Repro Flashcards
Sonic hedgehog gene
Zone of polarizing activity at base of limb bud
AP axis pattern, CNS deve3lopment
Mutations–> holoprosencephaly
Wnt 7 gene - apical ectodermal ridge– makes dorssal ventral limbs
Fibroblast growth factor-
apical ectodermal ridge, limb lengthening of mesoderm
Homeobox gene
segmental organizatoin in cranial caudal direction, transcription factor coding
mutation lead to appendages in wrong locations
Isotretinoid–> Hox gene expression
Neural crest cells
from ectoderm MOTEL PASSES
PNS and non neural structures near by
Melanocytes Odontoblasts Tracheal catrilage Enterochromaffin cells Leptomeninges (arachnoid and pia)
PNS ganglia Adrenal medulla Schwann cells Spiral membrane Endocardial cussions Skull
Mesoderm
Middle/ meat layer
Mesodermal defects- Vacterl
Vertebral defects, Anal Atresia, Cardiac defects, TE fistula, Renal defects, Limb defects
Spleen, lymphatics blood, wall of gut tube, upper vagina, kidney, adrenal cortex dermis testes, ovaries
Endoderm
Gut tube epithelium, urethra and lower vagina, luminal epithelium, lungs liver gallbladder, pancreas, eustachian tube, thymus, PTH thyroid follicular cells
Twinning
Dizygotic (2 eggs separately fertilized by 2 different sperm , 2 separate amniotic sacs, 2 separate placentas)
Mono (1 egg, and 1 sperm that splits in early pregnancy- the timing of cleavage determines
cleave 0-4 days separate everything
4-8 days- shared Chorion, 8-12 days shared amnion- Cleavage after 13 days- shared body
rule of 4
Placenta
1’ site of nutrient and gas exchange between mom and fetus
Fetal component: Cytotrophoblast (inner layer of chorionic villi) makes the cells. Syncytiotrophoblast- outer layer of chorionic villi- synthesizes and secretes hormones (hCG (structurally like LH, stimulates corpus luteum to secrete progesterone during first trimester)- lacks MHC 1 expression–> decreased chance of attack by mom immune system
Maternal component- decidua basalis- derived from endometrium , maternal blood in lacunae
umbilical cord
2 arteries (that carry deoxy blood to mom heart) 1 umbilical vein (away from mom carries oxy blood to baby)
Artery or vein terminology refers to baby
Urachus
allantois forms from hindgut and extends into urogenital sinus
Allantois becomes the urachus a duct between fetal bladder and umbilicus, failure of urachus to involute can lead to anomalies that may increase risk of infection and/or malignancy (adenocarcinoma )
Obliterated urachus is represented by the median umbilical ligament after birth, which is covered by median umbilical fold of the peritoneum
Patent urachus- total failure of urachus to obliterate–> urine discharge from umbilicus
Urachal cyst- partial failure, cyst can become infected and present as painful mass below umbilicus
vesicourachal diverticulum- slight failure of urachus to obliterate–> outpuching of bladder
Vitelline duct
7th week- obliteration of vitelline duct omphalomesenteric duct, which connects yolk sac to midgut lumen
Vitelline fistula- vitelline duct fails to close–> meconium discharge from umbilicus
Meckel diverticulum (partial closure of vitelline duct)- may be asymtomatic, may patent portion attached to ileum may have heterotopic gastric and or pancreatic tissue–> melena, hematochezia, abdominal pain
Aortic arch derivatives
develop into arterial system
1st- part of maxillary artery (branch of external carotid) maximal
2nd- Stapedial artery and hyoid artery, Stapedial
3rd- Common carotid artery and proximal part of internal carootid artery (c 3rd letter of alphabet)
4th- on left, aortic arch, on right proximal part of right subclabian, 4th limbs
6th- pulmonary
Pharyngeal apparatus
composed of pharyngeal clefts, arches, pouches
Pharyngeal Clefts- derived from eCtoderm- and grooves
