ANATOMY/PHYSIOLOGY Flashcards
ideally want a ________ shaped pelvis to allow baby through it
gynecoid
platypelloid shaped pelvis
horizontal oval
android shaped pelvis
heart shaped
anthropoid shaped pelvis
vertical oval
when a C-section or hysterectomy is done - be very aware of cutting or clamping the uterine artery instead of the
ureter
uterine artery lies directly over the ureter
used to think that the ___________ uterus position was the only one viable for pregnancy
anteverted
- Anteverted = lying on top of the bladder; other positions =
- anteverted & anteflexed = lying on top of bladder, but curving too
- Mid position = sticking up
- Retroverted = lying on top of sigmoid colon/cecum
- Retroverted & retroflexed = lying on top of sigmoid colon/cecum and curving too
BLOOD SUPPLY OF FEMALE REPRODUCTIVE TRACT
- ovarian artery = connects abdominal aorta to ovary
- uterine artery = connects iliac artery (internal) to uterus
- vaginal artery = connects iliac artery (internal) to vagina
most common incision for C-section
pfannenstiel
horizontal vs vertical C-section incisions
⦁ Paramedian & Midline incision = vertical - woman must have recurrent C-sections because her uterus is at risk for rupture if she tries to have a vaginal birth later
- Pfannenstiel incision allows women to try having a vaginal birth after C-section
granulosa cells secrete
estrogen
theca = progesterone
⦁ The blood supply of anterior pituitary originates in the
hypothalamus
the hypothalamus has no direct
nerve connections
all through the blood supply
hypothalamic neurohormones
⦁ GnRH - Gonadotropin releasing hormone
⦁ TRH = thyrotropin releasing hormone
⦁ SRIF = somatotropin release inhibiting factor (inhibits somatostatin/growth factor)
⦁ CRF = corticotropin releasing factor
⦁ PIF = prolactin release inhibiting factor (inhibits dopamine)
the anterior pituitary is derived from
ectoderm
the posterior pituitary is derived from
neural tissue
posterior pituitary releases what 2 hormones
ADH (vasopressin)
oxytocin
hormones released from anterior pituitary
- FSH - gonadotrophs
- LH - gonadotrophs
- TSH - thyrotrophs
- Prolactin - lactotrophs
- GH
- ACTH
- MSH = melanocyte stimulating hormone - Addison’s disease
hormone pathway summary
GnRH --> FSH / LH --> Ovaries TRH --> TSH --> Thyroid SRIF --> GH --> skeletal system CRF --> ACTH / MSH --> Adrenals PIF (dopamine) --> Prolactin -- Breasts
PULSATILE SECRETION OF GnRH is stimulated by ________________ and is inhibited by _________________
stimulated by NE
is inhibited by dopamine (PIF)
PULSATILE SECRETION OF GnRH
- Low pulse frequency triggers ___
- High pulse frequency triggers ____
- Low pulse frequency triggers FSH
- High pulse frequency triggers LH
GnRH reaches the anterior pituitary by ________________________________ and stimulates secretion of FSH (follicle stimulating hormone) and LH (luteinizing hormone)
hypothalamic-pituitary portal vascular system
if pregnancy occurs, the ______ released from the zygote is what keeps the corpus luteum functioning, which continues to secrete progesterone & estrogen, so that the endometrial lining is maintained
HCG
follicular phase
first 2 weeks (days 1-12)
in the follicular phase __________ dominates
estrogen
in the luteal phase, ___________ dominates
progesterone
when does negative feedback switch to positive feedback
ovulation
when is negative feedback turned off
menstruation
when does menstruation occur
first days of the follicular phase
the surge in LH does what 2 things
causes ovulation
causes ruptured follicle to become the corpus luteum (which secretes progesterone and estrogen)
__________ “builds up” the endometrium
estrogen
the low levels of LH cause theca cells to secrete ______________.
androgens
the FSH binding to granulosa cells secretes aromatase, which converts androgens to estrogen
LH surge leads to _________ being released
the oocyte
elevated basal body temp in which phase
luteal
role of estrogen
on cervix, uterus, breasts, vagina, bone, etc.
