repro huge review - minus pregnancy foetus and giving birth and gametogenesis and peritoneum Flashcards
1
Q
what makes up the testes
A
seminiferous tubules, made up of sertoli cells (site of spermatogenesis)
2
Q
what surround seminiferous tubules
A
tunica albuginea - leydig cells secrete testosterone (lipid)
3
Q
Blood supply to testes
A
abdominal artery- gonadal artery
4
Q
venous drainage
A
right - right testicuar to IVC
left- left testicular to left renal to IVC
pampimiform plexus
5
Q
lymph drainage of testes
A
para aortic
6
Q
scrotal lymphatic drainage
A
inguinal lymph notes
7
Q
spermatic cord made up of
A
3 fascia layers (internal, cremasteric, external0
3 arteries (testicular, to vas, cremasteric)
3 veins (testicular, to the vas, cremasteric0
3 nerves (ilioinguinal, cremasteric, sympathetic)
vas deferens
8
Q
layers of scrotum
A
S skin
D dartos fascia and muscle
E external spermatic fascia (EO muscle)
C cremasteric fascia and muscle (IO)
I internal spermatic fascia (transverse abdominus)
T tunica vaginalis
T tunica albuginea
9
Q
cremasteric muscle supply
A
cremasteric artery vein and nerve
10
Q
functions of prostate
A
prevent urine escaping, produce alkaline solution
11
Q
BPH and prostate cancer location
A
transitional zone BPH
peripheral zone cancer
12
Q
what goes through prostate as well as urethra
A
vas deferens, joined by ejaculatory duct before, bringing fructose rich solution from seminal vesicle
13
Q
ejaculate make up
A
65% seminal fluid
25% prostate
10% testes
14
Q
penis blood supply
A
internal iliac artery, smaller vessels can get blocked by atherosclerosis giving erectile problems
15
Q
Erection nerve control
A
vasodilation PNS
vasoconstriction to terminate erection SNS
16
Q
nervous system for ejaculation
A
sympathetic
17
Q
external os pre and post baby
A
pre is hole, post is slit
18
Q
uterus in pregnancy
A
push up on stomach - acid reflux
push down on bladder - frequency
push back on LI - constipation
19
Q
vagina
A
full of glycogen for lactobacillus, lactic acid. Less oestrogen = less glycogen = less respiration altering ph
20
Q
What is pouch of douglas
A
recto uterine pouch, fluid build up can cause shoulder tip pain due to parabolic gutters irritating diaphragm supplied by phrenic nerve C3,4,5
21
Q
peritoneal ligaments
A
Broad ligament- mesometrium, mesosalpinx, mesovarium
Suspensary ligament to the ovary - covers blood vessels and nerves to uterus
Round ligament and ligament to ovary- remnants of gubernaculum
22
Q
blood supply female repro system
A
uterine artery (internal iliac), ovarian artery (abdominal aorta), pam-uniform venous plexus
23
Q
important in hysterectomy
A
ureter travels under uterine artery - must not damage ureter
24
Q
lymph nodes of uterus drain to
A
para aortic sinus
25
lymph nodes of cervix drain to
internal/external iliac and sacral
26
normal uterus position
anteverted and ante flexed (less than 180 degrees)
27
journey of egg
1- burst through peritoneal membrane of ovary, fimbrae in fallopian tubes
2 - goes through infundibulum, ampulla (fertilisation/ectopic pregnancy), isthmus (ciliated cells help)
28
fallopian tubes features
infection can spread from fallopian tubes into peritoneal cavity eg STI, contain peg cells (secrete factors to nourish and maintain egg), and ciliated cells
29
ovarian cancer
egg bursts through ovary causing trauma
30
cervical cancer
columnar epithelium of cervix exposed to acidic environment of vagina in transitional zone, this exposed area is not used to this unlike stratified squamous cells, metaplasia occurs
31
ovarian cysts
fluid filled lesions, pain due to stretching of peritoneum, rupture, direct pressure and torsion. DO not burst due to seeding
32
Ectopic pregnancies
felt as severe pain on side of implantation, confused with appendicitis. Rupture - uterine and ovarian arteries can cause haemorrhage
33
Endometriosis
endometrial tissue which is normally found lining inside of uterus is found elsewhere, possibly pouch of douglas
34
embryonic development of girl or boy
start with primordial germ cells
SRY from Y chromosome = testes and vas deferens and epididymis
No SRY (XX) - gonads develop into ovaries and uterus tubes and vagina
