Reproductive Flashcards
sonic hedgehog
- produced at base of limbs in zone of polarizing activity
- involved in CNS development
- causes holoprosencephaly
Wnt-7 gene
- at apical ectodermal ridge
- for proper organization along dorsal-ventral axis
FGF gene
- at apical ectodermal ridge
- mitosis of underlying mesoderm
- for lengthening of limbs
homeobox
- segmental organization of embryo in a craniocaudal directions
- leads to appendages in wrong location
agenesis
no organ due to absent primordial tissue
aplasia
no organ even with primordial tissue
effect of fetus of alkylating agents
absence of digits
effect of fetus of aminoglycosides
ototoxicity
effect of fetus of DES
vaginal clear cell adenocarcinoma
effect of fetus of lithium
ebstein anomaly (displacement of tricuspid valve)
effect of fetus of drugs
low birth weight, preterm labor, placental problems
effect of fetus of maternal diabetes
caudal regression syndrome, congenital heart defects, neural tube defects, macrosomia, hypoglycemia
findings in fetal alcohol syndrome
- retardation, microcephaly, smooth philtrum, thin vermillion border, small palpebral fissures, limb dislocation, heart defects, fistulas, holoprosencephaly
cytotrophoblast (fetal component)
inner layer of chorionic villi (cyto makes cells)
syncytiotrophoblast (fetal component)
synthesizes hormones like bHCG
- lacks MHC-1 expression
decidua basalis
derived from endometrium, maternal blood in lacunae
umbilical cord
- two arteries from iliac arteries
- one vein from IVC
umbilical vessels are derived from…
allantosis
urachus
duct between fetal bladder and umbilicus
vitelline duct
connects yolk sac to mid gut lumen
first aortic arch derivatives
part of maxillary artery (1st is MAXimal)
second aortic arch derivatives
stadedial and hyoid artery (S=second)
third aortic arch derivatives
common carotid artery and proximal part of internal carotid (C is third letter)
fourth aortic arch derivatives
left = aoritc arch right = proximal part of right subclavian artery (4th = 4 limbs, systemic)
sixth aortic arch derivatives
pulmonary arteries and ductus arteriosus
study embryology
do it
female embryology
mesonephric duct degenerates and paramesonephric duct develops
male embryology
- SRY on Y produces TDF
- sertoli cells produce MIF that suppresses paramesonephric ducts
- leydig cells secrete androgens stimulating mesonephric ducts
mullerian agenesis
Mayer-Rokitansky-Kuster-Hauser syndrome
- lack of uterine development
- primary amenorrhea
mesonephric vs paramesonephric ducts
mesonephric = male paramesonrphric = female
no sertoli cells leads to….
no MIF, leading to development of both male and female internal and external genetalia
5alpha reductase deficiency
cant convert to DHT, leads to male internal and ambiguous external
Leydig and Sertoli for sexual differentiation
leydig leads to male
sertoli shuts down female
genital tubercle
becomes glans penis, corpus cavernosum and spongiosum and clitoris
urogenital sinus
becomes Bartholin/Cower glands, skene’s gland and prostate, lower vagina
urogenital folds
become shaft of penis and labia minora
labioscrotal swelling
becomes scrotum and labia majora
difference in gonadal veins
left takes the longest way (renal vein to IVC)
- right is direct to IVC
structures to para aortic nodes
ovary/testes
structures to external iliac nodes
uterus/cervix/superior bladder
structures to internal iliac nodes
prostate/certix/proximal vagina
structures to superficial inguinal nodes
distal vagina, vulva, scrotum, distal anus
structures to deep inguinal nodes
glans penis
infundibulopelvic ligament
connect ovary to pelvic wall
- contains ovarian vessels
- close to ureter in retroperitineum
cardinal ligament
- connects cervix to side wall of pelvis
- contains uterine vessels
- close to ureter
round ligament
- uterine fundus to labia majora
- same as gubernaculum
ovarian ligament
- uterus to ovary
- ovarian ligament latches to lateral uterus
epithelium of ovary
simple cuboidal, germinal epithelium covering surface
pathway of sperm
Seminiferous tubules Epididymis Vas deferens Ejaculatory ducts Nothing Urethra Penis
urethral injury in pelvic fracture
membranous urethra in posterior
urethral injury in perineal straddle injury
bulbar urethra in anterior
functions of sertoli cells
- secrete inhibin B, androgen binding protein, MIF
- form tight junctions
- nourish spermatozoa
- temperature sensitive
- use aromatase to convert testosterone to DHT
inhibin B
secreted by sertoli cells to inhibit FSH
leydig cell function
- secrete testosterone in presence of LH
source of estrogen
ovary, placenta, adipose tissue
functions of estrogen
- development of genitals and breasts
- growth of follicle, endometrial proliferation
- upregulation of estrogen, LH and progesterone receptors
- inhibits LH,FSH
changes in estrogens in pregnancy
- 50 fold increase in estradiol and estrone
- 1000 fold increase in estriol
progesterone is produced by…
copus luteum, placenta, adrenal cortex, testes
functions of progesterone
- stimulation of spiral artery and gland secrections
- maintain pregnancy
- thicken cervical mucus
- inhibit, FSH, LH
- uterine smooth muscle relaxation
- prevents endometrial hyperplasia
meiosis I is arrested in…
prophase (until ovulation)
meiosis II is arrested in….
