Dr. Mohanad R. Alwan Pathophysiology of Reproductive System SMS3033
Reproductive System Disorders Pathophysiology
Overview <ul><li>A. Ovaries </li></ul><ul><li>B. Oviducts </li></ul><ul><li>C. Uterus </li></ul><ul><li>D. (vagina & exter...
<ul><li>Anatomy </li></ul><ul><ul><li>gonads  = ovaries </li></ul></ul><ul><ul><li>ductal system </li></ul></ul><ul><ul><l...
I. Ovaries <ul><li>A. medulla </li></ul><ul><li>1. CT </li></ul><ul><li>2. vascular </li></ul><ul><li>B. cortex </li></ul>...
<ul><li>Ovaries </li></ul><ul><ul><li>contain gametes (oocytes) surrounded by some cells (follicular cells) </li></ul></ul...
II. Oogenesis <ul><li>A.  Oogonia </li></ul><ul><li>1. migrate to ovary from yolk sac </li></ul><ul><li>2. mitosis until 5...
Oogenesis <ul><li>D. Second meiotic division  </li></ul><ul><li>1. complete only after fertilization </li></ul><ul><li>2. ...
II I . Follicle Development <ul><li>A. Primordial follicle  </li></ul><ul><li>1. primary oocyte </li></ul><ul><li>a. ~25  ...
Follicle Development <ul><li>B. Primary follicle  </li></ul><ul><li>1. primary oocyte </li></ul><ul><li>a. growth to 125-1...
Follicle Development <ul><li>B. Primary follicle  </li></ul>
Follicle Development <ul><li>B. Primary follicle </li></ul><ul><li>3. zona pellucida </li></ul>
Follicle  Development <ul><li>B. Primary follicle  </li></ul><ul><li>4. theca folliculi </li></ul><ul><li>a. theca interna...
Follicle Development <ul><li>C. Secondary (vesicular) follicle </li></ul><ul><li>1. antrum </li></ul><ul><li>a. liquor fol...
Follicle  Development <ul><li>D. Mature (graafian) follicle </li></ul><ul><li>1. ~2.5 cm diameter  2. located near ovary s...
Follicle Development <ul><li>E. Follicular atresia </li></ul><ul><li>1. degeneration of follicle </li></ul><ul><li>2. phag...
Follicle Development <ul><li>E. Follicular atresia </li></ul><ul><li>4. interstitial cells </li></ul><ul><li>a. persistent...
Follicle Development <ul><li>F. Ovulation </li></ul><ul><li>1. ~ day 14 of menstrual  </li></ul><ul><li>cycle </li></ul><u...
Follicle Development <ul><li>G.  Corpus Luteum </li></ul><ul><li>1. remains after ovulation </li></ul><ul><li>2. granulosa...
Follicle Development <ul><li>Corpus luteum – granulosa lutein cells </li></ul>
Follicle Development <ul><li>G. Corpus luteum of menstruation </li></ul><ul><li>1. no fertilization </li></ul><ul><li>2. a...
Follicle Development <ul><li>H. corpus luteum of pregnancy </li></ul><ul><li>1. maintained by human  </li></ul><ul><li>cho...
Follicle  Development <ul><li>I. Corpus albicans </li></ul><ul><li>1. replaces corpus luteum </li></ul><ul><li>2. CT scar ...
<ul><li>Female Ductal System </li></ul><ul><ul><li>Fallopian Tubes </li></ul></ul><ul><ul><ul><li>distal end = fimbria </l...
II.Oviducts <ul><li>A. Between uterus and ovaries </li></ul><ul><li>1. ~ 12 cm long  2. fimbriae </li></ul>
VI. Oviducts <ul><li>B. Mucosa </li></ul><ul><li>1. longitudinal folds </li></ul>
Oviducts <ul><li>B. Mucosa </li></ul><ul><li>2. simple columnar epithelium </li></ul><ul><li>a. ciliated cells </li></ul><...
Oviducts <ul><li>C. Muscularis  </li></ul><ul><li>1. inner circular layer </li></ul><ul><li>2. outer longitudinal layer </...
Oviducts <ul><li>D. Serosa </li></ul><ul><li>1. visceral peritoneum </li></ul>
V. Uterus <ul><li>A. Gross anatomy </li></ul><ul><li>1. fundus </li></ul><ul><li>2. body </li></ul><ul><li>3. cervix </li>...
Uterus <ul><li>B. Layers  </li></ul><ul><li>1. serosa / adventitia </li></ul><ul><li>2. myometrium </li></ul><ul><li>3. en...
Uterus <ul><li>C. Myometrium </li></ul><ul><li>1. poorly organized layers </li></ul><ul><li>2. smooth muscle fibers </li><...
Uterus <ul><li>D. Endometrium </li></ul><ul><li>1. simple columnar epithelium </li></ul><ul><li>a. ciliated cells </li></u...
Uterus <ul><li>D. Endometrium </li></ul><ul><li>3. functionalis </li></ul><ul><li>a. coiled arteries </li></ul><ul><li>4. ...
<ul><li>The Menstrual Cycle </li></ul><ul><ul><li>begins after menarche ; ends with menopause </li></ul></ul><ul><ul><li>4...
VI. Menstrual Cycle <ul><li>A. Menstrual phase  </li></ul><ul><li>1. days 1-4 </li></ul><ul><li>2. begins with menstrual f...
VII. Menstrual Cycle <ul><li>B. Proliferative phase </li></ul><ul><li>1. days 5-14 </li></ul><ul><li>2. coincides with dev...
VII. Menstrual Cycle <ul><li>C. Secretory phase </li></ul><ul><li>1. days 15-28 </li></ul><ul><li>2. begins after ovulatio...