following this external genitalia will develop (either penis/scrotum or vulva)
35
urogenital and GI tract development
3 systems from hindgut (tube from yolk sac folding), dilated end (cloaca)
Cloaca has no surrounding mesoderm, no blood supply, so causes orifice
Urogenital ridge - area of intermediate mesoderm, produces kidneys and gonads
36
how do primordial germ cells get to urogenital ridge
come from allantois into wall of yolk sac and migrate along retroperitoneum to urogenital ridge
37
Duct differentiation
paramesonephric (mullerian) and mesonephric (wollfian)
Men - SRY causes androgens, testis produce Mullein inhibiting hormone, paramesonephric ducts regress. Androgens support development of mesonephric ducts - vas deferens and epididymis. Testis migrate down gubernaculum
Women - no SRY, no androgens, no MIH, paramesonephric ducts develop and mesonephric ducts degenerate. PM ducts move towards each other and fuse to form one tube, meets urogenital sinus, produces uterus and vagina
38
what can go wrong in duct differentiation
exogenous androgens but no testis to produce MIH = both ducts develop
Androgen insensitivity syndrome = testosterone receptors don't work so both ducts degenerate as MIH still present
39
external genitalia production
genital tubercle, folds and swellings in both genders
Male - genital tubercle elongates, genital folds fuse to form spongy urethra, driven by androgen dihydrotestosterone
Female - no fusion, genital swelling grows to labia majora and minor, genital tubercle forms clitoris
40
Descent
male - testis are retroperitoneal, descend down gubernaculum (attaches gonads to future scrotum), takes layers of muscle wall with it
Female - ovary descends down gubernaculum, has some remnants (round ligament and ligament to ovary)
41
what influences puberty
pineal gland; melatonin
47kg in girls - leptin will sense amount of adipose to sense if adequate for reproductive life
nutrition
42
puberty scale
Tanner scale
43
precocious puberty causes (pre 8)
congenital adrenal hyperplasia, hydrocephalus, brain injury, pineal tumour, meningitis (GnRH pulsations interfered with)
shorter child as epiphyseal growth plates fuse earlier, GnRH analogues block pituitary hormones = treatment
44
Delayed puberty
If LH and FSH hormones are normal, blockage preventing menstruation, ovaries don't respond to oestrogen
LH and FSH low due to weight or malnutrition
gonadal or pituitary problem
45
Female puberty
9-13, breast buds and pubic hair (testosterone)
Adrenarche - growth spurt and menstruation
Menarche - adult pubic hair and breasts
Aromatase = testosterone into oestrogen
Oestrogen closes epiphyseal growth plates and maintain bone mass
46
Male puberty
begins 10-14 with testicular development (4ml)
pubic hair growth and spermatogenesis
growth spurt (12 months after start), adult genitalia and pubic hair
47
initial levels of pre puberty testosterone and oestrogen boys and girls
same
48
HPG axis - hypothalamus - pituitary - gonadal
HPG axis switches on by gradual increase of GnRH in pulses from hypothalamus, controlled by Leptin and Photoperiod
GnRH travels in blood to AP, LH and FSH produced
pulsation avoids down regulation of GnRH receptor
GH needed for growth spurt
49
HPG axis control
positive and negative feedback, androgens and oestrogens prevents GnRH being produced
natural rise in pulsating of LH during sleep (hence high morning testosterone)
50
HPG in females
FSH target ovarian cells known as granulose cells to produce oestrogen
LH targets ovarian cells known as Theca internal cells to produce androgens
stimulate sex hormone production of oestrogen, progesterone and inhibit
51
feedback of HPG female
normal oestrogen = negative GnRH production
High = positive GnRH = LH surge
Progesterone prevents positive feedback from oestrogen and will increase negative feedback
52
Inhibit role women
produced by granulose cells in corpus lute to inhibit FSH
53
HPG in males
LH - leading cells, testosterone 9affected vy circadian cycle and environment)
FSH - sertoli cells, maturation of sperm cells and inhibin secretion (causes negative feedback on FSH0
