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Reproduction and Sexual health > physiology > Flashcards

physiology Flashcards

1
Q

which organ secretes Gonadotropin-releasing hormone (GnRH) ?

A

hypothalamus

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2
Q

what does GnRH stimulate the release of?

A

FSH - follicle stimulating hormone

LH - Luteinizing hormone

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3
Q

Where is FSH and LH released from?

A

the anterior pituitary

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4
Q

What does FSH initiate?

A

follicular growth

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5
Q

What does LH stimulate?

A

further development of follicles

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6
Q

what effect do LH and FSH have on the ovaries?

A

stimulate the ovarian follicles to secrete oestrogen

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7
Q

where is progesterone mainly secreted by?

A

the corpus luteum

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8
Q

What is the first phase of the menstrual cycle called?

A

menstrual phase

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9
Q

how long does the menstrual phase last for?

A

5 days

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10
Q

what occurs in the ovaries during the menstrual phase?

A

under the influence of FSH primary follicles develop into secondary follicles. This may take several cycles

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11
Q

What occurs in the uterus during the menstrual phase?

A

a fall in oestrogen and progesterone stimulates release of prostaglandins causing uterine spiral arterioles to constrict

cells supplied by these arterioles die and the entire stratum functionalise of the nedometrium sloughs off leaving the thin stratum basalis (2-5mm)

50-150ml of blood, tissue, mucus and epithelial cells shed from the endometrium passing through the cervix and vagina. Normal blood loss is 5-80ml

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12
Q

what is the name of the second phase of the menstrual cycle?

A

Preovulatory phase

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13
Q

what occurs in the uterus during the preovulatory phase?

A

oestrogens released into the circulation by the growing secondary follicles and graafian follicle strimulate growth of the endometrium

cells of the stratum basalis undego mitosis and produce a new stratum functionalis

endometrial thickness doubles to 4-10mm

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14
Q

what occurs in the ovaries during the preovulatory phase?

A

secondary follicles secrete oestrogen

one secondary follicle outgrows the rest to become dominant and develops into graafian follicle

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15
Q

how long does the menstrual cycle normally last?

A

lasts 24-38 days

there should be no more than 9 days difference between the length of woman’s shortest and her longest cycle

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16
Q

how long should bleeding last in a normal cycle?

A

8 days

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17
Q

what is the name of the third phases of the menstrual cycle?

A

ovulatory phase

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18
Q

when does ovulation occur in the menstrual cycle?

A

day 14 in a 28 day cycle - 14 days before menstruation

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19
Q

what occurs in the ovaries during the ovulatory phase?

A

oestrogen stimulates more GnRH release

leads to an increase in LH and FSH release

LH causes the rupture of the graafian follicle and expulsions of a secondary oocyte

the oocyte is taken into the fallopian tube

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20
Q

what occurs in the uterus during the ovulatory phase?

A

progesterone and oestrogen continue to stimulate proliferation of the endometrium

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21
Q

what is the 4th phase of the menstrual cycle?

A

the postovulatory phase

this is the most constant phase and lasts for 14 days with little variation

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22
Q

what occurs in the ovary during the postovulatory phase?

A

the collapsed follicle become the corpus luteum under the influence of LH

Corpus luteum secretes progesterone oestrogen, relaxin and inhibin

if fertilisation does not occur this secretory activity declines after 2 weeks and a new cycle begins

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23
Q

what occurs in the uterus during the postovulatory phase?

A

progesterone and oestrogen promote growth and coiling of the endometrial glands, vasculisation and further thickening of the endometrium

endometrial glands begin to secrete glycogen

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24
Q

what arteries enter the hilum of the ovary to supply blood?

A

helicine arteries

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25
Q

what ligament do the helicine arteries enter from?

A

broad ligament

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26
Q

are the follicles contained within the cortex or medulla of the ovary?

A

cortex

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27
Q

what is contained in the medulla of an ovary?

A

blood vessels
nerves
lymphatics
connective tissue

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28
Q

describe the superficial layer of the cortex of the ovary?

A

fibrous cortex covered by epithelium

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29
Q

what type of epithelium covers the fibrous cortex of the ovary?

