Repro Flashcards
Give one disadvantage of the migration of the primordial germ cells.
If they don’t make it can increase risk of later gonadal tumours
The reproductive system arises from which embryological tissue?
Intermediate mesoderm - indifferent gonad
Yolk sac - germ cells
How does the indifferent gonad differentiate into male or female genitalia?
SRY gene expression from Y chromosome - male
Absence of SRY - female
What hormone does the female gonad secrete during development of the internal genitalia?
Oestrogen
What hormones does the male gonad secrete during development of the internal genitalia? From which cells?
Testosterone - leydig cells
Mullerian inhibitory substance (MIS) - sertolli cells
What is the action of oestrogen in the developing female internal genitalia?
Destruction of wolfian duct
Formation of genitalia
What is the action of testosterone in the developing male reproductive tract?
Growth of wolfian duct
Formation of genitalia
What is the action of MIS in the developing male reproductive tract?
Destruction of the Müllerian duct
Describe the development of the ovarian follicle at puberty.
FSH and LH lead to the development of an Antrum (fluid filled space). This leaves it capable of rupture to release an oocyte.
Describe days 1-12 of the menstrual cycle.
Day 1 bleeding.
Then Follicular/proliferation stage
Gamete waits in the follicle and lining proliferates
When in the menstrual cycle does ovulation occur?
Day 12-14
Which hormones are produced by the corpus luteum and what are their effects on the menstrual cycle?
Oestrogen and progesterone
Maintain endothelium
Inhibin
prevent FSH stimulation of ovulation
When can spermatogonia begin meiosis?
After puberty
What happens to the testis at puberty?
Seminiferous tubules hollow out and testes migrate through the inguinal canal
Describe the mechanism that allows so many sperm to produced at a time?
Spermatogonia undergo mitosis. One cell is used for proliferation. The other becomes an A1 spermatogonia which undergoes mitosis to for a a whole chain of 64 identical diploid cells. These undergo meiosis to produce 256 haploid cells each - spermatids. These mature to spermatozoa
What hormone is produced by the hypothalamus to stimulate the HPGonadal axis?
Gonadotropin releasing hormone
GnRH
Which two gonadotrophs are released from the anterior pituitary in response to GnRH to stimulate the gonads?
FSH and LH
Follicle stimulating hormone and luteinising hormone
What is the action of inhibin?
Negative feedback onto FSH
Give two functions of testosterone in the male.
Irreversible - eg secondary sexual characteristics
Regulatory - eg negative feedback regulation of spermatogenesis
How often is GnRH released?
Regular pulses every 90 minutes
Describe the levels of FSH, LH, oestrogen, inhibin and progesterone in the follicular phase of the menstrual cycle.
Small follicle means low inhibin, oestrogen
No corpus luteum so low progesterone
Therefore no feedback and FSH and LH increase
FSH more than LH because it is used to having double inhibition
Describe the levels of FSH, LH, oestrogen, inhibin and progesterone in the ovulation phase of the menstrual cycle.
Follicle fully developed and oestrogen reaches peak
Oestrogen so high it flips to positive feedback onto GnRH, overpowering the high inhibin
LH (and FSH) surges
Describe the levels of FSH, LH, oestrogen, inhibin and progesterone in the luteal phase of the menstrual cycle.
Corpus luteum secretes oestrogen and progesterone
Together with inhibin they inhibit FSH and LH
For 14 days these levels are constant till the corpus luteum dies and triggers a bleed
On what gonadotroph does inhibin act?
FSH only
What is triggered by the LH surge?
Ovulation
When does oestrogen switch to providing positive feedback to the gonadotrophs?
When it is at a high enough concentration. This triggers the LH surge and ovulation
Where do the germ cells migrate through the body?
From mesonephric ridge - dorsal mesentery - inguinal canal - testis/ovar
As the germ cells complete their migration to the testis, the spermatic cord picks up 3 layers of fascia. What are they and where do they originate?
