REPRODUCTIVE DISORDER (RESPONSES)

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Please respond to these posts, you don’t have to argue with the post, just add some additional insight about the disorders discussed. Add some more diagnosis, treatment and factors that affect the disorders. Also add their similarities and differences.

 

Post #1 Endometriosis and prostatitis.

 

Endometriosis is an important female reproductive system disease because it affects 5-10% of the reproductive age women. Of the affected women, 25% develop infertility (Moore, 2019). Many factors such as genetics, environmental and cellular factors are thought to contribute to development of endometriosis in women of child-bearing age (Huether and McCance, 2017).

 Endometriosis presents with pelvic pain and can be classified as either superficial peritoneal endometriosis, ovarian endometrioma, or deeply infiltrating endometriosis. Laparoscopic surgery is the preferred method of diagnosing endometriosis. As explained by Huether and McCance (2017). Prostatitis is inflammation of the prostate in males. It can be acute or chronic. The causes of Prostatitis can either be bacterial or non-bacterial. Bacterial prostatitis presents with signs and symptoms of urinary tract infection such as fever, dysuria and urinary retention and is treated with antibiotics. In non- bacterial infection, patients complains of dull ache that is continuous or spasmodic in the suprapubic, penile or inguinal areas. It is diagnosed by exclusion and its management is focused on relieving symptoms.

As noted by Schuppe et al (2017), there is no conclusive data as to whether prostatitis affects male fertility.  One difference between prostatitis and endometriosis is that endometriosis has been found to cause a high rate of infertility in affected females whereas there is no conclusive data that implicates prostatitis as a cause of male infertility.

 

 

Post #2 Pelvic Inflammatory disease and cancer of the testis.

Introduction

Both male and female reproductive systems are unique to each gender but share a common function of reproduction. In this discussion, I am going to discuss pelvic inflammatory disease in females and cancer of the testis in males. I will discuss their similarities and differences as well as how age influence treatment of both conditions.

 

Pathophysiology of Pelvic Inflammatory Disease (PID) and Age Factor

As defined by Czeyda-Pommersheim et al., (2017) Pelvic Inflammatory Disease (PID) is an acute ascending inflammatory disease that may involve any organ or multiple organ of the upper genital tract. This includes the uterus, fallopian tubes or the ovaries. In severe cases, the whole peritoneal cavity may be affected. As noted by Huether and McCance (2017), usually PID occurs as a result of sexually transmitted infections to the vulva and vagina such as chlamydia and gonorrhea., Organisms considered to be vaginal normal flora such as Gardnerella vaginalis, enteric gram-negative rods may also cause PID. Anaerobic bacteria may cause PID because they alter the vaginal Ph damaging the mucus plug that blocks the cervical canal. In elderly women Escherichia coli may cause PID (Czeyda-Pommersheim et al., 2017).

Risk factor for PID include untreated previous sexually transmitted disease, being sexually involved with multiple partners, having a sex partner who has multiple sexual partners or has had a  PID in the past, being sexually active below 25 years of age, using vaginal douches as well as using intrauterine device for birth control. Other causative factors include deliveries, dilatation and curettage of uterus or abortions (Huether & McCance, 2017).

PID occurs when microbes ascend from the cervix to the uterus and adnexa. Infection normally involves the endocervical mucosa but can infect the Bartholin’s glands or other glands. From these areas, the infection spreads to other areas involving the fallopian tubes and the ovaries. PID can cause salpingitis which is permanent scaring of the fallopian tubes caused by both gonorrhea gonococci and chlamydia. Signs and symptoms of PID include severe abdominal pain which is made worse by activity such as walking or intercourse, fever, dysuria, irregular bleeding. Some patients may be asymptomatic. can cause Acute complications of PID include peritonitis and bacteremia which can cause other systemic complications such as meningitis or endocarditis. Chronic complications include infertility, ectopic pregnancies, intestinal obstructions due to adhesions (Huether & McCance, 2017).

As noted by Huether and McCance, (2017), due to the possible complications related to PID, Centers for disease control and preventions( CDC) advises clinicians to consider PID as  a possible diagnosis and commence treatment in women with “abdominal pain or pelvic tenderness and either cervical motion tenderness, uterine tenderness or adnexal tenderness” (p.811) Diagnosis is based on clinical presentation, pelvic ultrasound, laparoscopic identification of purulent exudate is the recommended diagnostic procedure for PID, however, it’s rarely done due to being invasive. Vaginal swabs may be analyzed for causative organisms (Spain & Rheinboldt, 2017). Due to its high sensitivity to inflammation and high-level tissue contrast, MRI may be considered in diagnosis of PID. Due to PID being a polymicrobial disease, it is treated with broad spectrum antibiotics for up to 14 days to eliminate all possible microbes. (Spain & Rheinboldt, 2017). In management of PID, as recommended by Dass, Rhonda and Trent (2016), health education should be provided to sexually active women especially those below 25 years of age so as to avoid risky sexual behaviors that predispose them to infections that can lead to complications such as infertility. Sexually active women should also be regularly screened for sexually transmitted infections (STIs) to prevent related complications. Those diagnosed with STIs should be educated on importance of medication compliance as well as treatment of their sexual partners (Dass et al., 2016).

