Reproductive pathophysiology

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2. REVIEW Ectopic pregnancy Ovarian Cysts Dysmenorrhea PID Tubal Ligation Accessory nipples 3. REVIEW MALE PATHO Inguinal Hernia Cryptorchidism BPH Prostate Cancer 4. ENDOMETRIOSIS Endometriosis is the presence of endometrial tissueoutside the uterus on structures such as the ovaries,ligaments or colon. This ectopic tissue responds to the hormonevariations and will grow, degenerate and shed withbleeding. But there is no exit for the blood, so the surroundingtissue is irritated and develops into fibrous tissue(leading to adhesions) The inflammation recurs with each cycle. 5. Endometriosis cont. Etiology: Unknown. Proposedmechanisms include migaration ofendometrial tissue up through thefallopian tubes into the pertonealcavity during menstruation. S&S: Dysmenorrhea, Constantpain and cramping abdomen, &back, dyspareunia. DX: Laparoscopic exam TX: Conservative treatment withvarious hormones is indicated foryounger patients.Totalhysterectomy with bilateralsalpingo-oophorectomy may beindicated. 6. Endometriosis Prognosis PX: Fibrous tissue maycause adhesions andobstructions ofassociated organs e.g.bladder or colon. Fallopian tubes may beblocked or the ovarycovered by fibrous tissue. The uterus may be pulledinto a retrovertedposition. Endometriosis fibrous tissue Infertility may result.on small intestine 7. TOXIC SHOCK SYNDROME Toxic shock syndrome is a rare, life-threateningbacterial infection that has been most oftenassociated with the use of superabsorbent tamponsand occasionally with the use of contraceptivesponges. (Septic bacteremia) Etiology:Toxic shock syndrome (TSS) is caused by atoxin produced by certain types of Staphylococcusbacteria. This may because of the length of time atampon is left inside, or contraceptive sponges.Surgery and skin wounds have also been associatedwith TSS.It is septic bacteremia S&S: high fever, rash, skin peeling and shocksymptoms 8. TSS continued DX: History , PE, and elevatedWBC, liver enzymes & BloodC&S TX: Antibiotics, fluidreplacement PX: Good with treatment. Iftreatment is delayed, deathmay result from shock. 9. CYSTOCELE Cystocele: is thedownwarddisplacement of theurinary bladder The bladder cannotempty completely andrecurrent cystitis iscommon. 10. UTERINE PROLAPSE Uterine Prolapse isdownward displacementof the uterus. 1ST Degree=cervix dropsinto vagina 2nd Degree=the body ofthe uterus lies in thevagina 3rd Degree=the uterusand cervix protrudethrough the vaginal os. 11. Concurrent uterine and rectal prolapse 12. RECTOCLE Rectocele: is theprotrusion of therectum into theposterior aspect ofthe vagina Interference withdefecation andfeeling of pressurein the pelvis arecommon complaints 13. Herniation/Prolapse Etiology: Pelvic floor weakening S&S: c/o bulge & pelvic pressure, stressincontinence. DX: History and exam TX: Kegels, surgical repair Marshall-Marchetti-Krantz Colporrhaphy (anterior) Posterior repair A&P repairBimanual Exam 14. FIBROCYSTIC BREAST DISEASE AKA: Mammary dysplasia Fibrocystic breast disease refers to benign changes inthe tissues of the breast, considered normal for mostwomen The cause is not completely understood S&S: Dense, irregular and bumpy "cobblestone"consistency in the breast tissue, breast discomfort,premenstrual tenderness and swelling. DX: Mammograms and aspirations of cysts TX: Must be aware of importance of SBE & annualmammograms PX: Women with fibrocystic breast disease do not havean increased cancer risk. 15. BREAST CANCER Breast cancer is the mostcommon cancer amongwomen in the UnitedStates, other than skincancer. It is the secondleading cause of cancerdeath in women, after lungcancer. For men, the lifetime risk ofgetting breast cancer is about1/10th of 1% (1 in 1,000). 