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Male and Female disorders 310

Terms in this set (75)

benign prostatic hyperplasia (BPH)
-Age-related non-malignant enlargement of the male organ -
-cause believed to be associated with sensitizing of prostatic tissue by estrogen and enlargement due to stimulation by dihydrotestosterone
-growth in number of cells toward center- localizing and constricting urethral
Risk factors for BPH
-Age
-Family history
-Race (African-Americans high, Japanese low)
-Large, discrete lesions around urethra
Hypospadias
Termination of urethra on ventral surface of the penis; defect in development of urethral groove; may be due to genetic defect or maternal drug ingestion;
Epispadias
Termination of urethra on dorsal surface of the penis; may be due to genetic defect or maternal drug ingestion;
Hydrocele
Excessive fluid collection between testes and tunica vaginalis; unilateral or bilateral; occurs following injury, torsion, epididymitis, or STI; differentiated from testicular mass by transluminating;
Varicocele
enlarged veins of the spermatic cord; can lead to poor sperm concentration and motility; treatment includes ligation or sclerosis;
Testicular torsion
Twisting of spermatic cord
leads to shortening
leads to blockage of blood which affect sperm viability
Torsion viability
Surgical emergency
Detorsion in 6 hours results in 100% viability
20% at 12 hours
0% at 24 hours
Epididymitis
-Inflammation of the epididymis
-can be due to STI or other infection -
-infections punched through ejaculatory duct into epididymis with voiding or physical straining
-Most common in post pubertal males
STI/Non-sti Epiditmitis
Non-STI - Gram negative infection most common
Prepubescent and men older than 35

STI - Chlamydia trachomatis and Neisseria gonorrhoeae most common

Can also be transmitted by blood or lymphatics
Epididymitis presentation
Tenderness over lower abdomen
Fever or dysuria
Treated with rest, elevation, and antibiotics
Testicular cancer
-unilateral painless mass that does not transilluminate
- most common cancer in make 15-35 years of age
-95% arise from primordial germ cells
-Can proliferate into any tissue type and secrete enzymes/hormones
Primordial germ cell
is any biological cell that gives rise to the gametes of an organism that reproduces sexually
Predisposing factors testicular cancer (3)
Cryptorchidism
Genetics
Problems with testicular development
Cryptorchidism
undescended testicles
Prostatitis
Inflammatory disorder of the prostate
can be due spontaneous or due to: instrumentation or bacterial infection
most common cause: E. coli
Prostate cancer
Most common non-skin cancer in US;
androgens believed to play a role in abnormal growth of cells;
genetics believed to play a big role
Risk factors of prostate cancer (4)
Age
Race (African-Americans high, Asian and Native Americans low)
Genetics
Environmental factors (high fat diet)
prostatic adenocarcinomas
Most common type of prostate cancer
multi centric, out in peripheral zones of prostate, metastasize to lung and bone
What are androgens?