A

simple cuboidal epithelium

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30
Q

what is the tunica albuginea of the ovary?

A

tough fibrous layer of dense connecive tissue

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31
Q

at what age do germ cells move into the ovaries of a female?

A

week 6 of embryonic development

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32
Q

what happens to the germ cells once the enter the ovaries?

A

proliferate by mitosis to form oogonia

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33
Q

what happens to oogonia within the ovaries?

A

divide by meiosis to form oocytes (ova)

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34
Q

what is oogenesis?

A

development of oocytes from oogonia

division via meiosis

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35
Q

what is folliculogenesis?

A

growth of the follicle

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36
Q

what does a follicle consist of?

A

oocyte (ova) and any associated support cells

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37
Q

what is atresia?

A

loss of oogonia and oocytes by apoptosis

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38
Q

before birth, what happens to an oocyte?

A

starts meiosis but the process halts at prophase 1

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39
Q

describe the stages of folliculogenesis?

A
  1. primordial follicle
  2. primary follicle
  3. growing primary follicle
  4. pre-antral (secondary) follicle
  5. early antral (tertiary) follicle
  6. Graafian follicle
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40
Q

what cells does the oocyte associate with to form the follcie?

A

pregranulosa cells

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41
Q

what type of cells are pregranulosa cells?

A

initially squamous

become cuboidal as follicle grows

42
Q

what type of supporting cells are found in the primary follicle?

A

cuboidal granulosa cells

43
Q

what are the cuboidal granulosa cells in the primary follicle known as?

A

zona granulosa

44
Q

what happens to the stromal cells that associate with the outside of the primary follicle?

A

go on to form the theca

45
Q

as the follicle grows, what forms between the oocyte and the granulosa cells?

A

zona pellucida

46
Q

what are the 2 parts of the theca that forms from stromal cells that surround the follicle?

A

theca interna

theca externa

47
Q

what is the function of the theca interna?

A

secretes oestrogen precursors

48
Q

what cells convert the oestrogen precursors to oestrogen?

A

granulosa cells

49
Q

at what stage in folliculogenesis does the antrum form?

A

secondary follicle

50
Q

what is the antrum within a follicle filled with?

A

follicular fluid

51
Q

what cells surround the oocyte once the antrum begins to form?

A

cumulus cells

52
Q

when do oocytes move past prophase 1 and complete meiosis?

A

1 day before ovulation

53
Q

what is produced by meiosis of the primary oocyte?

A

secondary oocyte and polar body

54
Q

explain what happens to the following during the physiological changes of pregnancy:

maternal blood volume

plasma

A

maternal blood volume up 30%

Plasma up 50%

therefore makes the mum loo like she anaemic even though she isn’t

55
Q

what are the physiological changes of the cardiovascular system in someone who is pregnant?

A

Stroke volume increases

Heart rate increases

cardiac output increases

systolic BP stays same

Diastolic BP decreases in the 1st and 2nd trimester

venous return may be affected by enlarged uterus

56
Q

what are the physiological changes of the respiratory system in someone who is pregnant?

A

pulmonary ventilation increases

tidal volume increases due to effect of progesterone on respiratory centre

oxygen requirements increase there over breathing leads to fall in pCO2 - gives a sense of dyspnoea

BMR increases

57
Q

What are the physiological changes of the haematology system in someone who is pregnant?

A

Maternal blood volume increases

Plasma increases

Low grade increase in coagulant activity

rise in fibrogen and factors VII, VIII, X

fibrinolytic activity is decreased

58
Q

what are the physiological changes of the urinary system in someone who is pregnant?

A

Blood flow increases

GFR increases

salt and water reabsorption is increased by elevated sex steroid levles

urinary protein losses increase

trace glycosuria is common

59
Q

what produces oestradiol?

A

granulosa cells

60
Q

what is produced once the ovarian follicle become the corpus luteum?

A

progesterone

61
Q

what is the zona pellucida?

A

a plasma membrane surround the oocyte and contains the protein ZP3 which is responsible for sperm binding

62
Q

what does the theca produce?