Pharyngeal Arches- derived from mesoderm (muscle arteries) and nueral crest (bones, cartilage)- mesoderm and neural crest
Pharyngeal Pouches- derived from endoderm
CAP (Clefts, Arches, Puches)
Pharyngeal cleft derivatives
1st cleft develops into external auditory meatus
2nd through 4- temporary cervical sinuses, obliterate
Persistent cervical sinus–> pharyngeal cleft cyst within lateral neck ANTERIOR to Sternocleidomastoid muscle (doesnt move with swallowing vs thyroglossal duct cyst)
pharyngeal arch derivatives
1st pharyngeal arch
Maxillary process–> maxilla, zygoMatic bone,
Mandibular process- Mechel cartilage–> mandible
Malleus and incus sphenoMandibular ligament
Muscles of Mastication– temporalis, Masseter, lateral and Medial pterygoids, Mylohyoid, anterior belly of digastric, tensor tympani, anterior 2/3 of tongue, tenso veli palatini
CN v3 chew
Pierre Robin sequence- micrognathia, glossoptosis, cleft palate, airway obstruction
Treacher Collin syndrome- AD neural crest dysfunction–> craniofacial abnormalities (zygomatic bone and mandidibular hypolasia) hearing loss, airway compromise
2nd pharyngeal arch
Reichert cartilage: Stapes, Stylid process, LeSSESr horn of hyoid Stylohoid ligament
Muscles of faciall expression, Stapediud, Stylohoid, platysma, posterior belly of digastric
CN7 - Facial expression SMILE
3rd pharyngeal arch
Greater horn of hyoid
Stylopharyngeus (glossopharyngeal nerve)
CN9 (swallow stylishy
4th and 6th
ACCCT
Artenoids, Cricoid, corniculate, cuneform, thyroid *used to sing)
CN x simply swallow and speak
Pharyngeal pouch pneumonic
EAR, Tonsils, bottom to top 1, Ear 2. tonsils 3. Dorsal (bottom for inferior parathyroids) 4. ventral (to= thymys 5. top superior parathyroids)
Cleft lip and ceft palate
Distint multifactorial etiologies, but often occur togerthe
Cleft lip- due to failure of fusion of maxillary and merged medial nasal processes (formation of 1’ palate)
Cleft palate- due to failure of fusion of the 2 lateral palatine shelves or failure of fusion of lateral palatine shelf woth nsasal septum and or 1’ palat formation
Genital embryology male vs female
Females- default development, mesonephric duct degenerates and paramesonephric duct develops
Males- SRY Gene on Y chromosome– produces testis determining factor–> testes development . Sertoli cells secrete Mullerian inhibitory factor (antimullerian hormone) that suppresees the development of paramesonephric ducts, Leydig cells secrete androgens that stimulate development of mesonephric ducts
Paramesonephric (Mullerian ducts)
Develops into female internal structures– fallopian tubes, uterus, upper portion of vagina (the lower portion is from the urogenital sinus) Male remnant is appendix testis
Mullerian agenesis- may present as 1’ amenorrhea (due to a lack of uterine due to lack of uterine development 2’ sexual characteristics (functional ovaries)
Mesonephric (wolffian ducts)
Develops into male internal structures (except prostate)- Seminal vesicles, Epididymus, Ejaculatory duct, ductus deferens (SEED) Female remnant is gartner duct
sexual differentiation
XY- has SRY gene–> testes (Leydig cells + Sertoli cells)
Leydig cells Make testosterone–> activates mesonephric duct (wolffian duct)–> internal male genitals
Leydig cells also contain 5a reductase–> External male genitals and prostate
Sertoli cells produce inhibitory mullerian duct
XX has no SRY–> ovaries–> estradiol–> external female genitals ( Clitoris, Labia, Distal vagina)
Lack of MIF–> internal female genitals (fallopian tubes, Uterus, Proximal vagina
Sexual differentiation issues
Absence of sertoli cells or lack of Mullerian inhibitory factor–> develop both male and internal female internal genitalia and male external genitals
5areductatse def–> no DHT –> male internal genitals with ambiguous external genitals until puberty
