Gyn. Phys Flashcards
tunica albuginea
outer connective tissue covering
ovarian follicles
- oocyte develops within it
- follicle cells
- granulosa cells
primordial follicle
oocyte + follicle cells layer
primary follicle
oocyte + 2 layers granulosa cells
secondary follicle
- fluid filled spaces
- coalesce to form antrum
vesicular follicle (Graafian)
- most mature
- bulging from surface
- ooctye sits on stalk of granulosa cells
corpus luteum
- post ovulation
- degenerating follicle
corpus albicans
degenerated follicle
anatomical sites of the duct system
- salpinx / fallopian tube: extends laterally from uterus
- isthmus
- ampulla
- infundibulum
- fimbriae
layers of the uterine tubes
- serosa
- subserosa
- muscular: longitudinal and circular smooth muscles; creates peristaltic movement
- mucosa: simple columnar; two populations
cells within the uterine tubes
- ciliated: MC; most abundant in infundibulum
- peg cells
function of the ciliated cells of the uterine tubes
create wave
function of the peg cells in the uterine tubes
- produce tubular fluid: nutrients and proteases
- estrogen increases secretions
- progesterone decreases
uterus
- thick, pear shaped
- anterior to rectum
- posterosuperior to bladder
regions of the uterus
- fundus
- body
- cervical canal
- internal and external os
- cervix
layers of the uterine wall
- perimetrium
- myometrium
- endometrium
myometrium
- bulky muscular layer
- interlaced smooth muscle fibers
endometrium
- stratum functionalis: undergoes cyclic changes, sheds every 28 days
- stratum basalis: provides new functionalis
uterine blood supply
internal iliac –> uterine artery –> arcuate arteries –> radial branches –> basal and functionalis layers
functionalis layer of uterine blood supply
- spiral arteries
- repeatedly degenerated and regenerated
uterine glands
- glycogen rich secretion
- nourish zygote
- action enhanced by P
vagina
- thin walled muscular tube 8-10 cm
- b/w bladder and rectum
- from cervix to exterior
- proximal ends form vaginal fornix around the cervix
layers of the vaginal wall
- adventitia
- muscularis
- mucosa
mucosa of the vaginal wall
- rugae
- stratified squamous
- no mucus glands
- mucus from cervical glands and exterior mucous glands
epithelial glands of vaginal wall
- glycogen granules
- vaginal normal flora metabolize
- releasing lactic acid
- pH 3.3-4
hymen
- external partition
- partially covers introitus
external genitialia
- vulva
- mons pubis
- labia majora
- labia minora
- vestibule
- bartholins glands
- clitoris
- perineum
muscles of perineum
- perinei
- coccygeus
- levator ani
mammary glands
- modified sweat glands
- anterior to pectoral muscles
- areola
- lobes
- lobules
- glandular alveoli (produce milk)
- lactiferous ducts
- nipple
oogenesis
- female gamete production
- release occurs puberty to menopause
oogonia
- diploid stem cells
- fetal ovary
- develop into oocytes
primary oocytes
- replicate DNA, enter meiosis
- halted at prophase 1
primordial follicle
- primary oocyte + follicles cells
- about 700k at birth
- a few develop every month thru reproductive years
secondary oocyte
- oocyte + polar body
- enters meiosis II
- halts at metaphase II
- ovulated in mature follicle
the 2 fates of secondary oocyte
- no sperm penetration: disintegrates
- sperm penetrates: completion of meiosis II
follicular phase
- primordial follicle becomes a primary follicle
- primary follicle becomes a secondary follicle
- secondary follicle becomes vesicular follicle
describe how the primary follicle becomes a secondary follicle
- follicle cells form layers and become granulosa cells
- theca folliculi forms around follicle
- zona pellucida forms around oocyte - from granulosa cells secretions
- LH influences meiosis to resume
- oocyte becomes secondary oocyte
describe how the secondary follicle becomes vesicular follicle
- antrum expands
- corona radiata forms around the zona pellucida
- ovum isolated on a stalk
- fluid fills space forms tension
ovulatory phase
- tension in mature follicle is high
- wall ruptures
- secondary oocyte and membranes enters peritoneal cavity
- mittelschmertz
luteal phase
- post ovulation
- granulosa and theca cells become corpus luteum
- antrum fills w/ blood clot
- converted to lipid rich luteal cells
- secretes progesterone and estrogen
2 fates of the luteal phase
- pregnancy: corpus luteum persists until placenta takes over endocrine duties
- no pregnancy: corpus luteum hormone function declines, degenerates, forms corpus albicans
hormone regulation of the establishment of the ovarian cycle
- in childhood, ovaries grow and secrete estrogen
- this inhibits GnRH release
- as puberty nears the hypthalamus becomes less inhibited by E and secretes GnRH
- gonadotropins are released
- ovaries increase estrogen production over 3-4 years
- menarche occurs
adult cyclic hormonal interaction of ovarian cycle
- rising levels of GnRH stimulate LH and FSH release
- they simulate follicular growth and maturation
- E levels rise
- feedback to pituitary to stop release of LH and FSH but increase production and storage
- rising E then stimulates midcyle LH burst which induces ovulation, continuation of meiosis II and corpus luteum production
LH
- what cells
- what does it produce
- thecal cells
- androgens
FSH
- what cells
- what does it produce
- follicle cells
- estrogen
what inhibits release of LH and FSH
progesterone
menstrual phase days 1-5
- Corpus luteum support of endometrium declines -Endometrium thins
- Local prostaglandins cause spasm of spiral arteries
- Initial hemorrhages appear
- Endometrium necroses and detaches
- Menses appear
- Meanwhile back at the ovary, the follicular phase begins
menstrual phase days 6-14
-Stratum basalis proliferates: under influence of E
-New functionalis layer grows
-Spiral arteries proliferate
-E thins cervical mucus
-Meanwhile back at the ovary follicular phase continues and
ovulatory phase occurs
menstrual phase days 14-21
- Corpus luteum is producing P
- Supports thick uterine lining
- Spiral arteries coil
- Endometrial glands secrete glycogen
- Cervical mucus thickens
- Uterus ready for implantation
- If no zygote, corpus luteum fades, P support of endometrium declines
- Sloughing ensues
- Menses on D1 of next cycle
breast cycle
- E causes proliferation of ducts
- P causes growth of lobules and alveoli
- pain and tenderness
- changes decline w/o pregnancy
GnRH
- source
- target
- action
- hypothalamus
- anterior pituitary
- prompts release of anterior pituitary gonadotropicns (LH FSH)
what inhibits GnRH?