<ul><li>Hormonal Control </li></ul><ul><ul><ul><li>hypothalamus-------- GnRH  (gonadotropin releasing hormone) </li></ul><...
Female reproductive tract disorders Overall Outline <ul><li>Structural abnormalities </li></ul><ul><li>Menstrual disorders...
Structural abnormalities <ul><li>Pelvic relaxation disorders </li></ul><ul><ul><li>Normal variations of uterine position <...
<ul><li>Normal variations of uterine position </li></ul><ul><ul><li>Uterine  mobility  is key to normalcy </li></ul></ul><...
<ul><li>Uterine Prolapse </li></ul><ul><ul><ul><li>def = downward displacement of uterus </li></ul></ul></ul><ul><ul><ul><...
<ul><li>Cystocele </li></ul><ul><ul><ul><li>downward displacement of bladder into vagina </li></ul></ul></ul><ul><ul><ul><...
<ul><li>Dysmenorrhea </li></ul><ul><ul><li>Primary dysmenorrhea  = when no obvious pathology found </li></ul></ul><ul><ul>...
<ul><li>Dysfunctional Uterine Bleeding (DUB) </li></ul><ul><ul><li>abnormal menstrual flow when no obvious cause is known ...
<ul><li>Endometriosis </li></ul><ul><ul><li>A condition when you get endometrial tissue located outside its normal positio...
<ul><li>menopause </li></ul><ul><ul><li>Get cessation of menses & drop in estrogens which can cause: </li></ul></ul><ul><u...
<ul><li>Vaginitis </li></ul><ul><ul><li>3 types:  </li></ul></ul><ul><ul><ul><li>Yeast Vaginitis </li></ul></ul></ul><ul><...
<ul><li>Pelvic Inflammatory Disease  (PID) </li></ul><ul><ul><li>usually acute, but may be chronic </li></ul></ul><ul><ul>...
 
<ul><li>Toxic Shock Syndrome  (TSS) </li></ul><ul><ul><li>vaginal infection with systemic symptoms </li></ul></ul><ul><ul>...
Tumors  of the Female Reproductive Tract
<ul><li>Cervix </li></ul><ul><ul><li>Benign </li></ul></ul><ul><ul><ul><li>Cervical polyps </li></ul></ul></ul><ul><ul><li...
<ul><li>Estimated that half the women get them during the reproductive years </li></ul><ul><li>Clinically symptoms depend ...
<ul><li>Ovary </li></ul><ul><ul><li>Benign </li></ul></ul><ul><ul><ul><li>Functional (commonest) </li></ul></ul></ul><ul><...
 
Breast disorders <ul><li>Fibrocystic breasts </li></ul><ul><ul><ul><li>Was called fibrocystic “disease” </li></ul></ul></u...
<ul><li>Breast cancer </li></ul><ul><ul><li>1 out of  8 women in USA </li></ul></ul><ul><ul><li>Most are intraductile carc...
<ul><li>Morning Sickness </li></ul><ul><ul><ul><ul><li>severe form =  Hyperemesis Gravidarum </li></ul></ul></ul></ul><ul>...
<ul><li>Preterm Birth  </li></ul><ul><ul><li>8% of all births in US </li></ul></ul><ul><ul><ul><ul><li>Preterm labor </li>...
STD’s <ul><li>AIDS (Acquired Immunodeficiency Syndrome) </li></ul><ul><ul><ul><li>Def: progressive impairment of the immun...
<ul><li>AIDS (continued) </li></ul><ul><ul><ul><ul><li>Get opportunistic cancers </li></ul></ul></ul></ul><ul><ul><ul><ul>...
<ul><li>Chlamydia </li></ul><ul><ul><li>Most frequent  bacterial  STD </li></ul></ul><ul><ul><li>Known as the “silent STD”...
<ul><li>Chancroid </li></ul><ul><ul><li>Soft chancre  (painful) with  bubo (necrotizing ulceration & lymphadenopathy)  in ...
<ul><li>Genital warts </li></ul><ul><ul><li>Very contagious </li></ul></ul><ul><ul><ul><li>First exposure incidence: </li>...
