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Patho test 9

Terms in this set (69)

Testes
Produce male sex hormones(androgens)
-spermatogenesis
Ductile system
-epididymides, vas deferens, ejaculatory duct
-storage/transport of sperm
Accessory organs
-seminal vesicles, prostate gland, bulbbourethral glands
-produce fluid constituents of semen
Penis
-urethra enclosed in penis, terminal portion of male genitoutinary system
-functions in both urine elimination and sexual function
mitotic divison
spermatogonia undergoes
meiotic division
primary spermatocyte undergoes
2 spermatids
secondary spermatocytes divide into
sperm cells
spermatids develop into mature
erection
increased blood flow into corpora cavernosa; penile rigidity
emission
expulsion of sperm into internal urethra
ejaculation
expulsion of sperm from urethra
deumescence
relaxation resulting from outflow of blood from corpora cavernosa
erectile dysfunction
inability to achieve and maintain erection
priapism
-involuntary prolonged (greater than 4 hours) abnormal and painful erection
-urologic emergency
peyronie diseasse
-localized, progressive fibrosis of unknown origin that affects the tunica albuginea of the penis (middle- age to elderly men)
-manifestations: pain erection, bent erect, hard mass at the site of fibrosis
hydrocele
-excess fluid collects between layers of tunica vaginalis
-primary congenital defect or secondary condition
-palpated as a cystic mass
-needs to be differentiated from testicular tumor by transluminate
hematocele
-excess blood collects between layers of tunica vaginalis
-may be related to scrotal trauma, bleeding disorder, testicular tumor or seen after abdominal surgery
spermatocele
-painless cyst containing sperm that forms at end of epididymis
-rarely cause problems; normally reabsorbs itself
varicocele
-varicosity of veins supplying testes (varicose vein)
-left side affected more than right side
-abnormal feeling of heaviness in left scrotum
testicular torsion
-twisting of spermatic cord
-2 types: extravaginal and intravaginal torsion
intravaginal torsion
-true surgical emergency; early recognition and treatment necessary
-twisting of testis obstructs venous drainage, results in edema and hemorrhage and eventually causes arterial obstruction
-clinical manifestations:severe distress within hour of onset, nausea, vomiting, tachycardia, affected testis is large, tender, pain radiating to inguinal area
-have to have surgery
epididymitis
-inflammation of epididymis
-less than 35: due to STI's such as chlamydia or gonorrhea
-greater than 35: usually due to UTI's caused by E. coli or Pseudomonas
-increased pressure associated with voiding or physical strain can force pathogen-containing urine back up the ejaculatory duct through vas deferens; infections can travel through lympathics also
-test by: urine test and urine culture and chlamydia and gonorrhea
-unilateral pain and swelling
-erythema and edema of overlying scrotal skin
-tenderness over the groin
-symptoms of a lower UTI: fever, frequency, urgency, dysuria
-possible urethral discharge (depending on organism)
-lab findings: elevated WBC; urinalysis may be normal with no evidence of bacteria
epididymitis is characterized by
orchitis
-infection of testes
-causes: primary infection in genitourinary tract, can spread from epididymis, bloodstream, lymphatics, complication of a systemic infection (parotitis (mumps): swelling of parotid lymph nodes; best known)
-sudden onset 3 to 4 days after onset of parotitis
-fever, painful enlargement of testes
-urinary symptoms absent
-complications: impaired spematogenesis in 30% of cases; permanent sterility can occur but is rare
prostatitis
-inflammatory disorders of prostate glands
-acute bacterial
-subtype of UTI
-risk of infection increases with diabetes, HIV, recent catherization or insturmentation or urethral strictures
-fever, chills, malaise, myalgia, frequent/urgent urination, dysuria, discharge, dull aching pain, malodorous urine
benign prostatic hyperplasia
-age-related, non-malignant enlargement of the prostate gland
-compresses urethra; produces symptoms of dysuria and difficulty urinating
-as obstruction increases retention of urine may occur leading to overdistention of bladder
-residual urine leads to increased frequency
-constant desire to empty bladder