16. Risk Factors to Breast CA Gender BCP Age Hormone Replacement Genetics Therapy BRCA1 AND Breast feedingBRCA 2 Alcohol History Obesity Race (White highest) Physical Activity Menarche/menopause Nongravida DiethylstibestrolExposure 17. DIAGNOSIS Mammogram:Age40 &>annual Clinical Breast Exam annual BSE-monthly MRI and Mammogram annually withhigh risk 18. Treatment Lumpectomy vs. Partial Mastectomy vs. Total Mastectomy vs. RadicalMastectomy 19. Surgery with or withoutreconstruction 20. Other treatments RadiationBrachytherapy uses multiple thin Brachytherapy catheters inserted directly in and aroundthe tissue that harbored the originalcancer. Chemotherapy Hormone therapy(Tamoxifen)Prognosis: Generally theearlier the cancer is found thebetter the prognosis 21. CERVICAL CANCER Cervical cancer was once one of the most commoncauses of cancer death for American women. Thecervical cancer death rate declined by 74% between1955 and 1992. The main reason for this change isthe increased use of the Pap test. The most important risk factor is HPV. S&S: Abnormal vaginal bleeding, abnormaldischarge (often with odor) and pain with intercourse. TX: Surgery (complete hysterectomy =uterus,ovariesand tubes), radiation and/or chemotherapy. PX: excellent if detected early. 22. UTERINE CANCER Most uterine cancers are of the endometrium. In the majority of cases the woman is postmenopausaland c/o vaginal bleeding. Risk factors: excessive estrogen (related to medication,oral contraceptives, women who have no children, beginmenstruation at a very young age, or enter menopauselate in life). Obesity and HTN. DX: No prophylactic tests are available. Biopsy andtransvaginal ultrasound are preformed with symptoms. TX: Hysterectomy with or without oophorectomy.Radiation before or after surgery. PX: Good with the 5-year cure rate at around 90% 23. OVARIAN CANCER Cancer of the ovaries is difficult to detect in its earlystage, only about 20 percent of ovarian cancers arefound before tumor growth has spread into adjacenttissues and organs beyond the ovaries. Most of thetime, the disease has already advanced before itsdiagnosed. Symptoms do not appear until the disease isadvance and may include: abdominal pressure,fullness, swelling or bloating,urinary urgency,pelvicdiscomfort or pain Etiology: The causes of ovarian cancer remainunknown 24. Ovarian Cancer cont. DX: Pelvic Exam andpelvic ultrasound TX: Bilateral oophorectomyand salpingectomy.Hysterectomy may beneeded if lymph glands areinvolved. Chemotherapy. PX: Varies if the tumor hasmetastasized. 25. MALE REPRODUCTIVE DISEASES REVIEW BPH Prostate Cancer CRYPTORCHIDISM HYDROCELE 26. HYPOSPADIAS & EPISPADIAS A congenital defect of the malepenis can result in the urethralocated on the superior surface(epispadias) or the inferior surface(hypospadias). In females the urethra is locatedmore anterior or posterior. TX: surgery between toddler andschool age. Often the defect issevere enough to require plasticsurgery to straighten penis. 27. TESTICULAR CANCER Testicular cancer is the most common form ofcancer in men between the ages of 15 and 34 and ismost common in white men. Risk factors: Undescended testicle (cryptorchidism):. Congenital abnormalities: Men born with abnormalities of the testicles, penis, or kidneys, as well as those with inguinal hernia History of testicular cancer Family history of testicular cancer: 28. Testicular CA S&S: a painless lump or swelling in a testicle pain or discomfort in a testicle or in the scrotum any enlargement of a testicle or change in the way it feels a feeling of heaviness in the scrotum a dull ache in the lower abdomen, back, or groin a sudden collection of fluid in the scrotum DX: Exam, US, Biopsy TX: 95% cure rate if dx early. Orchidectomy, chemo andradiation PX Good with EARLY treatmentindicating the need forTSE 29. Q&AQUESTIONS?