Leydig Leads to male (internal and external sex differentiation)
Sertoli Shuts down female (internal sexual differentiation)
Uterine (mullerian duct) anomalies
Septate uterus- common anomaly , incomplete resorption of septum–> decreased fertility and early misscarriage, cut out the septum
Bicrnuate uterus- incomplete fusion of mullerian ducts–> increased risk of complicated pregnancy, early pregnancy, malpresentation prematurity
Uterus didelphys- commplete failure of fusion double uterus, cervix and vagina– pregnancy possible
Gonadal venous drainage
Left ovary/ testes–> left gonadal vein–> left renal vin –> IVC
Gonadal lymph drainage
Ovaries/testes–paraaortic lymph nodes
Body of uterus/ cervix/ superior part of bladder–> external iliac nodes
prostate/cervix/corpus cavernosum/proximal vagina–> internal iliac nodes
Distal vagina/ vagina/ scrotum/ distal anus–> superficial inguinal nodes
Glans of penis–> deep inguinal nodes
Ligaments of female reproductive anatomy
Infundibulopelvic (suspensory ligament) Connects ovaries to lateral pelvic walls contains the ovarian vessels, ligate them during oophorectomy to avoid bleeding , Ureter courses retroperotneally at risk of injury
Cardinal/transverse cervical ligaments- connects cervix to side wall of pelvis, contains uterine vessels, ureter at risk of injury during ligation in hysterctomy
Round ligament of the uterus- connects uterine horn to labia majora. Derivative of gubernaculum, travels through round ligament of inguinal canal above the artery of Sampson
Broad ligament- connects uterus, fallopian tubes, and ovaries to the pelvic side wall. contains Ovaries, fallopian tubes, round ligaments of uterus, fold of peritoneum that comprimises the mesosalpinx, mesometrium, and mesovarium
Ovarian ligament- medial pole of ovary to uterine horn, derivative of gubernaculum, ovarian ligament latches to lateral uterus
urethral injury
Occurs almost exclusively in men
Blood at urethra
dont catheterize them
Anterior urethral injury- bulbar, spongy urethra. due to perneal straddle injury, blood accumulates in scrotum, if buck fascia breaks, urine escapes into perineal space, blood will accumulate at urethral meatus and scrotal hematoma
Posterior urethral injury- membranous urethra injured, due to pelvic fracture, urine leaks into retropubic space. Blood at urethra meatus and high riding prostate
Autonomic innervation of male sexual response
Erection- Parasympathetic nervous system (pelvic splanchnic nerves, S2-S4). NO–> increased cGMP–> smooth muscle relaxation–> Vasodilation-> proerectile
NE-> increased Ca–> smooth muscle contaction–> vasoconstriction –> antierectile
Emission–> sympathetic nervous system (hypogastric nerve, T11-L2)
Expulsion- visceral and Somatic nervers (pudendal nerve)
Point, Squeeze, and shoot
S234 keep the penis off the floor
PDE5 inhibitor (sildenafil–> decreased cGMP breakdown)
Spermatogonia
Line the seminiferous tubules, Germ cells
Maintain germ cell pool and produce 1’ spermatocytes
Sertoli cells
Secrete inhibin B–> inhibit FSH
Secrete androgen-binding protein –> maintain local levels of testosterone
Produce MIF. Tight junctions between adjacent sertoli cells form blood-testis barrier–> isolate gametes from autoimmune attack
Support and nourish developing spermatozoa, Regulated spermatogenesis
Temp sensitive–> decrease sperm production and decreased inhibin B with increase temperature
Line seminiferous tubulues, Non germ cells, Convert testosterone and androstenedione to estrogen via aromatase, Sertoli cells are inSide Seminfourus tubules, Support Sperm Synthesis, and inhibit FSH, homolog of female granulosa cells
increased tem seen in varicocele, cryptorchidism
Leydig cells
Secrete testosterone in the presence of LH, testosteron production unaffected by temperature
