Clase Pato vías reproductoras parte 1 PDF

# Trastornos Patológicos De Las Vías Reproductoras Femeninas y Masculinas ## Universidad Arturo Prat Del Estado de Chile ### Fisiología y Patología II - Química y Farmacia 2024 ### Parte I ## By Dra. Javiera Rodríguez Q. ## Contenidos * **Introducción** * **Trastornos de las vías reproductoras fe...

# Trastornos Patológicos De Las Vías Reproductoras Femeninas y Masculinas ## Universidad Arturo Prat Del Estado de Chile ### Fisiología y Patología II - Química y Farmacia 2024 ### Parte I ## By Dra. Javiera Rodríguez Q. ## Contenidos * **Introducción** * **Trastornos de las vías reproductoras femeninas** * Amenorrea * Metrorragia * Ovario Poliquístico * Cáncer cervico-uterino * Embarazo ectópico * Endometriosis * **Trastornos de las vías reproductoras masculinas** * Fimosis * Criptorquidea * Epididimitis * Hidrocele * Prostatitis * Cáncer de próstata ## **Bibliografía** ## Introduction The disorders of the reproductive tracts affect both the female and male reproductive system and can have a significant impact on the health and quality of life of people, in addition to affecting fertility. These disorders can be caused by infections, hormonal imbalances, anatomical anomalies, genetic factors, or chronic diseases. ## Las vías reproductoras femeninas The disorders of the female reproductive tracts can arise as a result of a disease in one of the many and varied reproductive organs: ovaries, fallopian tubes, uterus, cervix, vagina, or breasts. During the reproductive years, these disorders often manifest as alterations in menstruation, pelvic pain, or infertility. ## Los órganos reproductores pélvicos The pelvic reproductive organs include the vagina, cervix, uterus, fallopian tubes, and ovaries. * **The two ovaries** contain thousands of follicles, each containing an oocyte and granulosa cells surrounding it. * **The fallopian tubes**, which open into the peritoneal cavity, connect the ovaries to the uterus. * **The uterus** contains an inner lining that is sensitive to hormones called the **endometrium**. # **Trastornos de las vías reproductoras femeninas - Amenorrhea** ## **Etymology** Amenorrhea is the abnormal absence of menstruation. * **Amenorrhea Iria (0.3%)** absence of menarche in a 14-year-old adolescent without the development of secondary sexual characteristics or by the age of 16 with normal development of these characteristics. * **Amenorrhea IIria (4%)** secondary amenorrhea is the absence of menstruation for at least 6 months after the normal onset of menarche. The absence of menstruation is normal before puberty, after menopause, during pregnancy, and breastfeeding; it is pathological at any other time. ## **Etiology** * Anovulation due to deficient secretion (ovulatory cycle disorders) * Lack of ovarian response to gonadotropins * Constant presence of progesterone or other endocrine abnormalities * Endometrial adhesions (Asherman's syndrome) * Ovarian, adrenal, or pituitary tumor. ## **Cuadro 22-5 Causes of Amenorrhea** | **Category** | **Common causes** | **Physiopathological mechanisms** | **How to make a diagnosis** | **Intervention** | |-----------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------|--------------------------------------------------------------| | **Physiological processes - Normal** | * Pregnancy | * Sustained high levels of estrogen and progesterone | * Serum b-hCG, clinical history | * Prenatal care | | | * Menopause | * Lack of estrogen | * Clinical diagnosis | * Recommendations for osteoporosis prevention, surgical treatment | | **Uterine disorders and outlet disorders** | * Disorders of sexual development | * Excessive exposure to androgens | * Physical examination | * Surgical treatment | | | * Congenital anomalies (e.g., imperforate hymen) | | * Physical examination | * Surgical treatment | | | * Asherman's Syndrome | * Endometrial destruction (e.g., from vigorous curettage) | * Lack of response to estrogen-progestin tests, direct visualization of thin endometrium | * Removal of the ovaries or the ovaries and fallopian tubes; if a Y chromosome is found there is a high risk of gonadoblastoma | | **Ovarian disorders** | * Gonadal dysgenesis | * Deletion of genetic material from the X chromosome | * Karyotype | * Removal of the ovaries or the ovaries and fallopian tubes; if a Y chromosome is found there is a high risk of gonadoblastoma | | | * Premature ovarian insufficiency | * Lack of ovarian follicles | * Gonadotropin level check | * Reduction of ovarian androgen production (wedge resection, oral contraceptives), increase FSH secretion, | | | * Polycystic