12. Reproductive System Workshop Flashcards
Provide alternative names for:
a. Female gametes
b. Male gametes
c. Childbirth
a. ova
b. spermatozoa
c. parturition
Name the ‘sinuses’ which store milk in the breasts
Lactiferous sinuses
With regards to breast milk, describe the functions of:
a. Prolactin
b. Oxytocin
a. Prolactin stimulates milk synthesis
b. Oxytocin causes milk ejection
Name the three layers of the uterine wall
Perimetrium [visceral peritoneum]
Myometrium [three smooth muscle layers]
Endometrium [highly vascular]
Name four functions of the uterus
- Pathway for sperm
- Site of zygote implantation
- Location for foetal development
- The uterus contracts to initiate labour (parturition)
Describe specifically the structure and function of the endometrium
The endometrium is the highly vascular inner layer of the uterus that is divided into the ‘stratum functionalis’ which sloughs off during menstruation and the ‘stratum basalis’, which is the permanent deeper layer that regenerates the stratum functionalis. The endometrium is vitally important as the site of zygote and placental implantation.
Name one uterine tissue layer that contains smooth muscle
Myometrium
Name one ligament that holds the uterus in place
The broad ligament
Which layer of the uterus sheds during menstruation?
The stratum functionalis of the endometrium
Describe the difference between an embryo and a foetus
During the first eight weeks of pregnancy, the zygote (fertilised egg) is called an embryo. After eight weeks, the embryo becomes a foetus.
Describe the function and role of the placenta
The placenta is the site of exchange of nutrients and wastes between the mother and foetus and is attached to the endometrium. The placenta produces progesterone and oestrogen, which are needed to maintain the pregnancy.
What characteristic makes the placenta unique?
The placenta is unique because it develops from two individuals (maternal part from the endometrium)
Discuss the following statement: “The placenta is an effective barrier to all medicine and drugs”
Although the placenta is a protective barrier to most micro-organisms, unfortunately many drugs and substances such as alcohol can freely pass through the placenta and cause birth defects (especially during the first three months - teratogenic).
Which cell type cannot cross the placenta?
Blood cells
Describe the functions of the following placental hormones:
a. Progesterone
b. Relaxin
c. Oestrogen
d. Human Chorionic Gonadotropin (hCG)
e. Corticotropin releasing hormone (CRH)
f. Human placental lactogen (hPL)
a. Progesterone: maintains endometrial lining to sustain and nourish the foetus
b. Relaxin: targets ligaments and relaxes them
c. Oestrogen: promotes growth of breast tissue and myometrium
d. hCG: Maintains the corpus luteum for 8 weeks; increases transfer of nutrients to foetus.
e. CRH: triggers release of cortisol from adrenals to prevent the rejection of the foetus.
f. hPL: Increases the amount of glucose and lipids in maternal blood.
Using definitions, compare the following placental complications:
- Placenta praevia
- Placenta accreta
- Placental abruption
- Placenta praevia: occurs when the placenta attaches to the lower part of the uterine wall, potentially occluding the cervical opening.
- Placenta accreta: is the abnormally deep attachment of the placenta through the endometrium and into the myometrium.
- Placental abruption: is the rupture of the blood vessels adhering the placenta to the uterine wall, leading to separation of the placenta from the uterus.
Describe two differences between ‘monozygotic’ and ‘dizygotic’ twins.
Monozygotic twins are identical and originate from a single fertilised ovum that splits into two embryos that share one placenta. Dizygotic twins are non-identical and originate from two ova, fertilised by two sperm, and each have their own placenta.
Describe the two functions of the fallopian tubes.
The fallopian tubes provide a route for the sperm to meet the ova and for the ova/fertilised ova to reach the uterus.
Explain how the ovum travels from the ovary into the fallopian tubes.
Finger-like projections called fimbriae surround the ovary and ‘sweep’ the ova into the fallopian tube. The tubes, lined with ciliated columnar epithelium, help move the ova towards the uterus. The smooth muscle layer of the fallopian tube also performs peristalsis to assist in the ova movement.
Describe two functions of the ovary
The ovaries are the female gonads and produce female gametes. They also secrete the sex hormones oestrogen and progesterone.
Oogenesis refers to the formation of female _________ in the ovaries. Oogenesis begins in the ___________. Primary ___________ are formed from germ cells during foetal development. The formation of primary oocytes stops at _____ and they are surrounded by a layer of follicular cells. This entire structure is called a ____________ follicle. During a woman’s reproductive lifetime, about ______ follicles will mature and ovulate whilst the remainder ___________.
gametes foetus oocytes birth primordial 400 degenerate
Describe how FSH and LH play a role in post pubertal oogenesis.
