REPRODUCTIVE PATHOPHYSIOLOGYJanet J. Nelson RN

REVIEW

• Ectopic pregnancy

• Dysmenorrhea

• Tubal Ligation• http://

www.youtube.com/watch?v=yETDInQU6lQ tubal video with Filshie clips

• Accessory nipples

ACCESSORY NIPPLE/S

PID

• http://www.cdc.gov/std/pid/stdfact-pid.htm PID

• Complications of PID:– Scarred f.t. with infertility– Tubo-ovarian abcess– Ectopic pregnancy– Pelvic adhesions– Chronic pelvic pain

WHAT DOES DIFFERENTIAL DIAGNOSIS MEAN?

Differential diagnosis: The process of weighing the probability of one disease versus that of other diseases possibly accounting for a patient's illness. The differential diagnosis of rhinitis (a runny nose) includes allergic rhinitis (hayfever), the abuse of nasal decongestants and, of

course, the common cold.

SO WHAT DIFFERENTIAL DX could there be before PID is finally decided?

ENDOMETRIOSIS

• Endometriosis is the presence of endometrial tissue outside the uterus on structures such as the ovaries, ligaments or colon.

• This ectopic tissue responds to the hormone variations and will grow, degenerate and shed with bleeding.

• But there is no exit for the blood, so the surrounding tissue is irritated and develops into fibrous tissue (leading to adhesions)

• The inflammation recurs with each cycle.

Endometriosis cont.

• Etiology: Unknown. Proposed mechanisms include migaration of endometrial tissue up through the fallopian tubes into the pertoneal cavity during menstruation.

• S&S: Dysmenorrhea, Constant pain and cramping abdomen, & back, dyspareunia.

• DX: Laparoscopic exam

• TX: Conservative treatment with various hormones is indicated for younger patients.Total hysterectomy with bilateral salpingo-oophorectomy may be indicated.

Endometriosis Prognosis

• PX: Fibrous tissue may cause adhesions and obstructions of associated organs e.g. bladder or colon.

• Fallopian tubes may be blocked or the ovary covered by fibrous tissue.

• The uterus may be pulled into a retroverted position.

• Infertility may result.Endometriosis fibrous tissue on small intestine

TOXIC SHOCK SYNDROME

• Toxic shock syndrome is a rare, life-threatening bacterial infection that has been most often associated with the use of superabsorbent tampons and occasionally with the use of contraceptive sponges. (Septic bacteremia)

• Etiology:Toxic shock syndrome (TSS) is caused by a toxin produced by certain types of Staphylococcus bacteria. This may because of the length of time a tampon is left inside, or contraceptive sponges. Surgery and skin wounds have also been associated with TSS.It is septic bacteremia

• S&S: high fever, rash, skin peeling and shock symptoms

TSS continued

• DX: History , PE, and elevated WBC, liver enzymes & Blood C&S

• TX: Antibiotics, fluid replacement

• PX: Good with treatment. If treatment is delayed, death may result from shock.

• http://www.nlm.nih.gov/medlineplus/ency/article/000653.htm

CYSTOCELE

• Cystocele: is the downward displacement of the urinary bladder

• The bladder cannot empty completely and recurrent cystitis is common.

UTERINE PROLAPSE

• Uterine Prolapse is downward displacement of the uterus.

• 1ST Degree=cervix drops into vagina

• 2nd Degree=the body of the uterus lies in the vagina

• 3rd Degree=the uterus and cervix protrude through the vaginal os.

Concurrent uterine and rectal prolapse

RECTOCLE

• Rectocele: is the protrusion of the rectum into the posterior aspect of the vagina

• Interference with defecation and feeling of pressure in the pelvis are common complaints

Herniation/Prolapse

• Etiology: Pelvic floor weakening

• S&S: c/o “bulge” & pelvic pressure, stress incontinence.

• DX: History and exam

• TX: Kegels, surgical repair– Marshall-Marchetti-Krantz– Colporrhaphy (anterior)– Posterior repair– A&P repair– Mesh and slings have had problems in past but new are

being used with success

Bimanual Exam

FIBROCYSTIC BREAST DISEASE

• AKA: Mammary dysplasia• Fibrocystic breast disease refers to benign changes in the

tissues of the breast, considered normal for most women• 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, breast US and aspirations of cysts• TX: Must be aware of importance of SBE & annual

mammograms• PX: Women with fibrocystic breast disease do not have

an increased cancer risk.

BREAST CANCER

Breast cancer is the most common cancer among women in the United States, other than skin cancer. It is the second leading cause of cancer death in women, after lung cancer. (Am Ca Society 9/25/14)

For men, the lifetime risk of getting breast cancer is about 1/10th of 1% (1 in 1,000).

• PLEASE STAND AND COUNT OFF 1-8.

• “Breast cancer is the most common type of cancer among women—a woman born in the U.S. today is estimated to have a one in eight chance of developing breast cancer.”