ovary syndrome | * Alterations in intraovarian hormonal interactions | * Clinical diagnosis in patients with chronic anovulation and excessive androgens | * Replacement therapy in case of FSH deficiency, tumors should be investigated in case of excessive levels | | **Hypothalamic-pituitary disorders** | * Stress, exercise, athleticism, low body mass index | * Alterations in the pulsatile secretion of GnRH | * Check TSH, PRL, and gonadotropins in the serum | * Replacement therapy in case of deficiency, tumors should be investigated in case of excessive levels | **Key:** hCG, human chorionic gonadotropin; FSH, follicle-stimulating hormone; TSH, thyroid-stimulating hormone; PRL, prolactin ## **Fisiopatología** The mechanism varies depending on the cause and whether the defect is structural, hormonal or both. Women who have adequate estrogen levels but also have a progesterone deficiency do not ovulate and are therefore infertile. **Amenorrhea Iria** The **hypothalamic-pituitary-ovarian axis** is dysfunctional. Due to anatomical defects in the central nervous system, the ovary does not receive the hormonal signals that normally initiate the development of secondary sexual characteristics and menstruation. **Amenorrhea IIria** May result from any of various mechanisms: * **Central:** hypogonadotrophic, hypoestrogenic anovulation * **Uterine:** such as in Asherman's syndrome, which is intensely pathological scarring that replaces the functional endometrium. * **Premature ovarian insufficiency** <start_of_image> схема: [image of diagram of hypothalamic-pituitary-ovarian axis: the path of hormones and feedback loops ] ## **Manifestations clinic** * **Absence of Menstruation** * Amenorrhea itself implies the absence of menstrual cycles. * **Primary Amenorrhea:** Never occurs * **Secondary Amenorrhea:** Stops after recurring regularly. * **Hot Flashes (Vasomotor Flushes)** * These are due to alterations in the thermoregulatory center of the brain and are a common symptom of low estrogen levels. * **Vaginal Atrophy** * Without sufficient estrogen, the vaginal lining thins and loses elasticity, causing discomfort and dryness. * **Hirsutism** * Excessive hair growth in areas where it is normally minimal is caused by an imbalance between estrogen and androgen levels. * **Acne** * (Secondary Amenorrhea): Usually due to high levels of androgens. These increase the activity of sebaceous glands on the skin, leading to acne. # **Diagnosis** * **Physical and Gynecological Examination** to rule out pregnancy and anatomical abnormalities that may cause false amenorrhea * **Complete Medical Examination** (including appropriate X-rays, CT scans, MRIs, and biopsies) can help detect ovarian, adrenal, and pituitary tumors. * **Blood and Urine Tests** show hormonal imbalances, such as high or low pituitary gonadotropin levels and abnormal thyroid hormone levels. * **Other tests:** * **Fern Test:** Applying a cervical mucus smear to a slide and allowing it to dry under ambient conditions. A fern-like crystallization pattern is indicative of the presence of estrogen. * **Serum LH and FSH levels** (higher-than-normal levels indicate ovarian insufficiency) # **Treatment** * **Treatment for Secondary Amenorrhea Causes** * **Hormonal Replacement Therapy** * FSH and gonadotropins for menopausal women and women with hypo-pituitary disorders (e.g., Menotropin, HMG-Lepor, Pergowerk). * **Keep track of the menstrual cycle** * Teach a patient to keep a journal to record menstruate cycles, so that it is accurate for future reference. схемы: [ images depicting different medications and a calendar ] * **Estrogen Conjugate Replacement Therapy (TRE)** * The replacement of the appropriate hormone to restore menstruation. * **Induction of ovulation in cases of intact hypothalamic-pituitary axis** * Clomiphene citrate induces ovulation in women with secondary amenorrhea due to ovarian deficiency, polycystic ovarian disease, or excessive weight. # **Trastornos de las vias reproductoras femeninas - Metrorragia** ## **Etymology** Metrorrhagia is irregular uterine bleeding that occurs outside of the normal menstrual cycle, unrelated to menstruation. It can be mild or severe, occasional or recurring. ## **Etiology** The causes of metrorrhagia can be divided into two main categories: organic causes and functional causes. * **Organic causes** * **Neoplasias:** polyps, endometrial hyperplasia, endometrial or cervical cancer * **Infectious diseases:** cervicitis, endometritis * **Hormonal disorders:** polycystic ovary syndrome, ovarian insufficiency * **Structural lesions:** fibroids, adenomyosis, cervical