Reproduction

Breasts and Breast Pathology

Nipple Discharge

Intraductal Papilloma

  • can be benign or malignant
  • no palpable masses

Notes:

  • note that intraductal papilloma is the most common cause of bloody discharge from the nipples in women, especially if there are no palpable masses and if it is unilateral
  • note that nipple discharge can either by physiological or pathological
    --> whenever there is bloody discharge from the nipple, this is ALWAYS pathological

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Sexually Transmitted Diseases

HPV = Human Papilloma Virus
(anogenital warts)

Case example

Notes:

  • note that HPV is the most common sexually transmitted disease and there are over 100 sub types
  • most of these can be cleared by the host immune system
  • there are roughly 4 subtypes to worry about
    --> 6 and 11 cause anogenital warts
    --> remember this as people who do 69 wrong --> do 6 11 and get HPV anogenital warts
    --> 16 and 18 can cause cancer
  • note that HPV 6 and 11 like to infect stratified squamous epithelial cells that are on the vagina, penis, anus and cervix
  • interestlingly the true vocal cords are the only tissure in the larynx that have stratified epithelial tissue
    --> this is because the true vocal cords undergo a lot of friction so the stratified squamous cell layers can replace the layers after friction of the TRUE vocal cords
  • the TRUE vocal cords are how pregnant mothers with anogenital warts HPV 6 / 11 pass it on to their children
  • it is trasnfered to the infants true vocal cords
    --> they then present with hoarseness of the voice, weak cries, and even stridor due to warts on the true vocal cords
  • treatment = ?

Clinical Case

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*Oogenesis, Follicles and Ovulation

Primary / Secondary OOcytes / Meiosis 1 and 2 Arresting stages

  • meiosis arrest #1 - begins at puberty
    --> PUBERTY = prophase of Meiosis 1
  • meiosis arrest #2 - begins at ovulation and fertilization
    --> ends at fertilization
    --> fertilization needs a MALE = metaphase of Meiosis 1

Primary / Secondary OOcytes / Meiosis 1 and 2 Arresting stages CASE 1

  • arrest #1 - begins at puberty
  • arrest #2 - begins at ovulation
    --> ends after fertilization

Notes:

  • note that oocyte primary and secondary and meiosis is all happenning to the oocytes
  • these are within the follicles that contain the oocytes and feed them
  • thus the FSH growth of follicle and LH surge are happenning continuously each month while the oocytes are arrested in Meiosis prophase 1 = puberty state

Clinical Case

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Notes:


  • Gestation = mitosis of oogonium
  • Birth = start making Primary OOcytes from the oogonium
  • Childhood to puberty = Meiosis 1 prophase
    --> think PUBERTY = PROPHASE 1
  • MONTHLY MENSTRUATION = meiosis 1 complete / METAPHASE 2 arrest
  • Metaphase 2 arrest = until MEN arrive
    --> once sperm fertilize the metaphase 2 and entire meiosis 2 completes

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Reproduction terms:


  • gravida = # times pregnant (regardless if brought to term)


    --> primagravida = first pregnancy


    --> nulligravida = NEVER been pregnant (null = means without)


  • para / parity = # of pregnancies brought to term


    --> nullipara = NEVER brought a fetus to full term (null = means without)


  • an / oligo / poly hydramnios = amount of amniotic fluid in amniotic sac

  • colpo- / colpos- = referring to the vagina
  • hematocolpos = collection of blood in the vagina
  • mucocolpos = collection of mucus in the vagina


  • salpingo- = referring to the fallopian tubes (also Eustacian /auditory tube)

  • hystero- = referring to the uterus tubes (also Eustacian /auditory tube)
    --> hysterectomy = removal of the uterus

*Gynecomastea

  • Gynecomastea = MALE KNOCKERS
    --> "SOME Hormones Create KNOCKERS"
  • spironolactone
    --> both spironolactone and cimetidine both accidently block DHT recetors
  • hormones
    --> anything that causes low THD and high estrogen
  • cimetidine
    --> both spironolactone and cimetidine both accidently block DHT recetors
  • Ketoconazole
    --> antifungal AK47 CYP 450 inhibitor
    --> blocks synthesis of ergosterol in fungi
    --> blocks hormone steroids in humans, BUT blocks androgens more than ergosterols
    --> lowers the androgen/estradiol ratio

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*Infertility causes in Women

  • PID = most common
    --> history of PID can casue infertility due to the damage caused to para uterine structure (fallopian tubes etc.)
  • endometriosis
    --> can cause fertility
    --> but it is reversible if you remove the endometriosis growths and cysts that form

*endometriosis

  • can cause fertility
    --> but it is reversible if you remove the endometriosis growths and cysts that form

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Endometriosis NOTES

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Treatment

Secondary Surgical Treatment

  • if Conservative treatment fails, move to laproscopic treatment
  • laproscopy performed
    --> both diagnostic and treatment
    --> gives absolute diagnosis of endometriosis
    --> endometriosis implants can be excised

Conservative Treatment

  • NSAIDs to relieve abdominal and pelvic pain
  • hormonal contraceptives used to lower the output and stimulation of the endometriosis implants

Clinical presentation

  • typically have shorter menstrual cycles (< 28 days), longer days of menstrual flow, younger age of menarche
  • after menstrual cycles have been established, usually develop dysmenorrhea
  • severe pelvic pain
  • endometriosis can cause infertility

*POI = Primary Ovarian insufficiency

  • menopause by age < 40
  • due to depletion of follicle pool
    --> either didn't make enough follicles and retain them at puberty
    --> normally make 2 million and have 25% of this left at puberty
    --> or you lost them due to chemotherapy, etc.
  • note that each month you are using up 20 follicles and only 1 is chosen
    --> the remaining 19 that were not chosen undergo APOPTOSIS and die

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Clinical Cases

Clinical Case

Clinical Case

Notes:

  • note that

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