The Reproductive System Chapter 27. Male Reproductive System Male Reproductive System.
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Transcript of Pathology of Reproductive Systems Dr. Donald Allen University of Mary copyright 2000 To insert your...
Pathology of Reproductive Systems
Dr. Donald AllenUniversity of Mary
copyright 2000
Functions of Reproductive Systems
Production of germ cells Sexual Reproduction Pregnancy Support of Neonate
Female Reproductive Anatomy
Male Reproductive Anatomy
Production of Germ Cells Ovaries - production of oocytes Fallopian tubes - transport of
oocytes, site of fertilization Testes - production of sperm Epididymus - maturation of sperm Ductus deferens - transport of
sperm
Sexual Function Vagina Uterus - menstrual cycle Penis Prostate gland - production of
seminal fluid
Pregnancy Uterus
Support of Neonate Breast
Pathology of the Reproductive Systems Infertility Infections and Inflammation Tumors
Special Aspects with Regard to Pathology Organs are open to the
environment Tissues produce tumors Tumors responsive to hormones
Pathology of the Male Reproductive System Congenital abnormalities Infection and Inflammation Tumors
Congenital Abnormalities Cryptoorchidism Testicular torsion
Cryptoorchidism Most common congenital defect In most boys, the testes are completely
descended by birth Malpositioning of the testes outside the
scrotum Unilateral or bilateral – if unilateral more
common on right Treatment is by surgery Complications
Complications of Cryptoorchidism Sterility if untreated Increased risk of testicular cancer
Testicular Torsion Abnormal twisting of the spermatic cord Infrequent cause of testicular
enlargement SURGICAL EMERGENCY Often associated with congenital
abnormalities Can occur after heavy physical activity Most often in men 8-18 y.o., rarely after
age 30
Testicular Torsion - Manifestations Rapid onset of scrotal pain and
swelling Pain may extend into inguinal region Possible nausea, vomiting and
tachycardia Testis - firm and tender, often
positioned high in scrotum Scrotal erythema and edema
Testicular Torsion - Treatment If untreated, may result in atrophy,
abscess and infertility Emergency surgery If < 3 hours before surgery, 80%
salvage of testis If > 12 hours, 20% salvage
Infection and Inflammation Orchiditis - testes Epididymitis Prostatitis
Orchiditis Bacterial or Viral Cause Complication of Mumps
18-35% of men with mumps, primarily adults
Mumps virus excreted in the urine Often secondary to UTI
Orchiditis – Manifestations Severe testicular pain Pain may occur in lower abdominal region Swelling Chills Fever Testes appears swollen and tender,
swollen and red scrotum Usually no signs of urinary dysfunction
Epididymitis Risk factors Manifestations Complications
Epididymitis Caused by bacterial pathogens Necrosis and fibrosis may occlude
the genital ducts and produce infertility
Epididymitis – Manifestations Fever Chills When bacteriuria is present, Urinary
frequency and urgency and dysuria may occur
Pain – unilateral scrotal pain is common May also have pain in lower abdominal,
groin or hip adductor regions
Prostatitis Acute or chronic, bacterial or non-
bacterial (Table 16-1) PTs most likely to encounter
chronic prostatitis Risk factors Pathogenesis Manifestations
Acute Bacterial Prostatitis Urinary frequency and urgency Dysuria Urethral discharge High fever – chills Malaise Myalgia Arthralgia Pain – rectal and or sacral
Chronic Bacterial Prostatitis May be asymptomatic Urinary frequency and urgency Dysuria Nocturia Low grade fever Pain: Low back, rectal
Nonbacterial Prostatitis Most common kind Urinary frequency and urgency Dysuria Impotence, decreased libido Pain: low back, rectal, scrotal May be related to excessive
alcohol or caffeine intake
Tumors Testicular Tumors Benign Prostatic Hyperplasia Prostate Cancer
Testicular Cancer - Incidence Relatively rare 3% of male urogenital cancers Most common cancer of men 15-35
y.o.
