2. REPRODUCTIVE THE SYSTEM by: CMG

3. Endometriosis is a disorder in which abnormal growths of tissue, histologically resembling the endometrium, are present in locations other than the uterine lining. Although endometriosis can occur very rarely in postmenopausal women, it is found almost exclusively in women of reproductive age. All other manifestations of endometriosis exhibit a wide spectrum of expression. The lesions are usually found on the peritoneal surfaces of the reproductive organs and adjacent structures of the pelvis, but they can occur anywhere in the body . The size of the individual lesions varies from microscopic to large invasive masses that erode into underlying organs and cause extensive adhesion formation. Similarly, women with endometriosis can be completely asymptomatic or may be crippled by pelvic pain and infertility. Endometriosis

4. ENDOMETRIOSIS

5. Etiology Experts do not know what causes endometrial tissue to grow outside your uterus. But they do know that the female hormone estrogen makes the problem worse. Women have high levels of estrogen during their childbearing years. It is during these years—usually from their teens into their 40s—that women have endometriosis. Estrogen levels drop when menstrual periods stop (menopause). Symptoms usually go away then. It is a common disease in women of reproductive age. It involves tissues of the endometrium, the inner lining of the uterus. During the menstrual cycle, built-up endometrial tissues normally are shed if pregnancy does not occur. Some endometrial cells escape from the womb into the pelvic cavity, where they attach themselves and continue their hormone stimulated growth cycle. They may also migrate to remove parts of the body . Pathophysiology

11. Surgical intervention Hysterectomy -is the surgical removal of the uterus to treat cancer, dysfunctional uterine bleeding, endometriosis,non malignant growth, persistent pain, pelvic relaxation and prolapse, and previous injury to the uterus. Oophorectomy - is the surgical removal of one or both ovaries. It is also called ovariectomy or ovarian ablation. If one ovary is removed, a woman may continue to menstruate and have children. If both ovaries are removed, menstruation stops and a woman loses the ability to have children.

15. Ovarian cysts are small fluid-filled sacs that develop in a woman's ovaries. Most cysts are harmless, but some may cause problems such as rupturing, bleeding, or pain; and surgery may be required to remove the cyst(s). It is important to understand how these cysts may form. Women normally have two ovaries that store and release eggs. Each ovary is about the size of a walnut, and one ovary is located on each side of the uterus . One ovary produces one egg each month, and this process starts a woman's monthly menstrual cycle . The egg is enclosed in a sac called a follicle. An egg grows inside the ovary until estrogen (a hormone), signals the uterus to prepare itself for the egg. In turn, the uterus begins to thicken itself and prepare for pregnancy . This cycle occurs each month and usually ends when the egg is not fertilized. All contents of the uterus are then expelled if the egg is not fertilized. This is called a menstrual period. Ovarian Cysts

16. ovarian cyts

24. Surgical intervention Laparoscopic surgery: The surgeon fills a woman's abdomen with a gas and makes small incisions through which a thin scope (laparoscope) can pass into the abdomen. The surgeon identifies the cyst through the scope and may remove the cyst or take a sample from it. Laparotomy : This is a more invasive surgery in which an incision is made through the abdominal wall in order to remove a cyst. Surgery for ovarian torsion: An ovarian cyst may twist and cause severe abdominal pain as well as nausea and vomiting. This is an emergency, surgery is necessary to correct it. Cystectomy : This is like taking a clam out of the shell. The thinned out ovarian tissue is cut open, and the cyst is gently peeled away from inside the ovary. The cyst fluid is then removed with a suction device. The cyst now looks like a deflated balloon and can easily be removed through the small laparoscopy incision.

28. Dysmenorrhea Dysmenorrhea refers to the syndrome of painful menstruation. Primary dysmenorrhea occurs in the absence of pelvic pathology, whereas secondary dysmenorrhea results from identifiable organic diseases, most typically endometriosis, uterine fibroids, uterine adenomyosis, or chronic pelvic inflammatory disease. The prevalence of dysmenorrhea is estimated to be between 45 and 95% among reproductive-aged women. Although not life threatening, dysmenorrhea can be debilitating and psychologically taxing for many women and is one of the leading causes of absenteeism from work and school.

31. Pathophysiology Prostaglandins are released during menstruation, due to the destruction of the endometrial cells, and the resultant release of their contents. Release of prostaglandins and other inflammatory mediators in the uterus is thought to be a major factor in primary dysmenorrhea. Females with primary dysmenorrhea have increased activity of the uterine muscle with increased contractility and increased frequency of contractions.

42. n Medical intervention Consult the doctor once you find these symptoms in you and take the measurement of your follicle stimulating hormone for confirming yourself whether you are in menopause or post menopause stage.

