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29 Cards in this Set
- Front
- Back
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What are the main features of inflammation?
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1. Vasodilation, Increased Vascular Permeability (histamine and prostaglandins) 2. Haemostasis 3. Neutrophils, Polymorphonuclear leukocytes for phagocytosis (Virus- lymphocytes, parasites/worms-eosinophils) 4. Liquefactive necrosis 5. Monocyte/macrophages for phagocytosis of dead neutrophils, bacteria, irritant etc and production of growth factors that stimulate granulation tissue formation 6. Granulation Tissue- macrophages+fibroblasts (collagen)+endothelial cells (angiogenesis) 7. Scar tissue |
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What is chronic inflammation?
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Simultaneous occurence of inflammation and repair
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What are the types of chronic inflammation?
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1: Acute irritant is not eliminated (eg. PID), neutrophils may be present, no granulomas 2: Low intensity irritant not eliminated (eg. foreign bodies, tuberculosis, sarcoids), granulomas present |
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What are granulomas?
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Focal collection of macrophages and their derivatives. 1. Epitheloid cells 2. Multinucleated giant cells |
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What is Pelvic Inflammatory Disease and where is it located?
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Ascending infection and inflammation of the Cervix and Upper Genital Tract. Ovaries, Uterine Tube, Uteus. |
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What and how are host defences breached? |
1. Mucus plug in the endocervix (gonorrhoea and chlamydia breaks down the mucus plug) 2. Zone of ectopy – extension of columnar epithelium onto the ectocervix during infection facilitates attachment of microorganisms -Tubal ciliary movement and mucus flow in tubal lumen towards the uterus can be compromised during infection 3. Myometrial contractions – menstruation and sloughing of the endometrium is protective 4. Hormones – e.g. oral contraceptives can give rise to ectopic tissue (zone of ectopy above) |
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What is chlamydia trachomatis?
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It is an obligate intracellular bacteria that infects cells and replicates inside them. It has several different serotypes and is the most prevalent STI that is notifiable. |
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What is the treatment for Chlamydia? |
Antibiotics: azithromycin orally (single dose) or doxycycline (twice daily for 7 days) *Drugs must enter host cell and sexual partners and contacts must also be treated |
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How is chlamydia diagnosed? |
1. Vaginal Swab or First Catch Urine 2. NAAT- urine or cervical cells |
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What is neisseria gonorrhea?
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It is a gram negative diplocccus bacteria. |
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How does neisseria gonorrhea infect cells?
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1. Entry via mucosa (rectum, vagina, throat, urethra)
2. Adhesion via adhesive virulence factors and pili to prevent it from being flushed out 3. Rapid multiplication 4. Spread (female through cervix and urethra, males up the urethra) facilitated by bacteria IgA Protease which breaks IgA in the hinge region. IgA is the predominant immunoglobulin in the mucosa, and is a part of the host defence system. 5. Invasion of non-ciliated epithelial cells. Bacteria is internalised and multiplies within vacuoles. Protected against phagocytes & antibodies) 6. Fuses with basement membrane and discharged into sub-epithelial CT. 7. Outcome is inflammatory response induced by bacteria. |
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How is Neisseria Gonorrhea diagnosed and treated? |
Gram Stain for males, sensitivity 50% for females Nucleic-Acid Amplification Test- Cheap+more sensitive than culture, esp from throat and anus. Treatment: Ceftriaxone (single dose intramuscular) Azithromycine or tetracycline. |
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Salpingitis |
-Acute or chronic Infection/inflammation of fallopiantube -Chlamydia trachomatis -Neisseria Gonorrhoeae |
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Complications of acute salpingitis: |
-Vasodilation/vascular congestion -PMNs -Fibrin -Pus in the lumen (collection of necroticPMNs + debris + fibrin exudate) -Ulceration of epithelium |
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Complications of chronic salpingitis: |
-Inflammation -Mononuclear infiltrate, Macrophages, Lymphocytes -Plasma cell (activated B lymphocytes) -Neutrophils -Granulation tissue=macrophages,fibroblasts, endothelial cells(angiogenesis) |
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How does salpingitis cause ectopic pregnancy/infertility? |
1. STI (Chlamydia/Gonorrhoeae) 2. Ascends to fallopian tubes 3. Inflammation A. Vasodilatation-> vasc permeability-> Sticky Fibrinous exudate-> Fibrinous adhesions B. Recruitment PMNs->fibrinopurulentexudate, pus in lumen (persist to chronicity) C. Macrophages/lymphocytes/plasma cellsinfiltrate-> Granulation tissue D. Fibrinous adhesions->Fibrousadhesions-> distortion of anatomy E. Scarring within lumen->obstruction->non-patent lumen-hydrosalpinx F. Damage to cilia, fusion of plicae-> unable to move ovum toward uterus G. Fertilised ovum implants in wall of fallopiantube (ectopic pregnancy) or infertility |