54
sertoli cells features
gives blood barrier due to tight junctions, good as sperm is foreign antigens ( non self) and would be destroyed by bodies immune system
55
corpus luteum produces
oestrogen and progesterone
56
menopause hormones
follicle cells depleted, sex steroid hormones decrease, initially low oestrogen causes negative feedback so FSH and LH increase (FSH by more as less inhibin)
57
progesterone contraception
mucus sticky and stops sperm entry
58
ovarian cycle
follicle stage, luteal stage (corpus lute)
59
endometrial cycle
proliferative and secretory stage
oestrogen - proliferative
progesterone - specialise
Functional layer = hormone responsive, sheds if no pregnancy
Basal layer = grows functional layer
60
thickening of lining and mucous
Thickening occurs during follicular stage due to oestrogen thickening endometrium and myometrium
progesterone causes thickening of cervical mucous and endometrium to specialise into secretory form
Increases body temp, metabolic changes
61
Endometriosis
causes irritation to peritoneum giving adhesions, these areas respond to oestrogen
GnRH agonist would stop FSH and LH but this would cause osteoporosis
62
stages of menstrual cycle
preparation of gamete
ovulation
luteal/waiting phase
fertilisation
63
Preparation of gamete
FSH increases = primordial follicle into graafian follicle (mature), binds to granulose cells and allows theca interna development (day 1)
Mature follicle secretes oestrogen and inhibin secretion begins
FSH allowed to increase due to lack of inhibin up to this point
Low oestrogen levels prevents FSH and LH rising too much
Oestrogen and inhibin rise due to follicle secreting oestrogen
Positive feedback causes LH surge, but little FSH due to inhibin
Progesterone production begins as granulose cells become responsive to LH
64
Ovulation
rise in LH causes oocyte to complete meiosis 1 and 2 will start as well as ovulation
corpus luteum produces oestrogen and progesterone and inhibin
neg feedback - LH and FSH suppressedL
65
Luteal/waiting phase
corpus luteum producing all 3, regress in 14 days if no further rise in LH
fall in ovarian and gonadal hormones = cycle reset unless fertilisation occurs
66
Fertilisation
Syncytiotrophoblast produces HcG, same effect as LH, maintains neg feedback so no more FSH or new gametes maturing
corpus luteum and placental HcG = hormones to support pregnancy until placenta capable
67
Amenorrhoea
primary = failure to establish menstruation by 16
secondary = stopping of previously normal menstruation for over 6 months
main causes = pregnancy and menopause, or hormonal problems
68
Common menorrhagia causes
fibroids, polyps, endometrial cancer, bleeding diathesis, warfarin
69
Fibroids
benign tumours of smooth muscle of myometrium, hormone dependant, can go away at menopause. Cause heavy bleeding due to large surface area
Treated with GnRH agonists
70
Dysmenorrhea
primary = idiopathic
secondary = endometriosis or obstructed menses
71
Turners syndrome
XO, problems with ovary so it would respond to GnRH, FSH or LH
72
semen
seminal vesicles = fructose
prostate gland = citric acid
bulbourethral = alkaline
73
Gonorrhoea
gram negative diplococcus
males - urethral/anal discharge, dysuria
Females - asymptomatic, discharge, abdo pain
IM ceftriazone and oral azithromycin (good for chlamydia)
74
Abnormal discharge
chlamydia, gonorrhoea, trich (frothy), BV (fishy white thin), candida albicans (thick white)
75
ulceration
herpes painful, syphilis not painful
76
skin manifestations
anogenital warts, scabies, pubic lice
77
systemic complications
PID, reactive arthritis
78
chlamydia
chlamydia trachoma's
male- dysuria, urethritis
female - asymptomatic, increased discharge and intermensterual bleeding
Conjunctivitis and pharyngeal infection
doxycycline
79
why can you gram stain chlamydia
doesn't have cel wall, use serology, urine tests and PCR
urine test in men and endocervical swabs in women
80
syphilis
treponema pallidum
painless ulcer, 10 weeks after get rash, latent stage, tertiary stage (systemic eg aortic regurgitation)
congenital syphillis
PCR and serology
early syphilis = benzathine pencicillin
