Anatomy/Phys Flashcards
Gonadal venous drainage
Left ovary/testis –> L gonadal vein –> L renal vein –> IVC
RIght ovary/testis –> R gonadal vein –> IVC —– so more varicoceles on the left side!
Gonadal lymphatic drainage
Ovaries/testes (para-aortic lymph nodes) — distal vagina/vulva/scrotum (superficial inguinal nodes) — proximal vagina/uterus (obturator, external iliac, hypogastric nodes)
Infundibulopelvic ligament (suspensory ligament of the ovary)
Ovaries to lateral pelvic wall – contains ovarian vessles – ureter courses retroperitoneally and is at risk during ligation of ovarian vessels
Cardinal ligament (transverse cervical ligament)
Cervix to side wall of pelvis – contains uterine vessels
Round ligament of uterus
Uterine fundus to labia majora – travels through inguinal canal above artery of Sampson
Broad ligament
Uterus, fallopian tubes, and ovaries to pelvic side wall — made of mesosalpinx, mesometrium, and mesovarium
Ovarian ligament
Medial pole of ovary to lateral uterus
Female reproductive histology
Vagina and ectocervix (stratified squamous nonkeratinized) — transformation zone (squamocolumnar junction) — endocervix, uterus, fallopian tubes (simple columnar epithelium - glands in uterus, cilia in fallopain tube) — ovaries (simple cuboidal epithelium)
Pathway of sperm during ejaculation
SEVEn UP – Seminiferous tubules, Epididymis, Vas deferens, Ejaculatory duct, Urethra, Penis
Urethral injury
Blood seen at urethral meatus — posterior (membranous urethra damaged by pelvic fracture - urine leaks into retropubic space) — anterior (penile and bulbar urethra damaged by perineal straddle injury - urine leak beneath deep fascia)
Male sexual response
Erection (Parasympathetic - pelvic nerve - NO –> cGMP –> smooth muscle relaxation and vasodilation) – Emission (Sympathetic - hypogastric nerve) – Ejaculation (viseral and somatic nerves - pudendal nerve)
Spermatogonia
Germ cells - produce primary spermatocytes - line seminiferous tubules
Sertoli cells
FSH stimulates them —- Secrete inhibin (inhibit FSH) – androgen binding protein (local testosterone) – form blood testis barrier – support and nourish sperm – regulate spermatogenesis – produce MIF – temperature sensitive (seen in varicocele and cryptorchidism)
Leydig cells
Endocrine cells – secrete testosterone in presence of LH – INTERSTITIUM!
Estrogen
Ovary (17B-estradiol), placenta (estriol), adipose (estrone) — develop genitalia and breast, female fat distribution, endometrial proliferation, upregulate estrogen/LH/progesterone receptors, inhibit FSH and LH, then LH surge — increase HDL (increase hepatic HMG-CoA reductase), decrease LDL
Progesterone
Corpus luteum (for 10 days), placenta (after 10 days), adrenal cortex, testes — stimulate endometrial gland secretions, maintain pregnancy, induce gallbladder hypomobility (gallstones in pregnancy), thick cervical mucus, inhibit LH/FSH, prevent uterine contractions, prevent endometrial hyperplasia, inhibits prolactin —- increased progesterone indicates ovulation
Tanner stages
II (pubic hair, breast buds) – III (dark/curly hair, single contour breasts, increase penis length) – IV (increase penis width, darker scrotum, double contour breasts) – V (pubic hair on inner thigh)
Menstrual cycle follicular/proliferative phase
Variable length - ESTROGEN stimulates endometrial prolifeartion –> LH surge –> ovulation
Menstrual cycle luteal/secretory phase
ALWAYS 14 DAYS – PROGESTERONE (corpus luteum) maintains endometrium for implantation – progesterone falls and then menstruation occurs
Oogenesis
Primary oocytes (diploid 2N 4C) begin meiosis I in fetal life (stopped in prophase I until ovulation) — seconday oocytes (haploid 1N 2C) stopped in metaphse II until fertilization – ovum (haploid 1N 1C)
Pregnancy fertilization
MC occurs in ampulla of fallopian tube within 1 day of ovulation – implantation within uterine wall by day 6 – syncytiotrophoblasts secrete hCG (blood at 1 week, urine at 2 weeks)
Lactation
Decreased progesterone after labor increases prolactin (induces and maintains milk and decreases reproductive function), oxytocin (milk letdown and uterine contractions) – nerve stimulation (suckling) increase prolactin and oxytocin
Breast milk
IgA (passive immunity) – reduces infections and asthma/allergies/DM/obesity – reduces moms risk of breast and ovarian cancer – require vitamin D and K supplementation
hCG
From syncytiotrophoblasts] – maintains corpus luteum for first 8-10 weeks by acting like LH – identical a unit as LH/FSH/TSH but B unit is unique (B for baby) —- increased in hydaditiform moles, choriocarcinomas, Down syndrome — decreased in ectopic, Edward, and Patau