Interstitial cells, endocrine cells, Homolog of female theca interna cells- Leydies dig testosterone
Spermatogenesis
begins at puberty with spermatogonia, Full development takes 2 months, Occurs in seminiferous tubules
Produces spermatids that undergo spermiogenesis (loss of cytoplasmic contents, gain of acrosomal cap) to form mature spermatozoa
Gonium is going to be a sperm, Zoon is Zooming to the egg
Tail mobility impaited in ciliary dyskinesia/kartagner syndrome–> infertility Tail mobility normal in CF, just no vas degerens)
estrogen
Ovaries make them (17 B estradiol), placenta (estriol), adipose tissue (estrone via aromatization)
Potency (estradiol> Estrone> estriol)
Develops the genitals and breast, female fat distribution
Growth of follicle, endometrial proliferation, increased myometrial excitability
Upregulation of estrogen, LH, and progesterone receptors, feedback inhibition of FSH and LH surge stimulates prolactin secretion
increased transport proteins, SHBG, increases HDL, decreased LDL
Pregnanct- 50 fold increase estradiol and strone, 1000 fold increase in estriol (indicator of fetal well being
Estrogen receptors expressed in cytoplasm , translocate to nucleus when bond to estrogen
Progesterone
comes from corpus luteum, placenta, adrenal cortex and testes
During luteal phase, preps uterus for implantation of fertilized egg
Stimulation of endometrial glandular secretion and spiral artery development
Production of thick cervical mucus–> inhibits sperm entry
Prevents endometerial hyperplasia, increased body temp, decreased estrogen receptor expression, decreased gonadotropid LH FSH secretion
During pregnancy maintain of pregnancy, decreased myometrial excitability–> decreased contraction frequency and intensity, decreased prolactin action on breast
Fall in progesterone after delivery disinhibits prolactin–> milk let down increased progesterone is indicative of ovulation
OOgenesis
1’ oocytes begin meiosis 1 during fetal life and complete meiosis 1 just before ovulation
Meiosis 1 is arrested in prOphase 1 for years until Ovulation
Meiosis 2 is arrested in metaphase 2 until fertilization when egg METs sperm,
Ovulation
increased estrogen, increased gNrh receptors on aterior pituitary
Estrogen surge then stimulates LH release –> ovulation rupture of follicle
Increased temperature (progesterone induced)
Mittelschmerz– transient mid cycle ovulatory pain (Middle hurts) follicular swelling
Menstrual cycle
Follicular phase can vary in length, luteal phase is always 14 days (the corpus luteum can only survive 2 weeks without hCG, and the endometrium can only reach a certain length) Follicular growth is fastes during 2nd week of the follicular phase
Estrogen stimulates endometrial proliferation, estrogen maintains endometrium to support implantation
decreased progesterone –> dcrease fertility
Abnormal uterine bleeding
Characterized as either heavy menstrual bleeding or intermenstrual bleed
PALM COEIN Structural causes (palm)- Polyp, Adenomyosis, Leiomyoma, malignancy/hyperplasia
Nonstructural causes (COEIN) - coagulopathy, ovulatory, Endometrial, Iatrogenic, no idea
Pregnancy
Fertilization most commonly occurs in upper end of fallopian tube (the ampula) in one day of ovuation before progesterone creates a mucus plug
Syncytiotrophoblasts secrete hCG which is detectable in blood 1 week after conception
Gestational age- calculated from date of last menstrual period
increased GFR, decreased BUM and creatinine, decrease glucosuria threshold
increased CO, anemia (relatice), hypercoagulability (evolution to prevent blood loss at delivery)
hyperventilation (eliminate fetal CO2
increase lipolysis and fat utilization
HPL
syncytiotrophoblast of placenta
stimulates insulin production, overall increase insulin resistance
Gestational diabetes can occur if maternal pancreatic function