 
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Lect 1-pathophys repro

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Lect 1-pathophys repro

  1. 1. Dr. Mohanad R. Alwan Pathophysiology of Reproductive System SMS3033
  2. 2. Reproductive System Disorders Pathophysiology
  3. 3. Overview <ul><li>A. Ovaries </li></ul><ul><li>B. Oviducts </li></ul><ul><li>C. Uterus </li></ul><ul><li>D. (vagina & external genitalia) </li></ul><ul><li>E. (mammary glands) </li></ul>
  4. 4. <ul><li>Anatomy </li></ul><ul><ul><li>gonads = ovaries </li></ul></ul><ul><ul><li>ductal system </li></ul></ul><ul><ul><li>accessory glands </li></ul></ul><ul><ul><li>external genitalia </li></ul></ul>Female Reproductive System
  5. 5. I. Ovaries <ul><li>A. medulla </li></ul><ul><li>1. CT </li></ul><ul><li>2. vascular </li></ul><ul><li>B. cortex </li></ul><ul><li>1. follicles </li></ul><ul><li>2. germinal epithelium </li></ul><ul><li>3. tunica albuginea </li></ul>
  6. 6. <ul><li>Ovaries </li></ul><ul><ul><li>contain gametes (oocytes) surrounded by some cells (follicular cells) </li></ul></ul><ul><ul><ul><ul><li>these called Primary Follicles </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>each ovary has appox. 1 million at birth </li></ul></ul></ul></ul></ul><ul><ul><li>life cycle of oocyte after puberty : primary oocyte, secondary oocyte, ovum </li></ul></ul><ul><ul><li>FUNCTIONS </li></ul></ul><ul><ul><ul><li>Gamete production </li></ul></ul></ul><ul><ul><ul><li>Hormone production </li></ul></ul></ul><ul><ul><ul><ul><li>Estrogen = causes feminization ; from granulosa cells </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Progesterone = prepares for pregnancy ; from corpus luteum </li></ul></ul></ul></ul>
  7. 7. II. Oogenesis <ul><li>A. Oogonia </li></ul><ul><li>1. migrate to ovary from yolk sac </li></ul><ul><li>2. mitosis until 5 mo. </li></ul><ul><li>B. Primary oocytes </li></ul><ul><li>1. prophase of 1st meiotic div. </li></ul><ul><li>2. 3rd-7th mo. </li></ul><ul><li>C. Secondary oocyte </li></ul><ul><li>1. just before ovulation </li></ul><ul><li>2. first meiotic div. </li></ul><ul><li>3. first polar body + oocyte </li></ul><ul><li>4. ovum viable for 24 hrs. </li></ul>
  8. 8. Oogenesis <ul><li>D. Second meiotic division </li></ul><ul><li>1. complete only after fertilization </li></ul><ul><li>2. second polar body + ♀ pronucleus </li></ul><ul><li>3. zygote = ♂ + ♀ pronuclei fuse </li></ul><ul><li>4. mitotic div. </li></ul>
  9. 9. II I . Follicle Development <ul><li>A. Primordial follicle </li></ul><ul><li>1. primary oocyte </li></ul><ul><li>a. ~25  m diameter </li></ul><ul><li>2. single layer of flat follicular (granulosa) cells </li></ul><ul><li>a. desmosomes </li></ul>
  10. 10. Follicle Development <ul><li>B. Primary follicle </li></ul><ul><li>1. primary oocyte </li></ul><ul><li>a. growth to 125-150  m diam. </li></ul><ul><li>2. follicular cells </li></ul><ul><li>a. cuboidal cells </li></ul><ul><li>b. 1 to many layers </li></ul><ul><li>c. gap junctions </li></ul>
  11. 11. Follicle Development <ul><li>B. Primary follicle </li></ul>
  12. 12. Follicle Development <ul><li>B. Primary follicle </li></ul><ul><li>3. zona pellucida </li></ul>
  13. 13. Follicle Development <ul><li>B. Primary follicle </li></ul><ul><li>4. theca folliculi </li></ul><ul><li>a. theca interna </li></ul><ul><li>1) source of estrodiol precursor </li></ul><ul><li>b. theca externa </li></ul><ul><li>1) CT </li></ul>
  14. 14. Follicle Development <ul><li>C. Secondary (vesicular) follicle </li></ul><ul><li>1. antrum </li></ul><ul><li>a. liquor folliculi </li></ul><ul><li>2. cumulus oophorus </li></ul><ul><li>3. oocyte at maximal diameter </li></ul><ul><li>4. 1 st meiotic division: secondary oocyte & 1 st polar body (not visible) </li></ul>
  15. 15. Follicle Development <ul><li>D. Mature (graafian) follicle </li></ul><ul><li>1. ~2.5 cm diameter 2. located near ovary surface </li></ul><ul><li>3. corona radiata 4. secondary oocyte </li></ul>
  16. 16. Follicle Development <ul><li>E. Follicular atresia </li></ul><ul><li>1. degeneration of follicle </li></ul><ul><li>2. phagocytosis of follicle </li></ul><ul><li>3. may occur at any stage of follicular development </li></ul>
  17. 17. Follicle Development <ul><li>E. Follicular atresia </li></ul><ul><li>4. interstitial cells </li></ul><ul><li>a. persistent theca interna cells </li></ul><ul><li>b. secrete androgens </li></ul>
  18. 18. Follicle Development <ul><li>F. Ovulation </li></ul><ul><li>1. ~ day 14 of menstrual </li></ul><ul><li>cycle </li></ul><ul><li>2. release of ovum with </li></ul><ul><li>corona radiata </li></ul><ul><li>3. received by fimbriae of oviduct </li></ul><ul><li>4. fertilization usually in oviduct (triggers 2 nd meiotic division with second polar body) </li></ul><ul><li>5. male & female pronuclei fuse = zygote </li></ul>
