Block 5 Revision Flashcards
Give some examples of primative reflexes
What are they an indication of?
Moro (arm aduction, abduction, crying) , Asymmetrical Tonic Neck Reflex (turn head one side & see ipsilateral extension of limbs & contralateral flexion of limbs), Rooting, Grasping
Indication of motor development- underlying myelination of higher cortical motor pathways
What are the stages of childhood?
Baby 0-1 yrs
Infant 0-2yrs
Childhood 2-10yrs
Early Adolesence 11-13yrs
Middle Adolescence 14-17yrs
Late Adolescence 18-21yrs
What are the 1001 Critical Days?
From conception –> Birth for building optimum security & healthy brain development
Which region develops almost fully after birth?
Orbitofrontal cortex develops almost completely post-natally
Female Repro: What is the tendinous arch? What is its role?
Thickening of fascia over obturator internus. Provides attachment for pelvic floor
What is the perineum?
Space between plevic floor and thighs. Split into Urogenital and Anal triangle. Uses Sacrum, Pubic Symphesis & Ischial Spines as landmarks.
What is covered in perineal membrane?
What is it?
What is its role?
The urogenital triangle
Tough fibrous sheet
Attachment point for external genitalia
What is the perineal body?
What is its function?
Sits between the vagina & anus and is a mass of fibres
Functions:
Union between pelvic floor & perineal membrane
Important for pelvic floor integrity
Supports posterior vaginal wall
Attachment point for anal sphincters
What are the ischioanal fossae? What is the function of it?
Fat filled regions. Deep to the pelvic floor either side of the anus. Extensions into urogenital triangle. Helps support the pevlic floor & anal canal
What musculature does the deep perineal pouch contain in females? What is the innervation?
Compressor urethrae
External urethral sphincter
Sphincter Urethrovaginalis
Deep transverse perineal muscle
What is the contents of the deep perineal pouch in males?
If there is a muscle in here what is it’s innervation?
Bulbourethral glands (although open into urethra superficial to perineal membrane)
External urinary sphincter
Deep Transverse muscles
What structures are considered external genitalia for females?
Which is in the superficial perineal pouch? What provides an attachment point?
- Mons Pubis
- Clitoris (Formed by paried Corpora Cavernosa & Vestibular bulb)
- Labia majora
- Labia menora (surrounds the vestibule-space between L.menora where vag/urethra open onto)
- Opening of the Greater Vestibular Glands (bartholian glands)/ (actual) Bartholian Glands
Superficial Perineal Pouch
- Vestibular bulb (spongy explansile vascular tissue w/ overlying muscles. Lies deep to skin w/ on either side of vestible. Helps form clitoris w/ corpora cavernosa)
- Corpora Cavernosa (form cura of clitoris)
- Overlying: Ischiocavernous muscle (over Cura or Clitoris) & Bulbospongiosus muscle ( over greater vestibular glands & greater vestibule)
Attachment: Perineal membrane
What is sensory to the clitoris (& distal vagina & urethra)?
Pudendal
You perform a midline episiotomy, what are you going to cut through?
Skin & Subcut tissue
Transverse perineal muscles & bulbospongiosus muscle
Perineal membrane
Levator ani
Posterior wall of the vagina
How does the epithelium change in the cervix proximal to distal?
Proximal = Columnar
Distal = Squamous
Female Repro: What is the are the fornix?
Where the cervix projects into the vaginal vault forming a recess.
Posterior fornix is deepest and adjacent to rectouterine pouch
Where is the uterus linked to the uterine tubes?
Uterine horns (cornua)
Female Repro: What are fibroids and where do they form (think layers)
Benign smooth muscle tumors
Can form in uterus
If an ectopic pregnancy occurs in the uterine tubes and ruptures what does this lead to?
Haemoperitoneum
What nerve can ovarian pathologies impinge on?
Obturator nerve
What are the key ligaments of female repro?
Broad ligament
Suspensory ligament of ovary (contains lymph & vessels)
Round ligament of ovary (ovary –> uterus)
Round ligament of uterus (uterus –> labia majora via inguinal canal)
What is the broad ligament?
What is its function?
What are the 3 parts?
Double layered fold of peritoneum
Support & Surround: Ovary, Uterine tubes, Uterus
Mesovarium, Mesosalpinx, Mesometrium
The round ligaments (of ovary & uterus):
a) What are they remnanents of?
b) Clinically why is the round ligament of the uterus important?
a) Remanents of Gubernaculum
b) Provides a route of travel for cancer from ovary and uterus to the superficial inguinal lymph nodes
What has been removed in:
a) TAH
b) Subtotal hysterectomy
c) Radical hysterectomy
d) Bilateral Salpingoophorectomy
a) Uterus & Cervic
b) Cervix preserved
c) Uterus, Cervix, Associated supporting tissue Lymphatics
d) Uterine tubes & ovaries
Where is pelvic fascia?
What are the types?
Where does it lie?
Pelvic fascia is below the peritoneum
Types: Parietal, Visceral, Endopelvic
Parietal- Covers walls/ muscle
Visceral- Covers organs
Endopelvic fascia fillis in gaps (loose and fatty CT). In certain areas its very dense & forms fibrous supporting ligaments
Where do supporting ligaments of the female repro tract arise from?
What do they form? And where does this run?
What are the key parametrial ligaments formed from? What is there role?
What else connects to the the structure the support ligamnets forms? What is the function of this?
a) Endopelvic fascia which is very dense in certain areas)
b) collectively form Tendinous Arch (Pubis to Sacrum) runs over the obturator internus. [I believe this is different from tendinous arch of pelvic floor]
c) Cardinal/ Transverse Cervical, Sacrocerivcal/ Uterosacral, Pubocerical. Provide support to uterus
d) Paracolpium fascia around vagina connects to Tendinous Arch to support vagina
Cytocele
Rectocele
Where do these prolapse through?
a) Anterior vaginal wall
b) Posterior vaginal wall
What 2 key branches supply the female repro tract? Talk about the branching patterns- what do they supply?
What has an anastomtic supply?
-
Internal Iliac
- Internal pudendal- Perineum
- Vaginal
- Uterine
- (middle & inferior rectal)
-
Ovarian Artery from aorta
- Tubal branches
Uterus has an anastomotic supply from Internal Iliac & Ovarian artery
Where do the uteters pass in relation to one of the above arteries?
Water under the bridge!
Uterine artery anterior to ureters thus at risk of damage during a hysterectomy
What is the lymphatic drainage of the female reproductive organs?