External fascia - external oblique
Cremasteric fascia - internal oblique
Internal fascia -Transversalis fascia
What type of neoplasm is most common in the testis? Does it tend to be malignant or benign?
Germ cell neoplasm - seminoma or teratoma (malignant)
Not leydig or sertolli
What hormones stimulate and are secreted by sertolli cells? Where are they found?
Stimulated by:
FSH
Secrete:
Inhibin
Müllerian inhibitory substance
Inside the testis
What hormones stimulate and are secreted by leydig cells? Where are they found?
Stimulated by:
LH
Secrete:
Testosterone
Surrounding the testis
What is the rete testis?
Where the seminiferous tubules converge inside the testis.
Where is semen produced?
85% in the seminal vesicle
Some from the prostate
Some from the bulbourethral gland
How are sperm moved along the tract from testis to penis?
Stereocilia on the epithelia
Gradually more and more smooth muscle along the tract
What is significant about the zones of the prostate?
BPH - transition zone. Surrounds the urethra so can affect urination.
Cancer - peripheral zone. Few symptoms so present late. More likely Palpable on PR exam.
What passes out through the superficial inguinal ring?
Vas deferens
Lymphatics
Genitofemoral nerve
What is the embryological derivative of the broad ligament (female)?
The paramesonehpric (Müllerian) ducts fuse. Form a double layer of peritoneum.
What is enclosed by the broad ligament (female)?
Uterus, ovaries and the neuro vascular supply.
What are the name of the glands in the vestibule of the labia minora?
Bartholin glands
What is the ostium of the Fallopian tube?
Where it opens into the peritoneum - risk of peritonitis from pelvic inflammatory disease or sti
Describe the three areas of the cervix. Where are neoplasms most likely in the cervix?
Endo cervix - simple columnar and goblet
Ecto cervix - stratified squamous non keratinised
Squamocolumnar junction - location of neoplasm
Describe the layers of the uterus.
Endometrium -stratum functionalis - stratum compactum
- stratum spongiosum
- stratum basalis
Myometrium
Which layer of the uterus grows during the proliferative period? Describe two processes that occur.
Stratum functionalis of the endometrium
Remodelling of spiral arteries
Hyperplasia of endothelium
What type of secretion occurs in the breast?
Apocrine
What types of cell are found in the follicle?
Granulosa - inside
Theca - outer shell
Where is the pouch of Douglas?
Rectouterine
What is the difference between an sti and an std?
Sti includes asymptomatic
Std is symptomatic only
Define amenorrhea.
Absence of periods.
Primary - never
Secondary - stopped
Define menorrhagia
Heavy periods
Define Dysmenorrhea
Painful periods
Define oligomenorrhea.
Long delays/ irregular
What types of cause would you look for menstrual dysfunction with the following hormone results:
Low FSH and low oestrogen
HPG axis
Primary - kallmann syndrome, prolactinoma
Secondary - exercise, stress, low bmi, thyrotoxicosis
What types of cause would you look for menstrual dysfunction with the following hormone results:
High FSH, low oestrogen
Ovarian
Primary - Turner syndrome
Secondary - pregnant, menopause, pcos, tumour
What types of cause would you look for menstrual dysfunction with the following hormone results:
Normal FSH, normal oestrogen
Outflow tract
Primary - Müllerian agenesis, imperforate hymen
Secondary - asherman’s syndrome (endometrial fibrosis)
Describe the pathway that leads to erection.
Parasympathetic nervous stimulation, ip3 pathway, nitric oxide, cGMP, decrease Ca, vasodilation of pampiniform venous plexus.
Describe the pathway involved in ejaculation.
Sympathetic stimulation, smooth muscle, sphincter of bladder, bulbospongiosus and ischiocavernosus contract
Describe the process of fertilisation - 3 points.
- Capacitation - sperm matures in the female
- Acrosome enzymes digest the zona pellucida
- Cortical reaction - 1 sperm enters and cortical granules block the gap in the zona pellucida
By what three mechanisms do hormonal contraceptives prevent pregnancy?
