Repro 2 Flashcards
Give histology of cortex of ovary
primordial follicles contained
what is a primordial follicle
oocyte surrounded by single layer of squamous granulosa cells
state the changes that occur to oocyte from pprimordial follicle to tertiary follicle
pimary follicle - ZP forms. Granulosa becomes cuboid
2 follicle - stroma like theca cells recruitied, become theca exerna + interna. Increased number of granulosa cell and antrum forms between granulosa
3 follicle - theca interna expresses LH receptors and produces oestrogen. Granulosa cells become corona radiata and cumulus oophorus.
what is the cumulus oophorus
bridge of cells between granulosa cells and oocyte
what is layers of cells surrounding oocyte med to lat
oocyte surrounded by ZP surrounded by corona radiata surrounding cumulus oophorus
what happens to follicle after ovulation
GC become granulosa lutein cells, secrete prog
theca interna becomes theca lutein, secrete oest
what is corpus albicans
fibrosed corpus luteum after death
what are layers of uterus
endometrium - stratum functionalis (coiled arteries) and stratum basalis (straight arteries)
myometrium - 4 smooth musc layers
what are the stages of endomterial growth and what happens in each
proliferative - SF grows, glands coil
secretory - max thickness. Predecidual cells develop
menses - if no implantation > decreased prog > shedding
what type of cells are found in the endocervical canal and in vagina. what is transformation zone
canal - columnar
vag - strat squamous
transformation zone - columnar becomes strat squamous
what is the histology of vag
stratified squamous. No glands. mucosa, SM, muscular (smooth and skeletal)
lots of glycoproteins esp with oestrogen
give duct anatomy inside breast. what surrounds ducts
nip > lactiferous duct > major duct > minor duct > lobules
surrounded by adipose and stroma
how many lobules per breast
15-20
how does breasts change during puberty
lactiferous ducts develop and adipose deposited
what is outer layer of testes and ovary called
tunica albuginea
histology of testes
SF tubules contain sertoli cells (spermatogenesis). surrounding tubules is leydig cells (testost) and CT.
what connects SF tubule to rete testis
straight tubule
what epithelia is straight ST tubule and rete testis
both simple cuboidal
what connects rete testis to epididymis
efferent duct
epithelia of vas deferens
pseudostratified
histology of seminal vesicles
coiled glands and pseudostratified
what is primary sexual characteristic
develops before birth
what is order of development during female puberty
thelarche, adrenarche, growth, menarche, pubes, breasts
TAG
order of development during male puberty
GAS
gonad development, adrenarche, spermatogenesis, growth, genitalia, pubes
what causes puberty
GnRH from hypo
47kg weight in females
what causes pubic hair, libido, male genitalia, and breasts to develop
pubic hair and libido - androgens
male genitalia - test
breasts - oestrogen
what occurs in premenopause
decrease fertility, early/absent ovulation, decrease oestrogen and inhibin therefore increase LH and FSH (more FSH)
what happens in menopause
skin and bladder changes, hot flushes, osteoporosis, breast involution, loss vaginal rugae
how treat menopause and negative effects of treatment
HRT
-ves - DVT, breast cancer, stroke, PE, depression
define primary amenorrhoea
absence of menarche by 14 without SSC or 16 with SSC
define secondary amenorrhoea
no menses for 3 months if regular cycle or 9 months if irregular
primary amenorrhoea (PA) outflow tract causes
imperforate hymen, vaginal atresia
SA outflow tract causes
trauma, intrauterine adhesions
PA gonad causes
androgen insensitivity, gonad dysgenesis (e.g. turners)
SA gonad causes
menopause, pregnancy, PCOS
hypo/pit causes of PA
kallman syndrome
hypo/pit causes of SA
stress, sheehan syndrome (necrosis of pit due to excessive blood loss during childbirth), anorexia
define menorrhagia, causes and treat
> 80 ml bleeding or >7 days of menses
causes - PID, cancer, anovulation
treat - USS, hormones
define DUB, causes, pathology, treatment
heavy frequrent or prolonged bleeding with no obvious cause. anovulatory. NOT RELATED TO MENSES
cause - PCOS, extremes of life