Para Aortic: Ovaries, Uterine Tubes, Fundus of Uterus
Internal & External Iliac (& sacral): Body of Uterus, Cervix, Proximal Vagina
Inguinal Lymph nodes- Deep & Superficial (external iliac): Distal Vagina, External Genitalia
NOTE: Round ligament provide of uterus route of ca spread from fundus of uterus to superficial inguinal lymph nodes via the inguinal canal
Describe the innervation of the female repro tract
And therefore the type of anaesthesia you could give
Above pelvic pain line:
- Uterine tubes, Uterus, Bladder roof, Upper Anal canal
- Travel w/ sympathetics T11-L1/2
- Epidural/ Spinal
Below pelvic pain line:
- Cervix, Proximal vagina
- Travel w/ parasympathetics S2-S4
- Caudal (insert @ sacral hiatus) which targets sacral spinal nerves. Do not advance too far or you’ll give a spinal or epidural!
Distal vagina
- Sensory (including clitoris) via Pudendal nerve
- Pudendal nerve block- feel for the ischial spines
Pudendal nerve:
a) What does it supply? (males as well)
b) Branches? (males as well)
c) Route?
d) How can you anethatise
a) Perineal skin
External genitalia
Perineal pouch muscles (Deep & Superfical transverse, Compressor urethrae- F only)
Sphincters (External urethral, Sphincter urethrovaginalis-F)
b) Inferior rectal, Perineal, Dorsal nerve of Penis
c) Out via Greater Sciatic Foramen, loop round sacrospinal ligamnet near ischial spine then to perineum via Lesser sciatic Foramen
The uterine cycle: how does menses occur
Corpus luteum degrades so decreased progesterone
–> Spiral arteries in functional endometrium to contract causing ischeamia & necrosis –> menstruation
The uterine cycle: What happens to the endometrial glands after menses?
Tubular glands with columnar cells of the functional endometrium: proliferate, thicken, straighten & extend into finger like projections
The uterine cycle: What happens during the proliferative phase- what does oestrogen do? (5)
In general what else does it do?
Repair and growth of functional endometrium by:
1) Increased vascularity- spiral arteries grow into functional endometrum
2) Increased endometrial thickness
3) Development of secretory glands
4) Thins cervical mucus & makes it alkaline
5) Increases muscular contractions of uterine tubes
- Affects female fat distrubtion, hair, genitals and supports bone growth
- Supports breast development @ puberty & in pregnancy
The uterine cycle: The secretory phase
Endometrial glands secrete substances in preparation for pregnancy
What are the 4 functional windows of the menstural cycle?
1) Fertile
2) Implantation
3) Selection
4) Menstruation
Menstural Cycle Windows: Fertile- define, when does this occur and what happens?
When the probabilty of intercourse resulting in pregnancy is > 5%
4-5 days prior to ovulation and 1-2 days after
Changes in cervical mucus & contraction of the inner myometrium (junctional zone)
Menstural Cycle Windows: Implantation
When does this occur?
What happens?
5 days after ovulation and lasts for 2-4 days
Endometrium expresses molecules necessary for attachemnt & invasion of the blasocyst
Menstural Cycle Windows: Selection window
When is this?
What is it characteristed by? What is it triggered by?
What happens in the absence of pregnancy?
Days 21-23
Characterised by spontaneous decidualisation- endometrial stromal cells transform into specialised secretory epithelium (form nutrative matrix for trophoblast invasion). Triggered by ovarian hormones
In absence of pregnancy: progesterone –> breakdown of decidual cells
Menstural Cycle Windows: What is the role of decidual cells- apart from providing a welcoming environement for the invading trophoblast?
What happens if there is failure to decidualize properly?
Sense quality of implanting embryo
Rapid disposal of poor quality embryos and rapid support for good quality embryos
Failure to decidualise properly –> Miscarriage
The uterine cycle- what are the phases?
If there is variation in the cycle where does this occur?
Menses, Proliferative, Secretory
Variation occurs in proliferative phase
What is the framework to separate lower respiratory tract symptoms?
- Physical reproducive tract
- Functional reproductive tract
- Eg: defects in hormone production or responsivness of uterus
What is menometrorrhagia?
Menorrhagia but irregular
Define quantiatively menorrhagia?
>80mls lost or greater than 7days
What hormones does the corpus luteum cause the release of?
What do they do?
Progesterone & Oestrogen: Stimulate endometrial growth
Inhibin- inhibits FSH
Define Adolescence
Transitional phase of growth & development between childhood & adulthodo
Define puberty?
What is the average age?
The biological change of adolescence- the ability to reproduce
11yrs
What are the bones affected by bone growth in puberty and adolescence and which is the exception?
What happens to the bone mineral mass in G vs B and why?
In general the bone mineral mass growth is due to what?
How much more is skeletal mass at the end of puberty?
What happens to the building speed of the spine & hips?
In G- what happens to the bone the accumulate during ___ to ___yrs?
All long bones are affected EXCEPT female pelvis which follows a smooth & continous growth until adulthood
Bone mineral mass increases more in boys due to prolonged growth period
Growth in bone mineral mass as there is bone growth and very little change in density
Skeletal mass is x2 more than at the beginning of puberty
Spine and hips buidling speed increase x5
The accumulation of bone between 11-13yrs equals the amount loss during the menopause
Give an outline of what happens during female puberty
Breat develops & enlarges
Axillary and pubic hair grow
Growth spurt & Pelvis widens
Increase in subcut tissue around hips and breasts
Female: Tanner’s stage 2
Breast: Areolar enlargement and breast buds
Pubic hair: Few dark hairs along labia
Female: Tanner’s stage 3:
Breast: Enlargement of breast & areolar as single mound
PH: Curly pigmented hair across pubes
Female: Tanner’s stage 4:
Breast: Projection of areolar above breast as double mound
PH: Small adult configuration
Female Tanner Stage 5:
Breast: Mature adult breast w/ single contour
PH: Adult pubic hair distribution
What are the 6 peptide hormones produced by the AP?
GH
ACTH
TSH
FSH
LH
Prolactin
Where is oxytocin produced from? What is it involved in?
Posterior pituitary. Invovled in labour and MILK LETDOWN
GnRH
What time of hormone?
How is it released- which pathway does it go down?
Decapeptide (therefore short half life and acts on membrane receptors w/ intracellular transduction via second messengers)
Pulsitile release every 1-2 hrs
Causes release of LH and FSH from AP therefore tuberoinfundibular
What type of hormone is testosterone?
What is it produced by?
Where does it migrate to?
What cells convert it into _____
Then it binds to ___ receptors in ___ cells and this leads to (2)
Steroid hormone
Produced by leidig cells (from activation via LH)
Migrates to seminiferous tubules
Coverted into Dihydrotestosterone by Sertoli cells
Binds to Androgen receptor in Sertoli cells –> Sperm production & secondary sex characteristics
Tanners stage- what are they looking at in females and males?