Decrease ovulation - combined
Increase cervical mucus - mini
Decrease endometrium - combined
How does Viagra work?
Inhibits cGMP breakdown, decrease in cellular Ca, increase in vasodilation.
What percentage of sperm should be swimming?
More than 60
Less than 30 is abnormal
What produces hcg? What does it indicate?
Syncitiotrophoblast cells. Indicates pregnancy.
What is the function of hcg? (2 things)
- Mimics LH to maintain the corpus luteum and therefore the pregnancy.
- Immunosuppressant to prevent rejection
Name 2 functions of the hormone hpL during pregnancy.
- Increases insulin resistance
- Increases lipolysis
Both to free up more glucose for the foetus. The mother relies more on fatty acids.
What causes gestational diabetes? What is an important sign? Name 4 risks.
It is an extreme version of a normal physiological process. HpL increases blood sugar to provide more for the foetus but this can go a bit too far.
Abdo circumference > head
Risk of still birth, genetic defects, large baby, neonatal diabetes
Name 2 factors that raise the risk of acidosis in pregnancy.
- HpL increases lipolysis, so increase use of fatty acids, increase in ketones
- Kidneys are excreting extra bicarbonate to balance out respiratory alkalosis. This gets rid of the buffer so harder to self regulate if goes acidotic.
Give a factor that raises the risk of alkalosis in pregnancy.
Physiological hyperventilation
Name 3 physiological effects of progesterone during pregnancy and their potential complications.
- Decreased GI motility - constipation, gall stones, pancreatitis
- Dilates ureters - increased stasis leads to uti
- Reduces BP - postural hypotension
What are the symptoms of pre eclampsia?
Vasoconstriction - high bp Pitting Oedema Proteinuria Liver failure ( all because Inadequate placenta)
How does the placenta develop?
- High Progesterone causes decidualisation - remodelling of spiral arteries in the endometrium to increase flow
Pre decidual cells prevent too much invasion - Implantion
- Primary, secondary and tertiary villi
Describe the primary secondary and tertiary villi of the placenta?
- First projections of the trophoblast
- Invasion of mesenchyme
- Fetal vessels invade the mesenchyme and the membrane thins to one cell thick of syncitiotrophoblast
Name 3 metabolic functions of the placenta.
- Glycogenesis
- Lipolysis
- Cholesterol synthesis - for making oestrogen and progesterone
Name 2 endocrine functions of the placenta.
- Hcg and hpL
2. Oestrogen and progesterone
Name 3 active, 4 passive, 1 facilitated passive and 1 RME transport functions of the placenta.
- Active - iron, amino acids, vitamins
- Passive - water, electrolytes, gases, urea
- Facilitated passive - glucose
- Receptor mediated endocytosis - immunoglobulin
Which infections cross the placenta?
Toxoplasmosis O Rubella CMV Herpes
What is the difference between asymmetrical and symmetrical growth restriction?
Assymmetrical - caused by decreased growth support, growth prioritises the brain so that head circumference is normal but abdo circumference is reduced
(Or opposite in gestational diabetes)
Symmetrical - caused by decreased growth potential so that both circumferences are reduced.
Where is GnRH released from?
Hypothalamus
Where are FSH and LH released from?
Anterior pituitary
Why does only a small amount of FSH and LH have a large effect?
Released into the hypophyseal portal system where there is a small volume of blood so only a small volume of hormone will change the concentration a lot.
Which cells release oestrogen?
Theca cells release androgens which are converted and released by granulosa
Which cells release inhibin in the male and female?
Male - sertolli
Female - granulosa
Which cells release progesterone?
Corpus luteum and syncitiotrophoblast of placenta
What are the two names for the early part of the menstrual cycle that comes straight after menses?
Follicular and proliferative
What are the two names for the late part of the menstrual cycle that comes after ovulation?
Luteal and secretory
What is another name for the wolfian duct?
Mesonephric duct
What is another name for the Müllerian duct?
Paramesonehpric duct
Name three fetal cardiac shunts and describe their role.
