Repro Memorization Flashcards
what are the 4 weak areas of the pelvis?
pubic rami, acetabulum, SI joints, and iliac ala
where do obturator internus and piriformis attach?
greater trochanter so cause lateral rotation of thigh
what is the tendinous arch of levator ani made up of?
obturator internus fascial thickening
three muscles that make up levator ani and their orientation
iliococcygeus, pubococcygeus, and puborectalis from lateral to medial
nerve supply and vein system above pectinate line
inferior hypogastric plexus (visceral) and superior rectal vein (portal system)
nerve supply and vein system below pectinate line
inferior rectal nerves (somatic) and inferior rectal veins (systemic)
key landmark for ureters
runs inferior to vas deferent/uterine artery
internal urethral sphincter innervation
smooth muscle from inferior hypogastric plexus
external urethral sphincter innervation
skeletal muscle from deep perineal branch of pudendal nerve
what separates rectouterine and vesicouterine pouches?
broad ligament of the uterus
contents of broad ligament of uterus
round ligament, uterine tube, proper ovarian ligament, ovary, uterus, ovarian vessels (suspensory ligament)
Mesovarium location
connects ovary to mesosalpinx
mesometrium location
connects uterine tube to uterus
mesosalpinx location
connects uterine tube to uterus and ovary
cardinal ligament function
supports cervix
paracolpium
thick fascia from lateral vagina to tendinous arch
normal uterus position
anteverted and anteflexed
vert angle
cervix and vagina
flex angle
uterine body and cervix
where does inferior gluteal A. travel
through greater sciatic foramen but below piriformis
sacral plexus contributions and locations
L4-S4; posterolateral walls of pelvic cavity anterior to piriformis
pudendal nerve contributions and location
S2-S4; enters perineum through lesser foramen in the pudendal canal and innervates external genitalia and anal canal below pectinate line
superior gluteal nerve contributions and location
L4-S1 exits through greater foramen above piriformis
inferior gluteal nerve contributions and location
exits through greater foramen below the piriformis
coccygeal plexus contributions and location
S4-S5 on pelvic side of coccygeus muscle
superior hypogastric plexus
only sympathetic in front of L4 bifurcation, gives rise to ureteric, testicular, and common iliac plexuses
inferior hypogastric plexus
superior sacral sympathetic and pelvic splanchnic PS; gives rise to plexuses on pelvic viscera (rectum and internal anal sphincter)
gray rami communicantes
postganglionic sympathetic fibers from trunk to anterior rami
Pelvic splanchnic nerves
preganglionic PS fibers to inferior hypogastric plexus
Sacral splanchnic nerves
postganglionic sympathetic fibers to inferior hypogastric plexus
external pudendal artery supplies what?
scrotum and penis or labia majora and clitoris
Pudendal nerve contents (4)
preganglionic parasympathetic
somatic motor
somatic sensory
postganglionic parasympathetic
duct that opens into UG sinus
Wolffian or mesonephric duct
how does the paramesonpehric duct disappear in males?
SRY-SOX9-Anti mullerian hormone
AMH regression in weeks 8-10
hypospadia
urethral opening lower on ventral side of penis
epispadia
urethral opening on dorsal side of penis; associated with exstrophy of bladder
superior gubernaculum gives rise to
round ligament of ovary
inferior gubernaculum gives rise to
round ligament of uterus
What is the seminal colliculus
enlarged area on the urethral crest (prostatic) where the two ejaculatory ducts open into
blood supply of prostate
inferior vesicle and middle rectal arteries
blood supply of seminal vesicles
superior and inferior vesicular arteries
what makes up seminiferous tubules?
Sertoli cells with interspersed germ cells; spermatogonia near periphery and spermatozoa near lumen of tubule
what cells synthesize and secrete T? (males)
leydig cells
how is T stored?
bound to ABP from Sertoli cells in the seminiferous tubules
action of 5alpha-reductase in peripheral tissues
conversion of T to dihydrotestosterone (DHT)
where are there high amounts of estrogens in males?
fluid of seminiferous tubules from the Sertoli cells (aromatase)
function of aromatase
T to estradiol
When does T production begin?
