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UA Pathophysiology (Lachel Story) Ch. 8 - Reproductive Function
Pathophysiology at University of Alabama's Capstone College of Nursing "Pathophysiology" by Lachel Story - Ch. 8 - Reproductive Function
Terms in this set (60)
stores sperm until mature
regulates metabolism and protein anabolism, inhibits pituitary secretion of gonadotropins, promotes K excretion and renal Na absorption, contributes to male pattern baldness and acne.
typical uterus position tilted over the bladder
atypical uterus position tilted backward away from bladder
Endometrium: mucosal inner lining that's shed during menstruation; Myometrium: muscular middle lining; Perimetrium: outer sac that doesn't cover cervix.
hormone form anterior pituitary gland that prompts milk production
urethral meatus on dorsal surface of penis. Develops during 1st mo of gestation. In females the meatus is in the clitoris. Causes urinary problems and misshapen penis. At risk for UTIs and urinary defects are often present. Treatment: surgery using the foreskin.
urethral meatus on ventral surface causing a chordee (downward) curve of penis. Doesn't usually affect females but can cause gender ambiguity. Treatment: surgery (often in stages) Urethra may need to be lengthened as the male grows.
one or both undescended testes prior to birth. Usually testicle remains along the path, but can deviate and be ectopic testicle. Risk factors: prematurity, low-birth-weight, family history of genital dev probs, fetal conditions that can restrict growth, maternal alcohol use during pregnancy and cigarette smoking or smoke exposure, maternal diabetes, parental exposure to pesticides.
moves back and forth btwn scrotum and lower abdomen
testicle has returned to lower abdomen and can't easily be guided back to scrotum. Diag: self exams, abdominal ultrasound, hormone levels, genetic studies. Treatment: manual manipulations, surgical repair to anchor down, orchiectomy, testicle implant, hormone replacement.
Male infertility problems
low sperm count or abnormalities, hormone deviations, physical impediments.
Female infertility problems
ovulation dysfunction, hormone deviations, physical obstructions (usually in fallopian tubes), and sever reproductive tract infections.
inability to attain or maintain an erection sufficient to complete intercourse. Psych causes: anxiety, depression, guilt, stress, feelings of inadequacy, relationship issues. Physiological causes: circulatory impairment, diabetes mellitus, MS, prostate disease, hypertension (BP meds cause vasodilation which can cause ED), neuro dysfunction, certain meds, low testosterone levels, alcohol/tobacco, liver cirrhosis. Diag: penile ultrasound, dynamic infusion cavernosometry and cavernosography, nocturnal tumescence test, and test for chronic diseases. Treatment: hormone replacement, phosphodiesterase inhibitors, herbal remedies, prostaglandin E injections directly into corpus cavernosum, pumps, implants, vascular surgery.
foreskin can't be retracted from glans. Problematic after 3 yrs of age. Causes: poor hygiene, infections, inflammation. Causes: urinary obstruction and pain.
foreskin can't be returned back over the glans. Penis becomes constricted and edematous which is a medical emergency. Gangrene is a complication. Treatment: circumcision, topical steroid cream, foreskin stretching.
prolonged painful erection not a result of sexual stimulation. Usually a result of too much blood shunting w/in corpus cavernosum (nonischemic or high-flow priapism), or blood trapping in the penis (ischemic or low flow priapism). Causes: sickle cell anemia, leukemia, trauma, tumors, diabetes mellitus, spinal cord injuries, neurologic diseases, meds, alcohol/illicit drugs, poisonous venom. Emergency if lasting longer than 4 hrs. Diag: abdominal/penile ultrasound, penile ABGs, CBC, toxicology tests, CT scan. Treatment: needle aspiration of blood, meds injected directly into penis, surgical shunt placement, cold press, lower the abdominal pressure, surgical repair of trauma, analgesics, sedation, hydration, urinary catheterization.
fluid accumulation btwn layers of the scrotum or along the spermatic cord. Causes: congenital defect, inflammation, infection, trauma, tumors. Diag: painless scrotal enlargement that transilluminates, and scrotal heaviness. Treatment: elevate scrotum, sitz bath, hot/cold application, aspiration, surgical removal.
