovulation) Spironolactone (med to block skin effects of androgens) + hair growth  Clinical Example: Toxic Shock Toxic shock syndrome – A severe, life-threatening infection caused by Staphylococcus aureus bacteria – Found almost exclusively in menstruating females using tampons – Symptoms: Sudden onset of high fever, vomiting, diarrhea Decreasing BP – Treatment: IV fluids. antibiotics  Clinical Example: Uterine Prolapse Uterine prolapse – Uterus protrudes into vagina – Symptoms: Heaviness in pelvis Urinary stress Dysuria Low back pain – Treatment: Hysterectomy Risks: aging, anatomy, multiple pregnancy, weak pelvic floor  Clinical Example: Cystocele Cystocele – Herniation of urinary bladder through anterior vaginal wall – Symptoms: Pelvic pressure Urinary urgency, frequency, and incontinence – Treatment depends on degree of herniation Kegel exercise Surgery like the sling to raise and support bladder  Clinical Example: Rectocele Rectocele – Herniation of rectum through posterior vaginal wall – Symptoms: Discomfort Constipation Fecal incontinence – Treatment: Surgical repair  Clinical Example: Fibroid Tumor Fibroid Tumor: Also known as leiomyomas Most are benign tumors of smooth uterine muscle –Most common tumor of female reproductive system –Symptoms: Abnormal uterine bleeding Excessive menstrual bleeding and pain Treatment depends on woman’s age and desire for children: Surgical removal or Hysterectomy  Clinical Example: Mastitis Mastitis: Inflammation of breast tissue – Can happen with breastfeeding moms as bacteria from baby’s mouth or mother’s hand enters breast tissue at the nipple puerperal (childbirth) mastitis – Symptoms: Redness, heat, swelling Pain*** Bloody nipple discharge – Treatment: May need to adjust lactation technique (call the lactation consultant!). Continue breastfeeding; empty breast Antibiotics, heat, analgesics, increase fluid intake, supporting bra to decrease discomfort  Clinical Example: Fibrocystic Breast Disease – Most common breast disorder of premenopausal females between age 30 and 55 - Benign cysts develop in breast tissue risk factors: genetic, caffeine intake – Cause: Cysts linked to estrogen levels – Treatment: To decrease breast pain: Reduce caffeine and salt Use mild diuretics Use mild analgesics week before menstruation  Pregnancy Clinical Examples Hyperemesis gravidarum Excessive vomiting during pregnancy Morning sickness – Mostly associated with first trimester of pregnancy Symptoms: – Cause? ? hormones: progestegen estrogen Excessive vomiting – Symptoms: Nausea and vomiting Leading to 1st trimester dehydration, weight Treatment: Not necessary unless excessive vomiting loss, and possible Light meals several times per day electrolyte imbalance Dry food before drinking Avoidance of fatty foods Rest after meals Treatment: B vitamins may help IV fluids Withholding all foods and oral fluids Zofran (antinausea meds) can be used in pregnancy Usually subsides by second trimester  Clinical Example Spontaneous abortion (aka miscarriage) – Natural termination of pregnancy before fetus is viable – Symptoms: Vaginal bleeding Cramping and pelvic pain – Treatment: Bed rest Once spontaneous abortion begins, it is difficult to stop D&C --(dilation and curettage) why is this necessary sometimes? to get all placental + embryonic tissue out  Clinical Example Ectopic pregnancy Fertilized ovum attaches to tissue outside uterus. Usually in fallopian tubes. *THIS IS NOT A VIABLE PREGNANCY* Symptoms: Acute pelvic pain Vaginal bleeding Positive pregnancy test –Diagnosis: blood test for HCG, ultrasound –Treatment: Prompt surgery to terminate pregnancy: Every effort taken to preserve ovary and tube if future pregnancy desired  Clinical Example Toxemia = Pre-eclampsia – Cause: not fully understood, but involves abnormal placental blood vessel function and response to hormones Serious blood pressure condition  Disorders of Pregnancy:Pre-eclampsia (cont) Usually appears during 3rd trimester Clinical Manifestations Hypertension develops slowly or suddenly Sudden weight gain Proteinuria Edema in face, hands, and feet. Vision changes. Can lead to eclampsia (with seizures) or stroke. Treatment: Only cure is delivery! May need to induce early! IV magnesium drip Monitor blood pressure closely in 3rd trimester ***can develop in the postpartum period, too ***  Clinical Example high risk pregnancy Placenta previa: Abnormal positioning of placenta in lower uterus often near or over cervical os monitor closely during pregancy found on ultrasound –Symptoms: Painless, bright red vaginal bleeding during 3rd trimester Drop in BP if severe bleeding Diagnose by ultrasound –Treatment: Vaginal delivery if asymptomatic or bleeding not severe Emergency C-section if maternal bleeding or fetal anoxia  Clinical Examaple Hydatidiform mole: rare aka molar pregnancy – Cyst-like growths in the uterus in an non-viable