pathology - No prog. Endometrium builds up continually and self sheds with erratic bleeding
manage - (prog) OCP, tamoxifen (block oest), iron
define dysmenorrhoea, oligomenorrhoea, premenstrual syndrome, mastalgia
mastalgia - boob pain
dysmenorrhoea - painful periods
oligomenorrhoea - >35 day cycle
premenstrual syndrome - physical and emotional symptoms 1-2 weeks before menses
give hormones secreted by ant pit and the type of hormone and cell that secretes
glycopeptide:
gonadotrophs - FSH and LH
thyrotrophs - TSH
polypeptide:
somatotrophs - GH
lactotrophs - prolactin
corticotrophs - ACTH
horomones secreted by post pit
oxytocin, adh
what does ovaries secrete horomones
oest, prog, test, inhibin
how does hypothalamus secrete GnRH and where does it go. what inhibits
pulsatile (once per hour) into hypophyseal portal circulation
inhibited by oest and inhibin
how does fsh and lh act on males and females
males:
fsh acts on sertoli - spermatogenesis and inhibin
lh acts on leydig - testosterone
females :
fsh acts on granulosa cells
lh acts on theca interna
during menstrual cycle explain following hormones - oest, prog, fsh, lh
oestrogen - rises slowly then peaks just before lh surge. rises again with CL and then regresses post death
prog - low then rises with CL and peaks
FSH - rise in first few days then down, then peak with LH surge and down after
LH - peaks at ovulation (day 14)
effects of estrogen on female repro
thickens endometrium, thin alkaline mucus at cervix, vaginal changes (thicker, elastic, glycogen)
prog effects on female repro
thick acid mucus at cervix, secretory phase of endometrium, breast tissue changes
where does PGC originate and go
PGC start in yolk sac > dorsal mesentery > gonads
what happens to mesonephric and paramesonephric duct in males? what is meso and PMN aka?
meso - wolffian
PMN - mullerian
mesonephric duct stays due to SRY genes on Y chromosome. PMN goes due to mullerian inhibited hormone. meso duct becomes SEED - seminal vesicles, epididymis, ejaculatory duct, ductus deferens
what happens to mesonephric and paramesonephric duct in females?
PMN fuses and forms uterus and vag.
describe what happens to indifferent genitalia to become male / female
influenced by testosterone
genital tubercle - clit / glans
genital fold - labia minora / spongy urethra + scrotal raphe
genital swelling - labia majora / scrotum
describe descent of testes and ovaries
gubernaculum pulls testes through inguinal canal. pulls ovaries to pelvi
what is hypospadias
incomplete fusion of urethral folds
difference uterus didelphys and bicornuate uterus
didelphys - 2 uteri horns and 2 cervixes
bicornuate - 2 uteri horns only
what is spermatogenic wave and cycle
cycle - development time from spermatogona to sperm
wave - distance between 2 areas in same part of cycle
describe spermatogenesis
spermatogonia > spermatocyte > spermatid > sperm
how are ovum produced
PGC enter ovarian cortex. meiosis halted at primary oocytes then continue to primordial follicles in puberty
define spontaneous abortion, preterm labour, and term labour
spont abortion -
what are 3 stages of labour
birth canal widening > fetal expulsion > plactena expulsion
what is fetal lie and presentation
lie - transvers or longitudinal (usually long)
presentation - cephalic (head) or breach (feet)
what happens in cervical ripening? triggered by…
trig by prostaglandins
decrease collagen and aggregation. increase GAGs
what happens to female repro organs during labour. what hormone released
cervical ripening. brachystasis (myometrium contracts more than relaxes). cervical thinning and flattening. oxytocin release
what are early and late cotnractions during pregnancy like
early - not felt, every 30 mins
late - braxton hicks. less freq but increase amplitude
how are myometrial contractions made more forceful
prostaglandins and oxytocin (ferguson reflex, +ve feedback)
describe baby expulsion
starts longitudinally + cephalic > uterus contracts and head flexes and rotates > vag and perineum stretch due to head (risk tear) > head delivers > shoulders rotate and deliver > rest follows
how does uterus prevent post partum hemorrhage. what can be given to help
uterus clamps down. oxytocin given.