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How does diagnosis of miscarriage/ectopic pregnancy work? |
1. b-hCG level test- serial measurements 2. transvaginal ultrasound 3. Progesterone level 4. Histological examination of the uterinecurettage specimens revealstrophoblastic tissue in a miscarriage |
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What is endometriosis? |
-Presence of normal endometrial mucosa(glands and stroma) outside the uterinecavity -Tissue responds to normal hormonalchanges menstrual cycle (Proliferation, secretory activity, sloughing) -Microscopic internal bleeding->inflammatory response->adhesions->fibrosis & neovascularization |
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What is the mode of transmission and transmission efficacy of Neisseria Gonorrhea? |
Transmission: Person to person, sexual intimacy Transmission efficacy: male to female: 60%, female to male: 30% because higher number of baceria in semen. -Women are the major source of infection as they are asymptomatic so there is lots of untreated infection |
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Infertility due to endometriosis: |
Infertility is due to adhesions thatdistort the pelvic anatomy.This more typically occurs in moderateto severe endometriosis, but can occurwith mild to minimal endometriosis. |
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What are the clinical presentations for PID? |
1. Asymptomatic (>50%) 2. Pain (mild-severe abdominal pain) 3. Post-coital bleeding 4. Dysuria 5. Cervical motion tenderness 6. Urethral discharge |
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What are the consequences of untreated PID? |
1. Morbidity high: physical and psychosocial 2. Chronic pelvic pain 3. Infertility (20% of people) - mostly due to tubal obstruction (tubal factor infertility). Can also get adhesions of ovaries and fallopian tubes 4. Ectopic pregnancy (50% of cases). 5. Mortality of 1/2000. 6. Recurrent PID – Increased risk of permanent damage. When cilia are damaged, it leaves you susceptible to further infection as it can't move the bacteria. 7. Bacteraemia (bacteria in blood) – can lead to suppurative arthritis, meningitis and endocarditis 8. Adhesions can lead to intestinal obstruction-Peritonitis can also occur |
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Human Papilloma Virus |
Structure: HPV Viruses have an icosahedral capsule, double stranded DNA and is a naked virus. Cause of: Papillomas-benign growths of skin or mucous membrane epithelium. Strong association with cervical cancer. Presenting symptoms: "Cauliflower" like lesion on the penis, vulva, peri-anal region Treatment: Removed by chemical (Podophyllin) means or physical means (Cryocautery, burning it off) Prevention: Condoms, 50% Pap smear and vaccine |
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Trichomonas Vaginalis |
Structure: Is a protozoan with four anterior flagella. Posterior flagellum attached to undulating membrane. Has axostyle membrane. Cause of: Trichomoniasis in the vagina and urethra, transmitted through sexual intercourse. Women are the main carriers. Asymptomatic men: important vector and reservoir. Presenting complaints: acute inflammation, foul smelling discharge (yellow-green or frothy). Strawberry cervix (haemorrhage). Diagnosis and treatment: *-Trichomonas PCR -High vaginal swab, specimen must be kept moist. laboratory examination of wet mount. CANNOT BE CULTURED ON AGAR. Treatment; metronidazole and tinidazole. drugs can treat protozoa and anaerobic organisms. |
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Herpes Simplex Virus |
Structure: double-stranded, linear DNA genome within an icosahedral capsid covered by viral envelope. Cause of: Genital ulceration. HSV1-oral herpes, HSV2-genital herpes Presenting Complaints: Swollen lymph nodes, headache, malaise, characteristic lesion Diagnosis: - NAAT -ELISA tests-sero conversion takes up to 12 weeks Treament: No curative therapy. Anti-virals can be used to shorten initial episode if lesions present. Protection: Condoms provide 50% protection. |
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Treponema Pallidum |
Structure: Thin coiled organism 10-13 micrometres long. Sluggishly motile, cannot be grown in vitro or gram stained. Multiplies extracellularly with an incubation period of 2-6 weeks. Cause of: Presenting complaint: Painless ulcer or chancre. Secondary: flu-like illness, mucocutaneous rash. Tertiary: aortic lesions, heart failure, neurosyphilis. IT IS A PROGRESSIVE DESTRUCTIVE DISEASE |
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Diagnosis and test for syphilis |
Microscopic diagnosis: Dark field microscopy/ direct fluorescent antibody TPHA microhemagglutination test Treatment: Benzathine Penicillin IM (single) or Procaine penicillin IM (10 days) |
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Candida Albicans |
Structure: Yeast Cause of: Vaginal Thrush, Balanitis in men (Approx 75% of women will have it once in their lifetime) Presenting complaints: thick curd like discharge (vaginitis) |
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Diagnosis and treatment of Candida Albicans |
Lower vaginal swab on wet mount. Gram stain- oval yeast with pseudohyphae cultured on sabouraud's medium Treatment: Topical Antifungals |