canal lacerations * **Functional causes** * **Anovulation:** Imbalance between estrogen and progesterone leading to excessive endometrial thickening. * **Coagulation disorders:** conditions such as hemophilia and Von Willebrand disease * **Medications:** Hormonal contraceptives, anticoagulants, antidepressants ## **Fisiopatology** The pathophysiology of metrorrhagia varies depending on the origin and can be divided into hormonal and structural categories. * **Hormonal Metrorrhagia** * **Ovarian dysfunction:** In anovulation the endometrium does not receive regular estrogen and progesterone levels. This can trigger excessive endometrial growth without progesterone balancing it out, resulting in continuous, irregular bleeding and eventually endometrial shedding. * **Hormonal imbalance:** Any issue with the hypothalamic-pituitary-ovarian axis, common during puberty and menopause, leads to irregular menstrual cycles and metrorrhagia episodes. * **Structural Metrorrhagia** * **Endometrial alterations:** Endometrial polyps, fibroids, and tumors can cause bleeding due to increased abnormal vascularization and the fragile nature of the affected tissue. * **Infections:** Chronic inflammation from cervicitis and endometritis can lead to vascular and tissue changes, increasing tissue fragility and bleeding. ## **Manifestations clinic** * **Irregular vaginal bleeding** * Outside the normal menstrual cycle, bleeding can range from mild to heavy. * **Pelvic pain** * In some cases, it may be associated with underlying conditions such as fibroids or infections. * **Associated symptoms:** * If metrorrhagia is due to a hormonal disorder, it may be accompanied by other signs of ovarian dysfunction, such as acne and hirsutism (seen in PCOS). * **Anemia** * Excessive or prolonged bleeding can lead to anemia, with symptoms including fatigue and pallor. ## **Diagnosis** The diagnosis of metrorrhagia entails clinical evaluation and additional tests to uncover the underlying cause. * **History and physical examination:** Identify bleeding patterns and any associated symptoms (e.g., pelvic pain, anemia). * **Imaging Studies:** * **Transvaginal ultrasound:** Examines the endometrium and rules out structural issues * **Hysteroscopy:** When necessary, provides direct visualization of the endometrium and allows for biopsies. * **Endometrial biopsy:** Used when tumors are suspected. * **Laboratory Tests:** * **Complete blood count:** Determines anemia * **Hormonal profile:** Assesses estrogen, progesterone, LH, FSH, TSH levels to identify ovarian dysfunction * **Coagulation tests:** Detect clotting disorders схема: [image of uterus and a histeroscopio ] # **Treatment** Metrorrhagia treatment depends on the identified cause and might include medical and surgical options. * **Medical** * **Hormone Therapy:** Oral contraceptives and progestogens are used to regulate the cycle, managing anovulation or ovarian dysfunction cases * **NSAIDs:** Alleviate bleeding in milder cases * **Tranexamic acid:** Reduces heavy bleeding, especially in patients with coagulation problems * **Antibiotics:** Given for infections like cervicitis or endometritis. * **Surgical** * **Uterine curettage or hysteroscopic surgery:** Used to remove polyps, fibroids, or perform an endometrial scraping for endometrial hyperplasia. * **Endometrial ablation:** Destroys the endometrium to reduce bleeding, suitable for when fertility preservation is not a priority. * **Hysterectomy:** Considered in severe cases, when other options are ineffective, or in the presence of a tumor. # **Trastornos de las vias reproductoras femeninas - Ovario Poliquístico** ## **Etymology** Polycystic ovary syndrome (PCOS) is a common disorder affecting women of reproductive age. It is characterized by a hormonal imbalance that disrupts ovulation, potentially resulting in menstrual irregularities, infertility, metabolic changes, and physical alterations. ## **Etiology** * **Genetics:** Family history of PCOS or other endocrine disorders * **Insulin resistance:** The majority of PCOS patients experience insulin resistance, which leads to hyperinsulinemia and affects ovarian function. * **Hormonal imbalance:** Excess androgens (hyperandrogenism) and improper gonadotropin (LH and FSH) production interfere with follicular maturation and ovulation. ## **Fisiopatología** The pathogenesis of PCOS is complex and focuses on the hypothalamic-pituitary-ovarian axis and insulin metabolism. * **Hypothalamic-Pituitary-Ovarian Axis Alterations:** * **Elevated LH secretion:** In PCOS, this axis displays increased luteinizing hormone (LH) levels and relatively low follicle-stimulating hormone (FSH) levels. * **Ovarian hyperandrogenism:** The excess LH increases the activity of ovarian thecal cells, leading to excessive androgen production (such as testosterone), which interferes with normal follicular development and ovulation. * **Insulin Resistance and Hyperinsulinemia:** * **Insulin resistance:** Peripheral tissues react poorly to insulin, resulting in higher blood sugar levels and hyperinsulinemia * **Increased androgen production:** Insulin further stimulates thecal celles to produce more androgens, exacerbating hyperandrogenism. * **Decreased sex hormone-binding globulin (SHBG):** Hyperinsulinemia reduces SHBG production in the liver, leading to higher levels of free androgens in the blood. схема: [ diagram of hypothalamic-pituitary-ovarian axis and insulin resistant cell ] ## **Manifestations clinic** * **Menstrual Irregularities:** such as amenorrhea, oligomenorrhea (long cycles), or metrorrhagia. * **Infertility:** Anovulation or irregular ovulation makes conception challenging * **Hyperandrogenism:** * **Hirsutism:** Excessive hair growth in typical male areas like the face, chest, and abdomen. * **Acne and oily skin:** Resulting from excess androgens. * **Metabolic symptoms:** * **Insulin resistance:** Can lead to type 2 diabetes * **Central obesity:** Increased abdominal fat deposition * **Dyslipidemia:** Elevated triglyceride and LDL cholesterol levels * **Androgenic alopecia:** Hair loss with a male pattern ## **Diagnosis** PCOS diagnosis relies on the Rotterdam criteria, requiring at least two out of three specific features to be present. * **Menstrual irregularities:** Oligomenorrhea or amenorrhea * **Polycystic ovaries on ultrasound:** 12 or more small follicles in each ovary or an increased ovarian volume (>10 mL) * **Clinical or biochemical hyperandrogenism:** Hirsutism. acne, alopecia, or high androgens in the blood. **To aid diagnosis, consider:** **History and Physical Examination:** Includes family and personal history, as well as an evaluation of symptoms. **Hormonal Profile:** Measures LH, FSH, testosterone, androstenedione, and DHEA-S. **Metabolic Tests:** Fasting glucose level, lipid profile, and insulin sensitivity assessment. **Transvaginal Ultrasound:** Examines the ovaries to look for multiple follicles. схема: [ image of woman and an ultrasound with the uterus and ovaries ] ## **Treatment** PCOS treatment is tailored to symptoms and objectives - whether it's focusing on controlling them or restoring fertility. * **Regularization of the menstrual cycle and management of hyperandrogenism symptoms:** * **Combined oral contraceptives:** Regulates the menstrual cycle and reduces hyperandrogenism (alleviating acne and hirsutism). * **Antiandrogens:** Medications like spironolactone manage hirsutism and acne, but are best used alongside contraceptives due to potential birth defects. * **Progestins:** Cyclic use induces bleeding and safeguards the endometrium in those who prefer or are unable to use combined contraceptives. * **Insulin resistance and metabolic control:** * **Metformin:** Improves insulin sensitivity, aiding in menstrual cycle regulation as well. * **Lifestyle modifications:** Balanced diet and regular exercise are essential. * **Induction of Ovulation for Fertility** * **Clomiphene citrate:** A first-line ovulation-inducing medication. * **Letrozole:** An alternative ovulation-inducing medication that can be more effective for some patients. * **Gonadotropins:** A more complex option, used in advanced cases or alongside assisted reproductive techniques. схема: [ images of different medications ] # **Trastornos de las vias reproductoras femeninas - Cáncer Cervico-Uterino** ## **Etymology** Cervical cancer, the third most common gynecological cancer, is classified as preinvasive or invasive. * **Preinvasive:** Cervical intraepithelial neoplasia (CIN) or **carcinoma in situ:** Confined to the cervical epithelium, not extending beyond the basement membrane. * **Invasive:** Cancer cells penetrate the basement membrane of the cervical epithelium and spread to nearby tissues. ## **Etiology** The primary cause of cervical cancer (cervical cancer) is persistent infection with the **human papillomavirus (HPV)** ## **Predisposing Factors** These factors contribute to HPV progression to cancer: * **Early onset of sexual activity** * **Multiple sex partners or partners who have had multiple partners** * **Immunodeficiency:** For example, HIV infection * **Smoking:** Increases the risk of cervical dysplasia. * **Lack of Pap or HPV