Females: Breast development & Pubic Hair
Males: Genital Maturity & Pubic Hair
Male Tanner stage 1:
Genital Maturity: Prepubertal less 2mls
PH: None
Male Tanner stage 2:
GM: Enlargement of Testes >4ml, Scrotum reddening
PH: Few darks hairs at basis of penis
Male Tanner stage 3:
GM: Lengthening of Penis, Further testicular enlargment 6-10mls
PH: Curley pigmented hair across pubes
Male Tanner stage 4:
GM: Broadening of Glands Penis, Testicular growth 10-15mls
PH: Small adult configuration- thighs spared
Male Tanner stage 5:
GM: Genitalia adult size & shape, Testes 15-25mls
PH: Adult pubic hair disribution
Beyond the Tanner’s stage what else occurs at puberty in males?
Increase in height, weight, muscle mass & bone
Larynx enlarges- voice deepens & breaks
Hair growth: Face, axillae, chest, pubis, abdomen
Scrotum, Penis & Prostate gland enlarges
Seminiferous tubules mature & spermatazoa produced
Deinfe precocious puberty
Before 8yrs in females
Before 9.5yrs in males
What is delayed puberty?
Lack secondary sexual characteristics by: 13yrs Girls & 14yrs Boys
OR lack of progression through tanner’s stages within 4.5/5yrs of onset
In general what happens in the adolescent brain just before puberty?
Where in particular does this happen?
Just before puberty there is exuberent synaptogenesis in PFC
Weaker connections are pruned espeically in frontal lobes
What happens in the adolescent brain- what ‘kicks in’ first and then what matures later?
Limbic system kicks into high gear during early adolescence therefore you percieve reward from risk
Frontal lobes matures later
What is the role of the PFC?
Executive functioning
Personality
Reward
Decision making
Social decision making
On Piaget’s scale of Cognitive development which catagory do adolsecents fall into?
Formal operational:
Ability to think abstractly- logical thought, deduction, reasoning, systematic planning emerges
What area of the brain is most invovled w/ social recognition?
Amygdala
What stage of Erickson’s Psychosocial development is an adolescent in?
Stage 5- Identity & Confusion
They need to develop a strong personal identity, failure –> role confusion & weak sense of self
What sort of social development tasks must adolescents achieve?
Emotional separation from parents
Development
- 1. Peer identity/ social autonomy
- 2. intimate relationships
- 3. vocational ability and financial independence
Exploratory behaviours
What are the key areas of forming an identity?
- Become independent
- Mastery/ sense of competence
- Establish Social Status
- Experience Intimacy
- Determine Sexual identity
- Develop autonomy:
- Physical
- Psychological
Where are adolsecents in Kolberg’s Moral Development theory?
Stage 2: Conventional
Good girl/ boy (attitude to seek approval of others) and Law and order
How does alcohol affect the adolescent brain?
More -ve affects on hippocampus
Less sensitive to sedative effects of alcohol
How does tobacco affect the brain?
Cell damage is worse in hippocampus
How much sleep does an adolescent need?
What happens to their circadian rhythm?
9-10hrs
Circadian rhythm shifts forwards- melatonin switched on later @ night and switches off later in the morning
Emotional intelligence
What is it?
What are the 3 parts of it?
Does it happen automatically during adolescent development?
Skills necessary for managing succesful relationships & managing emotions
Parts: Self-awareness, Social awareness, Self management
Does not automatically develop
What do drugs do to the adolescent brain? What NT do they target?
May affect brain development in areas of impulse control & ability to experince reward
Affects DA NT
What predicts the quality of romantic relationships in early adulthood?
Quality of PI interaction in first 42 months of life
When is the best indicator of psychopathy in adolescence?
Disorganised attachment (Group D) at 1yrs
What stage of Bilbace & Walsh’s Children’s Explanation of illness is an early/ mid adolescent in?
11-16yrs: Physiological- Illness caused my malfunction in system and organs which may be due to infection
What is the approach used to consider adolescent development in a clincal setting?
STEP
Sexual maturation & growth
Thinking
Employment/ Education
Peers/ Parents
What is cognitive ideation?
- Advanced reasoning
- Meta cognition
- Logical thought process
- Abstract thinking
What areas of the male repro tract secrete stuff that go into ejaculate?
What does each part secrete?
Testicles/ Epididymis (Sperm/ Testosterone)
Seminal vesicles (Semen Clotting Factor, Fructose, IL, PgE)
Prostate Gland (PSA, Coagulase, Phospahte/ Bicarb buffers, Zinc, Citric Acid)
Bulbourethral & Urethral Glands (Lubricating mucus)
Define infertility
1-2 years of attempting pregnancy without success
Which phase of Meiosis is the mature Oocyte in prior to fertilisation?
Metaphase II
What secretes hCG?
Trophoblast
How is Polyspermy prevented?
Fusion of the plasma membranes of sperm & oocyte
Fast Block: Depolarisation of the cell membrane- influx Ca2+ & sodium. Second polar body released
Slow Block: Increased Ca2+ Concentration. Cortical granules released
What hormone is used to determine the ovarian reserve?
Anti- Mullerian Hormone
What are the 2 reactions by which mature sperm nurrow into oocytes?
Hypersensitivity reaction
Acrosome reaction
Where does the majority of ejaculate arise from?
Seminal vesicles
What is sperm capacitation?
Membrane change
Change of the glycoprotein coat = fully mature and able to fertilise an ova
What are the stages of early embryo development?
Pronucleate (6-20hrs)
Cleavage (18hrs -3 Days)
Compaction (Days 3-4)
Blastocyst (Days 5-6)
Hatching (Day 5-7)
What could causes an IVF diagnosis of infertility?
1) Ova anomoly (genetic, cytoplasmic or maturation)
2) Fertilisation failure or abnormality
3) Abnormal embryo development
4) Implantation issue
What would cause a medical diagnosis of female infertility?
1) Oligo/Amenorrhoea (PCOD/ Primary or Secondary Ovarian failure)
2) Structural abnormality of tubes
3) Structural abnormailty of uterus/ cervix
What position (eg: intrapetrioneal) does the tesicle develop in?
Retroperitoneal
What is a patent processus vaginalis?
What can also develop from here?
Where does it develop from?
a) Connection between the peritoneal cavity and scrotum
b) Indirect hernia
c) Originally the Processes vaginalis of which the majority is obliterated to become the tunica vaginalis
What is the function of the dartos muscle?
What is it made of?
Wrinkles the skin of the scrotum, decreasing the surface area reducing heat loss
Formed from smooth muscle
What is the blood supply of the scrotum?