Sperm-containing cyst that develops btwn the testes and epididymis. ClinMan: painless, small moveable cyst that may transilluminate. Cause: unknown but may be a duct system blockage, infection, inflammation, trauma. Diag: similar to those of hydrocele. Treatment: usually not required but may require surgical removal.
Valve issues that allow blood to pool in veins results in dilated vein in the spermatic cord. Causes: congenital defects and obstructions. Most common cause for low sperm counts and decreased sperm quality bc of testicular ischemia. ClinMan: "bag of worms" and scrotal heaviness. Diag: similar to hydrocele. Treatment: often unnecessary, surgical repair, embolectomy, and sclerotherapy (injecting irritating chems into vascular spaces to harden, fill, or destroy them).
abnormal rotation of the testes on the spermatic cord. Causes: trauma and spontaneously. ClinMan: sudden scrotal edema and pain. Diag: phys exam, scrotal ultrasound. Treatment: manual manipulation and surgery to resume blood supply to testicle. Happens in older males and athletes.
no menstruation. May be primary (never had one), secondary (did have, but have stopped), or normal. Causes: genetic disorders, congenital defects, hypothalamic tumors, stress, sudden weight loss, extreme reduction in body fat, anemia, chemo, pregnancy, lactation, and menopause. Treatment: identify and manage underlying cause.
painful menstruation. Cramping pain impairs daily activities and begins at the conclusion of ovulation and thru menstruation. May be primary or secondary. Causes: unknown, reproductive conditions (endometriosis or reproductive cancers), and following birth. Diag: pelvic ultrasound, laparoscopy and hysterectomy. Treatment: analgesics, oral contraceptives, heat application.
increased menstrual blood flow amount (~80mL per period) and duration (8-10 days).
vaginal bleeding btwn periods in premenopausal women.
short (less than 21 days) periods, resulting in freq menstruation
long periods (more than 42 days) resulting in infrequent menstruation
Premenstrual Syndrome / PMS
group of physical and emotional symptoms. ClinMan: irritability, depression, fatigue, headache, bloating, joint pain, breast tenderness, weight gain, sleep disturbances beginning 5-11 before menstruation.
Premenstrual dysphoric syndrome
sever form of PMS characterized by sever depression, tension, and irritability. Diag: gynecological complaint history, phys exam. Treatment: hormone therapy, diuretics, antidepressants, analgesics, comfort measures, eliminating caffeine, soda, chocolate, fat, processed sugars and alcohol.
bladder protrudes into the anterior wall of the vagina. Causes: weakened pelvic support resulting from excessive straining (childbirth, chronic constipation, heavy lifting) usually in older women. Complicated by recurrent cystitis. ClinMan: may be asymptomatic, visualization of bladder from vaginal opening, feeling of fullness in the pelvis or vagina, stress incontinences, retention, frequency, urgency, pain, or urine leakage during sexual intercourse. Diag: physical, voiding cystourethrogram. Treatment: pessary devices, surgical repair, estrogen therapy (if postmenopausal), incontinences interventions, Kegels, avoiding straining.
rectum protrudes through the posterior wall of the vagina. Causes: condition that strains the fascia and menopause. ClinMan: asymptomatic, painless, visualization of the rectum from the vaginal opening, feelings of fullness in the pelvis or vagina, difficulty defecating, rectal pressure, bowel incontinence. Diag: similar to cystocele. Treatment: surgical repair, estrogen therapy (if postmenopausal), bowel training, and avoiding straining.