A

androstenedione - converted into oestradiol by granulosa cells

63
Q

state what occurs in the following days of fertilization:

day 1

day 5

day 5-8

day 12

A

day 1 - ovum is fertilized (zygote)

day 5 - blastocyst forms

day 5-8 blastocyst attached to the endometrium (implantation)

Day 12 - process of implantation complete?

64
Q

What is a blastocyst?

A

when the embryo has divided into two separate cell masses

inner cell mass: forms the embryo

outer cell mass:

forms the trophoblast which is responsible for initial production of progesterone.

Forms the placenta too.

65
Q

when is the placenta fully developed and functional?

A

5th week of pregnancy

66
Q

what is the function of the placenta?

A

1.Hormone secretion:

progesterone

HCG

2.Gas exchange:

umbilical artery: deoxygenated blood

umbilical vein: oxygenated blood

3.Nutrient and waste exchange:

calcium and iron are the only two electrolytes that can only travel unidirectional from mother to baby

67
Q

describe the hormonal changes in pregnancy with the following hormones:

  1. HCG
  2. progesterone
  3. Oestrogen
A

HcG - levels increase and peak at 10 weeks gestation before reducing

Actions:

stimulates corpus luteum to produce progesterone which will prevent endometrial shedding

Progesterone - levels steadily increase throughout pregnancy

initially produced by corpus luteum and then placenta

actions:

prepare and maintain endometrium

decreases uterine contractions

Oestrogen - levels steadily throughout pregnancy

principle site of production during pregnancy is the placenta

actions:

enlargement of the uterus

development of the breasts

Relaxation of the pelvic ligament

68
Q

what types of oestrogen are there?

A

E3 - indicator of fetal vitality

E4 - only produced through pregnancy

69
Q

what are the cardiovascular maternal adaptions in pregnancy?

A

SV increases

HR increases

cardiac output increases

systolic BP stays same

diastolic BP is reduced in the 1st and 2nd trimester, returning to non-pregnant levels by term

enlarged uterus may interfere with venous return which can lead to ankle oedema, supine hypotension and varicose veins

70
Q

what are the respiratory maternal adaptions in pregnancy?

A

Pulmonary ventilation increases

tidal volume increases

Oxygen requirements increase by only 20%

therefore over breathing leads to a fall in pCO2 - this can give rise to a sense of dyspnoea that may be accentuated by elevation of the diaphragm

BMR increases this may be due to increased thyroxine and adrenocortical hormones - women may hence find warm conditions uncomfortable

71
Q

what are the haematological maternal adaptions in pregnancy?

A

Maternal blood volume increases mostly in 2nd half

red cells number increases but plasma decreases: Hb falls (haemodilution)

Low grade increase in coagulant activity
rise in fibrinogen and Factors VII, VIII, X

fibrinolytic activity is decreased - returns to normal after delivery (placental suppression?)
prepares the mother for placental delivery
leads to increased risk of thromboembolism

Platelet count falls

WCC & ESR rise

72
Q

what are the urinary maternal adaptions in pregnancy?

A

blood flow increases

GFR increases

salt and water reabsorption is increased by elevated sex steroid levels

urinary protein losses increase

trace glycosuria is common due to the increased GFR and reduction in tubular reabsorption of filtered glucose

increase size of calycses and renal pelvis to deal with higher GFR - causes hydronephrosis (swollen kidneys)

73
Q

what is the ratio of oestrogen: progesterone during implantaiton?

A

low oestrogen: progesterone ratio

74
Q

when is the first trimester?

ii. what is releasing most of the hormones at this point?

A

week 1 -13

ii. corpus luteum

75
Q

where does the uterus grow to by 20 weeks?

A

umbilicus

76
Q

where does the uterus grow to by 36 weeks?

A

xiphoid process

77
Q

what is the fundal height?

A

distance from the symphsis pubis to the top uterus (fundus)

good way to measure gestational age

e.g. 36 weeks = 36 cm

78
Q

which hormone promotes milk production?

A

prolactin

79
Q

which hormone causes contraction of ducts and expulsion of milk?

A

oxytocin

80
Q

what mood changes can be caused by high oestrogen and progesterone?

