Pathophysiology Flashcards
What causes the regression of the Müllerian duct?
Müllerian inhibitory substance produced by Sertoli cells
Wha cause the persistence of wolffian duct?
Testosterone produced by leydig cells
When do meiosis I and II happen during the women life?
Oogonia at puberty arrested at meiosis I
Meiosis II happen with fertilization
What gene on the Y chromosome direct the development of male gonads?
SRY gene
How does female puberty starts?
Start with sleep-dependent release and then pulsatile release of GnRH (modulated by CRH) from hypothalamus—>leads to pulsatile release of FSH and LH—>ovary makes estrogen—>breast development (thelarche) and first menstrual period (menarche)
The order of menstrual cycle?
Follicular phase (many follicles grow—>only one is dominant. Growing follicles secrete estrogen—>stimulate the growing of endometrium)—>ovulation (dominant follicle releases its mature oocyte for fertilization and implantation. Estrogen positive feedback on LH and FSH preovulation —>LH surge)—->luteal phase (luteinization of ruptured follicle to make corpus luteum. Progesterone surge)
What does corpus luteum release?
Estrodial and progesterone that inhibits the release of FSH and LH
Granulosa cells are stimulated by?
FSH. Aromatase in granulosa cells convert androgen from Theca cells to estradiol (main estrogen of non pregnant women)
Theca cells are stimulated by?
LH
What is the mechanism of oral contraceptive pills?
Estrogen and progestin block the LH surge thus prevent ovulation
What hormone does the placenta secretes?
hCG—>maintain corpus luteum till placenta can produce progesterone—>then hCG falls
It also produces hCS (promote energy supply of the fetus)
The fetus provides what to the mother?
Androgen—>then made into estrogen
How is milk release from the breast inhibited before the birth of the fetus?
High level of estrogen and progesterone blocks milk release—>after birth—>estrogen and progesterone level drop
What stimulates the ejection of milk?
oxytocin
What does it mean by counterregulatory state regarding to pregnancy?
Insulin resistance. Several blood glucose elevating hormones are produced during pregnancy to promote energy supply for the fetus, e.g. hCS. As a result, non diabetic woman can develop transient diabetes during pregnancy.
What is fetal macrsomia and what usually causes it?
Large fetal size. Usually caused by poorly controlled gestational diabetes—>might lead to C section
What are the risks associated with the separation of placenta from the uterine wall?
Hemorrhage. The body is adapted to be hyercoagulable during pregnancy to prevent hemorrhage, which results in bad thrombosis sometime
What is third trimester bleeding associated with?
Placenta previa/abruption
What is the primary/secondary ovarian insufficiency of amenorrhea?
Premature loss of follicles/lack of hormone stimulation of normal ovaries
What is the kind of estrogen for pregnant women?
Estriol
Sex-hormone binding globulin has higher binding affinity for testosterone or estrogen?
Testosterone (also estrogen stimulates the production of SHBG)
Pregnant women has respiratory alkalosis/acidosis?
Increase PaO2—>decrease PaCO2—>alkalosis
T4 and cortisol in pregnant women increase or decrease?
Increase
Best marker for menopause
elevated FSH
What does aromatase convert?
It convert testosterone to estradiol and adrostenedione to estrone
Why do we micronization of estradiol when given as a drug?
So that it can increases its half life and resist destruction in the GI (we do the same for progesterone)
Estrogen has negative feedback on?
Estrogen itself and FSH
What are the risks for Hormone Replacement Therapy for postmenopausal women?
Stroke/DVT/pul embolism/bp/heart attack (though HDL is higher)/breast, cervical and endometrial cancers
Don’t give estrogen to any pt with above conditions
Benefit of HRT for postmenopausal women?
Treat osteoporosis/increase HDL/reduce postmenopausal symptoms like hot flushes
What is primary hypogonadism and how do we treat it?
Lack of hormones from sex gonads/use estrogen for premenopausal women
Should we give HRT to every menopausal women?
No, only for those with severe symptoms
What is the risk for untreated chronic anovulation?
High estrogen level increase risk for endometrial carcinoma
Increase serum insulin level (insulin resistance) has what effect on SHBG?
decrease SHBG–>increase free testosterone—>impede developing follicle for ovulation—>anovulation
The syndrome that is caused by ischemia of the pituitary from hypotension caused from hemorrhage during child birth is called?
Sheehan Syndrome
Which cytokine causes dysmenorrhea?
Disorder of prostaglandin F2alpa
Cervical and uteral cancer can what clinical finding?
Abnormal vaginal bleeding
Why give mother Rho(D) immune globulin at 28 wk as well as within 72 hour of delivery?
To sensitize the mother and prevent her from making Rh + antibody (reduce risk for erythroblastosis fetalis)
How to treat erythroblastosis fetalis?
Intrauterine fetal blood transfusions as needed and delivery as soon as fetal lung maturity is confirmed.
Erythroblastosis fetalis can cause?
Hydrops fetalis/kernicterus (bilirubin induced damage) and jaundice after delivery
Antibody of what class cross the placenta and cause erythoblastosis fetalis?
IgG
Where does bilirubin comes from?
Liver breakdown of RBC
Why do we measure fetal middle cerebral blood flow in response to erythroblastosis fetalis?
To see if there’s any high output heart failure
What is the most frequent cause of gout? (underexcretion or overproduction)?
Underexcretion
What does gout form at distal joints?
It is cooler there
What cells are responsible for clearing immune complexes in the reticuloendothelial system?
Monocyte and macrophages
