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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
what ligament do the helicine arteries enter from?
broad ligament
26
are the follicles contained within the cortex or medulla of the ovary?
cortex
27
what is contained in the medulla of an ovary?
blood vessels nerves lymphatics connective tissue
28
describe the superficial layer of the cortex of the ovary?
fibrous cortex covered by epithelium
29
what type of epithelium covers the fibrous cortex of the ovary?
simple cuboidal epithelium
30
what is the tunica albuginea of the ovary?
tough fibrous layer of dense connecive tissue
31
at what age do germ cells move into the ovaries of a female?
week 6 of embryonic development
32
what happens to the germ cells once the enter the ovaries?
proliferate by mitosis to form oogonia
33
what happens to oogonia within the ovaries?
divide by meiosis to form oocytes (ova)
34
what is oogenesis?
development of oocytes from oogonia | division via meiosis
35
what is folliculogenesis?
growth of the follicle
36
what does a follicle consist of?
oocyte (ova) and any associated support cells
37
what is atresia?
loss of oogonia and oocytes by apoptosis
38
before birth, what happens to an oocyte?
starts meiosis but the process halts at prophase 1
39
describe the stages of folliculogenesis?
1. primordial follicle 2. primary follicle 3. growing primary follicle 4. pre-antral (secondary) follicle 5. early antral (tertiary) follicle 6. Graafian follicle
40
what cells does the oocyte associate with to form the follcie?
pregranulosa cells
41
what type of cells are pregranulosa cells?
initially squamous | become cuboidal as follicle grows
42
what type of supporting cells are found in the primary follicle?
cuboidal granulosa cells
43
what are the cuboidal granulosa cells in the primary follicle known as?
zona granulosa
44
what happens to the stromal cells that associate with the outside of the primary follicle?
go on to form the theca
45
as the follicle grows, what forms between the oocyte and the granulosa cells?
zona pellucida
46
what are the 2 parts of the theca that forms from stromal cells that surround the follicle?
theca interna | theca externa
47
what is the function of the theca interna?
secretes oestrogen precursors
48
what cells convert the oestrogen precursors to oestrogen?
granulosa cells
49
at what stage in folliculogenesis does the antrum form?
secondary follicle
50
what is the antrum within a follicle filled with?
follicular fluid
51
what cells surround the oocyte once the antrum begins to form?
cumulus cells
52
when do oocytes move past prophase 1 and complete meiosis?
1 day before ovulation
53
what is produced by meiosis of the primary oocyte?
secondary oocyte and polar body
54
explain what happens to the following during the physiological changes of pregnancy: maternal blood volume plasma
maternal blood volume up 30% Plasma up 50% therefore makes the mum loo like she anaemic even though she isn't
55
what are the physiological changes of the cardiovascular system in someone who is pregnant?
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
what are the physiological changes of the respiratory system in someone who is pregnant?
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
What are the physiological changes of the haematology system in someone who is pregnant?
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
what are the physiological changes of the urinary system in someone who is pregnant?
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
what produces oestradiol?
granulosa cells
60
what is produced once the ovarian follicle become the corpus luteum?
progesterone
61
what is the zona pellucida?
a plasma membrane surround the oocyte and contains the protein ZP3 which is responsible for sperm binding
62
what does the theca produce?
androstenedione - converted into oestradiol by granulosa cells
63
state what occurs in the following days of fertilization: day 1 day 5 day 5-8 day 12
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
What is a blastocyst?
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
when is the placenta fully developed and functional?
5th week of pregnancy
66
what is the function of the placenta?
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
describe the hormonal changes in pregnancy with the following hormones: 1. HCG 2. progesterone 3. Oestrogen
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
what types of oestrogen are there?
E3 - indicator of fetal vitality E4 - only produced through pregnancy
69
what are the cardiovascular maternal adaptions in pregnancy?
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
what are the respiratory maternal adaptions in pregnancy?
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
what are the haematological maternal adaptions in pregnancy?
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
what are the urinary maternal adaptions in pregnancy?
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
what is the ratio of oestrogen: progesterone during implantaiton?
low oestrogen: progesterone ratio
74
when is the first trimester? ii. what is releasing most of the hormones at this point?
week 1 -13 ii. corpus luteum
75
where does the uterus grow to by 20 weeks?
umbilicus
76
where does the uterus grow to by 36 weeks?
xiphoid process
77
what is the fundal height?
distance from the symphsis pubis to the top uterus (fundus) good way to measure gestational age e.g. 36 weeks = 36 cm
78
which hormone promotes milk production?
prolactin
79
which hormone causes contraction of ducts and expulsion of milk?
oxytocin
80
what mood changes can be caused by high oestrogen and progesterone?
mental fogginess depression irritability anxiety depression
81
which hormone promotes release of prolactin?
oestrogen
82
where is prolactin released from?
anterior pituitary gland
83
which hormone inhibits progesterone?
progesterone- doesn't allow prolactin to be released until baby is born
84
what can change in center of gravity due to pregnancy cause in women?
lordosis lower back pain difficult to sleep
85
what happens to pelvic ligaments during pregnancy?
they loosen
86
what is labor?
hard work of delivering a baby starts with uterine contraction and ends with delivery of placenta
87
when is fetus full term?
(37-42 weeks)
88
what is the bloody show refer to?
plug of mucus and blood discharge during the third trimester
89
what does water breaking refer to?
amniotic sac ruptures
90
what can trigger true labor contractions?
1. plug of mucus and blood | 2. amniotic sac ruptures
91
what are false labor contractions (Braxton- hicks contractions)?
contractions which do not indicate that the baby is ready to be delivered just getting ready for true labor contractions
92
how many stages are there in labor?
3 firststage second phase third phase
93
what happens in the 1st stage of labor?
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
what factors are required for succesful second stage of labor?
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) 4. 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
what happens in the 2nd stage of labor?
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 2. internal rotation - fetal shoulders internally rotate 45 degrees so widest part of shoulders is in line with ischial spine 3. Extension - emerges from vagina 4. Restitution - head externally rotates so shoulders can pass through pelvic outlet and under symphysis pubis 5. expulsion - anterior shoulder passes under the symphysis pubis, then the posterior shoulder and then the rest of the body
96
what happens in the 3rd stage of labor?
delivery of the placenta uterus contracts forcing placenta to separate from the uterine wall
97
what happens in the 4th stage of labor?
several hours after delivery adaption to blood loss start of uterine involution - uterus returns to pre pregnant stage
98
how should you monitor labour?
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
what is the best diagnostic sign of labour?
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
how can you induce labour?
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
what observations should you carry out in normal labour?
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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