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Women's Health > Phys and Pathophys OBGYN > Flashcards

Phys and Pathophys OBGYN Flashcards

1
Q

Describe the FUNCTION of the hypothalamic-pituitary-ovarian cycle

A

Development of sexual characteristics
Coordinating regular periodic body changes
Ovarian Cycle
Uterine Cycle
Plays a role in cervix, vagina, breast function
Maintenance of pregnancy

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2
Q

Describe the MECHANISM of the hypothalamic-pituitary-ovarian cycle

A

GnRH by hypothalmus in pulsatile action
FSH and LH made from anterior pitutary
Go to theca (outside) and granulosa cells (inside) called folliculogensis

Dormant until ovulation!

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3
Q

What is the sexual the function of FSH and LH

A

estrogen and progesterone

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4
Q

What does the estrogen do

A

E = endometrium

tells endometrium to grow (like fertilizer)
stops body hair growth
help libido
thickens vaginal wall
acne formation (because of secretion)
reduced athersclorosis and cholestrol

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5
Q

Why do women have lower chance of heart disease?

A

Estrogen reduces atherosclosis by breaking down cholestrol deposits

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6
Q

What does progesterone do?

A

P= PREGNANCY

decreases contraction of the uterus (allows growth of the fetus)
promotes breast development
when it decreases, it triggers menstrual flow and also produces milk (so you can lactate after baby is born)

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7
Q

What do activins do vs Inhibins

A

Activins = Stimulate FSH and WBC
Inhibins = blocks FSH

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8
Q

Follistatins

A

binds and inhibits activins

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9
Q

relaxin

A

relaxes everything so that the fetus can grow

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10
Q

What does high level of estrogen do

A

increases release of GnRH and LH

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11
Q

What does high levels of activin do?

A

promotes gonadotropic cell function

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12
Q

Pathologic HPO axis examples

A

Hypogonadism
Polycystic ovarian syndrome (PCOS)
Hyperprolactinemia
Medications (Steroids, Hormones, Opioids)
Weight status

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13
Q

Why does weight status affect HPO axis?

A

Excess adipose tissue = more estrogen which can lead cancer even

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14
Q

What influences puberty onset?

A

Weight and nutritional status
Genetic factors (sometimes there is familial delay of puberty)
Abnormal hormone levels

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15
Q

Adrenarche

A

not technically puberty, but just increase secretion of adnreal adrongens

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16
Q

Explain the 2 parts of thelarche and what it is

A

Breast development

FIRST event of puberty in females
Estradiol (estrogen) - duct growth
Progesterone - lobule and alveoli growth

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17
Q

After thelarche, what is the next stage?

A

development of pubic and axillary hair
Second event of puberty in females

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18
Q

What is menarche

A

first menstrual cycle

Typically anovulatory for first 12-18 monhs

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19
Q

What is the length of a normal menstrual cycle

A

28 days +/- 7 days

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20
Q

How long does normal menstrual flow last and how much flow?

A

3-5 days

totaling 30 mL of blood loss

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21
Q

When are periods irregular

A

Onset and offset

~ 1-2 years after menarche
~ 2-3 years preceding menopause

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22
Q

follicular phase
ovulation
luteal phase

A

development of follicle
ovulation = kicking out egg
luteal phase = what the egg does

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23
Q

What is the first phase of menstrual cycle?

A

FIRST PHASE

Early in cycle - rise in FSH > rise in LH (because we are trying to develop follicles)

this is the phase that can vary in length

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24
Q

How does FSH promote negative feedback?

A

FSH causes production of inhibin B
inhibin B decreases release of FSH later in follicular phase

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25
Q

What happens to follicles as they grow?

A

1 follicle grows very rapidly, becoming dominant follicle
Other follicles regress to become atretic follicles

at day 6

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26
Q

What happens as the dominant follicle matures?

A

LH takes over!

