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Women's Health > Lecture 1: Phys and Pathophys > Flashcards

Lecture 1: Phys and Pathophys Flashcards

1
Q

What is the HPO Axis?

A

Hypothalamic Pituitary Ovarian Axis

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2
Q

What are the 4 roles of the HPO Axis?

A
  1. Development of sexual characteristics
  2. Coordinating regular periodic body changes
  3. Function of cervix, vagina, and breasts
  4. Maintenance of pregnancy
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3
Q

What is the role of the hypothalamus in the HPO axis?

A
  • GnRH production and release (pulse)
  • Binds to anterior pituitary
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4
Q

What is the role of the pituitary in the HPO axis?

A
  • Release of FSH and LH
  • FSH and LH go to ovary
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5
Q

What is the main role of FSH and LH in the HPO axis in relation to follicles?

A

Folliculogenesis

Theca and granulosa cells

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6
Q

What is the role of FSH and LH in the ovary?

A
  • Production of steroids (estrogen, progesterone, androgens)
  • Gonadal peptides (activins, inhibins, follistatins)
  • Growth factors
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7
Q

What is the role of estrogen in the HPO axis?

A
  • Induce surge of LH to release oocyte
  • Proliferation of endometrium tissue
  • Secondary sex characteristics development
  • Libido
  • Thickening of vaginal wall and lubrication
  • Reduced cholesterol/atherosclerosis
  • Reduced acne
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8
Q

What is the role of progesterone in the HPO axis?

A
  • Maintenance of pregnancy
  • Decrease uterine contractility
  • Promote breast development/differentiation
  • Once it falls, menses occurs and lactation occurs
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9
Q

What do activins do?

A
  • Stimulate FSH secretion
  • WBC production/embryo development
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10
Q

What do inhibins do?

A

Inhibit FSH secretion

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11
Q

What do follistatins do?

A
  • Regulate gonadotropin secretion
  • Inhibits activins
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12
Q

What is a relaxin?

A
  • Relax pubic symphysis
  • Inhibit uterine contractions
  • Development of mammary gland and follicular development

Relax and INhibit

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13
Q

What is the positive feedback loop of the HPO axis?

A
  • High estrogen => increased GnRH and LH
  • High activin => more gonadotropic function
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14
Q

What is the negative feedback loop of the HPO axis?

A
  • Progesterone inhibits GnRH and LH
  • Inhibin inhibits FSH secretion
  • Follistatin inhibits FSH secretion
  • Lactation increases dopamine and alters release of GnRH
  • Estrogen (moderate) decreases LH
  • Estrogen decreases FSH
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15
Q

How does puberty tend to vary between sexes?

A
  • Females occur 8-13 (earlier)
  • Males occur 9-14
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16
Q

What are the stages of puberty?

A
  1. Andrenarche (prior to puberty)
  2. Thelarche: Breast development (First event of puberty)
  3. Pubarche: pubic and axillary hair
  4. Menarche: first menstrual cycle

Thelarche also includes:
Estrogen => duct growth
Progesterone => lobule and alveoli growth

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17
Q

What counts as day 1 of a normal menstrual cycle?

A

Beginning of flow

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18
Q

What is the average menstrual cycle duration?

A

28d, +/- 7d

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19
Q

What are the two main phases of the menstrual cycle?

A
  • Ovarian cycle => Follicular phase => ovulation => luteal phase
  • Uterine cycle => proliferative phase => secretory phase => menses
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20
Q

How does FSH and LH change during the ovarian cycle in the follicular phase?

A
  1. FSH Rise > LH Rise
  2. Inhibin B production due to FSH starts to inhibit FSH via neg feedback
  3. Midfollicular phase 6d later, making 1 dominant follicle and other atretic follicles.
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21
Q

What two things occur as a dominant follicle matures?

A
  • LH receptor development
  • Estrogen release
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22
Q

As estrogen is released from the maturation of a dominant follicle, what occurs?

A
  • Increased GnRH pulses
  • LH surge
  • Ovulation
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23
Q

What happens during ovulation in the ovarian cycle?

A
  • Occurs around day 14 with mature follicle rupture as it goes to oviduct.
  • Corpus hemorrhagicum occurs as follicle fills with blood.
  • Mittelschermz can occur

Ovulation pain due to blood being an irritant

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24
Q

What is the corpus luteum?

A
  • Granulosa and theca cells of follicle make yellowish, lipid-rich luteal cells.
  • Makes estrogen and progesterone when stimulated by LH
  • Negative feedback inhibits FSH and LH

After it spits out the ovum

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25
Q

If there is no pregnancy, what happens to the corpus luteum?

A
  • FSH and LH decrease
  • Atrophy of corpus luteum 3-4d premenses into atrophic corpus albicans
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26
Q

What triggers menses?

