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Abbey MSII Unit 1 pt 2 > Pathophys 22. > Flashcards

Pathophys 22. Flashcards

1
Q

How do disorders of the reproductive system typically present?

A

altered menstruation, pelvic pain, infertility

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2
Q

How do disorders of other organs whose function affects reproductive organs (brain, hypothalamus, pituitary, thyroid, adrenals, kidney, liver) present typically?

A

painless

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3
Q

When can the sex of an embryo be determined?

A

week 8

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4
Q

What genital duct system is first to form?

A

Wolffian duct followed by Mullein duct

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5
Q

How do males develop in utero?

A

Sertoi cells produce anti-mullerian hormone and Leydig cells produce testosterone which leads to persistence of Wolffian duct

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6
Q

How many oogonia are present at birth?

A

1 million

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7
Q

When does completion of first meiotic division happen?

A

at the time of ovulation

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8
Q

When does completion of second meiotic division happen?

A

fertilization

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9
Q

What causes onset of puberty?

A

establishment of sleep-dependent and then pulsatile release of GnRH from hypothalamus

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10
Q

What is the key mediator of the onset of puberty?

A

kisspeptin/GPR54 ligand/receptor

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11
Q

What does an increase in GnRH lead to?

A

an increase in LH and then FSH

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12
Q

thelarche

A

appearance of breast development

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13
Q

menarche

A

first menstrual period

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14
Q

follicular phase

A

12-14 days. follicle begins to grow, a single dominant follicle is selected and the rest undergo atresia

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15
Q

ovulation

A

dominant follicle releases its mature oocyte

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16
Q

luteal phase

A

14 days - characterized by lutenization of the ruptured follicle to produce the corpus luteum

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17
Q

What does RSH and LH do?

A

stimulate the ovary to produce estrogen and inhibin

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18
Q

inhibin

A

feeds back to suppress FSH secretion - no effect on LH

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19
Q

estrogen

A

affects the pituitary by increasing the number of GnRH receptors and its sensitivity to GnRH stimulation - estradiol reaches critical concentration inducing a midcycle LH surge and ovulation

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20
Q

What does the corpus luteum do?

A

produces estradiol and progesterone which suppresses gonadotropin release for duration of luteal phase

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21
Q

What do LH and FSH do within the ovary?

A

lead to synthesis and secretion of steroid hormones and other paracrine/autocrine proteins

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22
Q

LH

A

stimulates production of androgens in the theca cells (augmented by inhibin)

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23
Q

What does continued secretion from corpus luteum require?

A

LH or human chorionic gonadotropin (hCG) stimulation

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24
Q

Endometrium proliferates under influence of what?

A

estrogen

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25
Q

What promotes maturation of the endometrium (tortuous glands with secretions)

A

estradiol and progesterone

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26
Q

How do birth control pills prevent pregnancy?

A

disrupt the precise timing of hormone-directed events

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27
Q

How does the formulation of estrogen and progestin prevent pregnancy?

A

block the LH surge at mid cycle

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28
Q

What 3 steroids are secreted by the ovary?

A

progesterone, androgens, estrogens

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29
Q

What is the rate limiting step in steroid production?

A

transport and side chain cleavage of cholesterol within the mitochondrion by P450 (makes the basic steroid backbone pregnenolone)

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30
Q

What are the functional epithelial layers of the placenta?

A

cytotrophoblast and syncytiotrophoblast

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31
Q

What is the maternal layer of the placenta?

A

endometrial decidua

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32
Q

hCG

A

secreted by placenta - LH-like hormone - secreted consistently until progesterone-producing capacity of the placenta has developed

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33
Q

What physiologic changes occur in the mother during pregnancy?

A

increased blood volume, increased total body water, increased output because of increased stroke volume and heart rate, increased minute ventilation, increased tidal volume (no change resp. rate), increase in renal blood flow and glomerular filtration rate

34
Q

what are the roles of progesterone in pregnancy

A

promotion of implantation, suppression of maternal immune response to fetal antigens, increased cardiovascular compliance, maintenance of myometrial quiescence, parturition

35
Q

What are the roles of estrogens in pregnancy?

A

volume expansion, cardiac remodeling, preparative production of clotting factors (anticipate blood loss pushing out the little fucker)

36
Q

hCS human chorionic somatomammotropin

A

counterregulatory hormone - action oppose those of insulin - defense against fetal hypoglycemia

37
Q

What do the pubertal and pregnant phases of breast growth require?

A

prolactin, progesterone, hCS

38
Q

What is required for milk production?

A

suckling (suppress dopamine to maintain high levels of prolactin) - afferent sensory nerve fibers stimulate synthesis, transport, and secretion of oxytocin from posterior pituitary

39
Q

oxytocin

A

promotes contraction of mammary myoepithelial cells triggering ejection of milk

40
Q

How does baby get passive immunity?

A

IgG placenta and IgA breast milk

41
Q

How does prolactin work as a contraceptive?

A

inhibits pulsatile secretion of GnRH

42
Q

Climacteric

A

transitory period of diminishing reproductive function - from 35-48 increased GnRH stimulated LH and FSH secretion

43
Q

PCOS

A

polycystic ovary syndrome - ovarian dysfunction resulting from a self-perpetuating cycle of altered feedback relationships —> anovulation, hirsutism, infertility, dylipidemia, abnormal uterine bleeding, amenorrhea

44
Q

How do myomas and endometrial cancer typically present?