how does adult circulation take place in fetus
fetus takes first breath due to trauma and cold > decreased pulmonary resistances and increase arterial pO2 > FO and DA closing
what does relaxin do
relaxes pelvic ligaments for delivery
what are 4 types of hips and briefly describe
gynecoid - wide
anthropoid - narrow transverse, wide AP
android - narrow
platypeloid - narrow AP. wide pelvic outlet
what are the head and breach presentation types
head - vertex, sinciput, brow, face
breach - front (feet by head), full (cross legs), single footing
what instruments can be used to aid deliveruy
forceps, ventouse (vacuum)
what happens to breasts during pregnancy
lobule and ducts hypertrophy and differentiate to produce milk
give properties of milk soon after birth and what its called
colostrum - high IgG and protein, some water fat and sugars
give properties of milk 2 weeks after birth
90% water, rest sugar, fas, protein (lactalbumin and lactoglobin), vit and minerals
how is milk produced
suckling (neuroendocrine reflex). let down reflex (oxytocin). promoted by decreased prog and oest post birth
benefits of breast feedin
bonding and babies reduce risk of infection
what happens to breasts with age
breast stroma replaced with adipose
physical properties of bresat carcinoma
hard, craggy and fixed breast lump
what breast pathology would suggest endocrine disorder
milk discharge from nip
what are the types of benign and malignant breast tumours and briefly explain properties
benign:
fibroadenoma - small and mobile. stroma tumour.
give 2 breast development disorders
milk line remnants - extra nips
accessory axillary breast tissue
symptoms, cause and treatment of acute mastitis of breast
staph aureus. red skin, pain, fever. antibiotics and let milk down
what is duct ectasia
blocked lactiferous duct. green discharge
what is atypical ductal hyperplasia
hyperplasia of 1-2 ducts. increase carcinoma risk
what is symptoms of breast papiloma
ductal papilloma. increases risk of carcinma. poss nip discharge +/- blood
give causes of gyno
liver cirrhosis, spironolactone, klinefelters, obesity
breast cancer risk factors
age, breast feeding (decrease risk), HRT, obesity, COCP, genetics
what types of breast carcinoma are there
in situ/invasive and ductal/lobar
symptoms of pagets disease of breast
eczematous nip. malignant
why peau d’orange
loss of lymph drainage due to malignancy
how diagnose BC
mammography, USS, FNAC, biopsy, history and exam
when is tamoxifen and Herceptin used
tamoxifen - if breast cancer is oestrogen receptor +ve
herceptin - Her 2 +ve BC
what tumours metastasise to bone?
PB-KTL (lead kettle)
prostate, breast, kidney, thyroid, lung
what tumours metastasise to liver
Cancer Sometimes Penetrates Benign Liver
Colon > stomach > pancreas > breast > lung
what tumours metastasie to brain
cancer - Some Love Killing Brain Glia
skin, lungs, kidney, breast, GI
what tumours metastise to lungs
Real Hardcore Cancers Fill Both My lungs
RCC, hepatocellular carcinoma, choriocarcinoma, follicular thyroid carcinoma, breast, melanoma
cause of cervical cancer and risk factors
caused by HPV 16 and 18
RF - smoking, OCP, immunosuppression
when does cervical screening occur
25+ yrs every 3 yrs and then every 5 50+
What is CIN and how treat. is it malignant
cervical intraepithelial neoplasia
treat CIN 1 - cryotherapy
3 - excision
CIN is premalignant
where does cervical carcninoma spread
locally - rectum, vag, bladder
how treat cervical carcinoma
microinvasive - excision
if malignant - hysterectomy, lymph dissection, radio and chemo
what happens in endometrial hyperplasia
increased gland:stroma ratio, increased risk of cancer.
what is symptom of endometrial adenocarcinoma. what 2 types
post menopausal bleeding
endometrioid - invades myometrium
serous - aggressive, spreads to peritoneum
name a myometrial tumour and symptoms
leiomyoma - benign and leads to fibroids.
heavy menses or dysmenorrhoea, infertility and urine freq
symptoms of ovarian cancer
hormonal problems. abdo pain. distention of abdo. urinary and GI symptoms.
late presentation
what are the 3 types of ovarian epithelial tumours and whether malignant
serous -
mucinous - mostly benign
endometrial - mostly malignant
what are the 4 types of ovarian cancer
surface epithelial stroma, sex cord stromal, germ cell tumour, mixed
features of germ cell tumours
mostly benign
teratomas
features of ovarian sex cord stroma tumours
masculinising or feminising
in children can cause or delay puberty
vulval tumours can be caused by
SCC, BCC, malignant melanoma, extramammary pagets