A

Declining levels of progesterone as corpus luteum atrophies and ceases to release progesterone

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27
Q

What is the phase of the uterine cycle following menses and what occurs?

A
  • Proliferative phase
  • End of menses, where only the stratum basale remains of the endometrium.
  • Days 5-16: Estrogen from developing follicles will regenerate endometrium, forming the stratum functionale.
  • Uterine glands lengthen without secreting anything

The rebuilding of the endometrium, not revascularization.

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28
Q

When does the secretory phase of the uterine cycle occur and what occurs?

A
  • 14d, post ovulatory
  • Estrogen and progesterone from the corpus luteum vascularize the endometrium and develop uterine glands.
  • However, once the corpus luteum regresses, spasms and ischemia of the endometrium occur with decreasing progesterone and estrogen.
  • Hemorrhage occurs as breakdown of endometrium occurs.
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29
Q

Image of ovarian and uterine cycle

A
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30
Q

Medcomic image of uterine and ovarian cycle

A

LH causes ovulation

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31
Q

What occurs in the cervix during the menstrual cycle?

A
  • Estrogen thins and alkalizes mucus to enhance sperm survival
  • Dries like a fern-like pattern on slide
  • Progesterone thickens mucus and does NOT cause a fern-like drying pattern.
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32
Q

When is cervical mucus thinnest?

A

At time of ovulation

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33
Q

When is cervical mucus thickest?

A

Day 21, which is after ovulation and during pregnancy

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34
Q

What kind of epithelium is present from endocervix to ectocervix?

A

Columnar

Cervical ectopy

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35
Q

Why does squamous metaplasia occur with rising estrogen levels in puberty?

A

Cervical os uncoils and exposes some columnar and the acidic environment results in squamous metaplasia.

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36
Q

What lifestyle habit accelerates metaplasia of the cervix?

A

Smoking

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37
Q

What medication can reverse/persist cervical ectopy?

A

OCPs

May increase susceptibility to STIs as columnar is weaker than squamous.

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38
Q

How do the two main steroid hormones affect ciliary beat frequency in the fallopian tubes? (CBF)

A
  • Progesterone: reduces CBF
  • Estrogen: increases CBF

Estrogen Enhances

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39
Q

How do the main steroid hormones affect muscles?

A
  • Progesterone: reduce spasms, relax smooth, antagonizes insulin effects on glucose metabolism
  • Estrogen: improves skeletal contractility
  • Both help protein metabolism

Estrogen Enhances

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40
Q

What is the effect of ovarian hormones on skin?

A
  • Maintain collagen and moisture
  • Increased healing and growth
  • Increased skin pigmentation
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41
Q

What is the effect of ovarian hormones on fat?

A
  • Increased fat deposition: pear shape
  • Progesterone: mediator of fat gain in pregnancy
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42
Q

What is the effect of ovarian hormones on sodium/water balance?

A
  • Estrogen: retention
  • Progesterone: excretion

Estrogen Enhances retention

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43
Q

Image of anatomy when pregnant

A
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44
Q

What CV changes occur during pregnancy?

A
  • Upward and Lateral shift of PMI
  • Increased heart size, SV, CO and +15 HR

Multiple gestation = more HR increase

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45
Q

What is supine hypotensive syndrome and the tx?

A
  • Hypotension, bradycardia, and syncope when laying down.
  • Tx: Lateral recumbent positions
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46
Q

How does BP change in pregnancy?

A
  • Minor arterial decrease
  • Widened PP
  • Increased LE venous pressure, potentially leading to edema and varicosities
  • PVR/SVR will decrease due to more vasodilators
47
Q

Where does blood flow increase to during pregnancy?

A
  • Uterus
  • Kidneys
  • Breasts
  • Skin
48
Q

What murmur is MC in pregnancy?

A

Split S1 or loud S3 at the left sternal border

90% of pts, generally normal

49
Q

What does pregnancy decrease the threshold of for heart rhythm?

A

Reentrant SVT

50
Q

What EKG changes may occur in pregnancy?

A
  • Left axis shift
  • ST Depression
  • T-wave flattening
51
Q

What happens to the rib cages in pregnancy?

A

Upward displacement

52
Q

What happens to the lungs and ventilation in pregnancy?

A
  • More tidal volume due to less dead space
  • Increased O2 consumption
  • Mild respiratory alkalosis
  • No change in RR
  • Increased dependence on diaphragm
53
Q

What happens to the kidneys in pregnancy?

A
  • Renal hypertrophy
  • Dilation of vessels => increased flow and GFR and creatinine clearance and renin activity
  • Upward and flattening of bladder, decreased tone (increasing capacity)
54
Q

What might be seen in urine during pregnancy?

A
  • Glucosuria
  • Urinary protein loss
55
Q

What happens to the GI system in pregnancy?

