Physiology Ii : Reproductive Disorders : (Test I) : Chapter 45 : Chapter 47 Porth

Front 1

List some general disorders of the male genitourinary system?

Back 1

1. Disorders of erectile function

2. Benign prostatic hyperplasia; prostate cancer

3. Male infertility factors

Front 2

List some disorders of the female genitourinary system?

Back 2

1. Disorders of the cervix and uterus

2. Disorders of the fallopian tubes and ovaries

3. Menstrual disorders

4. Female infertility factors

Front 3

Describe the tissue of the corpora cavernosa?

Back 3

Contains spongy tissue surrounded by an elastic membrane.

Front 4

Where are the corpus cavernosum and corpus spongiosum found?

Back 4

Cavernosum = 2 on ventral side of penis.

Spongiosum = 1 on dorsal side of penis

Front 5

An Erection is what kind of process?

Back 5

Neurovascular process

Front 6

An Erection is a neurovascular process requiring what 4 things?

Back 6

1. Autonomic nervous system
2. Neurotransmitters
3. Endothelial relaxing factors
4. Vascular smooth muscle of arteries and veins supplying penile tissue

Front 7

What part of the ANS predominates during an erection?

Back 7

The parasympathetic predominates over the sympathetic (although both are involved). During erection it is relaxed. It is not in fight or flight mode. It involves acetylcholine.

Front 8

What are some of the endothelial relaxing factors involved with erections?

Back 8

NO, Prostaglandins

Front 9

An Erection is controlled by the ?, but can be inhibited or stimulated by the ?. Explains.

Back 9

Erection controlled by ANS, but can be inhibited or stimulated by CNS. The CNS is involved so erection does not depend solely upon physical stimulation.('the brain is involved, like visual stimulation for example')

Front 10

Parasympathetic stimulation (NO release) causes what?

Back 10

Parasympathetic stimulation (NO release) causes the smooth muscle of penile to:

1. Arterioles to relax

2. Veins to contract

Front 11

What happens to the corpus cavernosa during an erection?

Back 11

Corpora cavernosa lengthens and widens = erection

Front 12

What is the ejaculation mediated by?

Back 12

The SNS (so the sympathetic part of the ANS).

Front 13

During ejaculation the SNS causes frequent strong contractions of what 6 structures?

Back 13

1. Vas deferens

2. Epididymis

3. Seminal vesicles

4. Prostate

5. Urethra

6. Penis

Front 14

Define erectile dysfunction?

Back 14

The inability to achieve and maintain and erection sufficient to permit satisfactory sexual intercourse

Front 15

How many men in the U.S. are affected by erectile and ejaculatory dysfunction?

Back 15

Affects up to 30 million men in US. Over 50% of men after the age of 50 are afflicted.

Front 16

List some causes of erectile dysfunction.

Back 16

1. Psychogenic

2. Organic
a. Neurogenic
b. Hormonal
c. Vascular

Front 17

What is the main downside of tx for erectile dysfunction?

Back 17

Therapy can also compound the problem.

Front 18

A psychogenic cause of erectile dysfunction involves what? Give examples.

Back 18

Brain Function:

ex. 'brain function'

ex. performance anxiety

ex. depression

ex. schizophrenia

Front 19

Give some examples of neurogenic causes of erectile dysfunction?

Back 19

ex. Parkinsons (decreased dopamine)

ex. Stroke (decrease CNS)

ex. Trauma (decrease CNS)

ex. Spinal cord injury

ex. Somatosensory input decreases with age

ex. Prostate surgery

Front 20

Give some examples of hormonal causes of erectile dysfunction?

Back 20

ex. Decreased testosterone levels

ex. Increased prolactin (b/c of decreased FSH, LH in hypothalamus)

ex. Vascular issues (ex. artherosclerosis)

ex. Veins (insufficient in closing and blood does not stay in penis)

Front 21

What is Benign prostatic hyperplasia (BPH)?

Back 21

Age-related, non-malignant enlargement of prostate gland.

Front 22

What is Benign prostatic hyperplasia characterized by?

Back 22

Characterized by formation of large, discrete lesions around the urethra (periurethral regions)

(This is related to Prostate CA which affects the peripheral zones)

Front 23

What is Benign prostatic hyperplasia caused by?

Back 23

The cause is unknown.

Front 24

List 6 risk factors associated with Benign prostatic hyperplasia?