As dominant follicle matures…
Develops LH receptors
Releases estrogens

LH leads to:
Rising estrogen levels → increased GnRH pulses → LH surge → ovulation

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27
Q

Explain the midcycle of ovarian cycle

A

Midcycle - approximately day 14
Mature follicle ruptures (VIOLENT)

Ovum → extruded in abdominal cavity → transported into oviduct

Corpus hemorrhagicum - ruptured follicle fills with blood

Mittelschmerz may occur (which is stingy pain)

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28
Q

What is Mittelschmerz?

A

Stingy pain that is subjective and seen in

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29
Q

What is the most strict time-dependent process of the ovarian cycle?

A

Luteal phase
strictly 14 days

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30
Q

Describe the luteal phase

A

Corpus Luteum - granulosa and theca cells of follicle lining proliferate to form yellowish, lipid-rich luteal cells
Reacts to LH by making progesterone and estrogen
Rising levels of estrogen and progesterone → negative feedback → decline in FSH and LH (because we are done making follicles)

big dominant structure that goes away after a few days after being shed d/t declining levels of progesterone

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31
Q

what is the first phase of the UTERINE cycle

A

proliferative phase

Preovulatory - varying length
At end of menses, all but the deep layer of the endometrium has sloughed - stratum basale
Days 5-16
Estrogen from developing follicles → endometrium regenerates from deep layer
Forms the stratum functionale (outer ⅔)
Uterine glands lengthen but do not become convoluted or secrete anything

sort of like throwing up the walls of a house with insulation but no one is in the house yet

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32
Q

What is the secretory phase?

A

day 14
fixed length
estrogen and especially progesterone is released

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33
Q

What does progesterone do?

A

Stops the building of walls, but adds decoration

dilates blood vessels allowing more blood flow

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34
Q

proliferative vs secretory phase imaging

A

proliferative = straight tissue that is not functioning

secretory phase = coiled tissue

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35
Q

which hormone causes ovulation?

A

LH

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36
Q

Function of the cervix

A

Barrier of external environment (vagina) from internal environment

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37
Q

Does the cervix shed? What is it’s function?

A

No
Cervical mucus is acidic though to stop sperm from being hospitable - which thins at the time of ovulation (day 14)

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38
Q

What is the function of progesterone for the cervix?

A

highest one week after ovulation (so day 21)
mucus becomes thick, and this remains during ovulation and pregnancy to house egg

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39
Q

What do you wanna see with mucous under microscope?

A

Some ferning but not too much

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40
Q

What is the epithelium of the cervix?

A

Columnar epithelium (extends from endocervix to ectocervix) allows it to look a little spotty early in women development. Eventually scars and then turns to squamous epithelium.

estrogen keeps columnar cells alive - which can be more vulnerable than squamous

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41
Q

What lines the fallopian tube and what stimulates this and what reduces this?

A

cilia

ciliary beat increased by estrogen and decreased by progesterone

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42
Q

What does progesterone d/t blood sugar?

A

Boosts it

think preggo = more need for sugar

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43
Q

What does estrogen and progesterone d/t skin

A

increases pigmentation
maintains skin collagen
increases hair growth (which is why patients)

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44
Q

what does progesterone d/t fat?

A

fat gain in preggo

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45
Q

What happens to organs when pregnant?

A

All compressed

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46
Q

Explain the CV changes in pregnancy?

A

Heart changes size and shape by 12% (muscle mass and volume)
PMI shift laterally d/t heart moving out of the weigh

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47
Q

What is supine hypotension syndrome? What is a risk factor for this?

A

Laying down compresses the IVC
seen in 10%

hypotension/bradycardia/syncope

later in pregnancy = more mass compressing

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48
Q

What happens to SV and HR during pregnancy?

A

Both increase

HR should not decrease more than 15 BPM above baseline though . Can be increased further by heat.

CO increases because it is HR x SV

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49
Q

Does SV and HR reverse after pregnancy?

A

Most of the time

but if it does not, it can lead to cardiomyopathy

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50
Q

what happens to arterial presssure in pregnancy?