FSH stimulates the maturation of the primordial follicles, which give rise to primary follicles, then secondary follicles and finally mature follicles.
A surge of LH triggers ovulation (the release of the ovum).
Briefly explain the formation of the corpus luteum
The remains of the ovarian follicle that has ovulated, becomes the corpus luteum (“yellow body”) which produces progesterone and some oestrogen to maintain the endometrium for the first 8 weeks of gestation. hCG prevents the degradation of the corpus luteum in the case of fertilisation.
List four stages of the menstrual cycle
- Menstrual phase (days 1-5)
- Pre-ovulatory phase (day 6-13)
- Ovulation (day 14)
- Post-ovulatory phase (day 15-28)
Describe in detail the first half of a typical menstrual cycle (Day 1-13)
During days 1-5 (menstrual phase), the endometrium is being shed and in the ovaries the follicles are developing under the influence of FSH. During days 6-13 (pre-ovulatory phase), the endometrium thickens in response to rising oestrogen levels and follicles start to mature and secrete oestrogen. Follicles also secrete inhibin which decreases the secretion of FSH, stopping further follicles from maturing.
Describe in detail the second half of a typical menstrual cycle (Day 14-28)
The ovulation phase occurs on day 14, when the high oestrogen levels creates a positive feedback loop that stimulates LH secretion. LH causes the rupture of a mature follicle and expulsion of the egg.
Days 15-28 is known as the post-ovulatory phase. The corpus luteum forms from the follicle wall and produces progesterone and some oestrogen. This is essential for establishing and maintaining the endometrium in pregnancy if the egg has been fertilised.
Describe what happens to a:
a. Fertilised egg
b. Non-fertilised egg
a. When the egg is fertilised, the zygote embeds in the uterine wall. The embryo (embedded zygote) produces hCG to maintain and stimulate the corpus luteum to produce progesterone and oestrogen, a role which is taken over by the placenta after a few weeks.
b. 14 days after ovulation, the corpus luteum degenerates into the corpus albicans. The levels of progesterone and oestrogen drop and a new cycle starts with menstruation.
Name three hormones involved in the onset of puberty.
Follicle stimulating hormone (FSH) Luteinising hormone (LH) Gonadotropin releasing hormone (GnRH)
List three body changes that typically occur during puberty
Breast development
Hair growth (pubic, axillary, legs)
Hips widen
Voice deepens
Define ‘menopause’
The menopause is the permanent cessation of menstruation for 12 consecutive months that naturally occurs at age 45-55.
Describe how the normal menopause develops.
Menopause occurs due to the number of follicles in the ovaries being exhausted, causing a drop in oestrogen and progesterone production and ovulation. This decline affects negative feedback, leading to high FSH and LH.
List three signs/symptoms of menopause
- Hot flushes and increased sweating
- Mood changes, irritability, anxiety
- Atrophy of mucosal linings: Vaginal dryness and painful intercourse; xerostomia
- Decreased libido
- Breast shrinkage
Explain why women experiencing menopause is at increased risk of osteoporosis
The decrease in oestrogen leads to a decline in osteoblasts and bone formation and maintenance. Oestrogen would normally suppress osteoclasts, thus a drop in oestrogen results in increased osteoclastic activity.
Explain why it is important to maintain balance blood glucose during menopause
Hypoglycaemia can contribute to increased hot flushes. Hyperglycaemia can result in an acidic environment detrimental to bone formation and a host of other things.
Name four components of the male reproductive system.
Two testes One penis One prostate gland Two epididymis Two vas deferens Two spermatic cords Two seminal vesicles Two ejaculatory ducts
Which nervous system stimulates erectile tissue and involuntary muscle
The parasympathetic nervous system produces nitric oxide that causes vasodilation.
Name two functions of the male urethral canal
The male urethral canal has both reproductive and urinary functions.
List two key functions of the testes
It is the site of spermatogenesis and the site of testosterone production and secretion.
Explain the role of FSH and LH in relation to the male testes
Spermatogenesis is regulated by FSH and testosterone production and secretion is regulated by LH
Describe the role of the epididymis
After their formation in the seminiferous tubules, spermatozoa mature and are stored in the epididymis.
What is the ideal body temperature for spermatogenesis
3 degrees below body temperature
Describe the role of the acrosome
The acrosome is a vesicle that covers the head of the sperm and contains enzymes to assist with penetration of the ovum.