81
testing for STIs
men = urine sample for chlamydia, bloods, rectal samples, swab ulcers
women = endocervical swabs for chlamydia and gonorrhoea
high vaginal swabs for BV
bloods/urine sample/swab ulcers
82
trichomonas vaginalis
protozoa
frothy discharge, dysuria, strawberry cervix
metronidazole
83
HSV
HSV 1 = oral and labial
HSV 2 = recurrent symptoms
painful ulceration, dysuria and discharge, fever
virus detection from vesicle fluid serology
aciclovir
84
anogenital warts
benign, HPV virus 6 and 11
physical excision/prevent with vaccination
85
BV
imbalance of pH, fishy discharge, metronidazole
86
candidiasis
candida albicans, COCP increases risk
vaginal discharge, itching, soreness
high vaginal smear
topical and oral antifungals
87
PID
infection ascending from endocervic causing endomertritis, salpingitis and ovarian abscesses
can cause adhesions, infmallatory exudate can fill tubes, can cause peritonitis
abdo pain, pyrexia, abnormal discharge, vaginal bleeding
88
causes of PID
chlamydia, gonorrhoea, BV, copper coil insertion
89
consequences of PID
future ectopic pregnancies, infertility, chronic pelvic pain (fixed retroverted uterus), Fitz Hugh Curtis syndrome (RUQ pain and hepatitis as peritonitis spreads to liver, seen in chlamydia)
90
PID treatment
ceftriazone, doxycycline and metronidazole for 14 days
surgery for adhesions and abscesses
91
menopause
end of menstruation for 12 months with no biological cause
45-55
pathological pre 40
92
histology of cervical cancer
dyskaryosis (abnormal nuclei0, increased nuclear:cytoplasmic ratio, abnormal chromatin, mitotic figures
93
cervical cancer risk factors
HPV 16 and 18, E6 and E7 produced, inhibit tumour suppressing p53 and pRB
94
Screening for cervical cancer
Pap test and colposcopy
95
CIN
Cin I = some dysplasia but mostly regresses
CIN II = some more
CIN III = carcinoma in situ, not invaded basement membrane, can cone excise
96
Invasive cervical cancer
SSC most common, can be adenocarcinoma
Exophytic (polyps) or infiltrative (through basement membrane). Spreads to bladder, ureter, rectum, vagina and para-aortic lymph notes
Screening abnormality, vaginal bleeding
excision/hysterectomy/chemotherapy
97
Ovarian cancer presentation
functional (hormones) or non
Non functional = ascites, distension, pain
CA - 125
BRAC associated
COCP protective
98
Classification of ovarian tumours
Mullerian epithelial tumours - serous, mucinous, endometriod
Germ cell tumours - teratomas mostly, rarely malignant or mono dermal (thyroid), can get yolk sac tumours and choriocarcinomas (malignant)
Sex cord stromal cell - endocrine areas of ovaries (feminising or masculinising)
Mets to ovaries - kruckenberg tumour = from stomach
99
vulvar tumours
usually SSC, HPV and lichen sclerosis are risk factors
VIN = precursor (not in basement membrane)
Vulval cell carcinoma = spreads initially to inguinal, pelvic, iliac and para-aortic lymph nodes. Can then spread to lungs and liver
100
endometrial cancer
endometrial hyperplasia caused by increased oestrogen (an ovulation, obesity and exogenous oestrogen)
In obesity, adipose tissue contains aromatase to convert androgens into oestrogen so there's more circulating
101
endometrial adenocarcinoma
presents with vaginal bleeding, can be polyploid or infiltrative, endometriod or serous
Endometrioid endometrial adenocarcinoma = most common, usually from hyperplasia
Serous carcinoma = more aggressive as cells can drop off, spread to other locations and still be viable
102
Leiomyomas
fibroids = benign smooth muscle tumours ,white and well shaped
Heavy/painful periods, urinary frequency due to bladder compression, infertility
rarely become malignant to cause uterine leiomyosarcoma which mets to lungs
103
testicular cancer
AFP and HCG
risk: testes fail to descend: Cryptorchidism = orchiopexy needed
2 types germ cell (NS or Seminomatous), or sex cord stromal (sertoli or Leydig)
104
Non seminomatous testicular tumours
mix of yolk sac tumours, embryonal carcinomas, choriocarcinomas and teratomas
teratomas are malignant post puberty
seminomas spread to iliac and para aortic lymph nodes
Non seminomatous spread earlier
105