  19. 19. Follicle Development <ul><li>G. Corpus Luteum </li></ul><ul><li>1. remains after ovulation </li></ul><ul><li>2. granulosa & theca interna cells </li></ul><ul><li>a. steroid secreting </li></ul><ul><li>b. granulosa lutein cells </li></ul><ul><li>c. theca lutein cells </li></ul><ul><li>3. progesterone & estrogens </li></ul>
  20. 20. Follicle Development <ul><li>Corpus luteum – granulosa lutein cells </li></ul>
  21. 21. Follicle Development <ul><li>G. Corpus luteum of menstruation </li></ul><ul><li>1. no fertilization </li></ul><ul><li>2. after 10-14 days corpus luteum degenerates </li></ul>
  22. 22. Follicle Development <ul><li>H. corpus luteum of pregnancy </li></ul><ul><li>1. maintained by human </li></ul><ul><li>chorionic gonadotropin </li></ul><ul><li>(HCG) </li></ul><ul><li>a. from placenta </li></ul><ul><li>2. secretes steroids during pregnancy </li></ul><ul><li>3. secretes relaxin </li></ul><ul><li>a. softens pubic symphysis </li></ul>
  23. 23. Follicle Development <ul><li>I. Corpus albicans </li></ul><ul><li>1. replaces corpus luteum </li></ul><ul><li>2. CT scar tissue </li></ul>
  24. 24. <ul><li>Female Ductal System </li></ul><ul><ul><li>Fallopian Tubes </li></ul></ul><ul><ul><ul><li>distal end = fimbria </li></ul></ul></ul><ul><ul><ul><li>Outer 1/3 = fertilization </li></ul></ul></ul><ul><ul><li>Uterus </li></ul></ul><ul><ul><ul><li>composed of fundus, body, & cervix </li></ul></ul></ul><ul><ul><ul><li>has myometrium & endometrium] </li></ul></ul></ul><ul><ul><li>Vagina </li></ul></ul><ul><li>Accessory Glands </li></ul><ul><ul><li>Bartholin’s (greater vestibular) </li></ul></ul><ul><ul><ul><li>exocrine gland </li></ul></ul></ul><ul><ul><ul><li>provides lubrication </li></ul></ul></ul><ul><ul><li>Breasts </li></ul></ul><ul><ul><ul><li>composed of glands & ducts surrounded by fat tissue </li></ul></ul></ul><ul><li>External Genitalia </li></ul><ul><ul><li>clitoris, labia majora & minora (no hair follicles), vestibule, perineum </li></ul></ul>
  25. 25. II.Oviducts <ul><li>A. Between uterus and ovaries </li></ul><ul><li>1. ~ 12 cm long 2. fimbriae </li></ul>
  26. 26. VI. Oviducts <ul><li>B. Mucosa </li></ul><ul><li>1. longitudinal folds </li></ul>
  27. 27. Oviducts <ul><li>B. Mucosa </li></ul><ul><li>2. simple columnar epithelium </li></ul><ul><li>a. ciliated cells </li></ul><ul><li>b. secretory cells </li></ul><ul><li>1) supports / transports ovum </li></ul><ul><li>2) capacitation </li></ul>
  28. 28. Oviducts <ul><li>C. Muscularis </li></ul><ul><li>1. inner circular layer </li></ul><ul><li>2. outer longitudinal layer </li></ul>
  29. 29. Oviducts <ul><li>D. Serosa </li></ul><ul><li>1. visceral peritoneum </li></ul>
  30. 30. V. Uterus <ul><li>A. Gross anatomy </li></ul><ul><li>1. fundus </li></ul><ul><li>2. body </li></ul><ul><li>3. cervix </li></ul>
  31. 31. Uterus <ul><li>B. Layers </li></ul><ul><li>1. serosa / adventitia </li></ul><ul><li>2. myometrium </li></ul><ul><li>3. endometrium </li></ul>
  32. 32. Uterus <ul><li>C. Myometrium </li></ul><ul><li>1. poorly organized layers </li></ul><ul><li>2. smooth muscle fibers </li></ul>
  33. 33. Uterus <ul><li>D. Endometrium </li></ul><ul><li>1. simple columnar epithelium </li></ul><ul><li>a. ciliated cells </li></ul><ul><li>b. secretory cells </li></ul><ul><li>2. lamina propria </li></ul><ul><li>a. loose CT </li></ul><ul><li>b. uterine glands </li></ul>
  34. 34. Uterus <ul><li>D. Endometrium </li></ul><ul><li>3. functionalis </li></ul><ul><li>a. coiled arteries </li></ul><ul><li>4. basalis </li></ul><ul><li>a. straight arteries </li></ul>
  35. 35. <ul><li>The Menstrual Cycle </li></ul><ul><ul><li>begins after menarche ; ends with menopause </li></ul></ul><ul><ul><li>4 basic parts: </li></ul></ul><ul><ul><li>Menses </li></ul></ul><ul><ul><li>Proliferative Phase = first half of cycle-deals with maturation of follicle & development of more granulosa cells thus producing more estrogen </li></ul></ul><ul><ul><li>Ovulation = usually at midcycle </li></ul></ul><ul><ul><li>Secretory Phase = second half of cycle </li></ul></ul><ul><ul><li>deals with conversion of ruptured follicle to corpus luteum </li></ul></ul><ul><ul><li>corpus luteum produces progesterone </li></ul></ul>
  36. 36. VI. Menstrual Cycle <ul><li>A. Menstrual phase </li></ul><ul><li>1. days 1-4 </li></ul><ul><li>2. begins with menstrual flow </li></ul><ul><li>3. no fertilization </li></ul>4. corpus luteum degenerates a. drop in progesterone and estrogens 5. coiled arteries constrict 6. ischemia & necrosis of functionalis 7. shedding of functionalis.