Ductus venosus - avoids wasting too much O2 on the liver
Ductus arteriosus - avoids deoxy getting back into the oxy via the lungs
Foramen ovale - avoids wasting too much 02 on the lungs
What is the crista dividens?
Separates the deoxy flow from the oxy flow in the right atrium
What are two functions of maternal physiological hyperventilation?
- Slightly raises the oxygen concentration in the maternal blood to help create a gradient for it to diffuse across the placenta.
- Keeps the maternal blood basic by preventing CO2 levels rising, because the fetal kidneys cannot neutralise acid.
What is amniocentesis and what does it measure?
Take a sample of amniotic fluid and test
Measures renal and urinary function because foetus swallows the fluid, absorbs water and electrolytes and excretes the remainder.
What causes neonatal jaundice?
The fetal liver cannot conjugate bilirubin and sends it to the mother to do. Normally triggered by light.
After birth if it doesn’t kick in right away, the baby can be jaundice for a short time.
When is the first pregnancy scan and what is its purpose?
9-13 weeks
Date pregnancy and estimate due date
Check location, number
Can check Downs
When is the second pregnancy scan and what is its purpose?
20 weeks Genetic defects (except downs) Growth monitoring - bi parietal diameter, abdo circumference, crown rump length
What type of growth is mostly occurring during the embryonic period?
Placental growth
Cell differentiation
What type of growth is mostly occurring during the early fetal period?
Protein deposition
What type of growth is mostly occurring during the late fetal period?
Adipose deposition
What symptom would indicate impaired renal function in a foetus?
Oligohydramnios - too little amniotic fluid volume
What symptom would indicate a swallowing impairment in a foetus?
Polyhydramnios - too much amniotic fluid volume
At what stage of development do fetal lungs become viable? Which week does it usually occur?
Terminal sac stage - week 26
What occurs at the terminal sac stage of respiratory development?
End sac develop off the end of bronchioles, giving critical surface area. And surfactant is secreted from pneumocytes
What is the cause of respiratory distress syndrome?
Not enough surfactant in the lungs at birth - they can’t stay inflated
What is the function of surfactant in the lungs?
Lowers surface tension and allows the alveoli to remain inflated throughout the breath cycle
When do the neurons begin myelination?
Late - week 36 and continue into adolescence
What is the embryological derivative of the upper vagina?
Intermediate mesoderm
What is the embryological derivative of the lower vagina?
Endoderm
What is the function of the embryological mesonephric (wolfian) duct?
Primitive renal function
What is the gubernaculum and what is its remnant in the male and female?
Cord attached to the gonad which helps migration of the testes
Male - scrotal ligament
Female - round and ovarian ligaments
What hormones stimulate and are secreted by granulosa cells? Where are they found?
Stimulate:
FSH
Secrete:
Inhibin and oestrogen
What hormones stimulate and are secreted by theca cells? Where are they found?
Stimulate:
LH
Secrete:
Androgens for granulosa to convert to oestrogen
Outline the three stages of parturition.
- Creation of a birth canal
- Expulsion of foetus
- Expulsion of placenta
What is the lie of the foetus?
The relationship between the long axis of the foetus and the long axis of the uterus.
What is the presentation of the foetus?
Cephalic vs podalic (breech)
What position should the foetus be in at birth?
Well flexed
What factors affect the necessary diameter of the birth canal?
Lie
Presentation
Position
What is the limiting factor for the diameter of the birth canal?
Pelvic inlet of innominate bone
What are the boundaries of the pelvic inlet?
Sacral promontory
Superior pubic rami
Ilio pectineal line
Which two hormones are important in inducing labour?
Prostaglandins - cervical ripening
Oxytocin - contractions
What triggers labour?
Decrease in ratio of progesterone to oestrogen
What four changes occur during cervical ripening?
Decrease collagen
Increase glycosaminoglycans
Increase Nitric oxide
Increase inflammatory cells
What causes Brixton hicks?