A
  • Upward stomach and bowels
  • Increased salivation and gum hypertrophy
  • Decreased intestinal transmit time
  • Slowed gallbladder emptying
  • GERD and decreased gastric emptying
  • Decreased albumin, increased ALP from placenta
56
Q

What electrolyte binds to albumin primarily?

A

Calcium

57
Q

What occurs to blood volume in pregnancy?

A
  • 50% increase in plasma volume
  • Estrogen = elevates volume via water retention and RAAS stimulation.

Estrogen Enhances

58
Q

What heme changes occur in pregnancy?

A
  • Increased RBC
  • Anemia due to increased volume
  • Increased EPO requires more iron
  • WBC increase
  • Plts increase in both production and consumption, resulting in net decrease.
59
Q

What coagulation changes occur in pregnancy?

A
  • Increased clotting factors
  • Decreased protein S
  • Net effect: procoagulant state
60
Q

What happens to immune function in pregnancy?

A

Decreased.

Also means autoimmune conditions like SLE require LESS tx during pregnancy since immune system is depressed.

61
Q

How does the pituitary gland change during pregnancy?

A
  • Enlargement
  • Increased GH
  • 10x prolactin, going down after delivery.
62
Q

How does the thyroid gland change during pregnancy?

A
  • Increased thyroid hormone production without thyromegaly
  • hCG is similar to TSH structurally, so low TSH can be masked.
63
Q

How does the parathyroid gland change during pregnancy?

A
  • Decreased 1st tri, increased 2nd and 3rd tri.
  • Decreased Ca due to increased volume
  • Vit D increased
64
Q

How does the adrenal gland change during pregnancy?

A
  • Increased ACTH and free cortisol
  • Increased aldosterone (Na retention)
65
Q

What ophthalmologic changes occur during pregnancy?

A
  • IOP: decrease
  • Cornea: increased thickness, decreased sensitivity, may see krukenberg spindles
  • Transient loss of accommodation
  • No actual visual changes

Spindles: brownish-red opacity on posterior cornea

66
Q

What hyperpigmentation/skin changes can occur during pregnancy?

A
  • Linea nigra on abdomen (black line)
  • Melasma (mask of pregnancy), uneven darkening in cheeks, worsened by sun exposure
  • Also seen in OCP use
  • Stretch marks/striae gravidarum (MC in abdomen)

something like SLE should be DECREASING during pregnancy, so thats how u differentiate between melasma vs lupus malar rash

67
Q

What rashes/vascular skin changes can occur in pregnancy?

A
  • Spider angiomas
  • Palmar erythema
  • Cutis marmorata (mottled appearance)
  • Varicosities

MC in white women

68
Q

What nail change occurs during pregnancy?

A

Brittle and horizontal grooves (Beau’s lines)

69
Q

What hair changes occur during pregnancy?

A

Increased thickness and growth

70
Q

How does metabolism vary in pregnancy?

A
  • More fatigued
  • Increased appetite/thirst, esp by breastfeeding
  • Increased weight on avg of 12.5g/27.5lbs
  • Increased fat & water retention
  • Hyperinsulinemia and insulin resistance
  • Increased protein metabolism
71
Q

How do electrolytes vary in pregnancy?

A
  • Na & K decrease slightly, diluted by volume
  • Ca and Mg decrease
  • Phosphate minimal change
  • Iron decreases, requiring supplemental
72
Q

What additional nutrients should pregnant women be supplemented with?

A
  • Iron
  • Folic acid
  • Calcium
  • Zinc
73
Q

How much more cal should a pregnant women eat daily? Lactating?

A
  • Pregnant: 300kcal more daily
  • Lactating: 500kcal more daily

Jensen said shes seen it in PPP

74
Q

How much protein should a pregnant woman consume daily?

A

1g/kg/d + 20g/d in 2nd half of pregnancy

60-80g/d for an average pregnant women

75
Q

If a pregnant women is anemic, how much iron should they be consuming daily?

A

60-120mg/d

Might need if not getting enough in diet.

76
Q

What does folic acid supplementation prevent?

A

Neural tube defects

0.4mg/d, increased to 1mg/d depending on T1DM or 4mg/d if hx of NTD in previous

77
Q

What is the function of the placenta?

A
  • Release of hormones & enzymes to maternal bloodstream
  • Transport all fetal nutrients
  • Acts as fetal lungs
78
Q

What controls arterial bleeding in a pregnant woman?

A

Uterine wall contraction

79
Q

What substance characteristics make a drug likely to cross the placenta?

A

Small size and albumin-bound

Warfarin and salicylates are NONOs

Mother has less albumin, so the gradient is increased.

80
Q

What does the placenta secrete?

A
  • hCG
  • Proteins
  • Steroids: DHEAS and estriol
  • Control intrauterine growth and vital organs
81
Q

What common substances do not cross the placenta?