Describe the main role of the following in relation to seminal fluid:
a. Seminal vesicles
b. Prostate gland
a. The seminal vesicles are a pair of glands situated behind the bladder and they secrete alkaline seminal fluid that makes up 60% of semen, and nutrients such as fructose to nourish sperm
b. The prostate gland secretes a thin milky fluid that makes up 30% of semen, containing nutrients for ATP production and anticoagulants to increase fluidity such as citric acid. Also contained therein is proteolytic enzymes PSA and pepsinogen.
Explain why seminal fluid is alkaline
To protect sperm from the acidity of the male urethra and female vagina
Describe the main role of the Bulbourethral glands
The Bulbourethral glands (Cowper’s glands) secretes an alkaline, mucous fluid that neutralises urinary acids in the urethra prior to ejaculation and lubricates the end of the penis.
Provide the correct medical terminology for:
a. Painful periods
b. Pain on intercourse (female)
c. Mid-cycle bleeding
d. Enlarged breast tissue in men
e. Lactation without pregnancy
f. Absence of periods
g. Increased menstrual bleeding
h. Infrequent menstrual cycles
a. Painful periods - Dysmenorrhea
b. Pain on intercourse (female) - Dyspareunia
c. Mid-cycle bleeding - Metrorrhagia
d. Enlarged breast tissue in men - Gynaecomastia
e. Lactation without pregnancy - Galactorrhea
f. Absence of periods - Amenorrhea
g. Increased menstrual bleeding - Menorrhagia
h. Infrequent menstrual cycles - Oligomenorrhea
Describe the difference between ‘primary’ and ‘secondary’ amenorrhoea
Primary amenorrhoea is the failure of menses to occur by expected onset (16-17 years) while secondary amenorrhoea is the lack of menstruation for three months in previously menstrual women.
Name two causes of secondary amenorrhoea
PCOS
Pituitary tumour
Anorexia
Hypothyroidism
Describe the difference between ‘primary’ and ‘secondary’ dysmenorrhoea
Primary dysmenorrhoea is due to the excessice release of uterine prostaglandins during menses which causes the myometrium to contract.
Secondary dysmenorrhoea is associated with specific pelvic/systemic pathologies.
Name two reproductive pathologies that contribute to secondary dysmenorrhoea
Endometriosis, fibroids, pelvic inflammatory disease
Name the menstrual phase affected by premenstrual syndrome (PMS)
The luteal phase
List two causes of PMS
- Rapid shifts in oestrogen/progesterone which can influence neurotransmitters.
- Drop in progesterone > increased prostaglandins
- Serotonin deficiency
Name five signs/symptoms of PMS
- Anxiety
- Depression
- Aggression
- Headache
- Bloating
- Breast tenderness
- Pimples
- Fatigue
- Backache
Using definitions, compare ‘pelvic inflammatory disease’ with ‘endometriosis’
Pelvic inflammatory disease is an infectious and inflammatory disorder of the upper female genital tract including the uterus, fallopian tubes and ovaries while endometriosis is the growth of endometrial tissue outside of the uterus
List one infectious cause of pelvic inflammatory disease
Neiseria gonorrhoea
Chlamydia trachomatis
List two characteristic signs/symptoms of PID
- Lower abdominal pain (gradual or sudden, severe)
- Deep dyspareunia, purulent discharge
- Occasional dysuria, fever, nausea and vomiting
Name two complications of PID
Ectopic pregnancy
Infertility
Peritonitis
Septicaemia
Describe the pathophysiology of endometriosis
Ectopic endometrial tissue follows the menstrual cycle, but there is no exit point for blood that accumulates during menstruation, leading to irritation, inflammation and pain.
List two locations commonly affected by endometriosis
Ovaries Fallopian tubes Utero-sacral ligaments Pelvic cavity Intestines
Describe how the following might contribute to endometriosis:
a. Altered immune surveillance
b. Primordial cells
a. Altered immune surveillance in the pelvis affects the body’s ability to recognise ectopic endometrial tissue.
b. Primordial cells lining other body cavities or organs differentiate into endometrial cells.