Back 24

1. Age

2. Family history

3. Race

4. Ethnicity

5. Dietary fat and meat consumption

6. Hormonal factors

Front 25

HOw is age related to BPH?

Back 25

Increased age = increased risk. 90% of men over 80yo have BPH.

Front 26

What ethnicities are more at risk for BPH?

Back 26

It is more common in african americans. Lowest in native japanese.

Front 27

How are hormonal factors a risk factor for BPH?

Back 27

If men have lowered testosterone (like a missing testicle or something) then they have a lower chance of having BPH.

Front 28

What happens if someone with BPH has their testicles removed?

Back 28

The prostate shrinks.

Front 29

List 3 symptoms of BPH. Why do these symptoms occur?

Back 29

1. Weak urinary stream, postvoid dribbling

2. Frequency of urination

3. Nocturia (going at night)

Symptoms occur because the urethra flows through the prostate. An enlarged prostate compresses the urethra and leads to symptoms.

Front 30

List 3 ways that BPH may be diagnosed?

Back 30

1. Digital rectal exam

2. Urine flow studies

3. Prostate-specific antigen (PSA) may be done to screen for CA

Front 31

How is BPH tx generally?

Back 31

from self-care to meds to surgery. Surgery usually only if it is going to progress to cancer.

Front 32

Prostate cancer is the most common what?

Back 32

The most common NON-SKIN cancer in the U.S.

Front 33

Prosate Cancers is ? to lung CA as the cause of CA-related death in US men.

Back 33

Second to lung cancer.

Front 34

What ethnicity has the highest incidence of prostate cancer? Who has the lowest?

Back 34

African American men have the highest. Asians and Native Americans have the lowest.

Front 35

How is age related to the incidence of prostate cancer?

Back 35

85% of prostate CAs are diagnosed in men greater than 65yo.

Front 36

What is the cause of prostate cancer?

Back 36

The cause is unknown. (but as with all cancers it is a multi-step process that may involve genes of growth and differentiation)

Front 37

List 5 Risk factors for prostate cancer.

Back 37

1. Age

2. Family history

3. Race

4. Dietary fat and meat consumption

5. Hormonal factors

Front 38

Describe how family history is a risk factor for Prostate cancer?

Back 38

This is esp. true if a primary relative (like a father or brother) has it. This gives an individual 8X more of a chance then someone with a second degree relative.

Front 39

List 3 protective factors?

Back 39

1. Dietary substances (lycopene, selenium, vitamin E)

2. Chemoprevention using 5a-reductase inhibitor like Finasteride

4. Reduced risk in men without BPH

Front 40

Why would a 5 alpha-reductase inhibitor (finasteride) act as a protective factor against prostate cancer?

Back 40

Because 5 alpha-reductase converts testosterone to a more potent dihydrotestosterone.

Front 41

Describe the type of CA seen in prostate cancer.

Back 41

Adenocarcinoma in 98% of primary prostatic CAs. Multicentric (so multiple lesions INSIDE the prostate), found in prostate periphery. Metastasis to lung and bone.

Front 42

What sx are seen in the early stages of prostate CA?

Back 42

The early stages of prostate cancer are often asymptomatic.

Front 43

If Symptoms are seen what could it suggest about prostate CA? Give 4 examples.

Back 43

Symptoms suggest locally advanced or metastatic disease.

1. Low back pain (fractures indicative of bone metastasis)

2. Weight loss

3. Anemia

4. Shortness of breath

(by this point it is advanced and difficult to tx)

(there may also be changes in voiding patterns, depending on size and location)

Front 44

Describe some methods of Diagnosis and Screening for prostate cancer

Back 44

1. PSA test: prostate-specific antigen, used for screening; change in PSA level over time, if there is a large increase then there is possible CA

2. Confirmation via biopsy

Front 45

Define Infertility.

Back 45

Inability to conceive a child after one year of unprotected intercourse

Front 46

What is the prevalence of infertility in the U.S.?

Back 46

~15% of couples in the U.S.

Front 47

What is primary infertility?

Back 47

Infertility with no prior conception.

Front 48

What is secondary infertility?

Back 48

Infertility after one or more previous pregnancies that were carried to term. This is not necessarily the woman's issue. The problem could be from the male or female.

Front 49

What percentage of infertility is attributed to males?

Back 49

~ 25 – 35% of inferitility

Front 50

The diagnosis of infertility in men requires what 3 things?

Back 50

1. history

2. physical

3. lab test

Front 51

What percentage of infertility is attributed to females?