An androgen is any natural or synthetic steroid hormone that regulates the development and maintenance of male characteristics by binding to androgen receptors
Vaginitis
Inflammation of vagina
-causes include chemical irritants, foreign bodies, infectious agents
Symptoms of Vaginitis
vaginal discharge, itching, redness, and swelling
Premanarchal females Vaginitis
usually due to poor hygiene, parasites, and foreign bodies
Causes of vaginitis (3) during childbearing years
Candida albicans,
Trichomonas vaginalis,
bacterial vaginosis
Post menopause causes of vaginitis
atrophied vaginitis due to estrogen deficiency
Cervicitis
Inflammation of cervix
- due to direct infection of the cervix or secondary to local infection
-cervix is red and edematous;
-treated with antimicrobials
Cervicitis infectious agents
C. albicans, T. vaginalis, C. trochomatis and Herpes simplex virus;
chronic cervicitis
-Inflammation of cervix commonly following trauma (instrumentation, lacerations, childbirth);
- Staphylococcus and Streptococcus are common organisms which enter after trauma
-symptoms not very significant-can lead to stenosis of cervix
Cervical polyps
-Benign lesions attached to the cervix, caused by inflammatory hyperplasia
-incidence higher during reproductive years;
- can become malignant so its important to have them surgically removed
Cervical cancer
-Cancer with strong link to Human Papilloma Virus
-rare among celibate women arises from pre-cancerous lesions (dysplastic cells)
Cervical cancer risk factors (5)
-Early age of first intercourse
-Multiple partners
-Promiscuous partner
-Smoking
-STIs
Progression of Cervical cancer
-arises from pre-cancerous lesions (dysplastic cells)
-Atypical cells present with larger nuclei and changes in cytoplasmic components
-Large variations in cell size and shape
-Can progress to cancer in situ and invasive cancer
cervical intraepithelial neoplasia (CIN)
Histological classification delineating degree of cancer progression
High grade squamous intraepithelial lesion (HSIL) has greatest chance of converting to invasive cancer
High-grade squamous intraepithelial lesions (HSIL)
lesion with highest chance of converting to invasive cervical cancer;
Cervical cancer presentation
abnormal vaginal bleeding, spotting, discharge
Pelvic, back, leg pain
Cervical cancer treatment
Treated by excision, cryotherapy, cautery, or CO2 laser removal
Advanced disease may need radiation
Endometriosis
-Functional endometrium is found outside the uterus, fallopian tubes, other cavities of the bodies including the vagina, intestines, peritoneal cavity
-can lead to infertility
Possible causes of Endometriosis
-Regurgitation of blood and endometrium up Fallopian tubes into peritoneal cavity
-Invasion of blood vessels and lymphatics by endometrium
-Embryonic placement of dormant cells in other parts of the body
Endometriosis Presentation
-Pain with sexual activity
-Back pain
-Pain with defecation and urination
Endometriosis treatment
-Pain relief
-Suppression of endometrial growth
-Surgery to remove growths and improve reproductive capacity
Endometrial cancer stats
-Most common cancer of female pelvis
-more frequently in older women (55-65)
-most are well differentiated adenocarcinomas
-birth control can lead to this
-presents as abnormal painless bleeding
Endometrial cancer and estrogen
Estrogen stimulates endometrial hyperplasia
Can lead to development of these lesions
Contraception using estrogen unopposed by progesterone can lead to this, as well.
Process of endometrial cancer
A type of cancer that begins in the lining of the womb (uterus).
estrogen stimulates endometrial hyperplasia, can lead to development of lesions
Leiomyoma (fibroids)
Benign growths that occur in uterus of smooth muscle origin
-occur in 1/4 women older then 35
-Growth may accelerate during pregnancy or when taking estrogen
-Can impinge on UI tract
-can be removed to preserve uterus or have hysterectomy
Pelvic inflammatory disease
Infection of upper reproductive tract
-most common in age 16-24
-people w higher sexual partners is risk factor
-organisms ascend from cervix to Fallopian tubes and ovaries
-treat with IV antibiotics
Infections agents of Pelvic Inflammatory Disease
common STI: N. gonorrheae and C. trachomatis; common non-STI: H. Influenza, anaerobes, enteric gram (-) rods;
Presentation of Pelvic inflammatory disease
back pain, pain with sexual activity, discharge
Ovarian cysts
-Most common ovarian abnormal growth
- most are benign
-due to development of cysts each month associated with ovulation,
-cyst may not open up to release egg
-usually regress spontaneously
luteal cysts
every time you ovulate, your follicle begins producing large amounts of estrogen and progesterone. The follicle is now called a corpus luteum (Latin for "yellow body"). The corpus luteum will usually break down and become reabsorbed by the body. But sometimes the corpus luteum may fill with blood or fluid and turn into a cyst.
Polycystic ovarian syndrome (PCOS)
-A hormonal disorder causing enlarged ovaries with small cysts on the outer edges.
-Chronic: can last for years or be lifelong
-May involve a combination of genetic and environmental factors.
-Symptoms include menstrual irregularity, excess hair growth, acne, and obesity (Caused by insulin resistance that develops from PCOS).