7-8 weeks gestation; Androgens diffuse to target cells and bind to ARs which are NRs
What does FSH cause
Sertoli cells to secrete ABP into lumen of seminiferous tubules
what happens in the epididymis?
maturation for a month, sperm become strongly motile, and decpacitation
what do seminal vesicles secrete?
fructose, prostaglandins, other nutients
function of prostaglandins
reacts with female cervical mucous to make it less thick and helps move sperm toward ovaries
Capacitation changes
washing away of inhibitory factors
loss of cholesterol making sperm head weaker
sperm more permeable to Ca which increases motility
What are stored in the acrosomal head of sperm?
hyaluronidase- depolymerizes Hyaluronic acid polymers that hold ovarian granulosa cells together
proteolytic enzymes digest proteins that adhere to ovum
Kallman’s Syndrome
GnRH neurons fail to migrate to hypothalamus during embryonic development; delayed or absent puberty and an impaired sense of smell
Klinefelter’s Syndrome
XXY; phenotypically male, low androgen production but increased gonadotropins; seminiferous tubules destroyed leading to infertility
When does Meiosis II resume in women?
only at fertilization
Mural Granulosa Cell function
steroidogenic and remain in ovary after ovulation to become the corpus luteum
periovulatory period
time from onset of LH surge to ovulation
what is released from the oocyte in response to LH?
GDF9; stimulates cumulus cells to secrete hyaluronic acid to cause expansion of oocyte complex making it easier for sperm to locate and penetrate
receptors present on Theca cells
LH
receptors present on granulosa cells
LH and FSH
what acts on cells of the corpus luteum after ovulation>
LH
source and function of inhibins
granulosa cells secrete inhibits in response to FSH (and LH after ovulation) which inhibit FSH production
what does the corpus luteum secrete?
progesterone, estradiol, and inhibins
function of 17B-HSD
estrone to estradiol
theca cell contribution to estradiol synthesis
desolate and 17-a hydroxylase
granulosa cell contribution to estradiol synthesis
aromatase
what stimulates proliferation and differentiation of the endometrium?
estrogen from developing follicles
net effect of OCPs
suppressed secretion of LH and FSH (act on hypothalamus and anterior pituitary); low LH levels prevent LH surge and ovulation
Polycystic Ovarian Syndrome
high LH, low FSH, high T; hyperandrogenism and increased DHEA; young obese females
Spermatid Phases
Golgi-makes acrosomal vesicle and poles
Cap- AV caps anterior half of nucleus
Acrosome- head in sertoli and flagella tail in lumen of ST
Maturation- cytoplasm removed and spermatid released
when is manchette formed?
acrosome phase of spermiogenesis
What secretes ABP and what does it bind?
Sertoli cells; T and DHT
what is the layers of myoid cells that create peristaltic waves to move spermatozoa through ST to duct called?
lamina popria; thickens with age leading to infertility due to small ST lumen
what binds 3 corpora of the penis together forming a capsule?
tunica albuginea
what does the deep artery of penis branch into?
helicine arteries
what do granulosa-lutein cells secrete and what receptors do they have
progesterone and estrogen with FSH and LH; express LH receptors
what to theca lutein cells produce
androstenedione and progesterone with LH stimulation
where is SRY gene expressed?
pre-sertoli somatic support cells
when does paramesonephric duct begin to degenerate in males?
week 9
what does DHT from fetal leydig cells contribute to formation of? (3) think more outside features
genital tubercle - penis
genital swellings - scrotum
urethral epithelium - prostate
embryonic layer for seminal vesicle
buds from mesonephric duct which is intermediate mesoderm (from genital ridge)
prostate and bulbourethral glands derived from
endodermal buds of UG sinus
WNT4 expression causes
FOXL2 which suppresses SOX9 (leydig and Sertoli cells)
what does the gubernaculum become?
scrotal ligament
ovarian ligament or round ligament of the uterus
upper vagina and uterus derived from what germ layer
mesoderm
lower vagina (most of the entire vagina) derived from
endoderm
what two parts make the placenta a fetomaternal organ?
chorionic sac from fetus
endometrium from mother
extraembryonic structures from blastocyst
CUCA; connecting stalk, umbilical vesicle, chorionic sac, amnion
layers and function of the decidua
functional layer of endometrium that separates after birth
basalis - deep to conceptus and maternal part of placenta
capsularis- superficial overlies conceptus
parietalis- rest of decidua
what is the blood supply to the embryo coming through during amnion development (primordial uteroplacental circulation)
lacunar networks
what germ layer lines trophoblast and covers amnion?
extraembryonic somatic mesoderm
what germ layer surrounds umbilical vesicle
extraembryonic splanchnic mesoderm
how are amnion and umbilical vesicle attached to the chorion
connecting stalk
what is the chorionic sac made up of?
