REVISION

1. REVISION Identify 1 causal organism of vaginitis in child-bearing women. Outline the pathophysiology of endometriosis, with a particular focus on implantation of ectopic tissue and adhesions. Identify 3 signs of polycystic ovary syndrome. What is the most common neoplasm in men over the age of 50? Outline the foregoing conditions pathophysiology. Outline the cellular progression of breast cancer. Outline the pathophysiology of PID.

2. ALTERATIONS IN REPRODUCTIVE FUNCTION PART II

3. Disorders of the Vulva A variety of skin disorders, including inflammatory lesions, may manifest themselves in the vulva. Candidal infections may occur, particularly in diabetics. Herpes Simplex Type II Syphilis: primary and secondary syphilitic lesions may affect the vulva. The condyloma latum of secondary syphilis is characterised by oedematous, acutely inflamed hyperplastic epithelium with underlying chronic inflammation. Granuloma inguinale: calymmatobacterium granulomatis; It commonly causes chronic vulval ulceration, yet, may spread to other sites in the female genital tract. Candidiasis: may cause chronic irritation and inflammation of the vulva which may be associated with vaginitis. Vulvodynia: syndrome of unexplained vulva pain; characterised by burning, stinging, irritation, soreness; Vulvar vestibulitis syndrome.

4. Disorders of the Uterine Cervix Cervicitis: is an acute or chronic inflammation of the cervix. Acute cervicitis may result from: Direct infection of the cervix Secondary to a vaginal or uterine infection Causes: infective agents: C. albicans, T. vaginalis, Neisseria gonorrhoeae, Chlamydia trachomatis and herpes simplex virus II. Chronic cervicitis: represents a low grade inflammatory process. The cervix may become ulcerated; present with nabothian cysts.

5. Disorders of the Uterus Infectious disorders of the uterus and pelvic structures: Endometriosis Pelvic Inflammatory Disease Adenomyosis: condition in which endometrial glands and stroma are found within the myometrium, interspersed between smooth muscle fibres. Endometrial Cancer: Most frequent invasive cancer of the female reproductive tract in the West. It is typically a disease of postmenopausal women (> peri-menopausal women with excess oestrogen). Uterine Leiomyomas: are benign neoplasms of smooth muscle origin. They are the most common female reproductive tumour. Uterine Leiomyomas usually develop in the corpus of the uterus as intramural, sub-serosal or sub-mucosal growths.

6. Disorders of Uterine Support Uterine prolapse: is the bulging of the uterus into the vagina that occurs when the primary supportive ligaments are stretched. The symptoms associated with uterine prolapse result from irritation of the exposed mucous membranes of the cervix and vagina and the discomfort of the protruding masses. Cystocele Rectocele Enterocele

7. Disorders of the Ovaries Cystic lesions of the ovaries: Follicular cysts and Functional cysts. Polycystic ovary syndrome Benign ovarian tumours: ovarian tumours can be benign, boarder-line or malignant. Approximately 80 percent of these tumours occur during the reproductive years. Changes to normal menstrual cycle Ovarian Cancer: second most frequent gynaecologic malignancy after endometrial cancer. Tumours are categorised according to cell type of origin. The incidence of ovarian cancer is much less in countries where women bear numerous children. Increased susceptibility by way of BRCA 1 and BRCA 2 mutations.

8. Menstrual Disorders Amenorrhoea: primary and secondary Dysmenorrhoea: pain or discomfort with menstruation. Primary and Secondary. Premenstrual Syndrome Disorder: group of physical, emotional and behavioural changes that occur in a regular, cyclic relationship to the luteal phase of the menstrual cycle. Premenstrual dysphoric disorder: depressed mood, moodiness, anxiety, anger, irritability, fatigue, insomnia. Menopause: cessation of menstrual cycles, is more a process than a single event. Peri-menopause; Climacteric; FSH and Oestrogen.

9. Disorders of the Breast Inflammatory disorders: Mastitis: inflammation of the breast; resulting from an ascending infection (most commonly, staphylococcus aureus and streptococcus) that travels from the nipple to the ductal structures. The offending organism often originates from the suckling infant’s nasopharynx or the mothers hands. Mammary Duct Ectasia: refers to the presence of dilated breast ducts containing a thick pasty material, with accompanying per-ductal inflammation and fibrosis. Benign epithelial disorders: Fibrocystic breast changes: most frequent lesion of the breast.

10. Disorders of the Prostate Gland Prostatitis: inflammatory lesion of the gland, often associated with a specific infective cause. Acute suppurative prostatitis: caused by coliforms, staphylococcus or Neisseria gonorrhoea. Chronic non-specific prostatitis Granulomatous prostatitis: idiopathic, tuberculous, following transurethral resection or allergy.

11. Disorders of the Penis and Scrotum Congenital lesions: Hypospadias: is the commonest congenital abnormality of the male urethra, resulting from a failure of fusion of the urethral folds over the urogenital sinus. Epispadias: much less common than hypospadias. Results in urinary incontinence and infections. Inflammation and infections: Balanoposthitis: inflammation of the inner surface of the prepuce is usually accompanied by inflammation of the adjacent surface of the glans penis. Pathophysiology: tight prepuce; sebaceous material and keratin may accumulate beneath the prepuce, which may become infected by pyogenic bacteria. These bacteria include staphylococci, coliforms or gonococci. Peyronie’s disease: is a rare penile lesion presenting usually in the fifth and sixth decades with painful curvature of the penis on erection and sometimes difficulty with micturition. Dupuytren’s contracture.

12. Disorders of the Urethra Urethritis: gonorrhoea /chlamydia trachomatis (non-specific urethritis). Viral condyloma: minute viral warts occurring in the penile urethra. Transitional cell carcinoma: environmental carcinogenic influences.

13. Disorders of the Testis Cryptorchidism: 5 percent of boys. Hydrocele: primary and secondary Haematocele Orchitis: inflammation of the testes. Mumps Orchitis Idiopathic Granulomatous Orchitis Syphilitic Orchitis Testicular Tumours: relatively uncommon; Mal-descent of the testis; Local trauma is not considered a causal factor; Painless unilateral enlargement of the testis, secondary hydrocele, gynaecomastia. Male Infertility: endocrine disorders; testicular lesions; post-testicular lesions.