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23 Pathophysiology of the Reproductive System Cheat Sheet by

Urolithiasis (contnd week 22 topic), pelvic inflammatory disease, endometriosis, abnormal uterine bleeding, & female infertility, urinary infections, bening prostatic hyperplasia

Kidney stones

Defini­tion: Hard deposits of minerals & salts forming within the urinary tract
Signs & symptoms:
- Severe, sharp pain in the side & back, below the ribs
- Pain that radiates to the lower abdomen & groin
- Pain that comes in waves & fluctuates in intensity (due to stones moving)
- Pain or burning sensation while urinating
- Pink, red or brown urine
- Cloudy or foul-s­melling urin
- Persistent need to urinate, urinating more often than usual or urinating in small amounts
- Nausea & vomiting
- Fever & chills if an infection is present
=> Pain may change [e.g. shifting to a different location or increasing in intensity - as the stone moves through the urinary tract]
Pathop­hys­iology & mechanism: Diet, excessive body weight, medical condit­ions, supple­ments, medica­tions (& genetics) = urine becomes concen­trated, forming stones (in any part of the urinary tract)

Kidney stones

Benign Prostatic Hyperp­lasia (males)

- Enlarged prostate gland due to ↑ in cell number (noncancerous)
- More frequent in West
- More common in black people
Signs & symptoms:
- Freque­nt/­urgent urination
- ↑ urination at night
- Trouble starting to pee
- Weak urine stream (or stop-starts)
- Dripping at end of urination
- Not able to empty bladder fully
- Less common: UTI, not able to urinate, blood in urine
Pathop­hys­iology & mechanism: Aging, various hormonal, bladde­r/k­idney stones, problem with nerves that control bladder, prosta­te/­bladder cancer
Risk factors: Aging, family Hx, diabetes, heart disease, lifestyle
Treatment: Medica­tion, therapy, surgery

Benign Prostatic Hyperp­lasia

Benign Prostatic Hyperp­lasia (contnd)

Female Reprod­uctive Disorders

Pelvic Inflam­matory Disease
Abnormal Uterine Bleeding
Female Infert­ility
Defini­tion: Infection of he female upper genital tract, including the womb, fallopian tubes & ovaries
Defini­tion: Endome­trium (womb lining tissue) implants & grows in places other than the uterine cavity (ovaries, fallopian tubes); women of any age; long term condition
Defini­tion: Bleeding between monthly periods, prolonged bleeding, extremely heavy periods
Umbrella term for 2 different conditions ()
Defini­tion: Couple cannot conceive (both can be the issue )
Signs & symptoms:
- May be asymptomatic
- Pain around pelvis or lower abdomen
- Discomfort or pain during sex that is felt deep inside the pelvis (+/- bleeding)
- Bleeding between periods or after sex
- Unusual vaginal discharge
- Fever & vomiting
- Pain in the rectum
Signs & symptoms:
- Sharp, deep pain during ovulation, sex, bowel movements, &/or urination
- Heavy, painful periods or bleeding in between periods
- Indige­stion, diarrhoea, consti­pation, & nausea
- Fatigue
- Sciatica during menstr­uation
Signs & symptoms:
- Heavy periods
- Irregular bleeding
- Prolonged periods
- Incons­istent menstrual cycles
- Spotting
- Infection
- Fibroids
- Polyps
- Septations (conge­nital malformations)
- Polycystic ovaries (produce eggs not ready to be fertilised)
-Uterine tube blockage (eggs don't reach uterine cavity)
- Adhesions (due to past bleedings)
Pathop­hys­iology & mechanism: Infection (sexually transm­itted bacteria) in the vagina or the neck of the cervix => spreads higher up into the reprod­uctive organs
Pathop­hys­iology & mechanism: Retrograde flow endome­trial cells => flow through reprod­uctive organs = growth of endome­trium tissue occurs in wrong places
Pathop­hys­iology & mechanism:
Local causes: Polyp, Adenomy­osis, Leiomyoma, Malignacy
Systemic causes: Coagulo­pathy, Ovulatory, Endomet­rial, Iatrogenic, Not otherwise classified (Ishmocele)
=> Changes in prosta­glandin concen­tra­tion, increased endome­trial respon­siv­eness to vasodi­lating prosta­gla­ndins, and changes in endome­trial vascular structure
Pathop­hys­iology & mechanism: Any of above causes =>o­ocyte not released due to ↓ release of oestrogen by. ovaries/↓ follicles available to ovulat­e/g­entic damage­/↓t­ran­sport of oocyte through fallopian tubes/ ↓ egg/sperm mobility due to local inflam­mat­ion­/in­ability of cervix to produce normal mucus, &/or sperm unable to enter the cervix­/ut­erine lining disrup­tion/↓ vascul­ari­sation & endome­trial regrowth
- Can result in infert­ility or an ectopic pregnancy
- Chronic pelvic pain ()
=> Especially when asympt­omatic as it's left untreated
- Subfer­tility or infertility
- Signif­icant physical, emotional & social impact
Treatment: Medica­tion, hormonal contra­ception & surgery
Risk factors: Age; smoking; weight; Hx of STIs (chlamydia & gonorr­hea); alcohol
Treatment: Antibi­otics & in worst cases surgery
Treatment: Hormone therapy; hormonal contra­cep­tion; conser­vative surgery; hyster­ectomy (last resort)
Menorr­hogia: excessive &/or prolonged menstruation
Metror­rhagia: excessive, prolonged &/or irregular bleeding unrelated to menstr­uation
Treatment: Fertility drugs
Chronic Pelvic Pain: Any pain in the lower abdomen or pelvis lasting longer than 6 months; common (1/6 women); often without obvious cause (multiple conditions can cause it); physical, psycho­logical & social factors