Anterior (from external pudendal) & Posterior (from internal pudendal) Scrotal Arteries
Describe the layers of the tunica vaginalis
From parietal peritoneum- visceral and parietal layers
Serous fluid inbetween to allow testicles to move easily in scrotum
What is the name of the condition where there is too much fluid in the tunica vaginalis?
Hydrocele
What gives rise to Septa in the tesicles?
What is the function of the septa?
a) Tunica Albuginea (white fibrous outter testicular coating)
b) To divide tesis into lobules
Describe the route of sperm through the testicles
Seminiferous tubules –> Rete testis –> Efferent Ductules –> Epididymis
What are the parts of the epipdidymis and what recieves what?
Head connects to efferent ductules
Body
Tail connects to ductus deferens
What are the coverings of the spermatic cord and where are these from?
External Spermatic Fascia from Aponeurosis of EO
Cremasteric Fascia from IO muscle
Internal Spermatic Fascia from Transversalis Fascia
Describe the Cremasteric Reflex
Internal thigh stroked
Sensory via Ilioinguinal
Motor via Genitofemoral
Cremaster muscle contracts –> Testes lifting
What is the contents of the spermatic cord?
Rule of 3’s
Arteries:
- Testicular
- Cremasteric
- Ductus Deferens
Nerves:
- Genital branch of Genitofemoral
- Autonomic
- Ilioinguinal- not in spermatic cord all the way
Others:
- Ductus Deferens
- Pampiniform Plexus
- Lymphatics
Where can testicular pain refer to?
The abdomen
What is wrapped around the testicular artery?
Why is this good?
Pampiniform plexus
Helps keep testes cool via counter current heat exchange mechanism
What is the name of venous dilations of the pampinform plexus?
Varicocele
What embyological structure develops the Epididymis, Ductus Deferens & Seminal Vesicles?
What week of embryology and what drives this?
Mesonephric ducts
Week 8 and tesosterone
What movement are the ductus deferens capable of?
What innervation is this?
Peristalsis
via Sympathetic Innervation
What importnant structure do the ductus deferens cross in the pelvic cavity? And how?
Superior to the Ureter
What forms the ejaculatory duct?
Seminal vesicles
Ductus Deferens (it has widened forming ampulla)
What is the blood supply of the ductus deferens?
Local, on route of travel
Where are the seminal vesicles located?
Posterior to the bladder
Related posteriorly to Rectovesical Pouch
Describe the location of the prostate gland
Below the Bladder
Superior to Perineal membrane & Levator Anti
What type of tissue if the prostate gland made up of?
1/3 Fibromuscular
2/3 Glandular
What is the blood supply of the prostate gland?
Branches of Internal Iliac Artery- Vesicle & Rectal
Name the different parts of the urethra
Prostatic
Membranous
Spongy
What is the raised central area of the urethra called?
What opens onto here?
Seminal Colliculus
Ejaculatory ducts open here
Where do secretions of the prostate gland/ducts open up into?
Prostatic sinus
What is the homologue of the uterus in the prostate gland?
Prostatic utricle
What prevents retrograde ejaculation?
Internal Urethral sphincter under ANS innervation. Sympathetics cuase it to close during ejaculation
What is the naming system of the lobes in the prostate based on?
Position of the ejaculatory ducts and urethra to prostate tissue
Name the lobes of the prostate and describe their relation
What lobe may push into bladder in BPH?
Anterior (in front of urethra)
Middle (posterior to urethra and above ejaculatory duct)
Posterior (posterior to urethra and below ejaculatory duct)
b) Middle
What are zones of the prostate gland based upon?
Name them
Distribution of Glandular Tissue
Central
Transitional (BPH normally affects here- around urethra)
Peripheral (ca affects here normally)
Where does the prostatic plexus drain into?
Where can it also drain into?
Internal Iliac veins
Can also pass into vertebral venous plexus
Which structure forms the Glans Penis?
Corpus Spongiosum
Which tissue in the penis contains the urethra?
Corpus spongiosum
What embyrological feature forms the erectile tissue and Glans?
Genitle tubercle
What is the Root of the penis made up of?
Bulb (Corpus spongiosum) and Cura (Corpus cavernosum)
What is the root of the penis attached to?
Perineal membrane
What is the body of the penis?
The suspended part of the penis
What supports the base of the body of the penis?
Suspensory ligaments and fundiform ligament
What are the the Cura and Bulb covered by?
Ischiocavernous muscle
Bulbospongiosus muscle
Both Pudendal nerve innervated
What anchors the foreskin to the Glans?
Frenulum
Where are the majority of NV strucures located on the penis?
Dorsal side
Why is the tissue less erectile in the corpus spongiosum?
So you don’t squish the urethra
What is priapism?
Persistant and painful erection lasting >4hrs. Unrelieved by ejaculation
Where are the Bulbourethral glands located
What is their function?
In the deep perineal pouch but open up superifically
Secrete lubricating fluid
What can cause # of the penis?
Traumatic rupture of the corpus cavernosum
What is Phimosis?
Foreskin cannot be retracted over the glands
Causes: Recurrent infection- can cause fibrosis and narrowing of foreskin
What is Paraphimosis?
Foreskin stuck in retracted position behind glans
What is Hypospadias?
Urethra opens up on ventral side of penis but not at tip
What is Epispadius?
Urethra opens onto dorsal side of penis
What is the Ischioanal Fossae? Where is it located?
What are on each side of it?
Where can it extend into?
What are it’s functions?
Fat filled region below the pelvic floor- can communicate across midline
Anterior Recesses which project to pubic bone
Can extend into Urogenital triagnle/ Deep Perineal Pouch
Supports pelvic floor and anal canal
Where does the superficial perineal pouch lie?
Between Perineal membrane and Superficial perineal fascia (colle’s fascia)
What layer of superficial fascia continues from the anterior abdo wall to the perineum?
Scarpa’s fasica
The superficial fascia from abdo wall gets different names as it passes over different strucutres- name these
Penis, Scrotum as Dartos Fascia
Urogenital triangle and attached to posterior aspect of perineal membrane: Colle’s fascia
Where can fluid in the superficial perineal pouch track to?
Anterior abdominal wall
What does the Superficial perineal pouch contain?
Penis, Urethra, Scrotal contents, Superfical perineal muscles, OPENING of bulbourethral glands
Why does fluid in the superficial perineal pouch NOT track down to the lower limb
Scarpa’s fascia binds to Fascia Lata of the thigh
What is necrotising fascitis of the perineal region called?
Fournier Gangrene
What is a perianal fistula?
Abnormal connection between anal canal & skin due to infection
Male Repro: How does the major NV travel to penis?
Deep to pelvic floor through deep perineal pouch & pudendal canal
Where is the pudendal canal?
Within fascia over obturator internus
What is the internal pudendal artery a branch of?