pregnancy. – May include either embryonic or placental tissue, but is not a fetus – HCG level is________ normal preg level to elevated no viable placenta or embryo – Treatment: D&C (dilation and curettage) to remove tissue nonviable fertilized egg trophoblastic cells grow in excess (tumor)  Male Reproductive System Diseases Cryptorchidism – Undescended testicle – Common cause: Premature birth – Treatment: Surgery Can lead to infertility if 12-18 months not treated by 18 mo. Slight increased risk of testicular torsion and testicular CA  Male Reproductive System Diseases Prostatitis: Inflammation of prostate gland Cause: often from a UTI or STI (sexually transmitted infection) Symptoms: Dysuria Pyuria Fever Low back pain Diagnosis: UA, Urine culture, digital rectal exam (allows examiner to feel prostate) inflammed and painful UTI and STI check Treatment: PAIN Antibiotics Warm sitz baths Increased fluid intake Analgesics  Sexually Transmitted Infections (STIs)aka sexually transmitted A group of diseases many diseases that are spread by intimate or sexual contact Treatment : treat organism with appropriate meds; i.d. sexual partners and treat the infected individuals concurrently. Most are reportable conditions to health dept. Prevention of STIs is best achieved by avoiding intimate contact with infected individuals; condoms. Term: Dyspareunia= Pain or discomfort with sexual intercourse; Can be a symptom infection (STI or urinary tract) or structural deformity  STIs Genital herpes: viral infection of mucus membrane Very common; 1/6 people have Herpes simplex virus HSV-2 most common for genital herpes – Symptoms: HPV HIV Blisters HSV Extreme pain Severe itching Painful urination Remission and exacerbations Diagnosis: viral culture of active lesion condoms Treatment: Cannot cure; antiviral medications like help protect acyclovir for flare ups partner can transmit to sexual partner if active exacerbation  STIs Chlamydia (aka silent STI) – Very common, one of the most damaging STDs – Cause: bacterial Chlamydia trachomatis – Symptoms: Males can be asymptomatic discharge from penis or vagina Burning and itching of genital area or with urination Abdominal pain and dyspareunia in the infected (can be a sign of more severe infection PID-pelvic inflammatory disease=________________________________________ anywhere in reproductive tract Diagnosis: culture Treatment: Antibiotics Reportable STI, so partners are contacted and must also be treated  Gonorrhea STIs Cause: Neisseria gonorrhoeae bacterium Clinical manifestations Purulent discharge from penis or vagina Urinary frequency & dysuria Cervicitis in females Genital itching and burning pain Diagnosis: culture Often associated with chlamydia infection Treatment: Antibiotics like Penicillin GC lab to check for gonorrhea and chylmideia  STIs Trichomoniasis TRICH – Common STD affecting ~10% of all sexually active individuals – Cause: Protozoan – Trichomonas vaginalis – Treatment Flagyl (metronidazole) combo antibiotic and antiprotaozan Female Symptoms – Itching and burning of genital area – Green, frothy vaginal discharge Male Symptoms – Urethritis – Epididymitis – Prostatitis  STIs Genital warts – One of the most common STDs – Warts in the genital area – Cause: HPV (virus)—>100 types of HPV viruses. Types 6 & 11 related to genital warts; these are not the high risk types assoc. with cervical cancer Symptoms: vaccine available Tenderness, discomfort related to size, location, and number of warts Treatment: Chemical or surgical removal, laser treatment, electrocautery, cryotherapy  STIs: Syphilis – Chronic, life-threatening STD – Cause: Treponema pallidum bacterium – Symptoms: Three stages Primary – Painless skin chancre appears Secondary – Chancre heals – Rash appears  Syphilis (continued) Tertiary stage Dormancy after stage 2 can last 1-20 years Bacteria invades organs Gummy lesions appear (a gumma) on skin, bone, organs In pregnant women: risk of miscarriage, fetal death or birth defects Treatment: -Penicillin or Tetracycline Curable with antibiotics during this stage but possible complications are irreversible like heart failure, mental disorder, insanity, blindness, paralysis, death etc)  Epididymitis and Orchitis Inflammation of epididymis or testes Etiology: prostatitis, UTI, STI like chlamydia/gonorrhea , viral mumps. Can lead to scarring & sterility if not treated –Symptoms: Swollen, hard, and painful epididymis or testes Severe scrotal pain and swelling Fever/malaise Diagnosis: by symptoms, UA, urine culture, STI test –Treatment: Antibiotics---- Rest &Analgesics; Use of scrotal support Avoidance of sex  STIs-REVIEW from past chapters Acquired immunodeficiency syndrome (AIDS) – Blood-borne viral infection with HIV Hepatitis – Viral infection of the liver – Hepatitis B and C can be spread by sexual intercourse. Vaccine for Hep B, no vaccine for C but better treatment now for Hep C.  