A

dilates and lowers d/t having to contain more blood

pulse pressure increases

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51
Q

what happens to LE venous pressure in pregnancy

A

uterus compresses iliac valves d/t baby being there

52
Q

What happens to peripheral vascular resistance

A

decreases due to enhanced vasodilation

53
Q

What happens to blood flow distrubtion in pregnancy?

A

Increased to uterus and breast and skin (all stretching and growing)

54
Q

In addition to uterus, skin, and breast, where does blood flow increase?

A

Kidneys d/t having to filter more blood

55
Q

What type of murmur is seen in preggo?

A

systolic murmur in 90% of patients d/t heart pumping really hard

may also see sinus tachy, brady, PAC/PVCs

DO NOT WORRY if asymptomatic

EKG can even show Left axis shift and flattened T waves

56
Q

What happens to capillaries of preggo?

A

Capillary dilation (can lead to nasal congestion)

57
Q

What happens to rib cage of preggos?

A

rib cage opens up to make more space

58
Q

What happens to lung volumes and capacity?

A

Less dead space and more tidal volume d/t rib cage

respiratory rate the same and minute ventilation increased by 50% (facilitated by the above)
needed because the

59
Q

What happens to the renal system during preggo?

A

Hypertrophy of nephrons d/t hyperfilitration
Hydronephrosis (can lead to UTIs - further exacerbated by decreased immune system d/t not rejecting baby)
plasma flow increases 50-80%
renal artery and vein dilate
GFR increases d/t more blood flow
creatinine clearance increases even though there is more waste products
protein and glucose in urine (because the tubules can only reabsorb so much) should NOT be dramatic
Renin increases to increase fluid retention to increase blood volume and renal flow

60
Q

What happens to GI system of preggo?

A

Increased salivation
gum hypertrophy from vasodilation (tooth health should not be compromised)
Intestines time decreases in 2nd and 3rd trimesters
gallstone risk increased d/t less

61
Q

What causes acid reflux in preggo

A

progesterone relaxing smooth muscle of esophageal sphincters

62
Q

What happens to the liver in preggos?

A

Blood dilutes leading to decreased albumin and calcium (because calcium binds to albumin)

63
Q

What happens to blood volume in preggo?

A

Increases by 50% due to RAS system
feel thirsty because of the RAS system

need more blood to send to the rest of the body and protects mom and fetus from hypotension d/t vasodilation - mom will also lose blood after baby allowing mom to survive delivery

64
Q

What happens to RBC in women?

A

RBC increases by 33%
but still anemic because plasma increases by 50%

65
Q

What happens to coagulation in preggo?

A

Procogulant due to decrease protein S and increase clotting factors

66
Q

What happens to lupus during preggo?

A

Gets better d/t dampered immune system

67
Q

What happens to the endocrine gland in preggo?

A

enlarges by 135% during normal pregnancy
GH increased

68
Q

What happens to thyroid hormones in preggo?

A

Fetus does not have it, so 40-100% increase in thyroid hormone

69
Q

What happens to hypothyroid moms?

A

hCG

low TSH can mask hypothryoidism

70
Q

What happens to parathyroid in preggo?

A

decreased in 1st trimester but increased in 2nd and 3rd

leads to more calcium and more vit D which is needed
cortisol increases

71
Q

What happens to eyes in preggo?

A

Increased thickness of the cornea d/t retaining fluid (which the rest of the body does)
leads to contact issues sometimes
sometimes see spindles in dilated eye exam

mild blurry vision and contacts might not work

72
Q

What happens to skin pigmentation in preggo?

A

estrogen and progesterone leads to hyperpigmentation

linea nigra: dark line acro
melasma: melanocyte activity form brownish color on cheek (NOT red)

73
Q

What is striae gravidarum?

A

Stretch marks (red at first d/t increased BF and white with time d/t scar tissue)

younger maternal age
family history

74
Q

What is spider angiomas, palmar erythema, varicosities, nails,

A

brittle nails d/t nutritional demands
hair thickens and increases (body grew in extra hair and leads to hair loss postpartum)

75
Q

What happens to desire to rest, appetite/thirst, and weight?