Pathophysiology of Cancer of the Testis and the Age Factor.

As defined by Huether and McCance (2017) cancer of the testis is a highly curable cancer that occurs in young and middle-aged men about 15 to 35 years of age. It accounts for about 1% of all male cancers. It is classified as either seminoma whereby all stages are combined, and the cure rate is about 90%. The other classification is low stage seminoma or nonseminoma, the cure rate is close to 100%. The incidence of testicular CA in the white males is 0.3%, this incidence is 4.5 times higher than for black males. In 1-3% of cases, the occurrence is bilateral. Generally right sided tumors are more common than left sided tumors.

As found by Huether and McCance (2017), 90% of testicular CAs are germ cell tumors that arise from male gametes. These include, seminomas, embryonal carcinomas, teratomas and choriosarcomas. Cancer of the testis can also be caused by specialized cells of the gonadal stroma such as the Leydig, Sertoli, granulosa and the theca cells. Cause is unknown but genetic factors are thought to be associated because occurrence is higher among brothers, identical twins and other closely related male family members. Risk factors include a history of cryptorchidism, abnormal development of the testis, human immunodeficiency virus infection, Klinefelter syndrome and a history of testicular CA.

As noted by a study by Baird, Meyers and Hu (2018), Signs and symptoms include occurrence of a gradual painless, firm testicular enlargement, it may be accompanied by testicular heaviness or a dull lower abdominal pain. Rarely acute pain may occur due to rapid growth of the tumor causing hemorrhage and necrosis. 10% of those affected have epididymis, another 10% have hydroceles and about 5% have gynecomastia. At time of diagnosis about 10% of Individuals usually have developed metastasis. Patients may complain of lumbar pain which is usually an indication of retroperitoneal node metastasis. Signs of lung metastasis include cough, dyspnea, hemoptysis. Metastasis to supraclavicular node present with dysphagia and neck swelling. Metastasis to central nervous system present with altered mental status, vision problems, papilledema or seizures.

 About 25% of males with testicular CA are misdiagnosed with epididymitis and epididymo-orchitis being the most frequent misdiagnoses. Patient should be evaluated in a supine or elect position. On palpation of the scrotum, clinical manifestations include abnormal consistency, induration, nodularity or irregularity of the testis. Abdomen and lymph nodes are palpated for metastasis. Tumor type is identified via orchiectomy. Testicular biopsy is discouraged due to the possibility of spreading tumor cells and increasing recurrence (Huether & McCance, 2017).

As found by Baird et al., (2018), Ultrasonography can accurately and quickly assess a primary testicular CA. Staging of testicular CA is done using the tumor, nodes, metastasis, serum biomarkers (TNMS). Tumor markers are helpful in detecting a tumor that is too small to be palpated or visualized on imaging. As explained by Rajpert-De Meyts, Skakkebaek and Toppari (2018), the higher the tumor markers, the poorer the prognosis-rays, CT scans or magnetic resonance imaging (MRIs) should be done to rule out metastases.  Treatment includes orchiectomy, radiation and chemotherapy either singly or in combination. Prognosis is determined by the stage of the disease and choice of appropriate treatment. Some patients experience paresthesia, Raynaud’s phenomenon and infertility. About 10% of treated patients get relapses. If relapse is discovered early 99% are curable. Though not recommended by the American cancer society, many doctors recommend monthly testicular examinations after puberty. As observed by Rajpert-De Meyts (2018) bilateral testicular masses are often adrenal rests caused by adrenal hyperplasia. Caution should be exercised to avoid erroneous orchidectomy. In cases of orchidectomy, the young males should be educated on importance of cryopreservation of viable sperms if they ever wish to have children

Similarities.

In both of these diseases age is an important factor, PID is common in young females 25 years and younger whereas in CA of the testes, the disease can occur at any age but is common in young adult males between 15 to 35 with a peak diagnosis of around 25 years of age (Baird et al., 2018). Both conditions have the potential of causing infertility in affected individuals. With appropriate management, cure rate for both PID and CA of the testes is over 90%

Differences

PID is caused by infectious processes such as infection by Neisseria gonorrhoeae and Chlamydia trachomatis whereas the cause of CA of the testes is unknown but thought to be genetically predisposed. PID is a common ailment in the US affecting about one million women per year whereas CA of the testes is rare accounting for about 1% of all male cancers. It’s easier for PID patients to realize the need to seek medical attention due to the presenting symptoms such as pain whereas it may take a long time for CA of the testes patients to notice the symptoms because the nodules are usually painless.

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