A

abnormal vaginal bleeding

45
Q

How do pelvic infections rpesent?

A

abdominal and pelvic pain with fever, elevated WBC

46
Q

What are the effects of poor glucose control on the fetus?

A

unexplained fetal deaths, spontaneous abortions, congenital anomalie

47
Q

What is the result of gestational diabetes?

A

fetal macrosomia because high maternal blood glucose triggers increased fetal insulin secretion = larger fetus

48
Q

What is an adaptation to the risk of hemorrhage in pregnancy?

A

pregnancy is a hypercoabulable state established by estrogen stimulation of hepatic coagulation proteins

49
Q

Placenta previa

A

3rd trimester bleeding - placental obstruction of all or part of the internal os

50
Q

placental abruption

A

3rd trimester bleeding - premature separation of a normally implanted placenta

51
Q

Who is at increased risk for placenta previa?

A

women with multiple prior pregnancies esp Sections - due to scar tissue formation from previous implantations

52
Q

What are complications from hydatidiform mole?

A
  1. choriocarcinoma (trophoblastic neoplasm) 2. hyperthyroidism 3. severe hemorrhage or trophoblastic tissue pulmonary embolism
53
Q

Complete molar pregnancies

A

abnormal growths resulting from trophoblastic proliferation

54
Q

gonadal dysgenesis

A

bilateral streak gonads and immature female phenotype - normal height, no associated somatic defects, normal female karyotype

55
Q

amenorrhea

A

lack of menstrual bleeding

56
Q

dysmenorrhea

A

pain and other symptoms accompanying menstruation

57
Q

menorrhagia

A

excessive vaginal bleeding

58
Q

metrorrhagia

A

irregular or abnormally protracted vaginal bleeding

59
Q

asherman syndrome

A

destruction of the endometrium after curettage coupled with infection causing amenorrhea

60
Q

What are causes of amenorrhea

A

pregnancy, asherman syndrome, disorder of ovary, disorder of hypothalamus or pituitary

61
Q

primary ovarian insufficiency

A

premature loss of follicles

62
Q

secondary ovarian insufficiency

A

lack of gonadotropin stimulation of otherwise normal ovaries - failure to produce the estrogena nd progesterone needed

63
Q

genetic cause of primary ovarian insufficiency

A

abnormalities in FMR1 gene, fragile X, turner syndrome

64
Q

What are causes of chronic anovulation?

A

have adequate numbers of follicles but fail to mature and ovulate - hyperthyroidism, hypothyroidism, hyperprolactinemia

65
Q

What is the key etiologic factor of PCOS?

A

hyperinsulinemia - insulin decreases hepatic synthesis of steroid hormone-binding globulin (SHBG) and IGFBP-1 - causes free androgens, estrogens, and IGF-1 which stimulates IGF-1 receptor leading to increased theca androgen production - high androgens impede developing follicles and disrupt the feedback relationships

66
Q

Sheehan syndrome

A

postpartum hemorrhage causes hypotension and consequent ischemic necrosis of pituitary

67
Q

What happens to the pituitary during pregnancy?

A

doubles in size

68
Q

What causes primary dysmenorrhea

A

disordered prostaglandin production by the secretory endometrium - excessive production of PGF2a (stimulates myometrial contractions)

69
Q

What can cause abnormal vaginal bleeding (differential)?

A
  1. functional disorders 2. structural lesions 3. malignancy 4. systemic conditions with altered coagulation
70
Q

What causes unopposed estrogen stimulation?

A
  1. ovarian disorder (chronic anovulation) 2. enhanced peripheral aromatization of adrenal androgens 3. estrogen therapy without adequate progestin supplementation
71
Q

What does the peripheral aromatization of adrenal androgens?

A

CYP19A1

72
Q

How does endometrial cancer spread?

A

by direct involvement of lymphatics with distant meatless to lung, brain, skeleton, and abdominal organs

73
Q

What alleviates dysmenorrhea symptoms?

A

prostaglandin synthesis inhibitors (nonsteroidal anti-inflammatory agents)

74
Q

PMS

A

dysmenorrhea accompanied by additional symptoms - sensation of bloating, weight gain, edema of hands and feet, breast tenderness, acne, anxiety, aggression, mood irritability, food cravings, change in libido

75
Q

What is the initial approach in treating PMS?

A

lifestyle change - more sleep, exercise, improved diet, less tobacco, alcohol, caffeine

76
Q

What drug helps with PMS?

A

serotonin-reuptake inhibitors

77
Q

What is the most common cause of abnormal vaginal bleeding in children?

A

vulvovaginitis

78
Q

What are causes of infertility?

A
  1. male sperm sucks 2. ovulatory failure 3. endometrial or tubal disease 4. rare shit
79
Q

What is preeclampsia-eclampsia characterized by?

A

hypertension, proteinuria, and edema

80
Q

What is a complication of decreases in maternal blood pressure?

A

placental perfusion dependent on a pressure difference between the maternal and fetal circulations - decreases in maternal blood pressure can lead to undwrperfusion of the placenta

81
Q

What are predisposing factors for development of preeclampsia?

A

first pregnancy, obesity, preexisting diabetes or hypertension, hydatidiform mole, malnutrition, and a family history of preeclampsia

82
Q

What signs of preeclampsia does the placent show?

A

premmature aging, apoptosis, hyaline deposition, calcification , congestion - maternal dicidua shows hemorrhage and necrosis with thrombosis of spiral arteries

Abbey MSII Unit 1 pt 2 (21 decks)

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