Testicular Cancer – Risk Factors Cryptoorchidism – 35X higher
incidence Mother taking exogenous estrogen
during pregnancy –2-6% higher History of infertility, scrotal
trauma, or infection
Testicular Cancer - Manifestations Enlargement of the testis – most
common initial sign Enlargement may be accompanied
by ache in abdomen or scrotum, or heavy feeling in the scrotum
May metastasize with little or no change in scrotum
Testicular Cancer - Manifestations Signs of metastasis
Back pain – may be primary presenting complaint (21% of men with germ cell cancer, Cantwell et al., 1987)
Abdominal mass Hemoptysis Neck or supraclavicular adenopathy
Testicular Cancer – Treatment Orchidectomy Chemotherapy Radiation therapy Peritoneal lymphatic dissection
Testicular Cancer – Treatment side effects Changes in posture Changes in movement mechanics
of trunk, pelvis and hip Sexual dysfunction
Benign Prostatic Hyperplasia Non-malignant tumor Related to changes that occur with
aging Changes in estrogen and testosterone
levels
BPH - Risk Factors Age
75% of men over 50 y.o. have signs of prostatic enlargement
Geography More common in North America and
Western Europe Race
More common in African-Americans
BPH - Pathogenesis Proliferation of epithelial cells,
smooth muscle cells and fibroblasts in the prostate gland
Usually initially in the periurethral part of gland (Fig 16-2)
Narrowing of the lumen of the urethra
BPH - Clinical Manifestations Secondary to narrowing of urethra Urinary flow obstruction -
difficulties in initiation and force Increased risk of UTI Dysuria, hematuria Marked bladder distension Renal failure --> death
BPH - Treatment If mild, monitor condition Surgery
Side effects: Impotence Drugs
Side effects: Impotence, loss of libido, gynecomastia, drowsiness, dizziness, tachycardia, postural hypotension
Prostatic Cancer Most common cancer in men Usually develops in the periphery
of the gland Treatment Complications of treatments
Prostatic Cancer - Risk Factors Age, > 50 y.o.
25% of men 60-69 40% of men 70-79 >50% of men 80 and above
Black race Geography (US and Scandinavian
countries)
Prostatic Cancer - Risk Factors Family history Environmental exposure to
cadmium Diet - high fat intake Venereal disease Black race
Prostatic Cancer - Manifestations Usually asymptomatic in early
stages Early symptoms are usually those
due to urinary obstruction symptoms – by this time the tumor has often metastasizes
Pain Constitutional symptoms
Prostatic Cancer – Pain Pain in rectal region Pain in sacral or lumbar spine
regions Associated with bony metastasis
Pain in thoracic or shoulder girdle regions Associated with lymphatic spread or
bony metastasis
Prostatic Cancer – Constitutional Symptoms Due to metastatic spread of the
cancer Fatigue Anemia Weight loss Dyspnea
Prostatic Cancer - Treatments Surgery: Side effects: infection,
incontinence, impotence Radiation: Side effects: diarrhea, GI or
urinary bleeding Hormonal treatments: Side effects: loss
of libido, impotence, hot flashes, gynecomastia, bloating and pedal edema, nausea and vomiting, diarrhea, MI, CVA, deep venous thrombus
Pathology of the Female Reproductive Tract Hormonal disorders Infections Benign or malignant tumors Disorders related to pregnancy
Endometriosis Abnormal localization of
endometrial tissue Can be located in myometrium or
in sites outside the uterus Endometrial tissue is functional
and responds to hormonal stimulation
Endometriosis – Risk Factors Woman of childbearing years (10-
15%) More common in women who
postpone pregnancy Early menarche Menstrual cycles 27 days or less Menstrual periods lasting 7 days or
longer
Endometriosis – Signs and Symptoms Depend on location of endometrial
tissue Low abdominal or pelvic pain
associated with menstrual period Uterine involvement – dyspareunia Bladder involvement – dysuria Rectal – pain on defecation May produce false positive findings
Ectopic Pregnancy Fertilized ovum implants outside
the uterus – usually the fallopian tubes
One of the major causes of maternal death in the US
Ectopic Pregnancy – Risk Factors Pelvic inflammatory disease Prior tubal surgery Ruptured appendix Endometriosis Previous ectopic pregnancy Infertility
Pathogenesis Implantation in fallopian tube Bleeding occurs during implantation –
may be perceived as menstruation Pregnancy outgrows blood supply –
resulting in termination of pregnancy If termination does not occur, rupture
of tube occurs by 12th week - emergency