How does it enter the pelvic cavity?
What does it supply?
Branch of Internal Iliac
Leaves via greater sciatic foramen and enters pelvic cavity via lesser sciatic foramen
Supplies: Rectum (inferior branch), Perineum and Penis
What is the venous drainage of the penis?
Dorsal Penile Veins (superficial and deep) –> Prostatic Venous Plexus –> Internal Iliac veins
Can also go via vertebral plexus
What lymphatic drainage of male repro goes to the Superficial Inguinal Nodes?
Scrotal, Penile & Perineal skin (and distal anal canal)
What lymphatic drainage of male repro goes to the Deep inguinal Nodes?
Glans of Penis
What drains to the para aortic nodes?
Testicles
What other strucutre drains to the deep inguinal nodes in males?
Spongy urethra
Where do most other parts of the male repro tract drain to? Including the proximal urethra
Internal iliac nodes
What does the pudendal nerve branches supply?
- Anal sphincter
- Perineal skin
- Penis- Dorsal nerve of the penis (including distal spongy urethra)
- Bulbospongiosum & Ischiocavernous
This is all SOMATIC innervation
What is sympathetics to pelvic organs
Hypogastric nerves and Sacral Splanchnic Nerve from sympathetic chain
Where do the Parasympathetics (Pelvic Splanchinc nerves) and Sypathetics unite?
Inferior Hypogastric plexus (on lateral plevic wall)
What nerves extend from the prostatic plexus and what do they supply?
Where has the prostatic plexus originated from? Therefore what division of the NS system is this?
Cavernous nerves
Travel into the penis
From: Inferior Hypogastric plexus thus ANS
What allows blood to bypass the corpora cavernosa in the flaccid penis
AV anastomoses
How is erection achieved?
Parasympathetic innervation allows straightening of coiled helicine arteries so blood fills corpora cavernosa (NO mediated)
Ischiocavernous and Bulbospongiosus muscles compress venous plexus
How is emission achieved?
Via sympathetics (L1/2)
Secretion from Glands, Peristalsis of Ductus deferens & Closure of Internal Urethral Sphincter
Seminal fluid & Spermatazoa –> Bulb of Penis
What can damage sympathetics that are needed for emission?
Surgery around paravertebral plexus
What causes ejaculation?
Sympathetic innervation
Bulbospongiosus squeezes penile bulb & urethra (Pudendal nerve)
Name the 4 types of contraception
- Natural
- Barrier
- Hormonal
- Surgical
How does the Lactation contraceptive method work?
Prolactin inhibits FSH this supressing HPG axis which prevents follicular maturation and ovulation
What are the barrier methods of contraception?
Condoms
Diaphragm/ Cervical cap
+/- spermicide
What are the disadvanatges of the diaphragm or cap?
- Professional fitting
- Leave in after 6hrs post sex
- No STI protection
- Education for proper use
What are the main methods of termination of pregnancy?
1) Misoprostol/ Mifepristone (meds) before 9/40
2) Surgical:
- Vacuum Aspiration (up tp 15/40)
- Dilation & Curettage (>15/40)
Define abortion
The death and expulsion of a foetus from uterus either spontaneously or by induction before 22/40
(eg: Spontaneous or Threatened)
What is the IUCD Copper MOA ?
Copper = Spermicide & Mechanically prevent implantation
What are the SE of IUCD?
- Cramping
- Bleeding
What are the complications of IUCD?
- Expulsion
- Perforation
- PID
- Ectopic Pregnancy
When PO or Intra-Uterine System Progesterone what do they decrease risk of?
Endometrial Cancer
What are the advantages of IUCD?
- Long lasting -12yrs
- Don’t limit sexual activity
- IUCD- Copper: NO artificial hormones
- Amenorrhea
- Decreases Dysmenorrhea
When else can the IUCD also be used?
Emergency contraception within 5 days of unprotected sex
Which oral contraceptive may be used during breast feeding?
Progesterone only pill
How do Inta-uterine systems work?
Incorporate a progesterone release polymer (lasts up to 5yrs)
What are the endometrial effects of Progesterone? (contraception)
Asynchronus high levels:
- Thickens cervical mucus
- Inhibits endometrial glands- implantation less favourable
What are the disadvantages of the IUCD?
- Partner unaware of strings
- Decreased libido
- Iregular bleeding
- Cost
- Invasive
Define Atresia
Degeneration in ovarian follicles which do not ovulate during menstural cycle
What is the average age of menopause?
51yrs
Normal range: 45-60yrs
How is inhibin stimulated?
a) When FSH binds to ovaries it releases inhibin which has a negative effect on the hypothalamus
b) Corpus Luteum
What are the triad of symptoms for the menopause?
- Hot flushes
- Sweats
- Vaginal dryness
Menopause: What is meiotic non disjunction
Give an example of what this can lead to
When there is failure to separate of homologus chromosomes-Meiosis I
–> Triosmy 21 (Down’s Syndrome)
What are the non-specific menopause symptoms?
- Headache
- Migranes
- Palpitations
- Joint and Muscle aches
- Distrubed sleep
Urogenital symptoms associated with menopause?
- Vaginal dryness
- Increased frequency
- Urinary invontinence
- Cystitis
Psychological symptoms associated w/ menopause
- Decreased concentration
- Irritable
- Poor memory
- Lack of libido
- Panic attack
Connective tissue disorders associated w/ menopause
- Hair loss
- Brittle nails
- Skin thinning
- Aches & Pain
- Osteoporosis
Diagnostic criteria for menopause
Amennorhea for 12 months
FSH > 30mlU/mL (only tested in women under 40)
Why does FSH increase in menopausal women?
Decline in Oocyte number (wrapped in follicle- Granulosa and outter layer of theca cells in antral follicle)
Follicle maturation produces oestrogen which at high levels inhibits FSH, also causes inhibin release (when FSH binds to Granulosa cells) inhibiting FSH. In menopause less follicle maturation (so less oestrogen to have -ve feedback on AP) and less binding/ sensitivity of FSH to granulosa cells so less inhibin so less -ve feedback on FSH.
What are the benefits of HRT?
- Improved vasomotor symptoms
- Improved urogenital symptoms- dyspareunia, vaginal atropgy, vulvovaginitis
- Reduced fracture risk and osteoporosis
Define premature menopause
Premature Ovarian Failure Occurs before age of 40
What are some of the risks of premature menopause?
- Premature death
- Osteoporosis
- Neurological disease
- Psychosexual function
- Mood disorder
- IHD
- Infertility
What is premature ovarian failure?
Disconnect between hormones and ovarian function or autoimmune problem. Not necessarily due to to lack viable follicles
What are the causes of premature ovarian failure?