Name one hormone which is dominant in endometriosis
Oestrogen
List two signs/symptoms of endometriosis (not dysmenorrhoea)
Menorrhagia
Bloating/lower back pain
Pelvic pain occurring around menstruation
Infertility
Name two diagnostic procedures used to identify endometriosis
- Ultrasound
- Laporoscopy
Name two complications of endometriosis
- Recurrent inflammation, fibrous tissue and adhesions which obstruct the uterus/fallopian tubes, contributing to infertility
- Chocolate cysts (sacs with old blood)
Using definitions, compare fibroids to ovarian cysts
Fibroids are benign tumours of the uterine myometrium while ovarian cysts are fluid-filled sacs within the ovary
State two causes of fibroids
- High levels of oestrogen compared to progesterone
- Obesity
- Oral contraceptive use
- Family history and earlier menarche
List two characteristics signs/symptoms of fibroids
- Menstrual changes: menorrhagia and metrorrhagia
- Iron deficiency anaemia
- Frequent urination, urgency, constipation (pressing on bladder / rectum)
- Bloating and heaviness
- Infertility
Explain specifically why fatigue is a common symptom with fibroids
Heavy, prolonged periods coupled with mid-cycle bleeding can lead to iron deficiency anaemia which causes fatigue
Name one investigative procedure for fibroids
Ultrasound
Define polycystic ovarian syndrome (PCOS)
PCOS is an endocrine metabolic condition associated with menstrual dysfunction, ovulatory dysfunction, hyperandrogenism and metabolic disturbances
Explain in detail the pathophysiology of PCOS
PCOS is ascribed to the dysfunction of the hypothalamic-pituitary (HPO) axis where there is a LH:FSH imbalance. High circulating LH promotes higher ovarian androgen formation. Another factor is insulin resistance which can occur in 40% irrespective of body weight. This suppresses sex hormone-binding globulin (SHBG) which results in higher free circulating androgens. The excess androgen production will suppress ovulation and instead the follicles fill with fluid.
List four symptoms of PCOS
- Amenorrhoea / Oligomenorrhoea
- Hirsutism
- Acne and oily skin
- Acanthosis nigricans
- Lack of ovulation
- Infertility
- Anxiety, depression
- Weight gain / difficulty losing weight
Name two clinical signs associated with hyperandrogenism in PCOS
- Hirsutism
- Acne
- Elevated testosterone
List one blood test which may be used to identify PCOS
- Low sex hormone binding globulin (SHBG)
- High LH; Normal - low FSH
- Increased androgens
- Elevated blood glucose levels
Name two investigative procedures used to identify PCOS
- Ultrasound
- Laporoscopy
Name one endocrine pathology which individuals with PCOS are at an increased risk of developing
Type II Diabetes
State two locations in the body where an ectopic pregnancy could occur
Fallopian tube (97%) Ovary Cervix Abdomen
Name two observational signs of breast cancer
Painless, unilateral fixed lump
Overlying skin changes (dimpling, orange peel)
Inverted, discharging nipple
List two risk factors for the development of breast cancer
Oestrogen dominance
Genetic: BRCA1 and 2 genes
Family history
Poor diet, sedentary lifestyle, smoking, drinking
List two causes of male infertility
Low sperm count, poor viability and motility
Blocked sperm ducts
Undescended testes
Metal toxicity, smoking, drinking
List two causes of female infertility
PCOS, endometriosis, fibroids, PID
Hypothyroidism
Menopause
STIs
List one infectious cause and one non-infectious cause of balinitis
Infectious: Candida albicans, bacterial
Non-infectious: eczema, psoriasis, lichen sclerosus (autoimmune)
Name two signs/symptoms of balinitis
Pain, irritation, dyspareunia
List one known cause of undescended testes
Premature birth
Name two complications of an undescended testes
Damaged sperm (infertility) Testicular cancer
State two risk factors for testicular cancer
- Undescended testes
- Family history
Describe the ‘mass’ associated with testicular cancer
Hard, painless unilateral mass
Using definitions, compare prostatitis with benign prostatic hyperplasia
Prostatitis is the inflammation of the prostate gland that can be infectious or non-infectious. BPH is the enlargement of prostate tissue leading to compression of the urethra
List two risk factors for BPH (benign prostatic hyperplasia)
Abdominal obesity Genetics Sedentary lifestyle Sympathetic dominance Pesticides Zinc deficiency Increased activity of 5-alpha-reductase enzyme
Explain the role of the enzyme 5-alpha reductase in BPH
5-alpha reductase is the enzyme that converts testosterone to dihydrotestosterone (DHT). DHT has twice the effect of testosterone on the prostate and increased activity of this enzyme is associated with BPH.
List two signs/symptoms of BPH
- Obstructed/poor urinary flow
- Nocturia
- Increased urinary frequency
- Intermittent urine flow / dribbling
- Recurrent cystitis
- Reduced sexual function
Which blood biomarker is diagnostic for BPH?
PSA (Prostate Specific Antigen)
Describe the significance of back pain in prostate cancer
Back pain can indicate bone metastases
List one sign/symptom suggestive of prostate cancer specifically
- Haematuria / blood in ejaculate
List two diagnostic procedures used to identify both BPH and prostate cancer
- Digital rectal examination
- Biopsy