Back 51

~50% of infertility.

Front 52

What does the diagnosis of infertility in women require?

Back 52

1. Menstrual history

2. Lab tests

3. Pelvic exam

Front 53

What percentage of infertility is unexplained?

Back 53

~15-25% of infertility.

Front 54

List 5 male infertility factors?

Back 54

1. Sperm Disorders

2. Immunologic Disorders

3. Hormones

4. Genetics

5. Structural and Congenital Abnormalities

Front 55

List 2 sperm disorders?

Back 55

1. Azoospermia

2. Oligospermia

Front 56

What is azoospermia?

Back 56

Virtually no sperm in ejaculation.

Front 57

What is oligospermia?

Back 57

Abnormally low number of sperm.

Front 58

Are azoospermia and oligospermia the only sperm disorders?

Back 58

No, there are many more than just these. They pretty much all involve problems with differentiation.

Front 59

Describe how immunologic disorders are related to male infertility?

Back 59

Antibodies to own sperm. Due to surgery, infection, trauma, compromised blood testes barrier, etc.

Front 60

List 4 general Structural and congenital abnormalities resulting in infertility?

Back 60

1. Obstruction: numerous
ex. Prostate enlargement
ex. Testicular torsion

2. Congenital: hypospadias and cryptorchidism

3. Varicocele

4. Surgeries: e.g., vasectomy

Front 61

What is the most common acute testicular disorder?

Back 61

Testicular torsion (twisting)

Front 62

What occurs during testicular torsion?

Back 62

The vas deferens is twisted/obstructed. The testicles can die due to tissue necrosis. If this endures it requires surgery.

Front 63

Describe cryptorchidism?

Back 63

Means 'undescended testicles'.


This is seen in premature infants (22% of them). This usually represents failure of the testis to move, or "descend," during fetal development from an abdominal position, through the inguinal canal, into the ipsilateral scrotum. About 3% of full-term and 30% of premature infant boys are born with at least one undescended testis, making cryptorchidism the most common birth defect of male genitalia. (testes may stay in abdominal cavity)

Front 64

What occurs with most cases of cryptorchidism?

Back 64

In 75% of cases the undescended testicles will descend on own within 3 months. If it persists for more than 3 months surgery or hormonal therapy may be reqd.

Front 65

Why would cryptorchidism have to be tx?

Back 65

It needs to be tx because it can increase the risk of cancer and increases the risk of testicular torsion.

Front 66

Would cryptorchidism left untreated effect sperm production?

Back 66

If left uncorrected the environment would not be ideal for sperm. However, the other testicle would produce more than enough sperm. (so mainly tx to avoid increased risk of cancer)

Front 67

What are hypospadias?

Back 67

Hypospadias is a birth defect of the urethra in the male that involves an abnormally placed urethral meatus (opening). This can be repaired. Surgery is typical within 6-12 months of infancy.

Front 68

What is varicocele?

Back 68

Abnormally large veins in the scrotal sac.

Front 69

When is there an increased incidence of varicocele?

Back 69

See a higher incidence in men between 15 - 35yo.

Front 70

How is varicocle tx?

Back 70

Usually surgery.

Front 71

What is the most common reason for infertility in men?

Back 71

Varicocele

Front 72

How prevalent is cervical CA in the US?

Back 72

12,200 cases of INVASIVE cervical CA in US.

4100 deaths. So about 1/3rd die.

Front 73

How prevalent is cervical CA worldwide?

Back 73

About 1/2m cases each year. It is the 3rd most common cancer.

Front 74

Is cervical carcinoma in situ treatable?

Back 74

It is easily detected and cured. Detected by PAP smears.

Front 75

Cervical CA is considered what? Why?

Back 75

It is considered an STD because it is Viral.

Front 76

There is a causal link between cervical CA and ?.

Back 76

Between cervical CA and HPV infection.

Front 77

List some risk factors for cervical cancer.

Back 77

1. Early age at first intercourse

2. Multiple partners

3. Promiscous male partner

4. Smoking

5. STD history

Front 78

In cervical CA the cancer itself arises from what? This begins with the development of what?

Back 78

Cancer arises from precursor lesions, beginning with the development of atypical cells.

Front 79

Once cervical CA arises from precursor lesions what does it gradually progress to?

Back 79

Gradually progresses to carcinoma in situ (localized to epithelial layer) and to invasive CA of the cervix (deeper). (This doesn't necessarily always occur)

Front 80

Pap smears are conducted to observe what?