Cancers of the Reproductive System Breast cancer Adenocarcinoma of breast ducts Most common breast neoplasm Affects 1 out of 8 females –Risk factors: Breast cancer Age 40 and over Symptoms: Nontender lump Family member affected with of varying size (often not breast cancer detected with self exam) estrogen progesterone Onset of menses before age 13; Menses continuing after age 50 Diagnosis: mammogram Nullipara or First child after age 30 and biopsy Obesity no children Treatment: Lumpectomy give meds to supress estrogen Mastectomy targeted therapy immunotherapy Chemotherapy Radiation Copyright © 2018 Cengage Learning. All Rights Reserved. ® Cancers of the Reproductive System Uterine cancer=Endometrial cancer – Develops in endometrium and spreads to uterine wall Symptoms: like spotting Abnormal bleeding in postmenopausal females Vaginal bleeding in a menopausal woman is NEVER normal Needs endometrial biopsy to evaluate! Treatment: Surgical removal of uterus and ovaries; Radiation therapy, chemo possible Cancers of the Reproductive System Ovarian cancer Difficult to detect in early stages because symptoms are non-specific; Often fatal –Risk: Women with at least 1 child, those who’ve breastfed, or been on OCPs have lower risk. –Symptoms are very non-specific LH increases during menopause because Pressure on bladder there is no more estrogen Abdominal or pelvic pain General feeling of ill health –Treatment: Complete hysterectomy, Radiation & Chemotherapy Cancers of the Reproductive System Cervical cancer – 5th leading cause of cancer-related death in females – Most common cause: Human papillomavirus (HPV) High risk HPV types 16 & 18 – Symptoms: Abnormal cervical bleeding – Treatment: Surgical removal of tumor – Prevention: Reduce risk factors AND Have yearly pap smear tests – follow up on results Get HPV vaccine up to age 45  Cancers of the Male Reproductive System 1. Prostate Cancer (Ch. 18 slides)-slow growing, asymptomatic or BPH symptoms 2. Testicular tumor: Commonly affects young males between age 20 and 35. Most common type of cancer in this age group Diagnosis: Physical exam (painless testicular mass) Biopsy ***Testicular self-exam recommended monthly starting after puberty Symptoms: Painless mass felt in testicle Treatment: 90% cure rate if caught before metastasis Orchiectomy take off teste Chemotherapy & Radiation Mini-Endocrine Section ********** 1. What findings here are particularly significant? Case Study: SJ; 50 y/o female 2. What is the probable cause Clinical findings: of SJs disorder? Blood pressure 148/94 3. What would you suggest as high Rounded face a proposed treatment? Obesity of the trunk 4. What other symptoms is Slender extremities Sandra probably Muscular weakness experiencing? tumor pushes on pituary sending out ADH 5. Could this be any of the Plasma cortisol levels: following?: a) Addison’s disease 40 g/dL ( at 7am) (norm 5-25) b) Diabetes Plasma ACTH levels: problem c) Pheochromocytoma 100 pg/mL (at 7am) (norm 6-72) d) Cushing’s syndrome e) Hypoaldosteronism Xray—erosion of sella turca, MRI: tumor near pituitary adrenocortico tropic hormone - produces cortisol levels Adrenal Gland Diseases: Cushing’s Syndrome Overproduction of glucocorticoid cortisol Etiology: pituitary or adrenal gland tumor, or excess medication (#1 cause)) Symptoms related to excess cortisol: “moon face” immune Buffalo hump on upper back response Fatigue Poor wound healing Round abdomen and thin arms and legs Striae on skin (stretch marks) HTN Diagnoisis: cortisol blood level, MRI (view tumors) Treatment: surgery, meds to block cortisol production or effects of cortisol , wean down steroid meds NOTE: Oral Prednisone Glucocorticoids (prednisone) used to treat inflammatory disease (like asthma flares, skin reactions, autoimmune conditions). Should be used short-term due to side effects and masking symptoms of infections When prednisone is taken long term, the adrenal glands make less natural cortisol. Stopping prednisone quickly can cause withdrawal symptoms So we often taper dose of steroid to avoid this! Example of “moon face” from long term steroid use http://www.hugsforhailey.com/2012/10/moon-face.html 2. Cushing’s syndrome Hypoadrenalism( Addiso Overproduction of n’s disease): Low secretion glucocorticoid cortisol; of hormones by adrenal cortex pituitary tumor, adrenal gland tumor or excess medication https://pbs.twimg.com/media/EwTORBqW8AUZPyK.jpg  Clinical Example: Pituitary Gland Diseases: Diabetes (“diabetes” =passing through) Insipidus -Pituitary gland defect causing a _____ in ADH (antidiuretic hormone) release -Or defect in kidney tubules: decrease response to vasopressin (ADH) Causes: --- Symptoms: Excessive polyuria: diliuted Polydipsia Hypotension Dizziness Constipation  Pituitary Gland Diseases: Syndrome of Inappropriate ADH decrease urine volume low sodium ADH high ADH low