-can develop overflow incontinence with increase in intra-abdominal pressure
-can develop renal failure without treatment
prostate cancer
-precise cause unclear
-androgens may play a role
-early stage: usually asymptomatic
-presence of symptoms usually indicate advanced or metastatic disease
-changes with voiding patterns similar to those seen with BPH
-screening; although elevated PSA can indicate cancer; it is also elevated in BP and prostatitis
childhood disorders
-hypospadias
-epispadias
-phimosis
-cryptorchidism
hypospadias
-affects 1 in 250
-urethra terminates on the ventral surface
-testes may be undescended (cryptochidism)
-surgery is treatment of choice; usually between 6 and 12 months of age
-if not circumsized use that skin to correct this
epispadias
-less common
-urethral opening is on dorsal surface of penis
-may be associated with exstrophy of bladder: abdominal wall fails to cover bladder and urine leaks constantly
phimosis
-tightening of the prepuce or penile foreskin preventing retraction over the glans
-normal in babies until 3
cryptorchidism
-major manifestation: absence of one or both testes
-complications may include infertility, testicular torsion, malignancy
changes with aging in men
-gradual, less dramatic changes than seen in women
-fertility: remains until advanced age
-andropause: hormone levels decrease
-decreased testosterone: affects sexual energy, muscle strength, testes become smaller, prostate gland enlarges
-increased ED in elderly men can be related to vascular disease, HTN, diabetes, cardiac disease, medications
ovaries
-produce female sex hormones: estrogens, progesterone, some androgen
-produce ova
fallopian tubes
passageway for ova and sperm
uterus
-product of conception implants in the endometrium (inner layer); provides environment for growth of fetus
-if conception does not occur, the inner surface of the layer is shed through menstruation
cervix
-opening to uterus at end of vagina
-secretions protects uterus from infection, alters receptivity to sperm, forms a mucoid plug during pregnancy
estrogens
-secreted by cells in ovaries: transported in the blood bound to specific plasma globulins, inactivated and conjugated in liver, excreted in bile
-provide for process of ovulation, implantation of products of conception, pregnancy, parturition, and lactation
-effects on: bone resorption, some plasma proteins, lipoproteins, blood coagulation
-adipose tissue may be a significant source of estrogen also
progesterone
-maintains pregnancy: decreasing uterine contractions
-after ovulation: corpus luteum secretes large amounts of progesterone
-progesterone increases the body basal temperature and is responsible for the increase in body temperature that occurs with ovulation
-responsible for the cyclic development of endometrium
bartholin gland cyst
-fluid filled sac that develops due to obstruction of the main duct of the gland
-infection results in acute inflammation and can result in an abscess
-symptoms usually result of infection: pain tenderness, and dyspareunia (painful intercourse)
vaginitis
-inflammation due to chemical irritants, foreign bodies, infectious agents, poor hygiene, use of some antibiotics
-characterized by discharge, burning, itching, redness and edema, pain with urination and sexual intercourse
-causes vary with age groups
-symptoms common to several different types of vaginitis, precise identification of cause is necessary for proper treatment
cervicitis
-inflammation of cervix (acute or chronic)
-related to a variety of infective agents: candida albicans, trichomonas vaginalis, neisseria gonorrhoeae, gardneralla vaginalis, chlamdia trachomatis, herpes simplex virus
acute cervicitis
-cervix reddened, edematous, mucopurulent drainage
-friable
chronic cervicitis
low grade inflammatory process
untreated cervicitis
can develop into pelvic cellulitis, low back pain, dysparunia, cervical stenosis, dysmenorrhea, and ascending infection of the uterus of fallopian tubes
pelvic inflammatory disease
-organisms ascend through the cervical canal to the endometrial cavity, then to fallopian tubes and ovaries
-risk factors: 16-24 years, nulliparity, multiple sex partners
-manifestations: lower abdominal pain, dyspareunia, back pain, purulent cervical discharge, extreme abdominal tenderness/cervical tenderness during a bimanual pelvic exam, fever (greater than 101), elevated WBC, usually shuffle when walking
