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Year 2 > ILO WEEK 5 > Flashcards

ILO WEEK 5 Flashcards

1
Q

Summarise the development, structure and functions of a normal placenta in a healthy pregnancy

A

Differentiation of trophoblast:

  • the proliferating inner villous cytotrophoblast
  • non-dividing outer multinucleate layer called the syncytiotrophoblast
  • Lacunae begin to develop within the STB mass; blood from spiral arteries will fill the spaces
  • Initially maternal blood escaping from the spiral arteries passes into lacunae before the mouths of the spiral arteries become blocked with EXTRAVILLOUS TROPHOBLAST CELLS that form intra-arterial plugs; secretions from uterine glands keep it alive

VILLOUS TREE;
Cytotrophoblast cells migrate, forming villous projections that extend towards the maternal basal plate
By 3rd week of gestation tertiary villi have formed consisting of an outer monolayer of syncytiotrophoblast, invaded by an inner layer if cytotrophoblast cells and vascularised with foetal capillaries

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2
Q

Define the terms pre-eclampsia

A 
Hypertension occurring (typically) after 20 weeks with associated oedema and proteinuria ( different with existing hypertension)
Affects up to 6% of UK pregnancies
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3
Q

Give a brief explanation of the implications of these disorders in pregnancy (preeclampsia, eclampsia, foetal growth restriction)

A

They may lead to risk of life of both mother and child; eclampsia (seizures)

Preterm birth, stillbirth etc.

Is there more?!

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4
Q

Describe the pathophysiological mechanism s that underlie pre-eclampsia

A

Pre-eclampsia defined as: new onset hypertension (systolic >140 diastolic >90 mmHg) occurring after 20 weeks’ gestation with new proteinuria (protein:creatine ration >30mg/mmol)

  1. Abnormal placentation
  2. Abnormal maternal response to placental trigger
  3. Organ/systems failure

ENDOTHELIAL DYSFUNCTION CENTRAL
an imbalance between vasodilator and vasoconstrictor molecules produced by or acting on the endothelium

Many atypical presentations of PE; women with preexisting renal disease and/or hypertension = diagnosis challenging

Left untreated may progress to eclampsia, a life treating condition characterised by convulsions

Factors:
genes, the placenta, immune response, maternal vascular disease

Much of morbidity due to high rates if intervention an iatrogenic preterm delivery indicated as risk of severe maternal complications and still birth

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5
Q

Understand current guidelines for the management of pre-eclampsia

A

Reducing the risk of hypertensive disorders before and during pregnancy
Change lifestyle factors

PIGF Based testing

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6
Q

Define the term fetal growth restriction

A

Failure of the foetus to reach its genetically predetermined growth potential
Results in birthweight below 5th centile of individualised birthweight ration (IBR) charts (12 week scan; try to use ulrasound to establish; then with next scan see if growth restricted)
Affects 5-10% of pregnancies
May be associated with abnormal umbilical artery blood flow on Doppler ultrasound and/or oligohydramnios (lack of amniotic fluid)
Can also be associated with pre-eclampsia and other complications of pregnancy (e.g diabetes)
Major risk factor for stillbirth, survivors are at increased risk of neonatal and adulthood diseases

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7
Q

Define the term preterm birth

A

Delivery at <37 weeks gestation

Extremely preterm <28 weeks, very preterm 28-32 weeks, moderate to late preterm 32-37 weeks

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8
Q

Clinical features of pre-eclampsia

A

Multi-system maternal syndrome, unique to humans
Implications of the for research? very challenging; do not understand pathogenesis
Notoriously heterogenous presentation
- Hypertension
- Proteinuria
- Oedema- hands, feet, face

Consequence of endothelial dysfunction

Severe pre-eclampsia can cause:

  • Headaches
  • Blurred/ flashing vision
  • Pain in upper right abdomen
  • Nausea/ vomiting
  • Heartburn that does not go away with antacids
  • Rapid oedema
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9
Q

Permigrividae

A

1st pregnancy/ first with new partner/ first pregnancy in 10 years

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10
Q

Concretions

A

Commonly found in prostate

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11
Q

List and recognise the major histological tissue types of the ovary.