screening** ## **Fisiopatología** Preinvasive disease ranges from mild cervical dysplasia, where the lower third of the epithelium contains abnormal cells, to **carcinoma in situ,** where the entire epithelial thickness shows abnormal cell proliferation. Early detection and appropriate treatment of preinvasive disease can result in a cure rate of 75-90%. Without treatment, preinvasive disease has a chance of progressing to invasive cervical cancer. In invasive carcinoma, cancer cells break through the basement membrane and can spread directly to nearby pelvic structures or distant sites through the lymphatic system. * In approximately 95% of cases, cervical cancer is considered **squamous cell carcinoma**. The cells are present in varying levels of differentiation (ranging from well-differentiated to highly anaplastic fusiform cells). Only 5% of cases involve adenocarcinoma. ## **Cáncer de cuello uterino** схема: [ images of a normal cell, precancerous cell, carcinoma in situ and squamous cell carcinoma and the uterus ] ## **Manifestations clinic** * **Preinvasive Disease:** Generally no symptoms or other noticeable changes. * **Early-stage Invasive Cervical Cancer:** * *Abnormal vaginal bleeding* * *Persistent vaginal discharge* * *Pain or bleeding after intercourse* * **Advanced Stage:** * *Pelvic pain* * *Vaginal discharge of urine or feces due to fistulas* * *Loss of appetite, weight loss, and anemia* ## **Diagnosis** The diagnosis of cervical cancer includes Pap test, biopsy, colposcopy, and other imaging tests. * **Pap Test** * A pap test is done by taking cells from the cervix and looking at them under a microscope for abnormal cells. * **Colposcopy** * Colposcopy is done using a magnifying instrument to examine the cervix for details not visible with a routine pelvic exam. * **Biopsy** * A biopsy is a procedure that involves removing a small sample of tissue from the cervix to examine it under a microscope for cancerous cells. A cone biopsy is performed if the endocervical curettage results positive. * **ViraPap™** Examination of the structure of the sample DNA with the ViraPap™ test can detect the presence or absence of HPV. * **Linfangiography and cystography** can detect metastasis. * **Gamma scans of organs and bones** can detect metastasis. схема: [ images of a woman with a pap smear, a colposcopy and the uterus ] # **Treatment** Treatment for cervical cancer depends on the location and stage of the cancer. * **Preinvasive Lesions** * **Loop electrosurgical excision procedure (LEEP):** Surgical removal of the abnormal tissue. * **Cryosurgery:** Freezing and destroying abnormal tissue. * **Laser ablation:** Using a laser beam to remove the abnormal tissue. * **Conization:** Surgical removal of a cone-shaped piece of tissue from the cervix. * **Hysterectomy:** Surgical removal of the uterus. * **Invasive Carcinoma:** * **Radical hysterectomy:** Surgical removal of the uterus, cervix, fallopian tubes, ovaries, and lymph nodes. * **Radiation therapy (internal or external):** Used to destroy cancerous cells. * **Chemotherapy:** Medication used to kill cancer cells. схема: [ images of the uterus and the treatment options ] # **Trastornos de Las vías reproductoras femeninas - Embarazo Ectopic** ## **Etymology** An ectopic pregnancy occurs when a fertilized egg implants outside the uterine cavity, most commonly in the fallopian tube. This condition usually has a favorable prognosis with timely diagnosis, appropriate surgery, and control of bleeding. A few ectopic pregnancies reach term, with rare cases of abdominal implantation, where the fetus may survive to term. ## **Etiology** Several factors can contribute to ectopic pregnancy: * **Tubo-occlusive tumors:** These tumors can obstruct the fallopian tube. * **Prior surgical procedures:** Past tubal ligation (tubal sterilization) or tubal resection can be associated with ectopic pregnancy. * **Transmigration of the egg:** The egg may move outside the fallopian tube. * **Congenital defects:** Birth defects in the reproductive system can make ectopic pregnancy more likely. * **Pelvic inflammatory disease (PID) or sexually transmitted infections (STIs):** Inflammation or scarring in the fallopian tubes can lead to ectopic pregnancy. * **IUDs:** Intrauterine devices can increase the risk of ectopic pregnancy. ## **Fisiopatología** In ectopic pregnancy, the blastocyst's journey to the uterus is delayed, leading to implantation in a different, vascularized location, typically the fallopian tube lining. * **Early symptoms:** Initially, many women experience typical pregnancy signs (e.g., breast