metaphase (after fertilization)
mittelschmerz
transient mid-cycle ovulatory pain associated with peritoneal irritation
- can mimic appendicitis
gestational age
from date of last menstrual period
physiologic changes in pregnancy
- increase cardiac output and HR
- anemia (more plasma and RBC, but not to same extent)
- hypercoagulability
- hyperventilation
when does HCG peak in pregnancy
8-10 weeks
source of HCG
syncytiorophoblast of placent
function of HCG
- maintains corpus luteum and progesterone fro 8-10 weeks
- same alpha subunit as LH, FSH, TSH
hCG is high in….
multiple gestations, hydatidiform moles, choriocarcinomas and down syndrome
human placental lactogen
- made by syncytiotrophoblast of placenta
- stimulates insulin production, increases insulin resistance, increase in lipolysis
APGAR
Appearance (pink of blue) Pulse (100bpm) Grimace (cries) Activity (movement) Respiration (breathing)
breastfed infants require supplementation with…
vitamin D
diagnosis of menopause
amenorrhea for 12 months
hormones in menopause
estrogen decreases, very high FSH, high LH (no surge) and high GnRH
menopause before 40 suggests…
primary ovarian insufficiency
5alpha reductase
converts testosterone to DHT
aromatase
converts androgens to estrogens (in adipose)
order of sperm cells
- spermatogonium
- primary spermatocyte
- meiosis I
- secondary spermatocyte
- meiosis II
- spermatid
7 spermatozoan
hormones issues in XXY
- dysgenesis of tubules leads to less inhibin B and more FSH
- abnormal leydig cell function leads to less testosterone, more LH and more estrogen
most common cause of amenorrhea
turner syndrome
congenital adrenal hyperplasia
leads to virilization in females
androgen insensitivity syndrome
ambiguous genitalia in males
placental aromatase deficiency
- cant make estrogens
- masculinization of female
- can have maternal virilization
Kallman syndrome
failure of GnRH cells to develop
- failure to complete puberty
- infertility
- no FSH, LH or testosterone
cannonball metastases
in choriocarcinoma
cause of vasa previa
velamentous umbilical cord insertion (cord inserts in chorioamniotic membrane rather than placenta)
four Ts of post partum hemorrage
Tone (uterine atony)
Trauma (lacerations)
Thrombin (clots)
Tissue (retained products)
associations with polyhydramnios
- esophageal and duodenal atresia
- anencephaly
- maternal diabetes
- anemia
- mutiple gestations
associations with oligohydramnios
- placental insuffficiency
- bilateral renal agenesis
- posterior urethral valves
cause of Potter sequence
oligohydromnios
hypertensive drugs in pregnancy
methyldopa, labetalol, hydralazine and nifedipine
treatment of eclampsia
magnesium sulfate
preeclampsia
hypertension and end organ damage after 20 weeks (if before = molar pregnancy)
cause of preeclampsia
abnormal spiral arteries, endothelial dysfunction, vasoconstriction and ischemia
HELLP syndrome
hemolysis, elevated liver enzymes and low platelets
incidence of gyn cancers in US
endometrial, ovarian, cervical
leuprolide
- GnRH agonist (pulsatile or continuous)
- for fibroids, endometriosis, precocious puberty, prostate cancer, infertility
clomiphene
- blocks estrogen receptors in hypothalamus
- stimulates ovulation
- treats infertility in PCOS
tamoxifen
- estrogen antagonist in breast
- agonist in bone/uterus
- increases endometrial cancer
raloxifene
same as tamoxifen but no increase in endometrial cancer
- used to treat osteoporosis
letrozole
aromatase inhibitor
- inhibits conversion to estrogen
- treats breast cancer
anastrozole
aromatase inhibitor
exemestane
aromatase inhibitor
progestins
- decrease growth and increase vascularity of endometrium, thicken cervix
- for contraception, endometrial cancer, abnormal bleeding
mifepristone
anti-progestin
- used in a abortion
contraindications in oral contraceptives
- smokers above 35, blot clots, breast cancer, lupus, cholestatic disease
most effective emergency contraception
copper IUD
terbutaline
beta 2 agonist to relax the uterus and decrease contractions in pregnancy
ritodrine
beta 2 agonist to relax the uterus and decrease contractions in pregnancy
danazol
- partial androgen agonist
- treats endometriosis and angioedema
used to stimulate anabolism in burns
testosterone
finasteride
5alpha reductase inhibitor
- for BPH and baldness
flutamide
- blocks androgen receptor
- for prostate carcinoma
ketoconazole
- inhibits steroid synthesis
- used in PCOS
spironolactone
- inhibits steroid binding
- used in PCOS
tamsulosin
alpha 1 antagonist used to treat BPH
minoxidil
arteriolar vasodilator for male pattern baldness