Myometrium is usually spontaneously motile because it contains some pacemaker cells. But usually low amplitude, high frequency. As pregnancy continues amplitude increases and frequency decreases.
Why is it important to monitor fetal heart rate?
Contractions steal blood supply from placenta. As they increase in strength this increases. If labour takes to long the fetal heart rate can decrease.
How does the foetus move as it is expelled from the birth canal?
Flexes, extends, rotates
What is post partum haemorrhage? What are the two most common causes?
Excessive blood loss after labour.
Caused by atony of uterus or retained placenta
What physiological process reduces the risk of post partum haemorrhage?
Contractions of the uterus which expel the placenta compress the blood vessels.
Which part of the breasts are developed at birth?
Few ducts only
What happens to the breasts at puberty? What drives this change?
Increase in oestrogen and progesterone leads to:
Ducts sprout and branch
Acini develop
Breast size increases and some oedema at each period
How do the breasts change during pregnancy? What drives this change?
Increase in progesterone:oestrogen ratio.
Drives hypertrophy and cell differentiation but not secretion.
What processes drive milk production in the breast?
Decrease in oestrogen and progesterone.
Suckling - hypothalamus decreases dopamine - anterior pituitary increases prolactin
What is the initial milk produced by the breast known as? Why is it so good for the baby?
Colostrum.
Contains high concentrations of immunoglobulin which can be directly absorbed by the newborn gut. (Mature gut would digest)
Combined with placental immunoglobulin it confers passive immunity
If a baby only suckles for a short time, how will this affect the next feed and why?
Decrease suckling, decreases dopamine reduction, prolactin is still inhibited. Less prolactin and less milk for the next feed.
What is the process by which milk is expressed?
Let down reflex.
Suckling (or anticipation of suckling) - posterior pituitary increases oxytocin - myoepithelial cells contract
If a baby stops suckling altogether, what is the effect on lactation?
No suckling - turgor in breast - compressed blood vessels - milk production ceases
Describe the long and short term effects of suckling on the breast.
Long term
Decrease dopamine, increase prolactin, produce milk for next feed
Short term
Increase oxytocin, myoepithelia contract, let down milk
List three benefits of breast feeding.
Bonding
Passive immunity transfer
Free!
Describe one complication of breast feeding.
Acute mastitis
Staphylococcus aureus infection enters by nipple cracks. Pyrexia, pain, cyst, erythema. Treat by expressing milk and antibiotics.
What kind of pain in the breast would be concerning?
Non cyclical and focal
What kind of mass would be concerning?
Hard, fixed, craggy border, orange peel skin
What kind of nipple discharge would be concerning?
Spontaneous and unilateral
What is a mammogram? Why is it only useful in older women?
Breast x-Ray.
Younger women have more glandular tissue which clouds the picture.
Older women have more adipose which is easier to see past.
What are you looking for in a mammogram?
Densities and calcifications
Name three completely benign breast diseases.
Fibrocystic change
Fibroadenoma
Fat necrosis
What is the most common breast problem?
Fibrocystic change. Half of women will experience.
How would you identify fibrocystic change?
Collapses on fine needle aspiration.
When a woman presents with a breast lump, what must always be done?
Send to histology and cytology.
Name three types of breast carcinoma
- Ductal carcinoma in situ. —– if extends to nipple Paget’s disease
- Ductal invasive carcinoma
- Lobular invasive carcinoma
What are the risk factors for breast carcinoma?
Familial - mutation in BRCA 1 and 2 gene, or p53
Prolonged high oestrogen levels - obesity, uninterrupted menses, early menarche, transsexual, late first pregnancy.
Where does breast carcinoma tend to spread?
Lymph in ipsilateral axilla
Blood to bone (or liver, lung, brain)
What test would tell you if a women would benefit from chemotherapy?
Genetic marker test.
17 genes including HER2 and oestrogen receptor, indicate a high risk of metastasis. Chemotherapy is only worth the risk in these patients.
Why is it important to know if a breast carcinoma is HER2 positive or oestrogen receptor positive?