43. n Nursing care Consult the doctor once you find these symptoms in you and take the measurement of your follicle stimulating hormone for confirming yourself whether you are in menopause or post menopause stage.

44. What is a vaginal fistula? . A fistula is a passage or hole that has formed between: -Two organs in your body. -An organ in your body and your skin. A fistula that has formed in the wall of the vagina is called a vaginal fistula. A vaginal fistula that opens into the urinary tract is called a vesicovaginal fistula . A vaginal fistula that opens into the rectum is called a rectovaginal fistula . A vaginal fistula that opens into the colon is called a colovaginal fistula . A vaginal fistula that opens into the small bowel is called a enterovaginal fistula .

45. vaginal fistula

56. uterine prolapse

59. pathophysiology Normally, your uterus is held in place by the muscles and ligaments that make up your pelvic floor. Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, providing inadequate support for the uterus. The uterus then descends into the vaginal canal.

65. RECTAL PROLAPSE Is a condition in which the rectum (the lower end of the colon, located just above the anus) becomes stretched out and protrudes out of the anus. Weakness of the anal sphincter muscle is often associated with rectal prolapse at this stage, resulting in leakage of stool or mucus. While the condition occurs in both sexes, it is much more common in women than men.

66. RECTAL PROLAPSE

76. SURGICAL INTERVENTION Two types of surgery are used to treat a complete prolapse. A surgeon may operate through the belly to secure part of the large intestine or rectum to the inside of the abdominal cavity (rectopexy). Sometimes the surgeon removes the affected part of intestine. This type of surgery is most often used for younger, physically fit people. RECTOPEXY-Surgical fixation of a prolapsed rectum Surgery also can be done through the area between the genitals and the anus ( perineum ) to strengthen the anal sphincter . This type of surgery is best for people who are elderly or are not physically fit.

77. IMPERFORATED HYMEN The hymen originates from the embryonic vagina buds from the urogenital sinus. As a consequence, the hymen is a composite of vaginal epithelium and epithelium of the urogenital sinus interposed by mesoderm. Once the hymen becomes perforated or forms a central canal, it establishes a communication between the upper vaginal tract and the vestibule of the vagina (Mishell, 1997) . The cause may be related to failure of apoptosis due to a genetically transmitted signal, or it may be related to an inappropriate hormonal milieu.

78. Pathophysiology Any obstruction of the vaginal tract during the prenatal, perinatal, or adolescent periods results in the entrapment of vaginal and uterine secretions. In patients with imperforate hymen, this obstruction is at the level of the introitus and becomes evident when the distensible membrane bulges between the labia. Various terms, such as mucocolpos, hematocolpos, and pyocolpos, are used to describe this condition depending on the nature of the retained contents. In fetal development and in the immediate perinatal period, mucoid secretions from the uterovaginal tract result in mucocolpos under the influence of maternal estrogens. When the diagnosis is made in adolescence, the retained secretions consist of menstrual products, and the resulting mass effect in the vagina and uterus are referred to as hematocolpos and hematometrocolpos, respectively. Reflux of the endometrial tissue through the fallopian tubes (ie, hematosalpinx) may result in secondary endometriosis. An accumulation of infected material within the vaginal cavity (ie, pyocolpos) may occur because of an infection that is ascending through microperforations in the membrane.

83. SURGICAL INTERVENTION Surgical intervention for imperforate hymen should require only 1 definitive procedure to evacuate the retained secretions and to ensure the maintenance of patency. Simple drainage of the material confined beyond the hymen is contraindicated because it does not allow for adequate drainage of the thick fluid, it is not definitive, and it increases the risk of infection (pyometras). Two techniques are most commonly advocated: simple incision and small excision of the membrane. Simple incision of the hymen may be associated with postoperative stenosis with strictures, and it is not the method generally preferred at many centers. Use of an X -shaped incision ought to be the method of choice. An elliptical excision of the membrane is performed close to the hymenal ring, followed by evacuation of the obstructed material. This technique is considered to be most effective in definitive treatment. Avoid compressing the uterus and fallopian tubes to speed evacuation of the trapped contents after the hymen is incised.

85. TOXIC SHOCK SYNDROME Toxic shock syndrome (TSS) is a serious but uncommon bacterial infection. TSS was originally linked to the use of tampons, but is now also known to be associated with the contraceptive sponge and diaphragm birth control methods. TSS has also resulted from wounds secondary to minor trauma or surgery incisions where bacteria have been able to enter the body and cause the infection. The symptoms of TSS include sudden high fever, a faint feeling, watery diarrhea, headache, and muscle aches. If your child has these symptoms, call your doctor right away.

86. pathophysiology

93. THANK YOU. . So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand. Isaiah IV : X God bless.. by: CMG