endometriosis
-functional endometrial tissue found in ectopic sites outside the uterus
-lesions/locations are stimulated by ovarian hormones during the cycle in the same way that normal tissue is reacting: eventually undergoing menstrual breakdown
-bleeding into structures surrounding the ectopic sites results in pain
-associated with infertility: adhesions cause impaired release of ovum
cystocele
-bladder herniates into the vagina due to weakened muscle support
-symptoms: difficulty in emptying bladder, frequency, urgency, stress incontinence during coughing, laughing, sneezing and lifting
rectocele
-rectum herniates into vagina due to weakness of the pelvic floor and perineal muscles
-symptoms: discomfort, difficulty in defecation, backache
uterine prolapse
-bulging of uterus into vagina
-symptoms due to irritation of exposed tissue
ovarian cysts
-most common cause of enlarged ovaries
-pain, dull ache on side of cyst
-some regress spontaneously
-some may rupture
polycystic ovary syndrome
-endocrine disorder; source of anovulation
-manifestations begin in adolescence
-irregular menses, acne, excess body hair, male-pattern hair loss, infertility
-string of pearls
-on ultra sound
-may be associated with insulin resistance, worsened by obesity
-altered gonadotropin levels seen in most women
-complications: long term health cardiovascular disease, type 2 diabetes, lipid abnormalities, hypertension, increased risk factor for endometrial cancer due to lack of progesterone production
amenorrhea
absence of menstruation
oligomenorrhea
periods for more then 35 days apart
polymenorrhea
periods less then 21 days apart
menorrhagia
excessive menstruation
metrorrhagia
bleeding between periods (spotting)
menometrorrhagia
heaving bleeding between and during periods
estrogen deprivation
can result in irregular amount/duration of bleeding
lack of progesterone
causes abnormal bleeding
deficiency in both estrogen and progesterone
lead to absence of ovulation
mastitis
-infection ascends from nipple to ductal structures
-staph aureus and strep which originate from the infants nasopharynx or mom's hands
-breast area: hard, tender and inflamed; without treatment may abscess
-can occur due to hormonal changes, tumors, trauma or skin infection
fibrocystic disease
-present as nodular, granular breast masses
-discomfort (tenderness, heaviness)
-not all types of cysts increase risk of breast cancer
-food (cafienee)
menopause
-absence of menstruation for 1 year or has an elevated FSH
premenopause
precedes menopause by about 4 years: consist of menstrual irregularity
decreased estrogen
-breast tissue, body hair, skin elasticity, subcu fat decreases
-urogenital atrophy, urinary stress incontinence, urgency, nocturia, UTI, vaginal dryness
-vasomotor instability: hot flashes, palpations, dizziness, headaches, night sweats, insomnia, irritability, anxiety, depression
-osteoporosis, increased risk for CV disease
genital warts
-condylomata acuminata
-caused by HPV
-one of the fastest growing STI in last 10 years
-skin to skin contact: most often through sexual activity
-mother to newborn (vertical transmission)
-through fomites
-appearance: soft, raised, fleshy lesions on external genitalia: can have subclinical infection
genital herpes
-herpes simplex; highly contagious
-transmitted by contact with infectious lesions or secretions
-can spread through shedding of virus particles by people who do not know they have the virus
-virus ascending through the peripheral nerves to the sacral dorsal root ganglia: can remain formant or can reactivate; particles are transported back down the nerve root to the skin; they multiply and cause lesions to develop
-initial symptoms: tingling, itching and pain; eruption of small pustules and vesciles; lesions rupture around day 5 to form wet ulcers: over 10-12 day lesions crust over
-systemic symptoms: fever, headache, malaise, muscle ache, lymphadenopathy
-recurrent episodes usually milder: prodromal symptoms (itching, burning and tingling are similar)
candidiasis
-organism: candida albicans most common
-GI tract serves as reservoir for organism
-woman who are not sexually active can autonoculate
-symptoms:pruritis, irritation, erythema, swelling, dysuria, discharge (thick, white, and orderless, cheesy)
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