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Obs and gynae > Physiology > Flashcards

Physiology Flashcards

1
Q

What are the main functions of the vulva

A

Sensory tissue during intercourse

Assist in micturition (direct flow of urine)

Protect internal reproductive tract from infection

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2
Q

What are the main roles of the vagina

A

Transport of ejaculate to uterus

Channel of delivery in childbirth

Channel for outflow of menstrual fluid

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3
Q

What are the 5 main ligaments of the ovaries

A

Broad ligament

Round ligament

Ovarian ligament

Cardinal ligament

Uterosacral ligament

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4
Q

What are the 3 sections of the fallopian tubes

A

Infundibulum

Ampulla

Isthmus

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5
Q

What is the indifferent stage of gonad development

A

Not able to distinguish between male and female gonads

Begin as genital ridges

In 4th week, germ cells migrate from yolk sac to genital ridges

Epithelium of genital ridges and intermediate mesoderm form primitive sex cords

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6
Q

How do the testes develop

A

SRY gene on Y chromosome stimulates development of testes

Cords become seminiferous tubules during puberty

Leydig cells start producing testosterone in 8th week

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7
Q

How do the ovaries develop

A

Without SRY gene, primitive sex cord degenerates

Epithelium of gonad proliferates, producing cortical cords

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8
Q

How do the male internal genitalia develop

A

Testosterone causes mesonephric duct to develop into primary male genital duct

Paramesonephric duct degenerates due to presence of anti-Mullerian hormone

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9
Q

How do the female internal genitalia develop

A

Lack of testosterone causes mesonephric ducts to degenerate

Paramesonephric ducts develop due to lack of anti-Mullerian hormone

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10
Q

What is coitus

A

Sexual intercourse that results in the deposition of sperm at the vagina, at the level of the cervix

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11
Q

What are the main phases of the sex response

A

Sexual arousal

Excitement

Plateau

Orgasmic

Resolution

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12
Q

Explain the excitement phase of the sexual response in males

A

Sacral parasympathetic neurones

Vasodilation in corpora cavernosa

Increased penile blood flow

Penile filling = latency, penile tumescence = erection

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13
Q

Explain the plateau phase of the sexual response in males

A

Sacrospinous reflex

Venous engorgement and decreased arterial inflow

Testes become engorged and elevated

Secretions from accessory glands (5% of ejaculate)

Lubrication of distal urethra

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14
Q

Explain the orgasmic phase of the sexual response in males

A

Emission

  • Thoracolumbar sympathetic reflex
  • Contraction of smooth muscles and urethral sphincters
  • Semen pools in urethral bulb

Ejaculation

  • Spinal reflex with cortical control
  • Contraction of glands, ducts, and sphincters
  • Filling of internal urethra (stimulation of pudendal nerve, contraction of genital organs, expulsion of semen)
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15
Q

Explain the resolution phase of the sexual response in males

A

Thoracolumbar sympathetic pathway

Contraction of arterial smooth muscle in corpora cavernosa

Increased venous return

Detumescence and flaccidity

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16
Q

Explain the excitement phase of the sexual response in females

A

Sacral parasympathetic neurons

Vasocongestion

Vaginal lubrication

Clitoris engorges with blood

Uterus elevates

Increased muscle tone, heart rate, blood pressure

Inner 2/3 of vagina lengthens and expands

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17
Q

Explain the plateau phase of the sexual response in females

A

Sacrospinous reflex

Further increased muscle tone, heart rate, blood pressure

Clitoris withdraws under hood

Bartholin gland secretions lubricate vestibule

Uterus fully elevates

Orgasmic platform in lower 1/3 vagina

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18
Q

Explain the orgasmic phase of the sexual response in females

A

Spinal reflex with cortical control

Orgasmic platform contracts 3-15 times

Uterus contracts

Anal sphincter contracts

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19
Q

Explain the resolution phase of the sexual response in females

A

Thoracolumbar sympathetic pathway

Clitoris and labia return to normal

Uterus descends

Vagina shortens and narrows back to unaroused size

No refractory period

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20
Q

What factors are involved in the transport of sperm

A

Oxytocin (causes uterine contractions, helps sperm travel further)

Capacitation (tail changes from beat-like to whip-like movements)

Removal of protein coat (exposing sperm acrosome enzymes, needed for penetrating zona pellucida)

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21
Q

What happens once sperm has penetrated the zona pellucida

A

Sperm and oocyte membranes fuse

Calcium enters oocyte (cell depolarises, prevents polyspermy, egg undergoes final meiotic division)

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22
Q

What are the endocrine system maternal adaptations

A

Increased progesterone (by corpus luteum, then placenta)

Increased oestrogen (by placenta)

Increased thyroid-binding globulin (due to high oestrogen)

Increased human placental lactogen, prolactin, and cortisol (all anti-insulin, so get reduced peripheral glucose uptake)

Increased lipolysis (risk of ketoacidosis)

23
Q

What are the cardiovascular system maternal adaptations

A

Decreased diastolic blood pressure (due to increased progesterone (decreased systemic vascular resistance))

Increased cardiac output (by 30-50%)

Increased sodium and water retention

24
Q

What are the respiratory system maternal adaptations

A

Upward displacement of diaphragm

Increased tidal volume

Increased minute ventilation rate

Some may get hyperventilation

25
Q

What are the gastrointestinal system maternal adaptations

A

Upward displacement of stomack (increased intra-gastric pressure - reflux, nausea, vomiting)

Appendix in right upper quadrant

Smooth muscle relaxation (progesterone) - constipation, gallstones

26
Q

What are the urinary system maternal adaptations

A

Increased eGFR (50-60%)