A
  • Heparin
  • Insulin

Large molecular size and/or charge

82
Q

What occurs in weeks 1-4 of gestation?

A
  1. Zygote formation from sperm and egg
  2. Morula forms as zygote splits.
  3. Enters uterus 3-5d post fertilization
  4. Blastocyst formation, forming inner embryo and outer supportive tissues
  5. Days 6-7: implant and invasion of endometrium
  6. Day 10: Fully encased

Days 6-7 is peak of progesterone

Zygote > Morula > Blastocyst

83
Q

What occurs to the outer cell group of a blastocyst?

A

Becomes chorionic villa and eventually the placenta.

84
Q

What are the 3 layers of the inner embryo?

A
  1. Endoderm: Epithelial linings
  2. Mesoderm: connective tissue and muscles and bones
  3. Ectoderm: Skin, teeth, outer epithelium, nervous system

Inner to outer.

85
Q

What organs begin to develop at week 5 in an embryo?

A
  • Brain
  • Spinal cord
  • Heart
  • GI Tract

AKA the most important minus kidneys

86
Q

What begins to develop at weeks 6-7 for an embryo?

A
  • Eyes, ears, bones
  • Limb buds
  • Heart beating

Brain also splits into its 5 areas

87
Q

What should occur by week 9 of gestation?

A

All major organs should begin development

Milestone

88
Q

What should occur by week 10 of gestation?

A
  • Embryo is now a fetus
  • Fetal heart tones (FHT) audible by Doppler
89
Q

When is a fetus’s gender potentially distinguishable?

A

Around weeks 11-14

90
Q

What occurs in weeks 11-14 of a fetus?

A
  • RBC production in liver
  • Urine production
  • Ossification of bone centers
91
Q

What milestones occur around week 15-18 of a fetus?

A
  • Lanugo (fine hairs)
  • Movement
  • Meconium (first poop)
  • Fat accumulation
92
Q

When are fetal movements generally felt by a mother?

A

Week 19

Also when a fetus can begin hearing

93
Q

What is the midpoint of pregnancy?

A

Week 20

By this time, movements may be felt, all major organs are under development, and bony structure is progressing.
FHT and gender are distinguishable.

94
Q

What week is generally considered good survivability for a preemie? Why?

A

Around week 26 or later

Lungs are usually mature enough to survive

95
Q

What should occur by week 26 in a fetus?

A
  • Alveoli formation
  • Hand/startle reflex
96
Q

What is the main milestone that should occur around weeks 27-30 in a fetus?

A

Production of surfactant

97
Q

When in gestation is the biggest risk for major congenital defects?

A

Week 16 and earlier.

1st trimester

98
Q

What layer forms most of the GU system?

A

Intermediate mesoderm

99
Q

What is required to generate a functional Male GU tract?

A

Functional Y chromosome

100
Q

What are the 4 stages of GU development for an embyro?

A
  1. Genetic: chromosomes
  2. Gonadal: Expression of genes by testis determining factor (TDF) on Y chromosome
  3. Ductal: Mesonephric = male, paramesonephric = females
  4. Genital: Duct development into specific genitalia
101
Q

What hormone suppresses paramesonephric ducts for male development?

A

Antimullerian hormone

Paramesonephric = mullerian

102
Q

What hormone develops wolffian/mesonephric ducts?

A

Testosterone

Testosterone develops, antimullerian suppresses.

M for male

103
Q

If we have release of antimullerian hormone without testosterone, what will occur in an embryo?

A

Suppression of both ducts.

104
Q

Define agenesis and agonadism

A
  • Agenesis: no formation of gonads ever
  • Agonadism: Initial formation but later degeneration
105
Q

What are streak gonads?

A

Primordial gonad formation without differentiation.

106
Q

What is the precursor to urogenital structures?

A

Cloaca

Male: bladder, urethra, penis
Female: bladder, urethra, vagina

107
Q

Define vaginal agenesis, atresia, and septa

A
  • Agenesis: no development
  • Atresia: lower part is only fibrous (aka closed)
  • Septa: Either transverse or longitudinal
108
Q

What do the mesonephric ducts become for a male?

A
  • Epididymis
  • Ductus deferens
  • Ejaculatory ducts
109
Q

What might the paramesonephric ducts become in a male?

A

May persist as appendix testis

110
Q

Through what structure do the testes descend through?

A

Inguinal canal, going down to the scrotum

111
Q

What happens to the mesonephric ducts in a female?

A

Mostly regression, but small amount becomes trigone of bladder

112
Q

What happens to paramesophric ducts in a female?

A
  • Midline: Uterus
  • Distal: oviducts
113
Q

What can happen to the clitoris in development?

A
  • Agenesis: atresia or lack of tubercle formation
  • Bifid/double: failure of fusion
  • Hypertrophy: intersex disorders

Women's Health (15 decks)

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