Urinary Incont­inence

- Loss of bladder control
- 4 types of incont­inence: Stress incont­inence [Urine leak after coughing, laughing, sneezing, or exerci­sing]; Urge incont­inence [Urine leak after a strong, sudden urge to urinate]; Mixed incont­inence [mix of stress & urge, may leak urine with laugh or sneeze]; Temporary incont­inence [Illness e.g. UTI]
Signs & symptoms:
- Failure to void
- Failure to store
- Urodynamic studies
Pathop­hys­iology & mechanism:
- Overflow incont­inence => overfi­lling of the bladder from obstru­ction; Bladder Outlet Obstru­ction (tumour, stone, BPH, urethral or bladder neck stricture)
- Detrusor overac­tivity => overactive bladder (idiop­athic), CNS lesion (neuro­genic), inflam­mat­ion­/in­fection (cysti­tis­,UTI), diabetes mellitus
- ↓bladder wall compliance => progre­ssive ↑ in intrav­esicle pressure during bladder filling pushing urine from the bladder
- Urethral hyper mobility, intrinsic sphincter defici­ency, or a poorly coating urethra => ↓ pelvic floor muscle & ligament strength causing ↓ tone of vesico­ure­teral sphincter unit; ↓ urethral strength & associated strained & smooth muscle (iatro­genic)
Treatment: Exercises; therapies; medication & surgery

Urinary Incont­inence

Urinary Infection

- Infection in any part of the urinary system
- Women at greater risk (shorter urethra, increasing likelihood of infection ascension)
Causes: Bacteria (most commonly faecal bacteria)
Signs & symptoms:
- Strong urge to urinate that doesn't go away
- Burning feeling when urinating
- Urinating often & small amounts
- Cloudy & strong­-sm­elling urine
- Red, bright pink or cola-c­oloured urine (signs of blood)
- Pelvic pain (centre of pelvis & around pubic bone)
- Fever &/or chills
- Pain in lower back &/or side
Pathop­hys­iology & mechanism:
1. Coloni­sation (pathogen colonises the periur­ethral area & ascends through the urethra upwards to the bladder) 2. Uroepi­thelium penetr­ation (Cumbria allow bladder epithelial cell attachment & penetr­ation → bacteria continue to replicate & may form biofilms) 3. Ascension (once sufficient bacteria colonise, they may ascend on the ureter towards the kidneys) 4.Pyel­one­phritis (infla­mmatory response to the infection of renal parenc­hyma) 5. Acute kidney injury (if inflam­matory cascade continues, tubular obstru­ction & damage occurs → inters­titial edema, may → inters­titial nephritis → AKI)
- Repeated infections
- Permanent kidney damage (untreated UTI)
- Delivering a low birth weight or premature infant (UTI during pregnancy)
- Narrowed urethra (males)
- Sepsis (life threat­ening; infection that travelled up to the kidneys)
Treatment: Antibiotic or vaginal oestrogen therapy (after menopause)

Lower Urinary Tract Infection (LUTI)

Upper Urinary Tract Infection (UUTI)

Separation block

Pelvic Inflam­matory Disease (PID)


Abnormal Uterine Bleeding (AUB)

Female Infert­ility



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