Back 80

1. Changes in cells' nucleus and cytoplasm

2. Variation in cell size and shape (dysplasia) detected via histology

Front 81

What is cervical intraepithelial neoplasia (CIN)?

Back 81

AKA cervical dysplasia. Abnormal growth detected by grading system which describes changes in cancer precursors.

Front 82

Noninvasive cancer is limited to what tissue?

Back 82

Limited to epithelial tissue layer. This is 'carcinoma in situ'.

Front 83

What is endometriosis?

Back 83

A cond. in which functional endometrial tissue is found in ectopic sites outside of the uterus. (sites like the ovaries, posterior broad ligaments, pelvis, and vagina)

Front 84

What is the cause of endometriosis?

Back 84

Unknown

Front 85

List some theories for possible causes of endometriosis.

Back 85

1. Retrograde menstruation where dormant immature cellular elements undergo metaplasia in distant sites

2. Metastasis via lymphatics or vasculature

Front 86

Where is an increasing incidence of endometriosis observed?

Back 86

Increasing incidence in W. societies over the past 40-50 years. It is unknown why but may be more common in women who have postponed childbearing.

Front 87

List risk factors for endometriosis.

Back 87

1. Early menarche (young onset of menstration)

2. Regular periods with shorter cycles (<27days), longer duration (>7days), heavier flow

3. Increased menstrual pain

4. First-degree relatives

Front 88

List some sx associated with endometriosis?

Back 88

Sx are varied, but strongly suggested by:

1. Dysmenorrhea

2. Dyspareunia

3. Infertility

Front 89

How is endometriosis diagnosed?

Back 89

Laproscopy (visualize cells)

Front 90

List 5 common sites for endometriosis.

Back 90

1. Ovary

2. Rectum

3. Uterus

4. Bladder

5. Normal endometrium lining

Front 91

What are leiomymomas AKA?

Back 91

Fibroids or uterine fibroids

Front 92

What is a leiomymoma?

Back 92

Benign neoplasms of smooth muscle origin. It is the most common cause of pelvic tumor.

Front 93

What is the believed prevalence of leiomymomas?

Back 93

Believed to occur in 1 of every 4 to 5 women over the age of 35 years.

Front 94

Describe the sx associated with leiomymomas.

Back 94

1. >50% asymptomatic

2. Discovered on routine pelvic exam (Dr. feels for tumors)

3. Menorrhagia (xs menstrual bleeding)

4. Anemia

5. Urinary frequency

6. Rectal pressure/constipation

Front 95

With leiomymomas what occurs once a woman reaches menopause?

Back 95

Once a women reaches menopause, hormonal stimulation decreases and most fibroids regress. If not a historectomy may be warranted. (if a woman has not had menopause and wants kids then they can just remove fibroids...not a historectomy)

Front 96

Are leiomymomas dangerous?

Back 96

No real danger in and of themselves but they may cause secondary problems.

Front 97

What does pelvic inflammatory disease (PID) involve?

Back 97

Inflammation of the upper reproductive tract and may involve:

1. Uterus (endometritis)

2. Fallopian (salpingitis)

3. Ovaries (oophoritis)

Front 98

What is pelvic inflammatory disease generally caused by?

Back 98

Infection

Front 99

List 5 risk factors for PID.

Back 99

1. Age: 16-24

2. Unmarried

3. Nulliparity

4. Multiple sexual partners

5. Previous history of PID

Front 100

List 5 sx of PID.

Back 100

1. Lower abdominal pain

2. Purulent cervical discharge (pus)

3. Adnexal tenderness (accessory organs)

4. Very painful cervix

5. may/may not have sx of infection (like fever, increased wbc count)

Front 101

How is PID tx?

Back 101

Antibiotics

Front 102

PID may lead to ? tissue.

Back 102

PID may lead to scar tissue which may lead to adhesions of different structures in the reproductive tract. This can cause obstructions that lead to infertility.

Front 103

List 3 menstrual disorders.

Back 103

1. Amenorrhea

2. Dysmenorrhea

3. Premenstrual Syndrome (PMS)

Front 104

Dysfunctional menstrual cycles are related to what?

Back 104

Related to alterations in HORMONES that support normal cyclical endometrial changes.

Front 105

What is amenorrhea?

Back 105

Lack of menstration. May be primary of secondary.

Front 106

What is primary amenorrhea?