  37. 37. VII. Menstrual Cycle <ul><li>B. Proliferative phase </li></ul><ul><li>1. days 5-14 </li></ul><ul><li>2. coincides with development of ovarian follicles </li></ul><ul><li>3. regeneration </li></ul><ul><li>a. surface epithelium </li></ul><ul><li>b. lamina propria </li></ul><ul><li>c. uterine glands </li></ul><ul><li>d. coiled arteries </li></ul>
  38. 38. VII. Menstrual Cycle <ul><li>C. Secretory phase </li></ul><ul><li>1. days 15-28 </li></ul><ul><li>2. begins after ovulation </li></ul><ul><li>3. depends on corpus luteum secretions </li></ul><ul><li>4. uterine glands become coiled and distended </li></ul><ul><li>5. prepared to receive zygote </li></ul>
  39. 39. <ul><li>Hormonal Control </li></ul><ul><ul><ul><li>hypothalamus-------- GnRH (gonadotropin releasing hormone) </li></ul></ul></ul><ul><ul><ul><li>anterior pituitary---- FSH (follicle stimulating hormone) </li></ul></ul></ul><ul><ul><ul><li>LH (luteinizing hormone) </li></ul></ul></ul><ul><ul><ul><li>Ovary --------------- Estrogen </li></ul></ul></ul><ul><ul><ul><li>Progesterone </li></ul></ul></ul>
  40. 40. Female reproductive tract disorders Overall Outline <ul><li>Structural abnormalities </li></ul><ul><li>Menstrual disorders </li></ul><ul><ul><li>Endometriosis </li></ul></ul><ul><ul><li>Menopause </li></ul></ul><ul><li>Infections </li></ul><ul><li>Tumors </li></ul><ul><ul><li>Benign </li></ul></ul><ul><ul><li>Malignant </li></ul></ul><ul><li>Breast </li></ul><ul><li>Pregnancy </li></ul><ul><li>STD’s </li></ul>
  41. 41. Structural abnormalities <ul><li>Pelvic relaxation disorders </li></ul><ul><ul><li>Normal variations of uterine position </li></ul></ul><ul><ul><ul><li>Uterine mobility is key to normalcy </li></ul></ul></ul><ul><ul><li>Uterine prolapse </li></ul></ul><ul><ul><ul><li>First, second, & third degrees </li></ul></ul></ul><ul><ul><li>Cystocele </li></ul></ul><ul><ul><li>Rectocele </li></ul></ul>
  42. 42. <ul><li>Normal variations of uterine position </li></ul><ul><ul><li>Uterine mobility is key to normalcy </li></ul></ul><ul><ul><li>midline </li></ul></ul><ul><ul><li>Anteverted & anteflexed </li></ul></ul><ul><ul><li>Retroverted & retroflexed </li></ul></ul><ul><ul><li>&quot;retroverted&quot;: tipped backwards </li></ul></ul><ul><ul><li>&quot;retroflexed&quot;: the fundus is pointing backwards. Anterior of uterus is convex. </li></ul></ul>
  43. 43. <ul><li>Uterine Prolapse </li></ul><ul><ul><ul><li>def = downward displacement of uterus </li></ul></ul></ul><ul><ul><ul><li>etiol = fascial tissue defect </li></ul></ul></ul><ul><ul><ul><li>First degree </li></ul></ul></ul><ul><ul><ul><ul><li>Get vaginal shortening </li></ul></ul></ul></ul><ul><ul><ul><li>Second degree </li></ul></ul></ul><ul><ul><ul><ul><li>Cervix at introitus </li></ul></ul></ul></ul><ul><ul><ul><li>Third degree </li></ul></ul></ul><ul><ul><ul><ul><li>Vagina completely everted </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Uterus hanging outside vagina </li></ul></ul></ul></ul>
  44. 44. <ul><li>Cystocele </li></ul><ul><ul><ul><li>downward displacement of bladder into vagina </li></ul></ul></ul><ul><ul><ul><li>Can get retention & frequent cystitis </li></ul></ul></ul><ul><ul><ul><li>urethra may or may not accompany it </li></ul></ul></ul><ul><ul><ul><ul><ul><li>called cysto-urethrocele </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>frequently get symptom of urinary stress incontinence </li></ul></ul></ul></ul></ul><ul><li>Rectocele </li></ul><ul><ul><ul><li>displacement of rectum into vagina </li></ul></ul></ul><ul><ul><ul><li>Usually asymptomatic </li></ul></ul></ul><ul><ul><ul><li>If very large may get constipation & inability to completely evacuate rectum </li></ul></ul></ul><ul><ul><ul><li>May get ulceration of vaginal wall </li></ul></ul></ul><ul><ul><ul><ul><ul><li>See picture </li></ul></ul></ul></ul></ul>
  45. 45. <ul><li>Dysmenorrhea </li></ul><ul><ul><li>Primary dysmenorrhea = when no obvious pathology found </li></ul></ul><ul><ul><ul><ul><li>? Hormonal cause </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>prostaglandins </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>hormonal changes secondary to teenage ovulatory cycles </li></ul></ul></ul></ul></ul><ul><ul><li>Secondary dysmenorrhea = when obvious pathology found as the cause </li></ul></ul><ul><li>Amenorrhea </li></ul><ul><ul><li>Primary Amenorrhea = never having a menstrual flow </li></ul></ul><ul><ul><li>Secondary Amenorrhea = having menstrual cycles & then they stop </li></ul></ul><ul><ul><li>causes = many !!! </li></ul></ul><ul><ul><ul><ul><ul><li>Treatment directed at the underlying cause </li></ul></ul></ul></ul></ul>Menstrual Disorders