estrogen
LH
- source
- target
- action
-anterior pituitary
-gonads via circulation
Actions:
-E production
-thecal cells: androgen
-granulosa cells: convert to E
-oocyte meiosis
-ovulation
-convert spent follicle to CL
what inhibits LH
estrogen
FSH
- source
- target
- action
- anterior pituitary
- gonads via circulation
- stimulates E production by granulosa cells and follicle maturation
what inhibits FSH
- E
- inhibin
estrogen is synthesized from what?
cholesterol
what all secretes estrogen
- granulosa cells
- corpus luteum
- placenta
- adipose, muscle, brain
transport of estrogen
- 60% bound to albumin
- 33% bound to gonadal steroid binding globulin
- remainder free in plasma
elimination of estrogen
- conjugated in liver
- eliminated by kidney
MoA of estrogen
- binds intracellular receptors
- forms dimer
- binds DNA
- alters transcription
ERalpha
- uterus
- kidneys
- heart
- breast
ERbeta
- ovaries
- lungs
- GI
- bone
- CNS
effects of estrogen on the genitalia
- ovarian follicle growth
- increased uterine tube activity
- endometrial lining proliferation
- increased and maintain uterine muscle
endocrine function of estrogen on the anterior pituitary
inhibit FSH secretion
endocrine function of estrogen on the liver
increase angiotensin II production (vasoconstriction and and sodium reabsorption, water retention)
endocrine function of estrogen on CNS
- mood (increased serotonin R)
- cognition
endocrine function of estrogen on breast
- duct growth
- pigmentation of areola
- inhibits lactation post parturition
other effects of estrogen
- lowers cholesterol
- increases NO production and local vasodilation
- decreases bone degradation
- closure of epiphyseal plate
- libido
- estrus
- establishment and maintenance of secondary sex characteristics
progesterone is synthesized by what?
cholesterol
what all secretes progesterone
- corpus luteum
- placenta
- small amount from follicle
transport of progesterone
- 80% bound to albumin
- 18% bound to corticosteroid binding flobulin
- remainder in free plasma
elimination of progesterone
- conjugated in liver
- eliminated by kidney
progesterone is stimulated by?
LH
target of progesterone
- uterus
- breasts
- brain
effects of progesterone on the uterus
- progestational changes
- anti-estrogen effect
- decreases ER and myometrial exitation
- thickens cervical mucus
effects of progesterone on the breast
- development of lobules and alveoli
- supports secretory function
effects of progesterone on the CNS
- thermogenic
- relaxing effect, decrease seizure, increase sleep
other effects of progesterone
- increases osteoblast activity
- diuresis
- increased use of adipose for energy
hormone action during puberty
- low level release of E during childhood inhibits release of GnRH
- then gradual increase of GnRH resulting in increasing E release
- over about 3 years the system reaches adult levels of feminization of body
- breast buds precede menarche by about 2 years
note
there are a ton of other things she said about puberty but it’s all obvious - review if you want
what can influence sexual stimulation in the female sexual response
- touch
- internal fluctuation of hormones
- metal and physical stimuli
outcome of stimulation of the female sexual response
- engorged sexual tissues
- increase secretions from bartholins glands
- climax involves uterine contractions
- pleasure
- increase in skeletal muscle tension
- elevated HR, RR, BP
menopause
- ovarian failure
- 45-55
- one year post menses
perimenopause
- irregular periods
- hot flashes
- vaginal tissue changes
- difficultly sleeping
- urinary changes
- weight gain at waist
changes during menopause
- cessation of menses
- vaginal and vulvar thinning and dryness
- dysparenunia
- decreased libidio
- decreased bone density