Extraembryonic somatic mesoderm, cytotrophoblast, and syncytiotrophoblast
what is the fetal part of the placenta
villous chorion that projects into the intervillous space containing maternal blood
how does the chorionic villi (fetus) attach to decidua basalis (mother)
cytotrophoblastic shell on the external layer of trophoblast cells on maternal side
what marks the first stage of placental development
projections from primary chorionic villi
primary villi structure
cytotrophoblast core covered by syncytiotrophoblast
secondary villi structure
extraembryonic mesoderm invades primary villi
mesoderm core-cytotrophoblasts-syncytiotrophoblasts
tertiary villi structure
extraembyronic mesoderm differentiates into capillary and blood cells
what makes up a fetal cotyledon
2 or more main stem villi and multiple branch villi
cause of preeclampsia
reduced development of chronic villous tree
syncytial knots
nuclei in syncytiotrophoblast aggregate to form multinucleate protrusions in the 3rd trimester
what enzymes do testis lack that prevents making glucocorticoids and mineralcorticoids
21 beta hydroxylase and 11 beta hydroxylase
what do testis have that lets them convert androstenedione to T
17 beta hydroxysteroid dehydrogenase
what cells in male make estrogens
Sertoli cells because they have aromatase
if testosterone present at 2nd embryonic month
penis and scrotum development; if not vagina and clitoris
what hormone is essential for spermiogenesis
FSH acts on sertolis to nurse and form sperm cells
main action of FSH in follicular phase of the ovarian cycle
selection of the dominant graffian follicle
what cells persist during follicular atresia and why?
thecal cells (retain their LH receptors) to repopulate the cellular stroma of the ovary
what causes the surge in LH?
rapid rise in ovarian estradiol secretion
how does BBT change throughout menstrual cycle
BBT goes down with higher estrogen early in the cycle; rises after ovulation with higher progesterone
what stimulates proliferation and differentiation of endometrium
estrogen
endometriosis
tissue that grows normally inside uterus grows outside of it; painful; lots of bleeding
turner syndrome
elevated serum FSH and primary hypogonadism
what is the functional unit of the placenta
chorionic villi
how does the fetus excrete waste byproducts
amniotic fluid
what does hCG come from and do?
syncytiotrophoblasts; binds LH with high affinity to stimulate CL to not undergo luteolysis
what does hPL come from and do?
syncytiotrophoblasts; coordinates conversion of glucose to fatty acids and ketones; ANTAGONISTIC TO MATERNAL INSULIN; similar to prolactin
Progesterone actions during pregnancy
reduces uterine motility and prevents uterine contractions; released primarily into maternal compartment so blood levels in mother rise
estrogen actions during pregnancy
increases uteroplacental blood flow, LDL receptor expression, and prostaglandin/oxytocin receptors for birth
where is placental cholesterol derived from?
mother
where are placental enzymes derived from?
fetal adrenal gland and liver
why does the fetus lack the ability to produce estrogen?
no 3 beta hydroxysteroid DH or aromatase
what does the fetus do to steroid intermediates?
conjugates sulfates to reduce their activity, then uses sulfates to allow placenta to complete the steroidogenesis
what system mediates increase in maternal blood volume
RAAS; rapid increase during 2nd and 3 trimester
why does MAP decrease during pregnancy despite increase in blood volume
vasodilating effects of progesterone and estrogen
what causes increased alveolar ventilation during pregnancy?
progesterone
parturition stage 0
uterine tranquility
parturition stage 1
uterine awakening and initiation of birth extending until complete cervical dilation
parturition stage 2
active labor until delivery
parturition stage 3
delivery of fetus until expulsion of placenta and end of all contractions
when are prostaglandin and oxytocin receptors increased as well as enzymes to breakdown matrix and cervix?
stage 1
what 3 factors induce contractions during stage 2?
increased prostaglandins, myometrial cell connectivity, and myometrial response to PGs and Oxytocin
what does progesterone do during parturition?
relaxes myometrium need to antagonize to induce labor
what does an increase in estrogen receptors after desensitization to progesterone during parturition cause?
increase responsiveness to oxytocin and prostaglandins; forms gap junctions
prostaglandin function
stimulates myometrial contractions; PGF2alpha is key and potentiates oxytocin
what makes PGF2alpha
decimal production
what is the primary stimulus for release of oxytocin called? what does it do
Ferguson reflex; distention of cervix causes oxytocin release which then causes PGF production in bursts
relaxin origin and function
CL, placenta, and decidua; keeps uterus quiescent and may help soften/dilate the cervix
what does placenta made CRH do
promotes myometrial contractions; stimulates fetal ACTH secretion increasing cortisol and estrogen
what is considered a preterm labor
before 37th week
what is the fundamental secretory unit of the breast
series of secretory lobules that empty into ductules; ductules combine to duct which widens at ampulla