  46. 46. <ul><li>Dysfunctional Uterine Bleeding (DUB) </li></ul><ul><ul><li>abnormal menstrual flow when no obvious cause is known </li></ul></ul><ul><ul><ul><ul><li>frequently thought to be secondary to some type of hormonal imbalance, but specific diagnosis not necessary to have DUB </li></ul></ul></ul></ul><ul><ul><li>Types: </li></ul></ul><ul><ul><ul><ul><ul><li>oligomenorrhea </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>polymenorrhea </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>menorrhagia </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>metrorrhagia </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>meno-metrorrhagia </li></ul></ul></ul></ul></ul><ul><li>Premenstrual Syndrome (PMS) </li></ul><ul><ul><li>group of symptoms that occur in the woman’s secretory phase of cycle </li></ul></ul><ul><ul><li>Currently called : PMDD (premenstrual dysphoric disorder) </li></ul></ul><ul><ul><ul><li>Def of dysphoria = excessive pain, anguish, & agitation </li></ul></ul></ul><ul><ul><li>usually secondary to inappropriate ovulation </li></ul></ul><ul><ul><ul><ul><li>Key = too much estrogen & not enough progesterone in the </li></ul></ul></ul></ul><ul><ul><ul><ul><li>second half of the cycle </li></ul></ul></ul></ul>
  47. 47. <ul><li>Endometriosis </li></ul><ul><ul><li>A condition when you get endometrial tissue located outside its normal position, which is the inside lining of the uterus </li></ul></ul><ul><ul><li>symptoms depend on where the ectopic tissue is located </li></ul></ul><ul><ul><li>the tissue has function, i.e. </li></ul></ul><ul><ul><li>bleeds with menstruation </li></ul></ul><ul><ul><li>Sx : pain </li></ul></ul><ul><ul><li>Complications </li></ul></ul><ul><ul><ul><li>Fibrosis </li></ul></ul></ul><ul><ul><ul><li>Scarring </li></ul></ul></ul><ul><ul><ul><li>Adhesions </li></ul></ul></ul><ul><ul><ul><li>Infertility </li></ul></ul></ul><ul><ul><ul><li>Dyspareunia </li></ul></ul></ul>
  48. 48. <ul><li>menopause </li></ul><ul><ul><li>Get cessation of menses & drop in estrogens which can cause: </li></ul></ul><ul><ul><ul><ul><li>general symptoms </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>irritability </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>short term memory loss </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Insomnia </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Vasomotor instability = hot flashes & night sweats </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>gynecological symptoms </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>vaginal dryness & dyspareunia </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>urinary stress incontinence </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Cardiovascular problems </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>ASHD </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>coronary artery disease </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>strokes </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><li>Osteoporosis </li></ul></ul></ul></ul><ul><ul><ul><li>Dx: </li></ul></ul></ul><ul><ul><ul><ul><ul><li>High FSH; low estrogens </li></ul></ul></ul></ul></ul>
  49. 49. <ul><li>Vaginitis </li></ul><ul><ul><li>3 types: </li></ul></ul><ul><ul><ul><li>Yeast Vaginitis </li></ul></ul></ul><ul><ul><ul><ul><li>caused by fungus from genus Candida or Monilia </li></ul></ul></ul></ul><ul><ul><ul><li>Trichomonas </li></ul></ul></ul><ul><ul><ul><ul><li>caused by a protozoa </li></ul></ul></ul></ul><ul><ul><ul><ul><li>may be sexually transmitted </li></ul></ul></ul></ul><ul><ul><ul><li>Bacterial Vaginosis </li></ul></ul></ul><ul><ul><ul><ul><li>caused by different bacterial overgrowth </li></ul></ul></ul></ul><ul><ul><ul><ul><li>used to be called non-specific vaginitis or Gardnella </li></ul></ul></ul></ul><ul><li>Generally most cases of vaginitis are NOT sexually transmitted, but at times they ALL may be sexually transmitted !! </li></ul>Infections of the Female Reproductive Tract
  50. 50. <ul><li>Pelvic Inflammatory Disease (PID) </li></ul><ul><ul><li>usually acute, but may be chronic </li></ul></ul><ul><ul><li>may involve some or all of the pelvic organs </li></ul></ul><ul><ul><li>get tissue inflammatory reaction with resultant symptoms </li></ul></ul><ul><ul><ul><ul><li>Key symptom = pelvic pain </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Pain worsens with movement & sex </li></ul></ul></ul></ul><ul><ul><li>frequently secondary to untreated or inadequately treated STD </li></ul></ul><ul><ul><li>Complications </li></ul></ul><ul><ul><ul><ul><li>Infertility (pyosalpinx) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Adhesions </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Dysuria </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Irregular vaginal bleeding </li></ul></ul></ul></ul><ul><ul><ul><ul><li>See next slide </li></ul></ul></ul></ul><ul><li>Note PID spread: </li></ul><ul><ul><li>Vaginitis </li></ul></ul><ul><ul><li>Cervicitis </li></ul></ul><ul><ul><li>Endometritis </li></ul></ul><ul><ul><li>Oophoritis </li></ul></ul>
  51. 52. <ul><li>Toxic Shock Syndrome (TSS) </li></ul><ul><ul><li>vaginal infection with systemic symptoms </li></ul></ul><ul><ul><li>caused by staphlococci toxin which comes from nidus of infected tampon </li></ul></ul><ul><ul><li>prevention by proper tampon toilet </li></ul></ul><ul><ul><li>Symptoms begin immediately post menses </li></ul></ul><ul><li>Bartholin cyst (Bartholinitis) </li></ul><ul><ul><li>Etiol = pathogens that cause inflammation </li></ul></ul><ul><ul><li>Duct become obstructed </li></ul></ul><ul><ul><ul><li>Get “large pimple” </li></ul></ul></ul>
  52. 53. Tumors of the Female Reproductive Tract