A

All increase

appetite and thirst actually increases even more during breastfeeding actually then being preggo

76
Q

Desribe weight loss after preggo

A

5.5 kg after delivery
4 kg in next 2 weeks
no more after 2 weeks

greater weight loss in breastfeeding women

77
Q

what happens to water metabolism?

A

Decreases leading to increased water retention leading to pitting edema in LE

78
Q

What happens to carbohydrate and protein metabolism in preggo?

A

Mild fasting hypoglycemia
Postprandial hyperglycemia
Hyperinsulinemia and insulin resistance
Typically disappears after delivery

Protein Metabolism
Protein → 1 kg of weight gain
500 g - fetus and placenta
500 g - uterine contractile protein, breast glandular tissue, plasma protein, hemoglobin

79
Q

What happens to electrolytes in preggo?

A

all decreased d/t increased plasma volume (Na+/K+/Fe2+Ca2+,Mg2+)

phosphate stays the same though

80
Q

What is avg weight gain of preggo?

A

25-35 with normal BMI
even more with lower BMI
lower with higher BMI

81
Q

What numbers should memorize involved in additional calories needed in preggo vs breast feeding?

A

additional 300 kcal/d during pregnancy
additional 500 kcal/d during lactation

82
Q

what is the protein recommendation for preggo?

A

Protein
1 g/kg/day, plus 20 g/d in 2nd half of pregnancy
60-80 g/d in the average woman
Crucial for embryonic development
Lean animal, low-fat dairy, vegetable protein

83
Q

What nutritional deficiencies are we worried about in preggo?

A

Calcium
Iron (supplement double)
Folic acid
B6
Vit C (sometimes)

make sure to use iodized salt

84
Q

When should you take folic acid for preggo?

A

1 month prior to conception d/t neural tube development (0.4 mg)

up to 10x reccomendation if hx of neural tube defects

85
Q

What is the role of the placenta

A

Release hormones and enzymes to maternal bloodstream
Transport of all fetal nutrients and metabolic products
Exchange of O2 and CO2 for fetal circulation

86
Q

What is the DNA of the placenta?

A

Fetus DNA, but needs the blood from mom

87
Q

What does the placenta do?

A

Eats into the mom’s uterus and have sinuses that have open ended circulatory system and alveoli suck in the blood

88
Q

What causes the mom to keep blood from draining 100% to the placenta?

A

uterine wall contraction

if this doesn’t work it can lead to blood less in mom

if overactive, the preggo may be terminated

89
Q

Does maternal and fetal blood mix?

A

NO

not until delivery

90
Q

What produces hCG?

A

placenta

91
Q

What substances do not cross placenta

A

Large molecular size or charge - minimal transfer
heparin and insulin

large electric charge

92
Q

What is G1P0

A

G = 1 pregnancy
P = 0 deliveries

93
Q

Weeks 1-4 of gestation

A

conception
Causes formation of a zygote
Zygote slowly divides → forms a small ball of cells known as the morula
Enters uterus 3-5 days after fertilization

mom has not had the period yet

Gradual accumulation of fluid between cells of morula → becomes a blastocyst
inner cell group → embryo
outer cell group → supportive tissues
Day 6-7 - blastocyst implants and invades the endometrium and myometrium
Day 10 - blastocyst is totally encased in endometrium

94
Q

what becomes the placenta?

A

Outer cell group
chorionic villi → becomes placenta

95
Q

What composes the inner cell group of the fetus?

A

Endoderm
Mesoderm
Ectoderm

96
Q

Describe the endoderm, mesoderm, and ectoderm of the fetus?

A

Endoderm - innermost layer
Epithelial lining of multiple systems
GI, respiratory, endocrine, auditory, urinary
Mesoderm - middle layer
connective tissue - pericardium, peritoneum, pleura
muscle tissue, bone, most of the circulatory and GU systems
Ectoderm - outermost layer
Skin - epidermis, sweat glands, hair, nails
tooth enamel
“outer” epithelium - lining of mouth, nostrils and anus
nervous system

97
Q

When is the blastocyst formed?

A

3.5 weeks

98
Q

When do major development of organs occur?