Descent of uterus or cervix into the vagina. Causes: conditions that stretch or weaken the pelvic support. 1st degree: cervix has dropped into the vagina, 2nd degree: cervix is seen at vaginal opening, 3rd degree: cervix and uterus bulge through the vaginal opening. ClinMan: asymptomatic, visualize it, fullness in pelvis or vagina, difficult or painful sexual intercourse, vaginal bleeding, difficult urination or defecation. Diag: similar to cystocele and rectocele.
endometrium grows in areas outside the uterus, most commonly in fallopian tubes, ovaries, and peritoneum, but can grow anywhere in the body. The abnormal tissue continues to act as it normally would during menstruation, so blood gets trapped and irritates the surrounding tissue. Complications: pain, cysts, scarring, adhesions, infertility. ClinMan: dysmenorrhea, menorrhagia, pelvic pain, infertility. Diag: laparoscopy, pelvic ultrasound. Treatment: analgesics, hormone therapy, surgical repair.
firm, rubbery growth of myometrium. Most common benign tumors in women, more freq in Afro-Amer. Cause: unknown, but most seem to grow during menstruation years in presence of estrogen and shrink after menopause. Occur as multiple, well-defined, unencapsulated masses. Don't interfere w/ fertility but increase risk of spontaneous abortion and preterm labor. ClinMan: asymptomatic; menorrhagia; pain in pelvis, back, or legs; urinary frequency and retention; UTIs; constipation, abdominal distension; pain during sex; anemia. Diag: abdominal and transvaginal ultrasound, hysteroscopy, biopsy, laparoscopy, CT scan, MRI, CBC. Treatment: monitoring, hormone therapy, analgesics, surgery, myolysis, endometrial ablation, uterine artery embolization, anemia treatment.
benign, fluid-filled sacs on ovary. Often form in the ovulation process. May rupture and cause discomfort. Complications: hemorrhaging, peritonitis, infertility, amenorrhea. ClinMan: asymptomatic, abdominal pain/discomfort, abnormal menstrual bleeding, abdominal distension.
Polycystic ovary syndrome
ovary enlarges and contains multiple cysts. ClinMan: infertility (anovulation) amenorrhea, hirsutism, acne, male-pattern baldness. Increases risk for obesity, diabetes mellitus, cardiovascular disease, cancer. Diag: abdominal ultrasound, CT, MRI, laparoscopy, biopsy, hormone levels. Treatment: hormone therapy, analgesics, manage metabolic and other disorders, surgery.
Fibrocystic breast disease
numerous benign nodules in the breast. Firm, moveable masses that become prominent during menstruation and are more freq during childbearing years. Contributing factors: high-fat diet, excessive caffeine intake. ClinMan: dense, irregular and bumpy breast tissue; dull, heavy breast pain and tenderness; feeling of breast fullness; occasional nonbloody nipple discharge. Diag: mammogram, breast ultrasound, biopsy. Treatment: usually not required, needle aspiration of fluid, surgical removal of cysts, analgesics, supportive bra, hot/cold application, limited dietary fat, avoid caffeine, vitamin E, vitamin B6, evening primrose oil, oral contraceptives.
breast tissue inflammation associated w/ infection and lactation usually developing w/in 6 wks of childbirth. A staph or strep bacterium is introduced thru the nipple. Risk factors: impaired nipple/skin integrity. Complications: blockage of milk flow and abscesses. ClinMan: breast tenderness and swelling; redness and warmth; malaise; constant pain or burning or just while breastfeeding; fever. Diag: history and phys examination. Treatment: antibiotics, hydration, analgesics, supportive bra, cold press, adequate milk expression, needle aspiration.
inflammation of the prostate that can be acute or chronic. Causes: conditions that trigger the inflammation process. ClinMan: dysuria; difficulty urinating; frequency; urgency; nocturia; pain in abdomen, groin, lower back, perineum, or genitals; painful ejaculations; indications of infection; recurrent UTIs. Diag: phys exam (incl digital rectal exam), urinalysis, sperm analysis, cultures, cystoscopy, transrectal ultrasound. Treatment: long-term organism-specific antibiotic treatment, analgesics, antipyretics, hydration, sitz bath, prostatic massage.
Prostatitis category 1
acute bacterial prostatitis. Usually results from a UTI, least common, easiest to diagnose and treat.
Prostatitis category 2
chronic bacterial prostatitis. Usually from a recurrent UTI. Relatively uncommon.
Prostatitis category 3
chronic prostatitis / chronic pelvic pain. No clear etiology and may be noninflammatory. No present bacteria, but immune cells are found. Most common and least understood, symptoms last more than 3 months.