tenderness, fatigue, nausea, vomiting) and an enlarged uterus. * **HCG levels** remain lower than in an intrauterine pregnancy. схема: [ image of the fallopian tube and ovary ] ## **Manifestations clinic** Ectopic pregnancy can sometimes produce symptoms similar to a normal pregnancy or none at all. However, mild abdominal pain, often in the area of implantation, is common. * **Symptoms of ectopic pregnancy:** * **Abdominal tenderness and pain:** It can be caused by the fertilized egg implanting or the growing pregnancy in the fallopian tube. * **Amenorrhea:** Absence of menstrual periods. * **Unusual vaginal bleeding:** May be lighter or darker than a regular period. * **Unilateral pelvic pain:** Can be caused by the ectopic pregnancy growing in one of the fallopian tubes. * **Rupture of a fallopian tube:** This is a serious emergency. Symptoms include acute, intense lower abdominal pain that might radiate to the shoulders, and neck ## **Diagnosis** Diagnosis of ectopic pregnancy involves testing and imaging procedures: * **Serum hCG level:** Lower than expected in an intrauterine pregnancy. * **Culdocentesis:** A procedure to check for non-clotting blood. It suggests an active internal bleed, indicating a tubal rupture. * **Ultrasound:** Can show an intrauterine pregnancy, a tubal pregnancy, or an ovarian cyst. * **Laparoscopy:** A surgical procedure used to confirm ectopic pregnancy if ultrasound results are unreliable. ## **Treatment** Treatment for ectopic pregnancy depends on the severity and is often combined with supportive care. * **Supportive Care:** * **Blood transfusion:** Often necessary if the blood loss is significant. * **IV antibiotic therapy:** Used to prevent infection. * **Iron supplementation:** To address anemia. * **Medical Treatment:** * **Methotrexate:** A medication that interrupts the growth of cells and can sometimes be used to treat ectopic pregnancies. * **Surgical Treatment:** * **Salpingoclasia (tubal ligation or occlusion):** This procedure is performed during laparoscopy, Excision of a fallopian tube. * **Laparotomy:** A surgical procedure to remove an ectopic pregnancy if the tube has ruptured. * **Microsurgical tubal repair:** If the fallopian tube is not ruptured, surgical repair may be possible to preserve fertility. # **Trastornos de las vías reproductoras femeninas - Endometriosis** ## **Etymology** Endometriosis is a condition with endometrial tissue (normally lining the inside of the uterus) found outside its normal location. This tissue can be found in the pelvis, around the ovaries, uterus, fallopian tubes, bowels, bladder, and even in rare cases, other areas of the body. Endometriosis can cause pain, infertility, and other symptoms. ## **Etiology** While the exact cause of endometriosis is unknown, several theories suggest potential mechanisms: * **Retrograde Menstruation:** A common theory suggests that menstrual blood containing endometrial cells flows backward through the fallopian tubes into the pelvic cavity, where it can attach and grow. * **Genetic Predisposition:** Family history of endometriosis suggests a genetic link. * **Immune system dysfunction:** A weakened immune system might fail to recognize and destroy misplaced endometrial cells, allowing them to grow. * **Celomic Metaplasia:** This theory suggests that cells lining the abdominal cavity can transform into endometrial-like cells. * **Lymphatic or Hematogenous Dissemination:** Endometrial cells could spread through the lymphatic system or bloodstream to other locations. ## **Fisiopatología** Endometriosis is characterized by the abnormal growth of endometrial-like tissue outside the uterus. These misplaced cells respond to hormonal fluctuations just like the endometrial lining in the uterus, resulting in the same cyclic growth, breakdown, and bleeding. * **Menstrual cycle changes:** These changes lead to pain, inflammation, and scarring in the pelvic area. The bleeding can cause pain, particularly during menstruation, and can lead to the formation of adhesions. * **Inflammation:** Inflammation caused by bleeding within the ectopic tissue can trigger the growth of scar tissue and adhesions. * **Scarring and adhesions:** These can distort pelvic organs and cause pain and infertility. * **Infertility:** Endometriosis can impact fertility by blocking fallopian tubes, impeding egg release from follicles, or disturbing egg implantation. ## Endometriosis схема: [ a uterus with endometrial implants ] ## **Manifestations clinic** Endometriosis symptoms vary depending on the severity and location of the implants. The most common symptom is