A

mental fogginess

depression

irritability

anxiety

depression

81
Q

which hormone promotes release of prolactin?

A

oestrogen

82
Q

where is prolactin released from?

A

anterior pituitary gland

83
Q

which hormone inhibits progesterone?

A

progesterone- doesn’t allow prolactin to be released until baby is born

84
Q

what can change in center of gravity due to pregnancy cause in women?

A

lordosis

lower back pain

difficult to sleep

85
Q

what happens to pelvic ligaments during pregnancy?

A

they loosen

86
Q

what is labor?

A

hard work of delivering a baby

starts with uterine contraction and ends with delivery of placenta

87
Q

when is fetus full term?

A

(37-42 weeks)

88
Q

what is the bloody show refer to?

A

plug of mucus and blood discharge during the third trimester

89
Q

what does water breaking refer to?

A

amniotic sac ruptures

90
Q

what can trigger true labor contractions?

A
  1. plug of mucus and blood

2. amniotic sac ruptures

91
Q

what are false labor contractions (Braxton- hicks contractions)?

A

contractions which do not indicate that the baby is ready to be delivered

just getting ready for true labor contractions

92
Q

how many stages are there in labor?

A

3

firststage

second phase

third phase

93
Q

what happens in the 1st stage of labor?

A

early phase (latent)

lasts 20 hrs, irregular contractions every 5-30 mins last 30 seconds. cervix dilates from 0 to 3 cm

regular contractions then follow. every 3-5 mins last 1+ min.

active phase

intense contractions
60-90 secs

every 0.5 -2 min

cervix dilates from 3 to 10cm

94
Q

what factors are required for succesful second stage of labor?

A

pushing stage

success on this stage depends on the following:

  1. fetal size (head)
  2. fetal attitude - how fetal body is flexed

should be fully flexed (chin on chest, rounded back flexed arms and leg)

3.Fetal lie:
how is it positioned

longitudinal - ideal ( head pointing down)

transverse (horizontal)

Oblique ( slight angulated)

  1. fetal presentation:

first fetal part to descend into the pelvic inlet

cephalic - head first . vertex is best form as it means flexion of the head

breech - bottom first

shoulder - shoulder first

95
Q

what happens in the 2nd stage of labor?

A
  1. descent - downward movement of foetus to pelvic inlet

fetal station - measures degree of descent of foetus in relation to ischial spine

fetal station figures:

-5 - pelvic inlet

0 - ischial spine

+5 - pelvic floor

  1. internal rotation - fetal shoulders internally rotate 45 degrees so widest part of shoulders is in line with ischial spine
  2. Extension - emerges from vagina
  3. Restitution - head externally rotates so shoulders can pass through pelvic outlet and under symphysis pubis
  4. expulsion - anterior shoulder passes under the symphysis pubis, then the posterior shoulder and then the rest of the body
96
Q

what happens in the 3rd stage of labor?

A

delivery of the placenta

uterus contracts forcing placenta to separate from the uterine wall

97
Q

what happens in the 4th stage of labor?

A

several hours after delivery

adaption to blood loss

start of uterine involution - uterus returns to pre pregnant stage

98
Q

how should you monitor labour?

A

FHR monitored every 15 min

contractions every 30 mins

maternal pulse rate every hour

maternal BP ant temp should be checked every 4 hours

VE should be offered every 4 hours to check progression of labour

maternal should be checked for ketones and protein every 4 hours

99
Q

what is the best diagnostic sign of labour?

A

strong regular uterine contractions - result in progressive changes in the cervix (effacement and dilation) and descent of the presenting part. Rupture of membranes, either spontaneous or artificial via a sweep

100
Q

how can you induce labour?

A

membrane sweep

topical prostaglandin to the cervix - especially if closed and firm

artificial rupture of membrane via aminiotomy

IV oxytocin- membranes should have ruptured before use

101
Q

what observations should you carry out in normal labour?

A

via doppler and not CTG

stage 1 : every 15 mins and at the end of each contraction

stage 2: at the end of every contraction

indication of continual monitoring using CTG include:

augmentation of contractions with syntocinin

Reproduction and Sexual health (4 decks)

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