Prostatitis category 4
asymptomatic inflammatory prostatitis. No clear etiology and no bacteria are present, but immune cells can be found.
inflammation of epididymis. Causes: ascending bacterial infections or STIs, tuberculosis, antidysrhythmic medication amiodarone (Cordarone). Risk factors: being uncircumcised, recent surgery or history of structural problems in the urinary tract, urinary catheterization and unprotected sex w/ mult partners. Complications: abscesses, fistulas, infertility, testicular necrosis, chronic epididymitis. ClinMan: indicators of infection, scrotal tenderness, erythema, edema, penile discharge, bloody semen, painful ejaculation, dysuria, groin pain. Diag: CBC, ultrasound, urinalysis and cultures. Treatment: antibiotics, analgesics, bed rest, scrotal support and elevation, cold press, screen and treat sex partners.
yeast infection caused by the common fungus Candida albicans which is part of normal body flora. Opportunistic infection and most often occurs in the vagina and is common cause of vaginitis (inflammation of vagina. Vaginal pH changes causes flora imbalance. Causes: antibiotic therapy, bubble baths, feminine products, decreased immune response, increased glucose in the vaginal secretions. Not sexually transmitted, but men may have mild symptoms after sex. ClinMan: thick white vaginal discharge like cottage cheese, vulvular erythemia and edema, itching and burning, while patches on vaginal wall, dysuria, painful sex. Can mimic other vaginal infections. Diag: discharge culture and analysis. Treatment: antifungal agents, perineum care, no douching, no scratching, eating yogurt w/ live cultures, safe sex, no feminine products/sprays, cotton underwear and no tight clothing, pads instead of tampons, controlling blood glucose.
Pelvic inflammatory disease
infection of female reproductive system. Bacteria usually ascend from vagina. Can be acute or chronic. Causes: STIs, bacteria introduced during childbirth, endometrial procedures and abortions, bacterial invasion from blood stream. Complications: reproductive structure obstructions, peritonitis, abscesses, septicemia, adhesions, strictures, chronic pelvic pain, ectopic pregnancies, infertility, problems w/ surrounding structures. ClinMan: indications of infection, pain/tenderness in pelvis, lower abdomen, or lower back; abnormal vaginal or cervical discharge; bleeding after sex; painful sex; urinary frequency, dysuria, dysmenorrhea, amenorrhea, metrorrhagia, anorexia, nausea/vomiting. Diag: discharge culture, Pap smear, CBC, ultrasound, CT and laparoscopy. Treatment: antibiotics, screen/treat sex partners, safe sex, avoid douching, treat abscesses, follow-up reexamination and infertility eval.
caused by bacteria Chlamydia trachomatis, intracellular parasite that req a host cell to reproduce. Most common STI. Highest in women, afro-americans, those living in Mississippi. Transmitted via sex and birth. Complications: neonatal conjunctivitis, PID, epididymitis, prostatitis, infertility, ectopic pregnancy. Increases risk of other STIs. ClinMan: symptomatic, dysuria; penile, vaginal or rectal discharge; testicular tenderness or pain; rectal pain, painful sex. All pregnant women are screened and treated. Diag: cultures. Treatment: antibiotics, screen/treat partners, c-section.
Caused by bacteria Neisseria gonorrhoeae, and aerobic bacterium w/ many drug-resistant strains. 2nd most common STI. Highest rates in men, afro-americans, and ppl in Mississippi. Transmitted via sex and birth. Complications: neonatal conjuctivitis (can cause blindness), PID, epididymitis, prostatitis, infertility, ectopic pregnancy, arthritis, dermatitis, endocarditis. ClinMan: asymptomatic; dysuria; urinary frequency or urgency; penile, vaginal or rectal discharge; redness or edema at urinary meatus (in men); testicular tenderness/pain; rectal pain; painful sex; sore throat; white blisters that darken and disappear. Diag: cultures. Treatment: antibiotics.
ulcerative infection caused by bacteria Treponema pallidum, a spirochete that requires warm, moist environment to survive. Transmitted from skin or mucous membrane contact w/ chancres and via placenta to child. Highest rates in men, afro-americans, and those in La. Diag: serum antibodies. Screen/treat mother before 4th month of gestation is good so child doesn't contract it. Should get retested in the last trimester too. Untreated early maternal syphilis infections can also lead to fetal death and multiple defects affecting the bones, teeth, liver, lungs, and nervous system. Treatment: antibiotics, but are useless in latent stage.
