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Altrd Phys: Mech of Disease II Exam Notes

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Health Science
HLSC 2463U
Holly Taggart- Jones

Chapter 32: Alterations of the Reproductive Systems Objectives 1. Describe the causes, clinical indicators, and underlying pathologic changes associated with primary and secondary Amenorrhea.  Primary Amenorrhea o Defined as the failure of Menarche. Also means absence of menstruation by age 14 with no development of secondary sex characteristics. o Caused by: Congenital defects of Gonadotropin production (Turner Syndrome), congenital CNS defects (Hydrocephalus), congenital anatomic malformations of the reproductive system (Absence of vagina or uterus), or acquired CNS lesions, including trauma, infection, or tumors o Major clinical manifestation includes the absence of menarche. The cause of Amenorrhea determines if secondary sex characteristics or height will be affected o Pathophysiology:  In some congenital cases, the Hypothalamic – Pituitary – Ovarian (HPO) axis is dysfunctional. Due to anatomic defects of the CNS, the ovary does not receive the hormonal signals that normally initiate the development of secondary sex characteristics and menarche  Has also been associated with the absence or Hypoplasia of the uterus. Also related to some genetic disorders, including Gonadal Dysgenisis (Turner Syndrome), Androgen Insensitivity Syndrome (AIS), and Poly – X Syndrome.  In Turner Syndrome (XO), the ovaries lack gametes and ovarian failure is complete. In AIS, the individual is male genetically but female morphologically.  Secondary Amenorrhea o The absence of menstruation for a time equivalent to three or more cycles or 6 months in women who have previously menstruated. o Normal during early adolescence, pregnancy, lactation, and perimenopausal period. Can also be caused by high or low Gonadotropin levels. o Major manifestation is absence of menses. There may also be infertility, vasomotor flushes, vaginal atrophy, acne, and hirsutism (abnormal hairiness) 2. Discuss the mechanism and symptoms of Polycystic Ovary Syndrome  POS is the most common endocrine disturbance affecting women. Defined as the presence of any two of the following: (1) Polycystic (ie. Small cysts) ovary, (2) Oligo – Anovulation (Few anovulatory cycles), (3) or Hyperandrogenism  Mechanism o Hyperinsulinism stimulates androgen secretion by the ovarian stroma and reduces serum sex hormone binding globulin (SHBG) directly and independently. The net effect is an increase in free testosterone levels. o Excessive androgens affect Follicle growth and insulin affects follicular decline by suppressing apoptosis o Inappropriate Gonadotropin secretion triggers anovulation  Symptoms o Dysfunctional bleeding or amenorrhea, Hirsutism, and Infertility. Some women are obese and some are asymptomatic. Some even develop diabetes by the age of 30. 3. Discuss the manifestations and causes of Pelvic Inflammatory Disease  PID is an acute inflammatory process caused by infection. PID may involve any organ, or combination of organs, of the upper GI tract. In it’s most sever form, it can involve the entire peritoneal cavity. Inflammation of the fallopian tubes is termed Salpingitis and inflammation of the Ovaries is termed Oophoritis.  Sexually transmitted microorganisms that migrate from the vagina to the uterus, fallopian tubes, and ovaries cause most cases.  Manifestations of PID vary from sudden, sever abdominal pain with fever, to no symptoms at all. First sign of an ascending infection would be bilateral abdominal pain, often dull and steady. Other manifestations include Dysuria (Painful or difficult urination) and irregular bleeding. 4. Discuss the various disorders associated with Pelvic Relaxtion, including the clinical manifestations and risk factors for each.  Cystocele o The descent of the bladder and anterior vaginal wall into the vaginal canal. In severe cases, the bladder and anterior vaginal wall will bulge outside the Introitus (vaginal opening). o Usually caused by prolonged labor, multiple births, or birth of a large baby o Signs are urinary frequency, urgency, incontinence, difficulty emptying the bladder, or low backache o Usually accompanied by Urethrocele  Rectocele o Same as Cystocele, but with rectum and posterior vaginal wall o Symptoms include: difficulty defecating o Usually caused by childbirth  Uterine Prolapse o The descent of the cervix or entire uterus into the vaginal canal. In severe cases, the uterine falls entirely into the vaginal canal and protrudes from the Introitus. o First degree prolapse is not treated until causing discomfort o Second and third degree can cause feeling of fullness, heaviness, or collapse through vagina. Symptoms of other pelvic relaxation disorders may be present.  Urethrocele o Sagging of the urethra o Caused by pressure of fetal head on urethra and attachment beneath the symphysis pubis o Symptomatic unless it occurs in conjunction with Cystocele 5. Describe common benign cysts and growths for the female reproductive system, including causative factors and treatments for each  Benign Ovarian Cysts o May occur at any time over a female’s life. Most common during reproductive years. o Occurs when hormonal imbalances are more common, around puberty and menopause. Two common causes of benign ovarian enlargement are Follicular Cysts and Corpus Luteum Cysts. o Follicular Cysts can be caused by a transient condition where the dominant follicle fails to rupture or one of the non – dominant follicles fails to regress. o Corpus Luteum Cysts may develop due to intracystic hemorrhage that occurs in the vascularization stage, and the effect cyst then consists of blood. o Oral contraceptives may be used to prevent cysts from forming o Ova
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