A

Superficial - deep

Capsule

  • Germinal Epithelium, a cuboidal epithelium
  • Tunica Albuginea, a connective tissue.

Cortex, the outer region of follicle development.

Of the mature (graafian) follicle - theca interna/ externa.

  • antrum
  • liquor folliculi
  • follicle cells
  • oocyte
  • zone pelucida
  • cumulus oophorus
  • corona radiata
  • corpus luteum after ovulation is another key structure.
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12
Q

List and recognise the major histological tissue types of the uterus.

A

Know the difference between proliferative, secretory and menstrual histology of the uterus.

Key hormones are: LH and FSH.

Essentially focuses around two layers; the myometrium (smooth muscle) and the internal endometrium (itself made up of three layers: strata compactum, spongiosum (functionalists), basalis.

  1. Proliferative Stage
    Modulated by FSH.

The endometrium thickens and the Stratum Functionaliks forms from the Stratum Spongiosum, served by hastily built spiral arteries.

  1. Secretory Phase

Modulated by LH.
Glycogen rich secretions. Cork screw shaped glands. Less staining due to open spaces.

  1. Menstrual Phase (menses)

Modulated by decreasing LH as the Corpus Luteum deteriorates.

Spiral arterioles contract, and the Stratum functionalists becomes ischaemic. Becomes necrotic, and the arteries rupture producing menstruation.

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13
Q

Provide a brief overview of the cell types found in the female reproduction tract.

A

Uterine tubes:

Ciliates columnar cells, secretory cells.

Uterus:
Simple columnar epithelium.

Vagina:
Non-keratinised squamous epithelium.

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14
Q

Describe the structure and function of:

Theca Cells

Granulosa Cells

Germ Cells

A
  1. Theca Cells
    - work with granulosa cells. Produce oestrogens and androgens in the maturing follicle
  2. Granulosa (follicular cells) Cells
    - supportive. Produces oestrogen.
  3. Germ Cells
    - produces the gamete. Surrounded by zone pelucida and corona radiata.
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15
Q

Describe the peritoneal relationships of the reproductive organs in both sexes

A

FEMALE:
Uterus -> peritoneum covers it
Ovaries covered in layer of peritoneum forming a ligament
Fallopian tubes also enclosed in peritoneum

BUT COULDNT FIND NICE INFO!!!

MALE:
Peritoneum surrounds scrotum bladder and prostate but not the penis itself

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16
Q

Contents of the spermatic cord

A 
Vas deferens.
Testicular artery.
Artery of the ductus deferens.
Cremasteric artery.
Pampiniform plexus.
Genital branch of the genitofemoral nerve.
Parasympathetic and sympathetic nerves.
Lymphatic vessels.
17
Q

The skeleton of the penis

A 
I think it refers to the structures in the penis:
corpus cavernosum (2) and corpus spongiosum (1) ???
18
Q

ligamentous pelvis and inguinal ligament attachments

A

???

19
Q

clinical relevance of pelvic imaging

A

???

20
Q

histological features of the male reproductive tract and the kidney

A

???

21
Q

Contraceptive pills (mechanism of action)

A 
Combined pill (oestrogen + progestins)
- Prevents the ovaries from releasing the oocyte, they also thicken the cervical mucus and - endometrial lining to prevent the sperm from reaching the egg
This happens because progesterone and oestrogen have a negative feedback mechanism on the pituitary gland, thus reducing the pulsatile frequency of the gonadotropin release (LH&amp; FSH) from the anterior pituitary. The lack of the LH surge mid-cycle prevents the release of the oocyte.