Clinical Manifestations Amenorrhea or irregular bleeding Lower abdominal quadrant or back pain
Can be diffuse and aching or localized Will progress to sharper pain due to leakage of
blood into abdominal and pelvic cavities Pain may refer to shoulder if blood reaches high
in abdominal cavity Pelvic mass S & S of normal pregnancy
Fatigue, nausea, breast tenderness, urinary frequency
Amenorrhea Primary – failure to begin
menstrual cycles Secondary – failure after a variable
period of normal function
Amenorrhea – causes Physiological Anatomical Genetic Endocrinological Constitutional Psychogenic In athletes
Toxic Shock Syndrome Caused by bacterial toxin Most common in women under 30
who use tampons Also linked to barrier
contraceptives, burns, IV drug use, insect bites, surgical and non-surgical wounds, postpartum and gynecological infections, vaginitis and lung abscesses
TSS – Manifestations Sudden elevated temperature Vomiting and diarrhea Erythematous macular rash Renal dysfunction Hypotension and shock may
develop
Pelvic Inflammatory Disease General term of infection of upper
reproductive tract Risk factors Symptoms Complications
Ovarian Cancer 2nd most common urogenital
cancer 1st in number of deaths Difficult to diagnose
At diagnosis, 60-70% metastasis
Ovarian Cancer – Risk Factors Age – peak incidence 40-60 Geography – NW Europe, US and
Canada Race – White and Hawaiian Nulliparity Family history History of infertility
Ovarian Cancer – Protective Factors 1 or more full term pregnancies History of breastfeeding Use of oral contraceptives Native American women
Ovarian Cancer – Clinical Manifestation Asymptomatic or vague
Abdominal bloating Flatulence Abnormal vaginal bleeding – not
common Local pelvic pain – a late sign
Ovarian Cancer – Clinical Manifestation Metastasis
Unexplained weight loss Cachexia Weakness Ascites Shoulder girdle or thoracic pain
Breast Diseases Infections Hormonally-induced changes Tumors
Inflammation – Acute Mastitis Usually occurs in lactating women Can form a localized abscess or
spread through entire breast Signs
Swelling Redness Painful area – sensitive to palpation
Hormonally-induced changes Normal changes
Breast enlargement during puberty After menopause, the breasts
undergo atrophy – can be prevented by exogenous estrogens
Hormonally-induced changes Fibrocystic change – fibrosis and cysts
that occur in the breasts About 50% by biopsy or autopsy Only 10-15% of women have symptoms May or may not be painful Usually affects both breasts, but
symptoms may be asymmetrical Pain, fine nodules in breast tissue,
tenderness
Benign tumors - Fibroadenoma Usually well encapsulated Usually 2-5 cm in diameter Usually affect young women – peak
incidence in 20’s
Malignant tumors 2nd most common tumor in women Causes are hormonal and genetic
Risk factors Gender – 100X more often in women Genetic predisposition Hormonal factors
Early menarche - <12 Late menopause > 50 Nulliparous women or late first
pregnancy Presence of other cancers Premalignant fibrocystic change
Risk factors Age
Rare before puberty Increased incidence after 35 Peaks in postmenopausal women
about 60 y.o. Race – White Diabetes Obesity
Potential Risk Factors Oral contraceptives Hormone therapy High-fat diet Alcohol consumption
Breast Cancer Manifestations Tumors usually surrounded by dense
connective tissue Pulls on adjacent tissue – causing
puckering of the skin and retraction of the nipple
Tumors are firm, but do not have sharp margins
Most tumors are in upper lateral breast quadrant (45%)
Typically not painful
Breast Cancer Manifestations Most tumors metastasize into the
axillary lymph nodes Distant metastasizes common in liver,
bones, brain, and adrenals S & S – upper extremity edema, bone pain,
jaundice, weight loss Most breast cancers are detected by
self-examination, examination by a doctor, or mammography
Role of PT Awareness of non-muscular tissues
in shoulder and shoulder girdle Lymph nodes – 50% of women
have metastasis to axillary nodes at time of diagnosis
Menopause Cessation of menstruation Average age 50 Complete when there are no
menstrual periods for 1 year Also occurs after surgical removal
of ovaries
Physiological Changes Hot flashes Changes in reproductive organs
Dryness and atrophy Dyspareunia, stress incontinence,
vaginal itching and burning Osteoporosis Cardiovascular diseases
Hypertension, stroke, heart disease
Psychological Changes Nervousness Depression and feelings of
worthlessness and hopelessness Headache Insomnia Decreased sex drive Memory loss Vertigo