• Per Healthline.com update July 1 2014

Risk Factors to Breast CA

• Gender• Age• Genetics (first degree relative

with BRCA1 or 2)

• BRCA1 AND BRCA 2

• History• Race (White highest)• Menarche/menopause• Diethylstibestrol

Exposure

• BCP• Hormone Replacement Therapy• Breast feeding• Alcohol• Obesity• Physical Activity• Nongravida

DIAGNOSIS

• Mammogram:Age40 &> annual

• Clinical Breast Exam– <20 optional– 20-30 Q3y– 40 &> annual

• BSE-monthly• MRI and Mammogram annually with high risk

BSE

• http://www.womenshealthmag.com/health/breast-self-exam-instructions

Treatment

• Lumpectomy vs. Partial Mastectomy vs. Total Mastectomy vs. Radical

Mastectomy

Surgery with or without reconstruction

Other treatments

• Radiation

• Brachytherapy

• Chemotherapy

• Hormone therapy (Tamoxifen)

Brachytherapy uses multiple thin catheters inserted directly in and around the tissue that harbored the original cancer.

Prognosis: Generally the earlier the cancer is found the

better the prognosis

SBE video

• http://www.breastselfexams.org/self-exams/women-s-self-exams

CERVICAL CANCER

• Cervical cancer was once one of the most common causes of cancer death for American women. The cervical cancer death rate declined by 74% between 1955 and 1992. The main reason for this change is the increased use of the Pap test.

• The most important risk factor is HPV. (vaccine available for some of viruses)

• S&S: Abnormal vaginal bleeding, abnormal discharge (often with odor) and pain with intercourse.

• TX: Surgery (complete hysterectomy =uterus,ovaries and tubes), radiation and/or chemotherapy.

• PX: excellent if detected early.

American Cancer Society Pap Smear Reccomendations

• http://www.youtube.com/watch?v=bU85vvVNleY

UTERINE CANCER

• Most uterine cancers are of the endometrium.• In the majority of cases the woman is postmenopausal

and c/o vaginal bleeding.• Risk factors: excessive estrogen (related to medication,

oral contraceptives, women who have no children, begin menstruation at a very young age, or enter menopause late in life). Obesity and HTN.

• DX: No prophylactic tests are available. Biopsy and

transvaginal 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%

OVARIAN CYST

• http://www.nlm.nih.gov/medlineplus/ency/article/001504.htm ovarian cyst

OVARIAN CANCER

• Cancer of the ovaries is difficult to detect in its early stage, only about 20 percent of ovarian cancers are found before tumor growth has spread into adjacent tissues and organs beyond the ovaries. Most of the time, the disease has already advanced before it's diagnosed.

• Symptoms do not appear until the disease is advance and may include: abdominal pressure, fullness, swelling or bloating,urinary urgency,pelvic discomfort or pain

• Etiology: The causes of ovarian cancer remain unknown

Ovarian Cancer cont.

• DX: Pelvic Exam and pelvic ultrasound

• TX: Bilateral oophorectomy and salpingectomy. Hysterectomy may be needed if lymph glands are involved. Chemotherapy.

Blood test C-125• PX: Varies if the tumor has

metastasized.

REVIEW MALE PATHO

• Inguinal Hernia

• Cryptorchidism

MALE REPRODUCTIVE DISEASES

• REVIEW• HYDROCELE• http://www.mayoclinic.com/health/hydrocele/D

S00617

TESTICULAR CANCER

• Testicular cancer is the most common form of cancer in men between the ages of 15 and 34 and is most 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:

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 and

radiation• PX Good with EARLY treatment…indicating the need for

TSE

TSE video

• http://medical-diagonosis.wonderhowto.com/how-to/give-testicular-self-exam-146839/

BPH

• Common as men age with urinary bladder obstruction.

• S&S reflect the obstruction• Dx: digital exam, PSA, US, cystoscopy• Complication include urinary retention, renal

insufficiency, recurrent UTI, bladder calculi• Tx: medication to reduce size of prostate and/or

reduce symptoms, TURP, or laser or microwave (heat) using scope.

• Px: age/other conditions of patient interferes with treatment options

BPH

Prostate Cancer

• Is an adenocarcinoma that usually grows slowly.• Per 2013 statistics Prostate cancer is the leading

cause of cancer in the US• Risk factors for prostate cancer (gender of course)

– Age– Race– FH– Diet– Obesity– Exercise (or not)– Infection (prostatitis)

Prostate CA cont.

• SX: nocturia, urinary frequency, urinary retention after urination

• DX: PSA, DRE,TRUS, biopsy, • TX: Most common excision is a radical

retropubic prostatectomy,– Or laparoscopic radical

prostatectomy – or TURP

• PX Survival rate:– If local 100%– If regional 100%– If distant 31%

HYPOSPADIAS & EPISPADIAS

• A congenital defect of the male penis can result in the urethra located on the superior surface (epispadias) or the inferior surface (hypospadias).

• In females the urethra is located more anterior or posterior.

• TX: surgery between toddler and school age. Often the defect is severe enough to require plastic surgery to straighten penis.

Q&A

QUESTIONS?