Pathophys 22. Flashcards
How do disorders of the reproductive system typically present?
altered menstruation, pelvic pain, infertility
How do disorders of other organs whose function affects reproductive organs (brain, hypothalamus, pituitary, thyroid, adrenals, kidney, liver) present typically?
painless
When can the sex of an embryo be determined?
week 8
What genital duct system is first to form?
Wolffian duct followed by Mullein duct
How do males develop in utero?
Sertoi cells produce anti-mullerian hormone and Leydig cells produce testosterone which leads to persistence of Wolffian duct
How many oogonia are present at birth?
1 million
When does completion of first meiotic division happen?
at the time of ovulation
When does completion of second meiotic division happen?
fertilization
What causes onset of puberty?
establishment of sleep-dependent and then pulsatile release of GnRH from hypothalamus
What is the key mediator of the onset of puberty?
kisspeptin/GPR54 ligand/receptor
What does an increase in GnRH lead to?
an increase in LH and then FSH
thelarche
appearance of breast development
menarche
first menstrual period
follicular phase
12-14 days. follicle begins to grow, a single dominant follicle is selected and the rest undergo atresia
ovulation
dominant follicle releases its mature oocyte
luteal phase
14 days - characterized by lutenization of the ruptured follicle to produce the corpus luteum
What does RSH and LH do?
stimulate the ovary to produce estrogen and inhibin
inhibin
feeds back to suppress FSH secretion - no effect on LH
estrogen
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
What does the corpus luteum do?
produces estradiol and progesterone which suppresses gonadotropin release for duration of luteal phase
What do LH and FSH do within the ovary?
lead to synthesis and secretion of steroid hormones and other paracrine/autocrine proteins
LH
stimulates production of androgens in the theca cells (augmented by inhibin)
What does continued secretion from corpus luteum require?
LH or human chorionic gonadotropin (hCG) stimulation
Endometrium proliferates under influence of what?
estrogen
What promotes maturation of the endometrium (tortuous glands with secretions)
estradiol and progesterone
How do birth control pills prevent pregnancy?
disrupt the precise timing of hormone-directed events
How does the formulation of estrogen and progestin prevent pregnancy?
block the LH surge at mid cycle
What 3 steroids are secreted by the ovary?
progesterone, androgens, estrogens
What is the rate limiting step in steroid production?
transport and side chain cleavage of cholesterol within the mitochondrion by P450 (makes the basic steroid backbone pregnenolone)
What are the functional epithelial layers of the placenta?
cytotrophoblast and syncytiotrophoblast
What is the maternal layer of the placenta?
endometrial decidua
hCG
secreted by placenta - LH-like hormone - secreted consistently until progesterone-producing capacity of the placenta has developed
What physiologic changes occur in the mother during pregnancy?
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
what are the roles of progesterone in pregnancy
promotion of implantation, suppression of maternal immune response to fetal antigens, increased cardiovascular compliance, maintenance of myometrial quiescence, parturition
What are the roles of estrogens in pregnancy?
volume expansion, cardiac remodeling, preparative production of clotting factors (anticipate blood loss pushing out the little fucker)
hCS human chorionic somatomammotropin
counterregulatory hormone - action oppose those of insulin - defense against fetal hypoglycemia
What do the pubertal and pregnant phases of breast growth require?
prolactin, progesterone, hCS
What is required for milk production?
suckling (suppress dopamine to maintain high levels of prolactin) - afferent sensory nerve fibers stimulate synthesis, transport, and secretion of oxytocin from posterior pituitary
oxytocin
promotes contraction of mammary myoepithelial cells triggering ejection of milk
How does baby get passive immunity?