- Idiopathic
- Familiar tendancy, Genetic- Fragile X syndrome
- Autoimmune
- Radiation/ Chemotheraphy/ Tamoxifen, Surgical- Total hysterectomy, Oophrectomy
What does Progestin and Oestrogen HRT help to do (aside from improve the triad of symptoms)?
Avoid cystic endometrial hyperplasia
What are the route of administration of HRT?
- Oral
- Transdermal patch (lasts 2 weeks)
- Subcut Oestrogen implant
- Lasts up to 5 months
- Progesterone taken orally to avoid uterine symptoms
- Topical Oestrogen Creasm
What is the average age in a decline in fertility?
What is the main cause? What can this increase?
What else can it increase?
37yrs
Meiotic non-disjunction –> Triosmy eg:21
Miscarriage
Outline the Menopause stages?
- Pre-menopausal
- Premature menopause
- Perimenopausal
- Menopause
- Post menopause
What happens to the mesntural cycles during perimenopause?
Oligomennorhea
Describe the lymph node drainage of the axilla
Humeral, Subscapular, Pectoral (Anterior) –> Central
–> Apical
–> Supraclavicular
Where do breasts develop?
Along mammary ridge (groin to axilla)
Breast surface anatomy
2-6 rib
Parasternally to MAL
Axillary tail of Spence: Along inferior boarder of pec major/ anterior axillary fold
What type of glands open onto the AREOLAR? What are they called? What do they produce?
Sweat and Sebaceous glands called Montgomery Glands
Produce oil lubricant
What are the muscular relations of the breast?
Anterior to the Fascia of Pec Major and Serratus Anterior
What is in the retromammary space?
Where is it located?
What is the importantance of it- give a test
Space between breast tissue and pectoralis fascia
Filled with LOOSE CT and Adipose tissue
Permits: Free movement of breast from pec major. If breast moves with pec major it suggests pathology. Test via getting patient to press their hands on their hips
What are the Ligaments of Cooper?
What is the clincal relevance?
Fibrous suspensory ligaments in fatty tissue (helps divide brest up and support)
Attach to dermis. Cancer can cause fibrosis of these ligaments causing: Dimpling (? Nipple retraction and tethering)
What is a gland?
Epithelical cells that secrete a substance
Describe the breast microstrucutre
Lobes (Glandular Secretory units) in Fat and Connective Tissue
Lobes made of Lobules which are made of Acini (Spheres of secretory cells around a duct). Lobules drain via Terminal ducts into a SINGLE Lactiferous Duct. 15-20 Lactiferous Ducts open onto the nipple
How do ductal and lobular carcinomas of the breast present?
What is this called?
Paget’s disease of the breast
Cancer may spread along duct system and out onto nipple giving ECZEMA type apperance
Describe the microstrucutre of an actively lactating duct
Glandular secretory epithelium in ACINAR arrangement surrounded my myoepithelial cells- contract in response to oxytocin
What hormones lead to proliferation of the: duct system, glandular cells and hence milk production?
Oestrogen, Progesterone and Prolactin
Describe how the composition of breast tissue changes as you age and hence the imaging modality?
Younger- Non Pregnant: Fibrous (Use USS)
Pregnant: Glandular
Older: Adipose (Use Xray- less radioopaque)
Define mastitis
Inflammation of the glandular epithelium of the breast tissue
What is the word for painful breasts?
What could this be related to?
Mastalgia
b) Cyclic, Non-cyclic or non-breast origin
Innervation of the breast
T4-T6 Intercostal nerves
Blood supply of the breast
Interal Thoracic –> Medial Mammary branches
Lateral Thoracic (from axillary) –> Lateral Mammary branches
Describe where the Nipple, Areolar and Breast Tissue mainly drain to?
What should you always be aware of with breast lymphatic drainage?
Axillary & Parasternal Nodes
Lateral Side:
- Pectoral (Anterior) and Central Axillary Nodes
Medial Side:
- Parasternal nodes
Additional:
- Rotter Nodes
- Contralateral pectoral nodes
- Contralateral breast
- Subdiaphrgmatic
- Inguinal lymph nodes
As shown above lymphatic drainage may cross the midline into the other breast so cancer may spread to the other breast
Describe where the BREAST SKIN lymphatic drainage is?
- Infraclavicular
- Deep Cervical
- Axillary nodes
How might breast disease PRESENT?
- Lumps
- Pain
- Nipple Discharge
- Skin changes
- Nipper inversion
How can you elict skin thethering in breast?
Ask patient to raise arms
Give some examples of how breast cancer my present- why does it present like this?
- Asymetrical/ New onset nipple retraction (suspensory ligaments)
- P’eau d’ Orange (APPEARANCE OF ORANGE LIKE TEXTURE) (lympahtics are blocked)
- Nipple discharge
- Dimpling (suspensory ligaments)
- Tethering (suspensory ligaments)
- Paget’s disease of nipple (Eczema like changes)
- Inflammatory changes
Causes of wheeze in children
URTI
Asthma
Bronchiolitis
Childhood conditions: Characteristic od Eczema rash
- Erythematous
- Scaley
- Weeping
- MACULAR
- Itchy/ Dry
- Excoriated
Neonatal Milia
How does it present?
What proportion does it affect?
Few –> Numerous White spot lesions
Face, Chest, Nose, Scalp, Upper Trunk
Self limiting
Affects 40-50% newborns
Name some common childhood skin conditions
- Eczema
- Neonatal Milia
- Cradle Cap (Seborrhic dermatitis. Common in first 2 weeks of life)
- Paranychia (STAPHLOCOCCAL infection often. Nailbed swelling, Pus, Erythema)
When assessing a vulnerable child what things do you consider in the Hx?
- Age: <6months serious infections more common
- Activity: Happy/ Miserable/ Sleepy
- Function: E&D, Vomiting, Wet nappies
- Length of Illness: Unexplained fever >5days
- Other symptoms: Breathing, Rash, Posture
What are the key respiratory differences in a child?
- Ribs go horizontal –> Less able to increase TV so INCREASE RR instead
- Fewer Alveoli
What is the cardiac difference in children?
- Myocardium less contractile so to increase SV must increase HR
Why is Gluocse an importnat consideration in Neonates?
Hypoglycaemic = RED FLAG- stress response to illness
Children have a larger surface area to weight ratio- what does this put them at risk of?
- Increased dehydration
- Poor temperature control
What is the anatomical difference in airways in children?
- Shorter neck
- Larger tongue
- Larger head
What other anatomical differences are there?