A

Week 5

brain, spinal cord, heart, and GI tract

99
Q

When do limb buds and heart begin to develop?

A

Week 6-7

100
Q

What is used for energy early in developement?

A

Yoke sac

101
Q

When do lungs and all essential organs begin to form?

A

8 weeks = lungs

by week 9 = all essential organs

102
Q

What marks the end of the embryonic period and the start of the fetal period?

A

Week 10

Also FHT audible by doppler US

103
Q

When can you determine the gender of the fetus?

A

week 11-14 is when you can visualize the external genitalia on US

also RBC, urine, and ossifications at this stage

104
Q

When is lanugo developed

(probably don’t need to know)

A

15-18

just growing

105
Q

What is the midpoint of pregnancy?

A

20 weeks

106
Q

What is noticed at weeks 19-21 of fetal development

A

hearing
fluttering/movement

107
Q

What is the threshold of survivability of fetus?

A

20-26

25-26 sees major fetal survivability

108
Q

What is seen in week 26?

A

hand startle reflex

109
Q

What is seen in weeks 27-30?

A

surfactant development

110
Q

What happens during weeks 31-42?

A

Chunking up

just getting bigger and fatter and store iron and such

111
Q

When is biggest risk of fetus of toxins/insult?

A

Pretty much every risk factor is EARLY in pregnancy

this is because the organs are more independent further a long

112
Q

What is needed for a functional male GU tract?

A

Functional Y chromosome

113
Q

when are major anomalities of Gu structures?

A

During weeks 4-8

114
Q

What does the Y chromsome do?

A

Has TDF which tells gonad to make testis rather than ovary

remember, you default female

115
Q

what develops ducts in male?

A

antimüllerian hormone → suppresses “female” Müllerian (paramesonephric) ducts
testosterone → persistence and differentiation of “male” Wolffian (mesonephric) ducts

116
Q

What is agonadism vs agenesis?

A

agenesis - gonad did not form at all
agonadism - gonads formed initially and later degenerated

117
Q

What is streak gonads

A

primordial gonadal formation
no differentiation → lacks germ cells

118
Q

what two other gonadal abnormalities may you see?

A

May have release of antimüllerian hormone without any production of testosterone - suppresses both ducts
May see ectopic gonadal tissue

119
Q

what is vaginal agenesis, ateresia, septa, and rectovaginal fistula?

A

Vaginal agenesis - rare - 0.025%
Vaginal atresia - lower portion is only fibrous tissue
Vaginal septa - transverse (blind vaginal pouch) or longitudinal (surgically fixed)
Can have imperforate hymen
May see rectovaginal fistula

120
Q

What does the wollfian/Mesonephric Ducts develop into for male?

A

Epididymis, ductus deferens, ejaculatory ducts
Vestigial remnant - appendix epididymis
requires presence of gonads (testes)

121
Q

What happens to Müllerian/Paramesonephric Ducts for male?

A

regresses but may persist as appendix testis

122
Q

What does the wollfian/Mesonephric Ducts develop into for female?

A

Wolffian/Mesonephric Ducts
Mostly regress
Small portion becomes trigone of bladder

123
Q

What happens to Müllerian/Paramesonephric Ducts for female?

A

Müllerian/Paramesonephric Ducts
Ductal differentiation does not require ovaries
Midline fusion → uterus
Distal ducts → oviducts
Does not significantly descend in abdomen
Can manifest with complete or partial absence of uterine tube or many possible problems with fusion

124
Q

What are some external abnormalities of the female external Genitalia?

A

Labia Majora/Minora
Fusion → tissue separation failure or inflammatory reaction
May be hypertrophic or hypoplastic
Clitoris
agenesis - atresia or lack of genital tubercule formation
bifid /double - failure of fusion
hypertrophy - in intersex disorders
Perineum (Male/Female)
Imperforate anus
Anal stenosis
Anal agenesis with fistular ectopic anus

125
Q

What happens to ducts in female and male

A

female does not need influence
male DOES

Women's Health (2 decks)

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