Relaxation of ureters and bladder (progesterone) - more UTIs and pyelonephritis

27
Q

What are the haematology system maternal adaptations

A

Increased fibrinogen and clotting factors

Increased VTE risk (use LMWH)

Dilutional anaemia

28
Q

How do the breasts develop during pregnancy

A

Hypertrophy of ductular-lobular-alveolar system
- Prominent lobules form, differentiate to form milk

Not a lot of milk secretion (still have high progesterone:oestrogen)

29
Q

What is colostrum

A

Breast milk following delivery

More proteins (antibodies) and fat-soluble vitamins

Less fats, sugars, and water-soluble vitamins

30
Q

How is milk production regulated

A

Controlled by prolactin

Alveoli respond to prolactin after delivery of placenta

Prolactin release from anterior pituitary controlled by dopamine

Promoted by suckling (releases dopamine)

Suckling at one feed prepares milk for next feed

31
Q

Explain the milk let-down reflex

A

Oxytocin released in response to suckling

Causes myoepithelial cells to contract, squeezing milk out of breast

Can be triggered by cry/sight/preparation for nursing

32
Q

How is milk production maintained

A

Need enough suckling stimulation at each feed to maintain prolactin secretion

Can get milk suppression with steroids

Prolactin from suckling reduces fertility

33
Q

What is puberty

A

Developmental changes that a child undergoes to become sexually mature and physiologically ready for reproduction

Female: 8-14

Male: 10-16

34
Q

What are the hormonal changes in puberty

A

Controlled by HPG axis

Hypothalamus releases pulsatile GnRH

Anterior pituitary releases FSH and LH

35
Q

What effect does FSH have on the gonads

A

Oestrogen synthesis and oogenesis

Onset of sperm production

36
Q

What effect does LH have on the gonads

A

Increased progesterone

Increased testosterone

37
Q

What are the female physical changes in puberty

A

Thelarche

  • Breast buds at 9-10
  • Continue to develop after menarche

Pubarche
- Mediated by testosterone

Menarche

  • 1st period 1.5-3 years after thelarche
  • Due to FSH and LH
  • Average age 12.8
38
Q

What are the male physical changes in puberty

A

Genital changes

  • Increased testicular size
  • Scrotal skin thinner, darker, hangs down
  • 1st ejaculation possible 1 year after testes begin to grow
  • Growth of penis (length, then girth)

Pubarche

  • Initially at base of penis
  • On rest of the body 2 years after pubarche
39
Q

What causes growth spurts in puberty

A

Interaction between

  • Sex steroid hormones
  • Growth hormones
  • Insulin-like growth factor

Voice breaks in males (larynx and vocal cords enlarge)

40
Q

What are the phases of the ovarian cycle

A

Follicular phase

Ovulation

Luteal phase

41
Q

What happens during the follicular phase of the ovarian cycle

A

Follicles mature

Low steroid hormones and inhibin

Less negative feedback on HPG axis

Increased FSH and LH

Follicular growth and oestrogen production

Negative feedback reduces FSH

One follicle survives

Follicular oestrogen causes positive feedback on HPG axis

Increased GnRH and gonadotropins

Get LH surge

42
Q

What happens during the ovulation phase of the ovarian cycle

A

Mature oocyte released in response to LH surge

Follicle releases oestrogen and progesterone

Get negative feedback on HPG axis

Cycle stalls in preparation of fertilisation

43
Q

What happens during the luteal phase of the ovarian cycle

A

Corpus luteum releases oestrogen, progesterone, and inhibin

Corpus luteum regresses after 14 days

Significant fall in hormones

Less negative feedback on HPG axis

If fertilisation occurs, corpus luteum maintains HCG levels

At 4 months, placenta able to produce enough hormones

44
Q

What happens during the proliferative phase of the uterine cycle

A

Alongside follicular phase

Oestrogen causes:

  • Fallopian tube formation
  • Endometrial thickening
  • Increased growth and motility of myometrium
  • Thin cervical mucus production
45
Q

What happens during the secretory phase of the uterine cycle

A

Alongside luteal phase

Progesterone causes:

  • Endometrial thickening
  • Myometrium thickening
  • Thick cervical mucus
  • Changes in mammary tissue
  • Metabolic changes
46
Q

What happens during the menses phase of the uterine cycle

A

Absence of fertilisation

Corpus luteum breaks down

Inner lining of uterus shed

Lats 2-7 days

10-80ml blood loss

47
Q

What is the average age of menopause in the UK

A

51 years

Early menopause 40-45 years

48
Q

What are the main symptoms of menopause

A

Hot flushes

Urinary incontinence

Increased UTIs

Irregular vaginal bleeding

49
Q

At what point is menopause diagnosed

A

Amenorrhoea for 12 months

50
Q

What are the hormonal changes associated with menopause

A

Reduced circulating oestrogen
- Due to reduced sensitivity of ovaries to FSH and LH

Significant increase in FSH and LH

51
Q

What are the vasomotor changes associated with menopause

A

Hot flushes

Due to pulsatile LH release

52
Q

What are the urogenital changes associated with menopause

A

Atrophy of vagina

Thinning of myometrium

Thinning and dryness of vaginal walls

Bladder and urethra atrophy

53
Q

What happens to bone density after menopause

A

Increased bone reabsorption (decreased oestrogen)

Increased risk of fractures

54
Q

What happens to the rates of heart disease after menopause

A

Increase

Protection from oestrogen now gone

Obs and gynae (6 decks)

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