Liver and Kidney- both immature so less able to process stuff
Give some causes of Fever
- Post immunisation
- URTI
- LRTI- Pneumonia
- UTI
- GI- Gastroentertiris
- CNS- Meningitis
- Osteomyelitis
- Septicaemia
Give some symptoms/ signs you would see with BACTERIAL MENINGITIS
- Neck stiffness
- Buldging fontenelle
- Decreased conciousness
- Convulsive satus epilepticus
- Non blanching Rash- Purpura
What are the classic symptoms with childhood pneumonia?
Increased RR
- 0-5m: >60
- 6-12m: >50
- 12m: >40
Cyanosis
Chest drawing
Nasal Flaring
Crackes in chest
O2 sats <95%
What are the catagories for the traffic light system for identifying serious illness?
- Respiratory
- Circulation
- Colour
- Activity
- Other- Age, Temp, dehydration
Give some general causes of childhood illness
- URTI
- LRTI
- Rash
- Fever
- D & V
- Cough/ Wheeze
- Abdo pain
- Chronic eg: T1DM
- Cognitive
- Congenital
Traffic light system: Red
- Grunting (trying to keep alveolar sacs open)
- RR >60
- Cyanosed
- Does not wake
- High, Weak Pitched cry
- Chest drawing
- Reduced Skin turgour
- Bulging fontenelle
Traffic Light System Amber:
- Pallor reported by parents
- Nasal Flaring
- Not responding to social cues/ smile
- Wakes with only prolonged stimulation
- Decreased activity
- Dry mucus membranes
- Poor UO
- Rigors
- Poor feeding
Traffic light system: Green
- Cared at home with appropriate advice
- No red/ amber flads
SAFTEY NET!!
What is the triad of asthma?
Airway Hyperesponsivness
Airway Obstruction
Airway Inflammation
What is the first and second stages of management of DIAGNOSED asthma in children?
Stage 1:
- B2 agonist and
- Corticosteroid Inhaler
- OR <5yrs LTRA
Stage 2:
- B2 Agonist &
- Corticosteroid Inhaler &
- >5yrs: LABA
- <5yrs LATRA
What are the classic symptoms according to BTS for asthma?
- Chest tightness
- Wheeze
- Shortness of Breath
- Cough
On a structure clincal assessment (history, exam, previous notes) according to BTS what would you see?
- Recurrent episodes symptoms
- Symptom variability
- PEF or FEV1 variable
- Wheeze
- History of Atopy
- Absence of symptoms of alternative Dx
In ACUTE asthma for CHILREN over 1yrs
What would you see in Acute severe?
- O2 sats <92%
- PEF 35-50% best/ predicted
- HR
- >5yrs: 125
- <5yrs: 140
- RR:
- >5yrs: 30
- <5yrs: 50
In ACUTE asthma for CHILREN over 1yrs
What would you see in LIFE THREATENING asthma?
- O2 <92%
- PEF 33% best or predicted
- Silent chest
- Cyanosis
- Exhaustion
- Hypotension
- Confusion
According the BTS guidelines how do you manage tx according the high, intermediate and low risk catagories of asthma?
High- Initate Tx
Intermediate- Test for airway obstruction (spirometry and bronchodilator reversibilty)
Low- Look for other causes
How do manage Acute asthma?
OSHIT
- Oxygen if less than 94%
- Salbutamol- Inhaler or Nebuliser (one puff every 30-60 seconds. max 10puffs). Consider adding MgSO4
- Hydrocortisone (Dampen the inflammatory response)
- Ipatroium Bromide (Anti-cholinergic)
- Theophyline (Methylxanthine)- SEVERE/ LIFE THREATENING ONLY
Define embryonic and foetal period
Embryonic: First 8 weeks
Foetal: 8 weeks to Term
Define:
First Trimester
Second Trimester
Third Trimester
a) 1-12 Weeks
2) 13-28 Weeks
3) 29-40 Weeks
What is considered term?
What is post term?
37-42 weeks
Singleton: 41 weeks
Twins: 37 Weeks
Post Term: 42 weeks + (Induction from 41 weeks)
What are the 3 ways to measure EDD?
- LMP
- CRL
- Sonogram
- If greater than 84cm use Head circumference
- Symphsio Fundal Height (SFH)
- After 24 weeks
- Measure from fundus to Pubic Symphesis
- Use tape measure upside down
What 5 systems need to be addresses in the antenatal check?
- CVS
- Blood
- Respiratory
- Urinary/ Renal
- Glucose metabolism
What takes over Oestrogen and Progesterone production after the CL?
Placenta
When is the perinatal period
20th-28th week gestation & ends 1-4th week post birth
Define Foetal programming
Adverse influences during foetal life can affect structure/ function of distinct cells
Therefore programming the individual to be at increased risk of developing diseases
Mechanisms:
- Overexposure to glucocorticoid
- Decreased blood flow to foetus
- Stress on Transplacentral transfer
How does maternal stress affect the foetus?
Changes filtering capacity of placenta
Cortisol = Toxic & affects HPA axis –> individuals experiencing higher levels of stress in childhood/ adulthood
What are the OBSTETRIC consequences of Antenatal Anxiety?
- Low BW
- Premature labour
- Impaired blood flow OR increased resistance index to foetus through materal uterine arteries –>
- IUGR
- Pre-eclampsia
If parental stress occurs what are the neuodevelopment outcomes in children between 3-16yrs?
- Emotional Problems- Anxiety and Depression
- Symptoms of ADHD
- Conduct disorder
Unborn Baby: What x2 things happen in the antenatal period?
- Psychic re-organisation
- Materal Representation
What is Psychic reorganisation?
Psychic re-organisation and old psychological conflicts may be reviwed
May reflect on relationship with own mother and evaluate they way they were parented –> May awaken negative emotions
What is maternal representation?
Thoughts of what the unborn baby will be like.
Develops in the 2nd or 3rd Trimester
Balanced Respresentation: Securely attached infant at 12 months (more likely)
Distored/ Disengaged Representation: Insecurely attached or Disorganised Infant @ 12 months
How is Ax of the maternal representation made?
The working model of the child
What are the catagories of the working model of a child?
- Balanced
- Distorted
- Disengaged
- Disrupted
What is maternal representation affected by?
Psychological
Social- Environemental and relationship with other mothers to be
Who are more likely to be at risk of developing a negative MR?
Women experiencing domestic violence.
More likely to result in babies than have insecure attachment
What does the relationship with the unborn baby predict?
- Quality of parent-infant interaction postnatally
- PI Interaction = indicator of attchment security
- Infant Attachment by 1yrs
What are the 3 things than can happen postnatally? (1 may happen pre-natally)
- Ghosts in the nursery
- Unresolved parents
- Reflective functioning
Ghosts in the nursery
- Ghosts from parents childhood influence the way parents think & behave towards own baby
- Parents may re-enact w/ their baby scenes
- Can appear during pregnancy during Psychic reorganisation and MR
What are unresolved parents?
