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Reproductive System > 2 > Flashcards

2 Flashcards

1
Q

Where do ovaries form?

A

In the ovarian surface (germinal) epithelium

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2
Q

Why do females sometimes get a sharp pain at ovulation?

A
  • Because it is due to the rupture of the peritoneum when it releases the oocyte
  • since the capsule is made of peritoneum
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3
Q

Why do nuns tend to get ovarian cancer?

A
  • every time an oocyte is released, it ruptures the peritoneum making it damage the capsule
  • as a result it is susceptible to mitosis and mutations which leads to ovarian cancer
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4
Q

Describe the ovary.

A
  • a paired organ where oogenesis takes place
  • has a tunica albuginea
  • ovary is full enclosed in parietal peritoneum and contains follicles that will be stimulated by FSH
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5
Q

Describe ovarian cysts and how a patient may present with them.

A
  • increased androgen production may cause cyst formation
  • pt. Will experience lots of pain
  • cyst may rupture or ovary may twist (torsion)
  • will occlude blood supply
  • if older women has one, may likely have ovarian cancer
  • may cause discomfort during intercourse
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6
Q

Where do ovarian tumours usually arise from?

A

-commonly from epithelial component or from germ cells in the capsule epithelium

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7
Q

Describe the three parts of the uterus.

A
  • Base/top: fundus
  • Body
  • Cervix
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8
Q

Describe the suspensory ligament of the ovary.

A
  • allows passage of the ovarian artery and vein to the ovary
  • neurovascular pathway bulging into the peritoneum
  • ovary is suspended from this ligament as the vessels are coming down from above
  • it is a fold of peritoneum
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9
Q

What is the origin of the ovarian artery

A

-arises from the abdominal aorta

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10
Q

Describe the Fallopian tubes

A
  • allows passage of the ovum to the uterus and is site of fertilization (occurs in ampulla)
  • it opens into the peritoneal cavity so it can be very susceptible to infection
  • tubes have fimbrae (fingers) to allow a large surface area to “catch” ovum in the peritoneal cavity
  • ovum then first reaches the infundibulum (like a funnel for ovary)
  • then continues to ampulla
  • then ends at isthmus until it reaches fundus of uterus
  • lined with cilia which enable transprort of ovum to uterus
  • also contains ‘peg’ cells which release substance that supports the egg and sperm
  • tube is also very convuluted
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11
Q

What is an ectopic pregnancy? How would you an approach a patient with one?

A

When the zygote implants in the wrong area such as in the Fallopian tube, isthmus, Fimbria, cornua
-can cause severe haemorrhage
-Ask questions such as:
What is your menstrual cycle like?
Any unprotected sex?
Are you pregnant?
How are your bowel movement?
Any contraception?
-pain would be felt localized around the Fallopian tube
-pain can travel in the paracoelic gutters to the diaphragm, injuring the phrenic nerve
-as a result pain will be felt in the shoulder
-Best investigations would be ultrasound, pelvic exam, blood test for HCG levels

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12
Q

Which part of the uterus expands during pregnancy?

A

Fundus and it is covered by parietal peritoneum

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13
Q

What are the ligaments around the uterus?

A
  • Round ligament
  • ligament of ovary (continuous with the round ligament)
  • broad ligament (double fold of peritoneum)
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14
Q

Describe the round ligament

A
  • remnant of the gubernaculum
  • goes through the inguinal canal to become the labia major
  • helps to keep the uterus antiverted and antiflexed
  • stretching this ligament (i.e. pregnancy) can cause pain in the labia
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15
Q

Describe the ligament of the ovary or the ovarian ligament

A
  • continuous with the round ligament
  • remnant of gubernaculum
  • attaches ovary to uterus
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16
Q

Describe the broad ligament

A
  • is a double fold of peritoneum
  • subdivided into 3 parts:
  • mesovarium: surrounding the ovary
  • mesometrium: between the pelvic wall and the uterus
  • mesosalpinx: surrounding the Fallopian tubes
  • vessels to the uterus run between the layers of the broad ligament (like mesentry)
  • attaches the uterus to the pelvic side walls
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17
Q

Where does the uterine artery originate from?

