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Pathophysiology

Denver School of Nursing – BSN & ADN. Pathophysiology. BIO 206 / 308 – Ch 31 & 32 – Reproductive Phys / Path. Development of the Reproductive System. Dependent on sex hormones Males—testosterone Females—estrogen, FSH, and LH Sexual differentiation in utero Homologous structures

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Pathophysiology

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  1. Denver School of Nursing – BSN & ADN Pathophysiology BIO 206 / 308 – Ch 31 & 32 – Reproductive Phys / Path

  2. Development of the Reproductive System • Dependent on sex hormones • Males—testosterone • Females—estrogen, FSH, and LH • Sexual differentiation in utero • Homologous structures • Gonads • Ducts • Mesonephric • Paramesonephric

  3. Development of the Reproductive System • Negative feedback system • Present at term pregnancy • Gonadostat responds to placental estrogen • Release of GnRH

  4. Development of the Reproductive System • Puberty • 8 to 12 years of age gonads produce more sex hormones • Begins with thelarche and ends with menstrual period in females • Begins with voice changes and ends with mature sperm in males

  5. Development of the Reproductive System • Puberty • Adrenarche • Decreased gonadostat sensitivity • Positive feedback system between LH, FSH, and GnRH

  6. Internal Genitalia

  7. Internal Genitalia

  8. Ovary

  9. Follicle Development

  10. Female Sex Hormones • Estrogens • Estradiol (E2) • Estrone • Estriol • Progesterone • Androgens

  11. Menstrual Cycle • Menarche • Menopause • Phases • Menstruation (menses) • Follicular/proliferative phase • Luteal/secretory phase • Ischemic/menstrual phase

  12. Menstrual Cycle

  13. Menstrual Cycle • Ovarian cycle • Uterine phases • Vaginal response • Body temperature change

  14. Male Reproductive System • External genitalia • Testes • Produce gametes and sex hormones • Epididymis • Vas deferens • Scrotum • Penis • Glans and prepuce

  15. Male Reproductive System

  16. Male Reproductive System • Internal genitalia • Ducts • Vas deferens and ejaculatory • Glands • Seminal vesicles • Prostate gland • Bulbourethral glands

  17. Male Internal Genitalia

  18. Spermatogenesis • Spermatogonia • Primary spermatocytes • Secondary spermatocytes • Spermatids • Sertoli cells

  19. Spermatogenesis

  20. Male Reproductive System

  21. Male Sex Hormones • Androgens • Primary androgen—testosterone • Produced mainly in the Leydig cells of the testes • Testosterone • Sexual differentiation • Urogenital system development • Nervous and skeletal tissue development • Libido

  22. Aging and the Female Reproductive System • Perimenopause • Ovarian, uterine, and systemic changes • Vasomotor flush • Menopause • Breast tissue, urogenital, skeletal, and cardiac changes

  23. Aging and the Male Reproductive System • Testes atrophy, decrease in weight, and soften • Decreased levels of testosterone; gonadotropins increase

  24. Break Time…

  25. Chapter 32 Alterations of the Reproductive Systems, Including Sexually Transmitted Infections

  26. Two Points of… Clarification • Spermatogenesis • Occurs in the seminiferous tubules • Ovary • Is the female reproductive endocrine organ… therefore unlike other essential reproductive structures… only Ovarian cells have receptors for gonadotropins

  27. Alterations of Sexual Maturation • Delayed puberty • Secondary sex characteristics have not appeared in girls by age 13 • Secondary sex characteristics have not appeared in boys by age 14 • 95% of cases are simply a constitutional delay • 5% are caused by some type of disruption of the hypothalamic-pituitary-gonadal axis

  28. Alterations of Sexual Maturation • Precocious puberty • Sexual maturation before age 6 in girls • Sexual maturation before age 9 in boys • Forms • Isosexual precocious puberty • Heterosexual precocious puberty • Incomplete precocious puberty

  29. Disorders of the Female Reproductive System • Hormonal and menstrual alterations • Primary dysmenorrhea • Painful menstruation associated with prostaglandin release in ovulatory cycles • Related to the duration and amount of menstrual flow • Secondary dysmenorrhea • Painful menstruation related to pelvic pathology • Can occur any time in the menstrual cycle

  30. Hormonal and Menstrual Alterations • Primary amenorrhea • Absence of menstruation by age 14 • Secondary amenorrhea • Absence of menstruation for a time equivalent to three or more cycles or 6 months in women who have previously menstruated

  31. Hormonal and Menstrual Alterations • Primary amenorrhea • Causes • Congenital defects of gonadotropin production • Genetic disorders • Congenital central nervous system defects • Congenital anatomic malformations • Acquired CNS lesions

  32. Hormonal and Menstrual Alterations • Secondary amenorrhea • Causes • Pregnancy • Dramatic weight loss • Malnutrition or excessive exercise • Anovulation • Hyperprolactinemia • Hirsutism

  33. Amenorrhea

  34. Hormonal and Menstrual Alterations • Abnormal uterine bleeding • Menstrual irregularity • Dysfunctional uterine bleeding

  35. Hormonal and Menstrual Alterations • Polycystic ovarian syndrome • Oligo-ovulation or anovulation • Elevated levels of androgens or clinical signs of hyperandrogenism and polycystic ovaries • Leading cause of infertility in the United States

  36. Hormonal and Menstrual Alterations • Polycystic ovarian syndrome • Multifactorial • Hyperinsulinism, hypertension, dyslipidemia • Dysfunction of follicle development

  37. Hyperinsulinism

  38. Infection and Inflammation • Pelvic inflammatory disease (PID) • Acute inflammatory disease caused by infection • May involve any organ of the reproductive tract • Salpingitis • Oophoritis • Sexually transmitted diseases migrate from the vagina to the upper genital tract • Polymicrobial infection

  39. Pelvic Inflammatory Disease (PID)

  40. Pelvic Inflammatory Disease (PID)

  41. Infection and Inflammation • Vaginitis • Infection of the vagina • Sexually transmitted pathogens, bacterial vaginosis, and Candida albicans • Acidic nature of the vagina provides some protection • Maintained by cervical secretions, normal flora, and lactobacillus acidophilus

  42. Infection and Inflammation • Cervicitis • Inflammation or infection of the cervix • Mucopurulent cervicitis (MPC)

  43. Infection and Inflammation • Vulvitis • Inflammation of the female external genitalia • Causes • Contact with soaps, detergents, lotions, hygienic sprays, shaving, menstrual pads, perfumed toilet paper, or nonabsorbing or tight-fitting clothing • Vaginal infections that spread to the labia

  44. Pelvic Relaxation Disorders • The bladder, urethra, and rectum are supported by the endopelvic fascia and perineal muscles • The muscular and fascial tissue loses tone and strength with aging • Fails to maintain organs in proper position

  45. Pelvic Relaxation Disorders • Cystocele • Rectocele • Urethrocele • Cystourethrocele • Enterocele • Vaginal prolapse • Uterine prolapse

  46. Pelvic Relaxation Disorders

  47. Benign Growths and Proliferative Conditions • Endometrial polyps • Benign mass of endometrial tissue • Intermenstrual, and excessive bleeding can occur

  48. Benign Growths and Proliferative Conditions • Leiomyomas • Commonly called uterine fibroids • Benign tumors of smooth muscle cells in the myometrium • Cause abnormal uterine bleeding, pain, and symptoms related to pressure on nearby structures

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