What happens?
What do they believe?
What happens to their parenting style?
Parents who carry issues from their childhood that have not been addressed
Infant distress triggers their own stress/ painful memories of vulnerability and dependence –> Unable ro respond to child
Unable to understand the infant’s distress and make inaccurate assumptions about the reasons for the behaviours
Parents can become very withdrawn or intrusive if NOT resolved
How can parents go from unresolved to resolved?
Opportunity to address the issues from their childhood and learn how to understand the mental state of oneself and others
What is Reflective Functioning?
Why is this useful?
Capacity to experience the baby as an intentional being rather than viewing them in term of phsyical characteristics or behaviour
Helps baby to develop understanding of mental state in other people & regulate their own internal experiences
Why is reflective functining importnant?
In pregnancy, high RF is associated with a securely attached infant @ 12 months
Associated with postive (flexibility & responsivness) maternal behaviours and the baby’s use of a mother as a secure base
Low RF associated with emotionally unresponsive behaviours- withdrawal, hostile, intrusivness
How is RF measured?
Working model of the Child interview along with MR
When does long term nutrition from maternal circulation begin?
Day 12
What gives out hCG?
Syncitiotrophoblast
Placenta Lecture: What happens on Day 7?
Decidualisation- uterine cells accumulate glycogen & lipids in response to progesterone
Trophoblast differentiates
Placenta Lecture: What happens on Day 8?
- Invasion
- Bilaminar disc forming
- Amniotic cavity formation
- Syncitiotrophoblast produces hCG
- Decidual cells degenerate = nutrition
What can happen as the syncitiotrophoblast invades blood vessels between days 9-12?
Bleeding can occur- can be mistaken for menstural bleeding (although a bit early)
Where does implantation take place ideally?
Upper Uterine Wall
What is the role of the junctional zone?
Forms a bed for the placenta to sit on. Decidua Basalis is just above
Functions of the placenta?
HIT
Hormone:
- Progesterone
- Oestrogen
- hCG
Immunity:
- IgG can cross
Transfer of nutrition/ waste:
- Oxygen, Glucose, Ions, Proteins, Globulins
What days do lacunae form? And where? What opens up into them? What is the venous return?
Days 10-12
Lacunae form in Syncitiotrophoblast
Maternal Spiral Arteries and Veins invade the lacunae
Materal blood returns via Endometrial veins
What are anchoring villi?
Some chorionic villi attach to the Cytotrophoblastic shell
Shell attaches to the Decidua Basalis
Placental anchoring is important for attaching placenta to endometrium
How does the Placental Membrane Change?
- Arborisation
- Cytotrophoblast degerates at week 20
- Prior = 4 layers: Maternal Blood, Syncitiotrophoblast, Cytotrophoblast, Endothelium of fetal capillaries
What are the 4 broad types of placental dysfunction?
- Position & Development
- Growth
- Transport
- Blood flow compromise
Placental development: Types of problem
- Uncontrolled invasion
- Accrete or Percreta
- Inapproriate site
- Previa
- Abruption
Define placental previa
Placenta develops over Internal Os
Can cause tearing or bleeding in late pregnancy
(type of development issue. subclass- inappropriate site)
Define Placental Abruption
Placental separation from uterine wall with subplacental haemorrhage
Concealed or Revelaed OR both
Give some causes of Placental growth problems
- Choriocarcinoma
- Gestational trophoblastic disease
Give the types of Placental Dysfunctions in BLOOD FLOW COMPROMISE
- Inadequete placentation –> Pre-eclampsia (failure of normal invasion of trophoblast cells causing maladpatation of spiral arteries)
- Impairment
- Maternal vascular disease
- Gestation age-post date
- Mechanical
- Volume
–> Fetal growth problems or Death
What does the smooth chorion fuse with?
The amniotic cavity as it expands
What is the Umbilical Cord made up of?
x2 arteries (if only one check for cardiac defects)
x1 vein (this carries arterial blood)
Wharton’s Jelly
Amnion
What is the immunisation schedule?
What are they?
8, 12, 16 weeks
- Meningitis B
- Rotovirus
- Pneumococcus
- Polio
- Diptheria
- Hep B
- Haemophilus inflenzae B
- Tetanus
- Whooping cough (Pertussis)
MMR at one year
Describe the Suckling reflex
Prolactin stimulates nipple receptors
Stimulates Endocrine neurones –> PIF decrease
PIF releases the lactotrophes from inhibitory catecholamines
Promotes synthesis & release of prolactin
Describe the let down reflex
Suckling stimulates sensory nerve fibres of nipple –> Oxytocin release
Oxytocin –> Myoepithelial cell contraction –> release milk into lactiferous ducts and sinuses
Oxytocin release becomes conditioned: Visual stimulation or conscious thought
When observing the parent-infant interaction what are the 3 dimensions of interactional behaviour Svanberg 2015?
- Engagement
- Predictibilty
- Genuiness
Attachment cycle: Healthy
Attachment cycke: Disturbed
Baby has a need –> Baby cries –> Need met by PC –> Trust develops –> Secure attachement promoted
Baby has a need –> Baby cries –> Need not met by Pc –> Range of trust issues develop –> Disorganised attachment
Secure attachement- 5 domains infants have optimal functioning across
- Emotional
- Social
- Behavioural adjustment
- School achievement
- Peer-related social status
Common Framework Assessment Domains
- Child development needs
- Parenting capacity
- Family & Environmental factors
What is the function of hCG?
Produced by the Trophoblast (Syncitiotrophoblast)
Supports CL to produce progesterone and oestrogen in first trimester
What is the function of Oestrogen DURING pregnancy?
- Promote Gap junctions between myometrial cells
- Increase myometrial sensitivity to oxytocin
- Increases PGE2 –> Soften Cervix
1 & 2 increase uterine contractions
What does progesterone promote during pregnancy?
- Promote cervical plug
- Inhibit uterine contractions
- Milk gland development
What hormones are high during 2nd and third trimester?
Progesterone dominates
Oestrogen high
What happens to levels of progesterone and oestrogen near term?
Progesterone levels drop off.
Oestrogen increases
What happens after Week 12 to hCG?
Levels drop off
After week 24 it levels off
When does hCG peak?
Between weeks 8 and 12
What inhibits prolactin during pregnancy?
Oestrogen
When does Colostrum first appear?
What hormones cause active secretion of it post deliver?
Appears in 2nd trimester.
Breast alveoli contain significant amounts during 3rd trimester
Decrease in oestrogen and progesterone causes active secretion
Mitosis/ Meosis I and II
Mitosis- Spearation of sister chromatids
Meosis I: Separation of Chromosomes- sister chromatids still attached
Meosis II: Separation of Sister Chromatids