IgG placenta and IgA breast milk
How does prolactin work as a contraceptive?
inhibits pulsatile secretion of GnRH
Climacteric
transitory period of diminishing reproductive function - from 35-48 increased GnRH stimulated LH and FSH secretion
PCOS
polycystic ovary syndrome - ovarian dysfunction resulting from a self-perpetuating cycle of altered feedback relationships —> anovulation, hirsutism, infertility, dylipidemia, abnormal uterine bleeding, amenorrhea
How do myomas and endometrial cancer typically present?
abnormal vaginal bleeding
How do pelvic infections rpesent?
abdominal and pelvic pain with fever, elevated WBC
What are the effects of poor glucose control on the fetus?
unexplained fetal deaths, spontaneous abortions, congenital anomalie
What is the result of gestational diabetes?
fetal macrosomia because high maternal blood glucose triggers increased fetal insulin secretion = larger fetus
What is an adaptation to the risk of hemorrhage in pregnancy?
pregnancy is a hypercoabulable state established by estrogen stimulation of hepatic coagulation proteins
Placenta previa
3rd trimester bleeding - placental obstruction of all or part of the internal os
placental abruption
3rd trimester bleeding - premature separation of a normally implanted placenta
Who is at increased risk for placenta previa?
women with multiple prior pregnancies esp Sections - due to scar tissue formation from previous implantations
What are complications from hydatidiform mole?
- choriocarcinoma (trophoblastic neoplasm) 2. hyperthyroidism 3. severe hemorrhage or trophoblastic tissue pulmonary embolism
Complete molar pregnancies
abnormal growths resulting from trophoblastic proliferation
gonadal dysgenesis
bilateral streak gonads and immature female phenotype - normal height, no associated somatic defects, normal female karyotype
amenorrhea
lack of menstrual bleeding
dysmenorrhea
pain and other symptoms accompanying menstruation
menorrhagia
excessive vaginal bleeding
metrorrhagia
irregular or abnormally protracted vaginal bleeding
asherman syndrome
destruction of the endometrium after curettage coupled with infection causing amenorrhea
What are causes of amenorrhea
pregnancy, asherman syndrome, disorder of ovary, disorder of hypothalamus or pituitary
primary ovarian insufficiency
premature loss of follicles
secondary ovarian insufficiency
lack of gonadotropin stimulation of otherwise normal ovaries - failure to produce the estrogena nd progesterone needed
genetic cause of primary ovarian insufficiency
abnormalities in FMR1 gene, fragile X, turner syndrome
What are causes of chronic anovulation?
have adequate numbers of follicles but fail to mature and ovulate - hyperthyroidism, hypothyroidism, hyperprolactinemia
What is the key etiologic factor of PCOS?
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
Sheehan syndrome
postpartum hemorrhage causes hypotension and consequent ischemic necrosis of pituitary
What happens to the pituitary during pregnancy?
doubles in size
What causes primary dysmenorrhea
disordered prostaglandin production by the secretory endometrium - excessive production of PGF2a (stimulates myometrial contractions)
What can cause abnormal vaginal bleeding (differential)?
- functional disorders 2. structural lesions 3. malignancy 4. systemic conditions with altered coagulation
What causes unopposed estrogen stimulation?
- ovarian disorder (chronic anovulation) 2. enhanced peripheral aromatization of adrenal androgens 3. estrogen therapy without adequate progestin supplementation
What does the peripheral aromatization of adrenal androgens?
CYP19A1
How does endometrial cancer spread?
by direct involvement of lymphatics with distant meatless to lung, brain, skeleton, and abdominal organs
What alleviates dysmenorrhea symptoms?
prostaglandin synthesis inhibitors (nonsteroidal anti-inflammatory agents)
PMS
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
What is the initial approach in treating PMS?
lifestyle change - more sleep, exercise, improved diet, less tobacco, alcohol, caffeine
What drug helps with PMS?
serotonin-reuptake inhibitors
What is the most common cause of abnormal vaginal bleeding in children?
vulvovaginitis
What are causes of infertility?
- male sperm sucks 2. ovulatory failure 3. endometrial or tubal disease 4. rare shit
What is preeclampsia-eclampsia characterized by?
hypertension, proteinuria, and edema
What is a complication of decreases in maternal blood pressure?
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
What are predisposing factors for development of preeclampsia?
first pregnancy, obesity, preexisting diabetes or hypertension, hydatidiform mole, malnutrition, and a family history of preeclampsia
What signs of preeclampsia does the placent show?
premmature aging, apoptosis, hyaline deposition, calcification , congestion - maternal dicidua shows hemorrhage and necrosis with thrombosis of spiral arteries