To guide treatment.
Oestrogen receptor positive - tamoxifen to decrease oestrogen
HER2 receptor positive - herceptin to decrease epidermal growth factor
What is sentinel lymph node biopsy? Why is it preferable to removing all of the lymph nodes?
Removal of one or two nodes which are first reached by metastasis to prevent spread
Removal of all causes lymphoedema in the arm.
Give some risk factors of cervical cancer.
HPV 16 and 18
And things which are associated with high levels of oestrogen Eg. Early pregnancy Multiple births Long term pill Obesity
How does HPV give rise to cervical cancer?
Enters keratinocytes in the basal layer of stratified epithelium by receptor mediated endocytosis. Releases proteins e6 and e7 which downregulate tumour suppressor genes p53 and pRb.
In some cancers the pill is a risk factor and in others it is protective. Which are they?
Risk factor in areas it increases turnover: cervix, breast and vulva
Protective in areas it decreases turnover: endometrium, ovary
What is meant by the CIN grading system?
CIN grades 1, 2, and 3 describe increasing levels of dysplasia in cervical cancer. By level 3 it is probably carcinoma in situ but it is difficult to tell. So treat 2 and 3 with a cone/loop excision.
What is the most common type of cervical cancer?
Squamous cell carcinoma of the transition zone
What is the treatment for an invasive squamous cell carcinoma of the cervix?
Hysterectomy
Lymph node dissection
Where does cervical cancer tend to spread?
Nearby good “soil” eg bladder, rectum, vagina.
Lymph: para aortic, pelvic, para cervical
Which cancers have a screening program?
Breast
Bowel
Cervix
Give some risk factors of endometrial cancer.
Advancing age
Increased exposure to unopposed oestrogen:
Eg HRT
Obesity
Tamoxifen (pro oestrogen in this area)
(Pill is protective)
Describe the histological appearance of endometrial cancer.
Hyperplasia
Increased gland to stromal ratio
What are the effects of tamoxifen across the body?
Anti oestrogen in breast,
Pro oestrogen in the endometrium and bone
What are the two types of cancer in the endometrium? Give a brief description and indicate which is more common.
Endometrioid adenocarcinoma (common) Mimics normal endometrium. Causes direct invasion with lymph spread. Serous adenocarcinoma (rare) Poor differentiation, very aggressive. Falls apart and spreads to peritoneum.
What is the most common cause of a tumour in the myometrium? Give a brief description of the symptoms.
Leiomyoma (fibroids)
May be asymptomatic or press on nearby structures: incontinence, irregular/ heavy periods.
Does not lead to malignancy.
Give some risk factors for vulval cancer.
Same as cervical
HPV 16 Increased oestrogen: Eg early pregnancy Multiple births Long term pill Obesity
How does early benign vulval neoplasia present?
Vulval intra epithelial squamous neoplastic lesions
Dark lesions associated with HPV and therefore keratinocytes.
Which two cancers can be identified by increased levels of biomarker hcg?
Testicular
Gestational choriocarcinoma
What are the two types of gestational cancer?
Invasive molar pregnancy - oedema filled villi, loss of genetic material in foetus. Invades uterine wall and risk of rupture
Choriocarcinoma - cancer of trophoblasts so increased hcg. No villi
Which biomarker can identify ovarian cancer?
CA 125
What are the four general types of ovarian cancer?
Müllerian
Teratoma
Sex cord stromal
Metastases
What are 3 types of Müllerian ovarian tumour?
Serous
Mucinous
Endometrioid
What are the 3 types of teratoma in the ovary? Which are malignant? Which are most common?
Mature - common and benign
Immature - rare and malignant
Mono dermal - eg struma ovarii
What is struma ovarii?
A benign monodermal ovarian tumour made of thyroid tissue. Secretes thyroid hormone and can cause hyperthyroid.
What are the 2 types of sex cord stromal ovarian tumour? What type of cell are they constituted of?