Syphilis stage 1
primary syphilis. Painless chancres at site abt 2-3 wks after infection and disappear 4-6 wks later. Bacteria become dormant and no other symptoms are present. May not test positive, so should repeat test. Contagious at this stage.
Syphilis stage 2
secondary syphilis. 2-8 wks after the first chancres form. ClinMan: generalized, non-pruritic, brown-red rash, malaise, fever, patchy hair loss. Symptoms go away w/o treatment and bacteria becomes dormant again. Will test positive now if not treated and is contagious, especially w/ direct contact w/ rash.
Syphilis stage 3
latent or tertiary syphilis. Begins when secondary symptoms disappear and lasts 1-4 yrs. Infection spreads to the brain, nervous system, heart, skin, and bones. Complications: blindness, paralysis, dementia, cardiovascular disease, pathological fractures, death. Will test positive if untreated and is only contagious during early part of this stage.
Caused by herpes simplex virus and has 2 forms: 1. Above waist and manifests as a cold. 2. Occurs below waist. Both can spread above/below waist. Transmitted via sex, skin/skin contact, to fetus. Risk of transmission greatest w/ lesions are present. Complications: spontaneous abortion, encephalitis, brain damage. Highest rates in women and afro-americans. Virus causes initial infection at entry site, then travels along the dermatome to the nerve root to become dormant until next outbreak at same site. Tingling/burning occurs right before outbreak (prodrome). Diag: tissue and secretion cultures, Pap smear, polymerase chain rxn test. Treatment: antiviral meds (Valtrex), avoiding reoccurrence triggers, proper hygiene, no sex during outbreak, safe sex.
Genital herpes stage 1
primary herpes genitalis. Begins at time of infection and antibody development w/in 2-20 days. ClinMan: asymptomatic, painful lesion, malaise, low-grade fever, groin lymph node enlargement.
Genital herpes stage 2
latent herpes genitalis. Begins once antibodies are formed, which don't protect against reinfection, but make later outbreaks less sever. Virus travels up nerve root to become dormant. Asymptomatic once virus is dormant.
Genital herpes stage 3
shedding herpes genitalis. Virus is reactivated but produces no symptoms. It's secreted from the body and can be transmitted via sex. Stage occurs infrequently.
Genital herpes stage 4
recurrent herpes genitalis. Reactivation of the virus and manifestations. Virus travels back down nerve root to skin causing a blister at same site as first stage. Reoccurances vary from 0-many in a lifetime. Triggering factors include stress, menstruation, and illness.
Condylomata Acuminata / HPV
benign growths caused by a group of virus called HPVs. Can lead to the development of reproductive and anal cancers. Occurs in external genitals, cervix, and anus. HPV can incubate for longer than 6 mo. ClinMan: asymptomatic; growths that can be raised, flat, rough, smooth, flesh colored, white, grey, pink, cauliflower-like, large, or barely visible; abnormal bleeding; discharge; itching. Diag: pap smear, tissue biopsy, polymerase chain rxn test. Treatment: removal using chems, cryosurgery, electrocauterization, laser therapy, surgical excision, screen/treat partners, c-section deliveries.
Caused by Trichomonas vaginalis, a one-celled anaerobic organism that can burrow under the mucosal lining. In men it resides in the urethra and causes no symptoms. In women it resides in vagina and becomes symptomatic when flora imbalance occurs. Can't survive in the rectum or mouth. Transmitted via sex and prolonged moisture exposure. Complications: cervical cancer. ClinMan: lots of odorous, frothy, white/yellow-green discharge; vagina/vulva irritation; itching; painful sex; dysuria. Diag: pap smear. Treatment: antibiotics (metronidazole/Flagyl), screen/treat partners.
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