pain. * **Classic Symptoms:** * **Dysmenorrhea:** Painful menstrual periods frequently associated with endometriosis. * **Abnormal uterine bleeding:** Irregular bleeding between periods or heavier periods than usual. * **Infertility:** Endometriosis can make it difficult to get pregnant. * **Pain:** Endometriosis is often associated with chronic pelvic pain, especially during or right before menstruation. * **Pain in the ovaries or cul-de-sac:** Can cause deep pain during intercourse. * **Bladder pain:** Pain during urination or difficult urination * **Bowel pain:** Pain during bowel movements, diarrhea, or constipation. * **Cervical, vaginal, and perineal pain:** These regions might experience pain during intercourse. ## **Diagnosis** Diagnosis is often based on the patient's symptoms, a pelvic examination, and imaging tests. * **Pelvic Exam:** Helps assess the presence of any abnormal pelvic structures. The physician might be able to feel endometriosis nodules. * **Laparoscopy:** The gold standard for diagnosing endometriosis, Allows for a direct visualization of the pelvic organs and tissue biopsies for a definitive diagnosis. * **Laparotomy:** A larger surgery used for more complex cases of endometriosis, allowing the surgical exploration of the pelvic area. * **Pelvic Ultrasound:** Can sometimes detect endometriosis, but it's often less accurate than laparoscopy. * **Magnetic Resonance Imaging (MRI):** Can help to identify endometriosis lesions, however, it's not as precise as laparoscopy to confirm the diagnosis. ## **Treatment** Treatment for endometriosis can range from managing symptoms to surgically removing the ectopic tissues. The choice of treatment depends on the severity of symptoms, the patient's age, and whether they wish to have children. * **Conservative Treatment for Younger Women who Want to Have Children:** * **Progestins and Oral Combined Contraceptives:** These medications can help to regulate the menstrual cycle, reduce pain, and slow the growth of endometriosis. * **Gonadotropin Releasing Hormone (GnRH) Agonists:** These induce a temporary menopausal state, suppressing estrogen production and effectively reducing endometriosis growth. * **Anti-gonadotropin Medications:** This helps to rule out cancer when nodules are present. * **Surgical Treatment:** * **Laparoscopic surgery:** A minimally invasive approach to remove endometriosis lesions, adhesions, and cysts, using specialized instruments inserted through small incisions. * **Laparotomy:** A larger surgical procedure that involves cutting through the abdominal wall to remove endometriosis tissues. It may be necessary in complex cases where laparoscopic surgery is not feasible. * **Treatment of last resort for patients who do not want to have children or have extensive advanced disease:** * **Hysterectomy** (removal of the uterus) is a definitive solution for severe endometriosis, but it ends fertility. схема: [ an image of anatomical uterus ] # **Trastornos de Las vías reproductoras masculinas** ## **Fimosis** Fimosis is a condition in which the foreskin of the penis cannot be retracted over the glans. This can cause pain, discomfort, and difficulty urinating. Fimosis is commonly treated with circumcision, which involves the surgical removal of the foreskin ## **Orquirdea** Cryptorchidism is a condition in which one or both testicles fail to descend into the scrotum before birth. This can cause infertility and an increased risk of testicular cancer. Cryptorchidism is often treated with surgery to bring the testicle down into the scrotum. ## **Epididimitis** Epididymitis is an inflammation of the epididymis, a coiled tube located behind the testicle where sperm matures. It is usually caused by a bacterial infection and can cause pain, swelling, and discomfort. Epididymitis is typically treated with antibiotics. ## **Hidrocele** A hydrocele is a fluid-filled sac that forms around a testicle. It is usually painless, but can cause swelling and discomfort. Hydroceles are often treated by draining the fluid or surgically removing the sac. ## **Prostatitis** Prostatitis is an inflammation of the prostate gland, a small gland located below the bladder. It can cause pain, difficulty urinating, and pain during ejaculation. Prostatitis can be caused by a bacterial infection or by other factors. Treatment depends on the underlying cause. ## **Cáncer de próstata** Prostate cancer is a common cancer affecting men. Symptoms often appear in the later stages. Prostate cancer is usually treated with surgery, radiation therapy, or hormone therapy, depending on the stage of the cancer.