Masculinising - Leydig cells
Feminising - theca and granulosa cells
Where does ovarian cancer tend to metastasise from?
Rest of repro tract and breast
Stomach - Krukenberg tumour
Give some risk factors for ovarian cancer
Increased ovulation - no pregnancy, early menarche, late menopause
BRCA 1 and 2
Smoking
(Pill is protective)
Which type of ovarian cancer will rarely metastasise?
Teratoma
When is a teratoma likely to be malignant?
In the testis
How does the copper IUD prevent conception?
Stops endometrial prostaglandin release to prevent implantation.
What are the primary mechanisms of action of the combined and mini pills?
Combined mimics luteal phase to prevent ovulation
Mini induces thick, acidic cervical mucus
Why can an ectopic pregnancy cause so much bleeding/rupture?
Normally implants in the ampulla of the Fallopian tube (or peritoneum) where there are no pre decidual cells. Invasion goes unchecked and causes excessive bleeding and rupture.
What are the names of the two sides of the placenta?
Maternal - decidual plate
Fetal - chorionic plate
Where is an epidural given?
L1
Describe the cervical mucus at different stages of the menstrual cycle.
Proliferative - alkali and thin
Secretory - acidic and thick
What are the best ways to measure a foetus in trimester 1 and 2/3?
- Crown rump length
2/3. Bi parietal diameter or symphysis fundal height (difficult if moving or in a lateral lie)
How is amniotic fluid initially produced?
Maternal fluids and the extra cellular fluid of the fetus through their Unkeratinised skin.
Where is the correct place to make a c section incision? Why?
Arcuate line
Where there is 1 less layer of fascia because their is no posterior rectus sheath
Give 4 possible causes of precocious puberty.
Pineal gland tumour - increase melatonin
Meningitis
Gnrh secreting tumour
Idiopathic
If an ectopic pregnancy in the Fallopian tube were to rupture, which arteries would be implicated?
Ovarian and uterine
What is the difference between a false and a true pelvis?
False - area between the iliac bones.
True - deeper area surrounded by the pelvic inlet
Describe the lymphatic drainage of the scrotum and testis. Why is this relevant?
Testis - lumbar and para aortic nodes
Scrotum - superficial inguinal nodes
Means a lump in the scrotum is very unlikely to be testicular cancer. But bad because it means it presents late.
What is a hydrocoele/haematocoele? Where and why do they occur?
Hydro - fluid behind the tunica vaginalis. Due to failure of processus vaginalis to close properly
Haemo - blood behind the tunica vaginalis. Due to trauma or a tumour.
What is a varicocoele? Why are they more common on the left?
Varicosities of the pampiniform plexus due to venous reflux
Feels like a bag of worms
More common on the left because left testicular vein drains via renal artery at a steep angle. (Reflux more likely)
More dangerous on the right because it drains straight to the vena cava.
What is the relationship between dopamine and prolactin?
Which drug can therefore be used to treat hyperprolactinaemia?
Dopamine inhibits prolactin
Bromocriptine mimics dopamine so treats hyperprolactinaemia
What are the symptoms of hyperprolactinaemia?
Inhibits GnRH
So infertility, hirsutism, amenorrhoea
What is the significance of the perineal body?
Fibromuscular connective tissue where all of the pelvic floor muscles insert.
Good flexibility for childbirth
But risk of prolapse or incontinence when damaged. Because it is connective tissue it does not heal easily. Episiotomy avoids tear of perineal body.
Name the levator ani muscles. Which is involved in faecal incontinence?
Puborectalis - faecal incontinence
Iliococcygeus
Ischiococcygeus
Which muscles comprise the pelvic diaphragm?
Levator ani and coccygeus
Name the deep perineal muscles.
External urethral sphincter
Urethrovaginal sphincter
Deep transverse perineal
Name the superficial perineal muscles.
Bulbospongiosus
Ischiocavernosus
External anal sphincter
Superficial transverse perineal
Which muscles are implicated in ejaculation?
Bulbospongiosus
Ischiocavernosus