- breast development during puberty
- stimulates cell growth (proliferative phase) of the endometrium
- stimulates abundant clear mucus at mid cycle - Cervix
- stimulates lubrication of vagina. also growth & maturation of vaginal epithelium
- helps maintain bone density; there are estrogen receptors in osteoblasts
role of progesterone
on temperature, cervix, breasts, fallopian tubes
- **Thermogenic effects at the level of the hypothalamus (increases basal body temp by 0.5-1)
- cervical mucus thickens & decreases in amount
- stimulation of ducts, nipple & areola - contributes to fullness & tenderness of breasts
- decreases mucus & causes relaxation of the fallopian tubes - to speed ovum transport
stimulates abundant clear mucus from cervix
ESTROGEN
cervical mucus thickens & decreases in amount
progesterone
body temp increases
progesterone
helps maintain bone density
estrogen
stimulation of ducts, nipple & areola - contributes to fullness & tenderness of breasts
progesterone
breast development during puberty
estrogen
decreases mucus & causes relaxation of the fallopian tubes - to speed ovum transport
progesterone
how to track ovulation
track length of menstrual cycles
- can perform serial transvaginal ultrasounds to follow follicular development from dominant follicle to corpus luteum
- measure LH surge (using OTC urine kits)
⦁ ovulation occurs 36 hours after LH surge
⦁ LH shows up in urine 12 hrs after a surge
⦁ LH also increases with PCOS, POI, and menopause
Basal body temp rises 0.5 - 1
- can also measure serum progesterone at mid luteal phase (peaks)
follicular phase begins with ________ and ends with ____________
menstruation
LH surge
luteal phase begins with ________ and ends with ___________
LH surge
onset of next menses
day 1 = first day of
menses
day 1 = used for LMP
Onset of __________ signals reactivation of the Hypothalamic-Pituitary-Gonadal Axis with pulsatile Gn-RH secretions
puberty
role of estrogen in puberty
- augments the accrual of bone during puberty
- 2 estrogen receptors (alpha & beta) mediate the actions of estrogen - the presence of both has been demonstrated in the growth plate
- contributes to growth plate fusion at end of puberty
- stimulates breast development
1st thing to start in puberty for girls
breast development
delayed puberty
- absent or incomplete sexual maturation by an age at which 95% of girls started pubertal development
⦁ absence of secondary sex characteristics by age 13
⦁ absence of menarche by age 15-16
⦁ no menarche 5 years after onset of thelarche (breast development)
Mullerian agenesis
absence of uterus, cervix and upper vagina
causes of delayed puberty
- Hypergonadotrophic hypogonadism : FSH >35
- Gonadal dysgenesis (Turner’s Syndrome)
- Hypogonadotropic hypogonadism: FSH & LH <10
- Constitutional (physiologic delay) of HPO
- Suppression of HPO axis by illness, malnutrition or excessive exercise
-Elevated prolactin (certain drugs, pituitary tumors) - Kallmann Syndrome (genetic)
- Anatomic
⦁ Imperforate hymen/ transverse vaginal septum
⦁ Mullerian agenesis: absence of uterus, cervix and upper vagina
precocious puberty
Onset of secondary sexual characteristics before age 6 in black girls and prior to age 7 in white girls (or > 2 SD from normal)
GnRH -dependent = central precocious puberty
⦁ early activation of HPO with both breast and pubic hair development:
⦁ 90% idiopathic (dx of exclusion: MRI)
⦁ CNS lesions (tumor, hydrocephalus, )trauma, inflammatory disease
⦁ Severe hypothyroidism : high TSH activates FSH receptor
⦁ Generally treated with GnRH agonist
GnRH - independent = peripheral precocious puberty
⦁ Autonomous functional ovarian cysts
⦁ McCune-Albright syndrome (rare genetic disorder)
⦁ Adrenal pathology: Nonclassical Congenital Adrenal Hyperplasia (CAH)
- May mimic PCOS due to accompanying hyperandrogenism
- Adrenal tumors
⦁ Exposure to exogenous estrogens or xenoestrogens (endocrine disruptors which mimic estradiol)
MENOPAUSE
Permanent cessation of menses:
Retrospective diagnosis: no period (amenorrhea) for 12 months without other explanation= postmenopause
-Primary ovarian insufficiency (premature ovarian failure)
cessation of menses prior to age 40
FSH is _______ in menopause
elevated
(no estrogen –> feedback to GnRH to increase FSH/LH)
but elevated FSH is seldom needed for dx unless confirmation of infertility is a concern
estrogen loss in postmenopause leads to
⦁ Urogenital atrophy ⦁ Increase in LDL and decrease HDL ⦁ Decrease in bone density ⦁ Estrogen acts to maintain the appropriate ratio between bone-forming osteoblasts and bone-resorbing osteoclasts in part through the induction of osteoclast apoptosis ⦁ Vasomotor symptoms (Hot Flashes)
thelarche
onset of breast development
reproductive physiology: breasts
Both male and female infants may have palpable breast tissue at birth
Some will have galactorrhea- an effect of maternal hormones
By 2-3 months of age, the breast tissue regresses
Thelarche: onset of breast development starts at age 12.5 in US in 95% of girls
Growth during pregnancy from hormones including: prolactin, estrogen, progesterone, cortisol, insulin, thyroid hormones and growth hormone
blood supply to the breast
blood supply comes from subclavian artery → internal & lateral thoracic artery
most cancers form _________ on the breast
upper outer & tail
in pregnancy, the release of _____ & _________from the placenta and __________ from the anterior pituitary causes breast development
estrogen and progesterone
prolactin
breast milk production is inhibited while pregnant because of the effect that _________ has on prolactin
progesterone
Milk production stimulated by
prolactin
Prolactin release stimulated by direct stimulation of the _______
nipple
Milk ejection results from nipple stimulation – neuro-endocrine reflex with release of oxytocin
Neuro-endocrine reflex disturbed by maternal tension resulting in problems with nursing
CAUSES OF GALACTORRHEA
⦁ Idiopathic
⦁ Medications - tranquilizers, antidepressants, anti-hypertensive medications, herbal supplements, and birth control pills
⦁ Hypothyroidism
⦁ Pituitary tumors
⦁ Stimulation of the breasts
⦁ Chest surgery, burns, nerve damage from injury
⦁ Spinal cord injury
galactorrhea
non-physiologic milky discharge from nipples