  53. 54. <ul><li>Cervix </li></ul><ul><ul><li>Benign </li></ul></ul><ul><ul><ul><li>Cervical polyps </li></ul></ul></ul><ul><ul><li>malignant </li></ul></ul><ul><ul><ul><li>key ages: 20 - 40 </li></ul></ul></ul><ul><ul><ul><li>pap smear </li></ul></ul></ul><ul><ul><ul><li>Etiol: HPV </li></ul></ul></ul><ul><ul><ul><ul><li>Vaccine available </li></ul></ul></ul></ul><ul><li>Uterus </li></ul><ul><ul><li>benign </li></ul></ul><ul><ul><ul><li>fibroids = commonest tumor of female repo. System </li></ul></ul></ul><ul><ul><ul><ul><li>leiomyomas </li></ul></ul></ul></ul><ul><ul><ul><ul><li>only in premenopause </li></ul></ul></ul></ul><ul><ul><ul><ul><li>See next slide </li></ul></ul></ul></ul><ul><ul><li>malignant </li></ul></ul><ul><ul><ul><li>? Estrogen related </li></ul></ul></ul><ul><ul><ul><li>Age: 50 – 70 </li></ul></ul></ul><ul><ul><ul><li>Dx: pmb </li></ul></ul></ul>
  54. 55. <ul><li>Estimated that half the women get them during the reproductive years </li></ul><ul><li>Clinically symptoms depend on size & location </li></ul><ul><ul><ul><li>Submucous = bleeding problems, infertility </li></ul></ul></ul><ul><ul><ul><li>Intramural = sx only if large </li></ul></ul></ul><ul><ul><ul><li>Subserous = pressure sx from surrounding structures </li></ul></ul></ul>
  55. 56. <ul><li>Ovary </li></ul><ul><ul><li>Benign </li></ul></ul><ul><ul><ul><li>Functional (commonest) </li></ul></ul></ul><ul><ul><ul><ul><li>Follicular cyst </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Corpus luteum cyst </li></ul></ul></ul></ul><ul><ul><ul><li>Non-functional (benign germ cell) </li></ul></ul></ul><ul><ul><ul><li>(e.g. Teratoma) </li></ul></ul></ul><ul><ul><li>Malignant </li></ul></ul><ul><ul><ul><li>Factors that suppress ovulation decrease the risk </li></ul></ul></ul><ul><ul><ul><li>Avg age = 40 </li></ul></ul></ul><ul><ul><ul><li>2 basic types </li></ul></ul></ul><ul><ul><ul><ul><li>Epithelial (line ovary or follicles) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Germ cell – aggressive </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Mainly in children & adolescents </li></ul></ul></ul></ul></ul><ul><ul><ul><li>See next slide re: </li></ul></ul></ul><ul><ul><ul><ul><li>Late diagnoses </li></ul></ul></ul></ul><ul><ul><ul><ul><li>seeding </li></ul></ul></ul></ul><ul><li>Functional (follicular) cyst </li></ul>Solid teratoma
  56. 58. Breast disorders <ul><li>Fibrocystic breasts </li></ul><ul><ul><ul><li>Was called fibrocystic “disease” </li></ul></ul></ul><ul><ul><ul><li>“ lumpy” breasts </li></ul></ul></ul><ul><li>Fibroadenoma </li></ul><ul><ul><ul><li>Benign </li></ul></ul></ul><ul><ul><ul><li>In young girls (age 15-25) </li></ul></ul></ul><ul><ul><ul><li>nontender </li></ul></ul></ul><ul><li>Intraductile papilloma </li></ul><ul><ul><ul><li>Get nipple discharge </li></ul></ul></ul><ul><li>Mammary duct ectasia </li></ul><ul><ul><li>Get lumpiness beneath areola </li></ul></ul><ul><ul><li>Seen in </li></ul></ul><ul><ul><ul><li>Postmenopausal </li></ul></ul></ul><ul><ul><ul><li>Pregnancy </li></ul></ul></ul><ul><ul><ul><li>Lactation </li></ul></ul></ul><ul><ul><li>Get thick nipple discharge </li></ul></ul><ul><ul><li>Pathophysiology: ducts dilate & fill with cellular debris; get inflammation </li></ul></ul>
  57. 59. <ul><li>Breast cancer </li></ul><ul><ul><li>1 out of 8 women in USA </li></ul></ul><ul><ul><li>Most are intraductile carcinomas </li></ul></ul><ul><ul><li>50% in upper outer quadrant </li></ul></ul><ul><ul><li>Ca in situ = mammary dysplasia </li></ul></ul><ul><ul><li>Risk factors: </li></ul></ul><ul><ul><ul><ul><li>Family history </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Menstrual history </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Reproductive history </li></ul></ul></ul></ul>
  58. 60. <ul><li>Morning Sickness </li></ul><ul><ul><ul><ul><li>severe form = Hyperemesis Gravidarum </li></ul></ul></ul></ul><ul><li>Spontaneous Abortion </li></ul><ul><ul><ul><ul><li>3 Types : Complete, Incomplete, Missed </li></ul></ul></ul></ul><ul><li>Ectopic Pregnancy </li></ul><ul><li>Toxemia of Pregnancy = syndrome of hypertension, proteinuria, & edema </li></ul><ul><ul><ul><li>called Preeclampsia </li></ul></ul></ul><ul><ul><ul><li>If severe & accompanied by convulsions, called Eclampsia </li></ul></ul></ul><ul><li>Placental Problems </li></ul><ul><ul><ul><ul><li>Placenta Praevia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Abruptio Placenta </li></ul></ul></ul></ul><ul><li>Hydatidiform Mole = development abnormality of conception </li></ul><ul><ul><ul><li>may progress to Choriocarcinoma </li></ul></ul></ul>Pathology in Pregnancy
  59. 61. <ul><li>Preterm Birth </li></ul><ul><ul><li>8% of all births in US </li></ul></ul><ul><ul><ul><ul><li>Preterm labor </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Preterm PROM (premature rupture of membranes) </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Responsible for half of all premie deliveries in US </li></ul></ul></ul></ul></ul><ul><li>Trauma during pregnancy </li></ul><ul><ul><li>Complicates 1 out of 12 pregnancies in US </li></ul></ul><ul><ul><li>Watch for: </li></ul></ul><ul><ul><ul><ul><ul><li>Uterine contractions </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Uterine tenderness &/or irritability </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Ruptured BOW </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Nonreassuring FHR pattern </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Vaginal bleeding </li></ul></ul></ul></ul></ul><ul><li>Maternal hemorrhage </li></ul><ul><ul><li>Is the leading cause of maternal mortality </li></ul></ul><ul><ul><li>Hemorrhagic shock </li></ul></ul><ul><ul><li>Postpartum hemorrhage </li></ul></ul><ul><li>Endometritis </li></ul><ul><ul><li>Occurs in 1-3% of vaginal births </li></ul></ul><ul><ul><li>Occurs in 10-50% of cesarean sections </li></ul></ul>