-cause is not well understood;
Ovarian cancer
Second most common female GU cancer and most lethal;
-biggest risk factor is ovulatory age (length of time women has ovulated)
- pregnancy and use of birth control decreases risk bc ovaries ovulate less (decrease in ovulatory age);
-BRCA gene mutation associated with it;
-hard to diagnose: typically asymptomatic until it has metastasized;
Presentation of Ovarian cancer
Symptoms very non-specific
Often not attributed to ovarian cancer
Abdominal/pelvic pain
Bloating
Feeling full quickly
Primary amenorrhea
Failure to menstruate by 15 years of age or 13 years of age with no secondary sexual characteristics
Causes of primary amenorrhea
gonadal dysgenesis, testicular feminization or hormone imbalance (hypothalamus-pituitary-ovarian axis), gonadal dysgenesis, defective development of the gonads
Testicular feminization
Women that have testicle and female reproductive organs
Secondary amenorrhea
Cessation of menses for at least 6 months;
Causes of secondary amenorrhea
Hormonal imbalance (H-P-O axis), infection, intrauterine adhesions, anorexia, strenuous exercise;
Primary dysmenorrhea
-Menstrual pain not associated with physical abnormality or pathology
-occurs 1-2 days before menses, and peaks on day one
-treatment focused on controlling symptoms;
Secondary dysmenorrhea
Menstrual pain caused by specific condition; ie endometriosis, fibroids, adhesions, IUD, PID; treatment depends on cause;
premenstrual syndrome (PMS)
Spectrum of symptoms from mild to severe; mostly relieved by onset of menses; painful swollen breasts, bloating, abdominal pain, headache, depression, anxiety, irritability; treatment depends on symptoms;
Prolactin and PMS
affects sodium/water retention... bloating
Progesterone and PMS
stimulates depression
Estrogen and PMS
stimulates anxiety
Fibroadenoma
Firm rubbery, mobile mass on breast; premenopausal; requires surgical excision;
Fibrocystic change
-Most frequent lesion of breast
-common between 30-50 years of age
-modular, glandular mass, noncancerous changes that give a breast a lumpy or ropelike texture.
-painful during literal portion of the menstrual cycle
- associated with an increased risk of breast cancer
Microscopic fibrocystic change
Cystic dilation of terminal duct in beasts which leads to fluid accumulation, increase in fibrous tissue and variable proliferation of terminal duct epithelial tissue
Breast cancer stats
Most common female type of cancer
1 in 8 women
increased rates of carcinoma in situ
5-10% is hereditary
Risk factors Breast Cancer (Unmodifiable)
Sex
Age
Family history - BRCA tumor suppressor gene
History of benign breast disease
Early menarche or late menopause
Modifiable risk for Breast cancer
obesity,
physical inactivity,
excessive alcohol intake,
long-term hormone therapy
BRCA 1
-Gene located on chromosome 17 responsible fo tumor suppression;
-mutation of this results in lifetime risk of 60-85% for breast cancer and increased risk for ovarian cancer
BRCA and Ovarian cancer
39 percent of women who inherit a harmful BRCA1 mutation and 17 percent of women who inherit a harmful BRCA2 mutation will develop ovarian cancer by age 70 years
BRCA 2
Gene located on chronic 13; mutation associated with increased breast cancer risk;
The role of BRCA genes
both are normally expressed in the cells of breast and other tissue, where they help repair damaged DNA, or destroy cells if DNA cannot be repaired. They are involved in the repair of chromosomal damage with an important role in the error-free repair of DNA double-strand breaks. Therefor, they are refereed to as tumor suppression genes
Breast cancer presentation
-presents with firm, fixed mass with poorly defined -borders in breast
-nipple retraction
-nipple discharge
-puckering change in contour of breast
Treatment of Breast cancer
Biopsy for evaluation and staging
Excision (definitive diagnosis)
May not need additional surgery
PET scan or MRI to further evaluate with history of breast cancer or carriers of BRCA mutation
Surgery, radiation, chemotherapy, hormone therapy
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