A

From internal iliac artery

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18
Q

Describe the anatomical relations in the pelvis and the pouches that are formed

A
  • bladder is anterior to uterus
  • rectum is posterior to uterus
  • peritoneal reflection between the uterus and bladder anteriorly: vesicouterine pouch
  • peritoneal reflection between the rectum and uterus posteriorly: rectouterine pouch (Pouch of Douglas)
  • clinically important as they can be a site of fluid collection ex. Haemorrhage or infection
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19
Q

What is the uterus comprised of?

A
  • internally: smooth muscle (myometrium)

- externally: epithelial layer of endometrium lined with simple columnar epithelium

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20
Q

What is endometriosis?

A
  • condition in which ectopic endometrial tissue is dispersed to various sites along the peritoneal cavity and beyond
  • may be associated with ovaries or the attachments of the uterus and is often associated with severe period pain, infertility or both
21
Q

What is the space between the cervix and vagina called? What does it help do?

A
  • fornices

- helps to feel for other structures

22
Q

What are the two openings of the cervix?

A

External os: hole that is visible on speculum examination and is the opening of the cervix into the vagina
Internal os: located at the internal opening of the uterus to the cervix

23
Q

Describe the structure of the cervix

A
  • a fibrous structure that can change through hormonal stimulation during menstrual cycle and pregnancy
  • lined with simple columnar epithelium that produces cervical mucus which changes in consistency and pH depending on the menstrual cycle to help facilitate or prevent entry of sperm
  • outside is lined with stratified squamous
24
Q

What is the transitional zone of the cervix?

A
  • area where the epithelium changes from cervical (columnar) to vaginal (stratified squamous)
  • at most risk of malignant changes
25
Q

How does the external os change when the pt. Has had babies

A

-becomes more slit-like

26
Q

What is a cervical ectropian?

A
  • when the inner lining of cervix cells (simple columnar) spread to the outside of the cervix
  • occurs during menstrual cycle, when on contraception or when pregnant
27
Q

What is the normal angle between the cervix and vagina known as?

A

Anteversion (if angle less than 180)

If angle more than 180 it is retroflexed

28
Q

What is the normal angle between the cervix and uterus known as?

A

Anteflexion (if angle is less than 180)

If angle is more than 180 then it is retroflexed

29
Q

How does the uterus expand as the fetus grows?

A
  • GI organs will be compressed thus women may feel gastric-oesophageal reflux
  • will also have constipation and urinary frequency due to pressure on pelvic organs
  • ligaments are stretched which can cause pain in some patients
30
Q

Where do the uterine and vaginal artery originate from?

A

Internal iliac artery

Anastomoses around this area

31
Q

How is anteversion/anteflexion maintained?

A

-uterus is tethered at the round ligament which helps it to be in this position

32
Q

How might a retroverted/retroflexed uterus manifest?

A

-patients wont realize it

33
Q

Describe the vagina

A
  • lined with stratified squamous epithelium
  • contains glycogen which is metabolised by various bacteria such as lactobacilli
  • lactobacilli regulates pH and converts glycogen into lactic acid to keep environment acidic to prevent infections such as candida
  • vagina is adapted to expand during birth and its epithelium is designed to resist friction
  • cannot provide any lubrication, but cervix can do that
34
Q

Describe the vulva

A
  • external genitalia which is comprised of the labia majora and labia Minorca
  • vulval tumours can occur
35
Q

During embryonic development, what are the three germ layers that arise?

A

-ectoderm, mesoderm and endoderm

36
Q

Which germ layer primarily forms the reproductive tracts?

A

Intermediate mesoderm

37
Q

Embryonic folding gives rise to a gut tube, which can be separated into foregut, midgut and hindgut. Which of these is an important anatomical location in the creation of the reproduction and urinary tracts and why?

A
  • hindgut
  • gives rise to the cloaca (a single opening)
  • this eventually becomes the urogenital sinus (common opening for the reproductive and urinary systems)
38
Q

What is the urogenital ridge?

A

-an area of intermediate mesoderm in the posterior abd wall that gives rise to the embryonic kidney and gonad

39
Q

What is the gonad (indifferent) derived from?

A

-derived from intermediate mesoderm plus primordial germ cells (extragonadal)

40
Q

What are primordial germ cells?