  60. 62. STD’s <ul><li>AIDS (Acquired Immunodeficiency Syndrome) </li></ul><ul><ul><ul><li>Def: progressive impairment of the immune system caused by the immunodeficiency virus (HIV) </li></ul></ul></ul><ul><ul><ul><ul><li>Attacks helper T lymphocytes </li></ul></ul></ul></ul><ul><ul><ul><li>Initial infection similar to URI </li></ul></ul></ul><ul><ul><ul><li>Then latency </li></ul></ul></ul><ul><ul><ul><li>Then AIDS </li></ul></ul></ul><ul><ul><ul><ul><li>Begins with generalized adenopathy, weight loss, fatigue, nt. Sweats, and diarrhea </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Get opportunistic infections: </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>PCP (pneumocystis carinii pneumonia) = caused by small protozoa (? fungus) that can normally be found in lung tissue of certain animals (dogs) and in humans </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Toxoplasmosis = small protozoan that can infect many mammals including cats and dogs </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Herpes simplex </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Herpes zoster (shingles) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>TB </li></ul></ul></ul></ul></ul>
  61. 63. <ul><li>AIDS (continued) </li></ul><ul><ul><ul><ul><li>Get opportunistic cancers </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Non-Hodgkins lymphoma </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Kaposi’s sarcoma </li></ul></ul></ul></ul></ul><ul><ul><ul><li>HIV also has predilection to attack G-I cells & CNS cells </li></ul></ul></ul><ul><ul><ul><ul><li>Get malabsorption, colitis, and proctitis </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Dementia </li></ul></ul></ul></ul><ul><ul><ul><li>Diagnosis </li></ul></ul></ul><ul><ul><ul><ul><li>ELISA (enzyme-linked immunosorbent assay) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Western blot test </li></ul></ul></ul></ul><ul><ul><ul><li>Treatment </li></ul></ul></ul><ul><ul><ul><ul><li>AZT = reverse transcriptase inhibitors </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Protease inhibitors </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Fusion inhibitors </li></ul></ul></ul></ul>
  62. 64. <ul><li>Chlamydia </li></ul><ul><ul><li>Most frequent bacterial STD </li></ul></ul><ul><ul><li>Known as the “silent STD” </li></ul></ul><ul><ul><li>Transmitted via oral, anal, or genital intercourse </li></ul></ul><ul><ul><ul><ul><ul><li>Oral route can lead to conjunctivitis </li></ul></ul></ul></ul></ul><ul><ul><li>If symptomatic, get urethritis </li></ul></ul><ul><ul><li>Incubation = 1-3 weeks </li></ul></ul><ul><li>Gonorrhea </li></ul><ul><ul><li>Bacterial </li></ul></ul><ul><ul><li>Incubation = 1-3 weeks (usually less than 1 week) </li></ul></ul><ul><ul><li>Very similar in signs & symptoms to chlamydia </li></ul></ul><ul><ul><li>Antibiotic resistance </li></ul></ul><ul><li>Syphilis </li></ul><ul><ul><li>Bacterial </li></ul></ul><ul><ul><li>Can get primary, secondary, and tertiary forms </li></ul></ul><ul><ul><li>New cases at an all time low </li></ul></ul><ul><ul><li>Primary = hard, painless chancre in 2-3 weeks ------------ see pictures </li></ul></ul><ul><ul><li>Secondary syphilis may appear 1-3 months later </li></ul></ul><ul><ul><li>Then latency for years & then possible tertiary syphilis </li></ul></ul>
  63. 65. <ul><li>Chancroid </li></ul><ul><ul><li>Soft chancre (painful) with bubo (necrotizing ulceration & lymphadenopathy) in 1 week </li></ul></ul><ul><ul><ul><li>See pictures </li></ul></ul></ul><ul><ul><li>Bacterial </li></ul></ul><ul><ul><li>Frequent in developing tropical countries </li></ul></ul><ul><ul><li>Increasing in urban USA </li></ul></ul><ul><li>Genital Herpes </li></ul><ul><ul><li>Type I & type II </li></ul></ul><ul><ul><li>Short incubation of 2-7 days </li></ul></ul><ul><ul><li>See pictures </li></ul></ul><ul><li>Hepatitis B & C </li></ul><ul><ul><li>Transmitted in body fluids </li></ul></ul>
  64. 66. <ul><li>Genital warts </li></ul><ul><ul><li>Very contagious </li></ul></ul><ul><ul><ul><li>First exposure incidence: </li></ul></ul></ul><ul><ul><ul><ul><li>40% ---to--- 90% </li></ul></ul></ul></ul><ul><ul><li>Viral; HPV </li></ul></ul><ul><ul><ul><li>120 different serotypes </li></ul></ul></ul><ul><ul><ul><li>A few cause dysplasia & neoplasia </li></ul></ul></ul><ul><ul><li>Condylomata accuminatum </li></ul></ul><ul><ul><ul><li>Benign growths </li></ul></ul></ul><ul><ul><ul><li>See picture </li></ul></ul></ul><ul><ul><li>Prolonged incubation of 1-6 months </li></ul></ul><ul><ul><li>Most frequent STD </li></ul></ul><ul><ul><ul><li>Estimated that 60% of sexually active young women in USA have it </li></ul></ul></ul><ul><ul><li>New vaccine available </li></ul></ul>

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