Back 106

Failure to menstruate by 16yo. Or the failure to develop secondary sexual characteristics by the age of 14yo. (ex. poor gonad development, defective development of mallarian tubes...something wrong with hormonal axis/hypo-pit axis)

Front 107

What is secondary amenorrhea?

Back 107

Observed in women who have had menstruation but it ceases for 6mo. or more. This (like primary) involves hormonal changes. (this can be seen in anorexics and athletes who often fail to menstruate, some have such a lack of body fat that they couldn't support a pregnancy anyway)

Front 108

Whay is dysmenorrhea?

Back 108

Pain and discomfort during mentstration.

Could be secondary (due to physical problems like fibroids, etc).

Could be primary where there is no physical cause but pain is felt 1-2d b/f menstruation and then peaks the first day of menstruation.

Front 109

How would you tx primary dysmenorrhea?

Back 109

Just tx the sx.

Front 110

How would you tx secondary dysmenorrhea?

Back 110

Tx the cause.

Front 111

What is hypomenorrhea?

Back 111

Little menstruation

Front 112

What is oligomenorrhea?

Back 112

'few'

Front 113

What is Polymenorrhea?

Back 113

Menstruation that occurs too often.

Front 114

What is menorrhagia?

Back 114

Excessive bleeding

Front 115

Describe PMS?

Back 115

Premenstrual Syndrome (PMS). This is related to hormones. For 20-40% of women there are more severe sx than normally observed.

Front 116

How might severe pms be tx?

Back 116

With oral contraceptives.

Front 117

List 6 possible female infertility factors.

Back 117

1. Anatomic abnormality

2. Genetic abnormality

3. Hypothalamic dysfunction

4. Pituitary dysfunction

5. Ovarian failure

6. Other causes

Front 118

List 4 possible anatomic abnormalities associated with female infertility factors.

Back 118

1. Vaginal and uterine aplasia

2. Cervical stenosis

3. Asherman's syndrome

4. Tumors (inc. fibroids)

Front 119

What is cervical stenosis?

Back 119

The closing of the cervix. (this is an anatomic abnormality that may be a female infertility factor)

Front 120

What is Asherman's syndrome?

Back 120

Intra-uterus adhesions

Front 121

Why do pituitary dysfunctions cause female infertility?

Back 121

Interferes with LH and FSH secretions.

Front 122

List 5 aspects of the medical mgmt of infertility.

Back 122

1. Workup of both partners (medical, surgical, drug history)

2. Rule out structural abnormality (varicocele, obstruction, etc)

3. Manage underlying disease (diabetes, hypopituitarism, orchitis, etc)

4. Tx infection

5. Use alternative reproductive technology

Front 123

List 8 types of assisted reproductive technology?

Back 123

1. Ovulatory-inducing drugs (hormones)

*2. In-vitro fertilization

3. Blastocyst transfer

*4. Intracytoplasmic sperm injection

5. Oocyte donation

6. Cytoplasmic transfer

7. Use of surrogate parent

*8. Cloning

(* = what she focused on in class)

Front 124

In-vitro fertilization was first used successfully in what year?

Back 124

1978

Front 125

Describe in-vitro fertilization. (7)

Back 125

1. Ovaries are basically super stimulated using FSH

2. Produce multiple follicles

3. Follicular dev. is monitored (ultrasounds, estrogen concentration in blood etc)

4. LH surge is induced (done with analog of LH = HCG = Human Chorionic Gonadotropin hormone)

5. Aspirate follicles, find ova

6. Inseminate ova IN VITRO (outside woman's body)

7. If fertilized, eggs returned back to woman's uteruse

Front 126

What is the success rate of in vitro fertilization?

Back 126

20-50% depending on the clinic. So may take a couple rounds of tx.

Front 127

Describe intracytoplasmic sperm injection.

Back 127

This may be used at times such as when a man has oligospermia. Must harvest eggs and sperm and basically inject sperm into an egg cell/ovum.

Front 128

Describe the process of cloning.

Back 128

1. Female, gamete + Female or male, somatic cell needed

2. The nucleus is removed from both cells and inserted into ovum.

3. This gives a clonal zygote

4. The ultimate result is a clonal embryo that is not identical to either of the original cells

Front 129

List 5 animals that have been successfully cloned.

Back 129

1. Pigs

2. Cows

3. Mice

4. Cats

5. Rabbits

Front 130

What is telomere length associated with?

Back 130

Tumors, infection, and lifespan. Shorter telomeres related to shorter lifespan.