Mini pill (continous progestin)
- need to take everyday at the same time
- it thickens the mucus in the cervix, preventing the sperm from reaching the egg. Sometimes it
may also prevent ovulation (not always)

22
Q

The process of gametogenesis in female

A

From one primary oocyte we only get one mature egg; the rest becomes polar bodies that support and nurture the egg

In fetal development the process is arrested at the meiosis I prophase (still diploid)

After big spurge of FSH in puberty process restarts (one egg at a time)
primordial follicle ->
a cluster of primary oocytes with a single layer of cells
primary follicle ->
- (granulosa cells present; theca cell develop Kit Ligand)
- Zona pellucida present
- Production of androgens begins
secondary follicle ->
-propper blood supply
- fluid-filled antrum
- granulosa cells develop hormone receptors
- aromatase
- oestradiol from granulosa cells inhibits secretion of FSH and LH (but stimulates the production
- inhibin stops the release of FSH

Tertiary (Graafan) follicle -> on the point of release
- corona radiata develops
- positive feedback to oestrogen develops
LH released in massive proportion -> ovulation

Then CORPUS LUTEUM -> progesteron
Corpus ALBICANS -> degeneration

If any of the other follicles develop as well -> undergo death -> ATRESIA

23
Q

Contraceptive pills (mechanism of action)

A 
Combined pill (oestrogen + progestins)
- Prevents the ovaries from releasing the oocyte, they also thicken the cervical mucus and - endometrial lining to prevent the sperm from reaching the egg
This happens because progesterone and oestrogen have a negative feedback mechanism on the pituitary gland, thus reducing the pulsatile frequency of the gonadotropin release (LH&amp; FSH) from the anterior pituitary. The lack of the LH surge mid-cycle prevents the release of the oocyte.

Mini pill (continuous progestin)
- need to take every day at the same time
- it thickens the mucus in the cervix, preventing the sperm from reaching the egg. Sometimes it
may also prevent ovulation (not always)

24
Q

Development and regression of the kidney

A

Develops from intermediate mesoderm

3 structures -> pronephros (cervical region)
-> mesonephros (abdominal region)
-> metanephros (pelvic region)
Metanephros forms the definitive kidney (together with ureteric bud -> mesonephric duct)

Others form then regress; rudimentary
Becomes functional in week 11

25
Q

Describe the cellular movements in the formation of the indifferent gonads

A

Pre germ cells need to move out into the yolk to both protect them from signalling that could be harmful and to make space for quick development;
They have to find their way back to the gonadal ridges by week 6

26
Q

Testes from indifferent gonad

A

Mesonephric duct

Drain urine from the mesonephric kidney
Play an essential role in the development of the male reproductive system
Under the influence of testosterone, duct forms the ductus deferens and ejaculatory duct when mesonephros vanishes
In the female -almost completely disappears, leave a few non functional remnants

TESTES
Testes determining factor SRY; Acts on somatic cells (not the gametes) ; proliferation of the sex cord
Cords become horseshoe shaped; break into tubules
Leydig cells (special foetal cells) produce testosterone; Sertoli cells -Antimullerian hormone

Dense connective tissue forms (tunica albuginea; separates the cords from the surface epithelium

No lumen in the cord until puberty

27
Q

Ovary from indifferent gonad

A

paramesonephric duct

Develop lateral to the gonads and mesonephric ducts
Form funnel shaped cranial ends which open into the peritoneal cavity
Migrate caudally, parallel to the mesonephric ducts until they reach the future pelvic region
Approach each other in the midline
Cranial portion forms the uterine tubes
Caudal portion fuse to form the uterovaginal primordium
Uterus and superior vagina

In the male – degenerate due to the action of anti-mullerian hormone. This is a protein made by the Sertoli cells of the testis

OVARY
Wnt 4 needed for development!!!
Cortical and medullary cords form
Surface epithelium starts to proliferate

Mitotic division of germ cells -> pool of oogonia (then meiotic arrest)
Follicular cells develop as well -> somatic cells support germ cells

28
Q

Common clinical conditions associated with development of the system

A

Double uterus -> failure of fusion (bicornuate uterus)

Vaginal atresia -> failed canalisation (no hole)

Absence of vagina and uterus

HYPOSPADIAS
Urethra opens on the underside of the penis; surgical correction may be necessary (~12 months) 70% very mild

29
Q

Origin of the primordial germ cells

A

yolk sac; need to travel to protect them from different signalling

30
Q

External genitalia development

A

genital tubercle forms either the penis or the clitoris

caudally the cloacal folds are subdivided:
urethral folds in front - form labia minora in female
anal folds behind
genital swellings then appear on either side of the urethral folds
form scrotal swellings in male, labia majora in the female

31
Q

Be able to recognise the pelvic organs and appreciate their anatomical positions and relationships.