A
  • special population of cells that arise from the yolk sac and migrate into the retroperitoneum, along the dorsal mesentery
  • “seed” for the next generation
  • develop soon after gastrulation
  • will ultimately go on to produce sperm or ova once sexual maturation has occurred
41
Q

Explain the differentiation of the gonads

A
  • primordial germ cells migrate along retroperitoneum to gonad (indifferent)
  • if gonad has Y chromosome then it will start forming seminiferous tubules and primordial germ cells will remain and will begin gametogenesis at puberty
  • will form testis, medullar cords, and thick tunica albuginea but no cortical cords
  • no Y chromosomes then gonad will differentiate into an ovary and the primordial germ cells remain as primordial follicles, which will then develop into oocytes at puberty
  • will form ovary, and cortical cords but the medullary cords degenerate and no tunica albuginea
42
Q

Explain the development of the internal genitalia

A
  • male and female embryos have ducts which are used in the urinary system which are called mesonephric and paramesonephric ducts respectively
  • presence of testes: androgens (testosterone) is produced, driving the development of epididymis and vas deferens by maintaining the mesonephric duct (Wolffian duct)
  • mesonephric ducts NEEDS to be stimulated by male hormones in order to remain
  • absence of testes: causes formation of the uterus, Fallopian tubes and part of the vagina as the mesonephric duct regresses BUT the paramesonephric duct (Mullerian duct) remains
  • paramesonephric ducts needs no stimulation so it is “default”
  • testes also produce Mullerian Inhibitory Substance (MIH) to prevent Müllerian duct from developing in males
  • Wolffian=Wolf=alpha Male
  • Mullerian=Mother=female
  • Wolffian ducts fuse with testes so it is continuous and not open in peritoneum
  • Mullerian duct is separate to gonad so there is a gap to the peritoneum
43
Q

What happens when things go wrong in the development of internal genitalia?

A
  • testosterone-treated female: exogenous androgen, supports the Wolffian duct, but no testes so no MIH is produced, thus Müllerian ducts develop
  • androgen-resistant male: AIS (androgen-insensitivity syndrome), receptors for testosterone dont work, Wolffian ducts dont survive, but MIH is present so Müllerian ducts degenerate
44
Q

How do the mesonephric (Wolffian) ducts develop?

A
  • first acts as the duct for the embryonic kidney
  • drains into the urogenital sinus
  • urogenital sinus becomes urinary bladder
  • surplus to requirement once true kidney develops
  • Wolffian duct is maintained by testes derived androgens
  • converted into the vas deferens and epididymis
  • migrates with testes as they descend
  • look at diagram
45
Q

How do the paramesonephric (Mullerian) ducts develop?

A
  • appear as invaginations of the epithelium of the urogenital ridge
  • Caudally: make contact with the cloaca (urogenital sinus)
  • Cranially: open into the abdominal cavity
  • look at diagram
46
Q

Explain the development of external genitalia

A
  • indifferent stage of development
  • Main components: genital tubercle (GT), genital folds, genital swellings
  • male: GT elongates and genital folds fuse to form the spongy urethra, GT develops into glans penis, scrotum formed by fusion of genital swellings, influenced by testis-derived androgen hormones (dihydrotestosterone)
  • female: no fusion occurs, development of labia majora and labia minors, GT develops into clitoris, urethra opens into the vestibule, formation of vulva
47
Q

Explain the descent of the gonads for both female and males

A
  • gonad is connected to what will be scrotum or labia by gubernaculum
  • as a domino pelvic cavity increases in volume, gonad begins its descent inferiorly
  • male: area of peritoneum pinches off to descend first, then the gubernaculum and testes follow behind all the way to scrotum, this area is called processis vaginalis and will close off
  • female: gubernaculum attaches ovary inferiorly to labia-scrotal folds, ovary descends to pelvis, uterus has developed which forms a physical barrier and prevents further descent, gubernaculum remains as the round ligament (attaches to labia majora and goes through inguinal canal)
48
Q

What are maldescended testes?

A
  • when testes are not located in the scrotum but can be ectopic along the path it descends down
  • important to examine a newborn and check
49
Q

What is anatomically lateral to the vagina?

A

Ureter and levator ani muscle

Reproductive System (11 decks)

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