(Load blank image)

A

Name organs seen.

Female:

https://images.app.goo.gl/CHnG2vxFS1Q8KfoS8

Male:

https://images.app.goo.gl/1b187MneqV3oQEC7A

32
Q

Discuss the production and function of cervical mucus.

A

Produced by glands in the endocervix, 20-60mg/ day or 600mg/day during ovulation.

Main constituents:

  1. Water (93-98%)
  2. Electrolytes - calcium, sodium, potassium
  3. glucose
  4. amino acids

Roles:

  1. Protection of or barrier to spermatozoa.
  2. Lubrication
  3. Slightly acidic as innate immunity (acidity increases with increasing progesterone to form “infertile mucous”).
  4. Formation of the cervical mucous plug (operculum).
33
Q

Describe the gross anatomy of the male reproductive tract including blood supply and venous drainage.

A

Following the route of the sperm:

  1. Testis
  2. Epidydimis
  3. Vas deferens/ ductus deferens
  4. Passes over the bladder and via the seminal vesicles.
  5. Runs through the prostate, passing the bulbourethral glands.
  6. Moves along the membranous then spongey urethra.

Blood supply of these organs
1. Paired testicular arteries, which access the testes via the inguinal canal. The cremasteric artery also perfuses this area.

Drainage is via the pampiniform plexus of the scrotum, draining to the left testicular vein - left renal vein - inferior vena cava on the left, and directly from the right testicular vein - inferior vena cava on the right.

  1. As above
  3. Seminal vesicles: a shit ton. All stem from the internal iliac artery, which gives rise to the inferior vesicle, internal pudental and middle rectal arteries. These subdivide further.
    There are no notes on venous draining on TMA.
  4. Prostate:
    Prostatic arteries mostly derived from internal iliac artery.

Drainage via the prostatic venous plexus - internal iliac veins.

  1. Three sources:

All branches of the internal pudental artery, from the internal iliac artery.

  1. Dorsal arteries of the penis
  2. Deep arteries of the penis
  3. Bulbourethral artery.
34
Q

Describe the gross anatomy of the female reproductive tract including blood supply and venous drainage.

A
  1. The ovaries. Paired gonads. Internal and found in the pelvis.
  2. Via the fimbrae, move into the uterine tubes. Infundibulum - ampulla - isthmus - uterine part.
  3. Enters the uterus at the uterine horns into the uterine cavity. The top of the uterus is called the fundus. Three layers contribute the wall: perimetrium, myometrium and the endometrium.
  4. Internal Os
  5. (Endo)Cervical canal through the cervix
  6. External Os, flanked by the lateral vaginal fornix.
  7. The vaginal canal.

Vasculature:

  1. The ovaries.
    Ovarian arteries, from the abdominal aorta.
    Drained by the ovarian veins into the inferior vena cava.
  2. Uterine tubes. Uterine and ovarian arteries + veins.
  3. Uterine artery + veins. Venous drainage is via a plexus on the broad ligament.
  4. Uterine artery + vein. As above.
35
Q

Describe lymphatic drainage of the female reproductive tract.

A
  1. Ovaries
    - para-aortic nodes.
  2. Uterine tubes
    - Iliac, sacral and aortic lymph nodes
  3. Uterus
    - Iliac, sacral, aortic and inguinal lymph nodes
  4. Cervix
    - Iliac, sacral, aortic and inguinal lymph nodes
  5. Vagina
    - Three sections.
    1. Superior - external iliac nodes
    2. Middle - Internal iliac nodes
    3. Inferior superficial inguinal lymph nodes.

Year 2 (8 decks)

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