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Pathophysiology > Reproductive Disorders > Flashcards

Reproductive Disorders Flashcards

1
Q

What are the key hormones in hormone regulation?

A

GnRH, LH, FSH

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2
Q

How is the hormone release initiated?

A

In puberty, hypothalamic neurosecretatory cells increase secretion of GnRH, binds to gonadotropes in anterior pituitary to release gonadotropin (LH and FSH)

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3
Q

What are the components of the male reproductive system?

A

Testes, ducts, accessory sex glands, penis

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4
Q

What is the function of the epididymis?

A

Sperm transport and maturation

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5
Q

What is the function of the vas deferens?

A

Long muscular tube from epididymis into pelvic cavity, transports mature sperm to urethra

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6
Q

What are the seminiferous vesicles?

A

Located in the testes and are long, tubular structures that carry out sperm production

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7
Q

What are accessory sex glands?

A

Seminal vesicles, prostate, bulbourethral glands

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8
Q

What are the seminal vesicles?

A

Pair of glands that secrete approx. 60% of volume of semen

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9
Q

Why is the prostate considered an accessory sex gland?

A

Secretes variety of enzymes including pepsinogen (breaks down proteins), amylase, lysosomes, hyaluronidase (breaks down hyaluronic acid). Helps with mobility and motility of sperm

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10
Q

What function do the bulbourethral glands serve?

A

Secrete mucus to protect sperm and more alkaline fluid for a buffer

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11
Q

What are the two main cells in the seminiferous tubules?

A

Interstitial cells (5% of volume, produce androgens) and Sertoli cells (form blood-testes barrier, regulate sperm development, secrete hormones)

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12
Q

What two hormones do the Sertoli cells secrete?

A

Androgen binding protein (binds with testosterone, keeps it available for interstitial cells) and inhibin (feedback hormone, released if enough sperm produced, will decrease FSH production)

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13
Q

What is the function of LH in males?

A

Stimulates interstitial cells in the seminiferous tubules to secrete testosterone (and small bit of estrogen)

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14
Q

What is the role of testosterone?

A

Involved in spermatogenesis, has androgenic effects, facilitates male pattern development, role in anabolism and protein synthesis

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15
Q

What are some of the components of the female reproductive system?

A

Ovaries, fallopian tubes, uterus, vagina, mammary glands

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16
Q

What are the layers of the uterus?

A

Endometrium (has functional layer that sheds and basal layer that does not shed/is adjacent to myometrium), myometrium (thick muscle layer), perimetrium (outer layer)

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17
Q

Where is the pelvic floor?

A

Underneath the bladder and the uterus

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18
Q

What is the HPO axis?

A

Hypothalamic pituitary ovary axis

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19
Q

What are the roles of FSH and LH in females?

A

FSH stimulates growing follicles on ovaries, LH helps with development and will facilitate development of oocyte/maintain uterine lining

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20
Q

What is the role of estrogen in females?

A

Primary sex hormone, secreted by follicular cells with goal to develop and maintain the reproductive structures, secondary sex characteristics, anabolic role

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21
Q

What is the role of progesterone and what secretes it?

A

Secreted by cells of corpus luteum at end of menstrual cycle, works with estrogen in helping to prepare endometrium, preparing mammary glands, etc.

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22
Q

What is the role of inhibin in females?

A

After ovulation, role is to inhibit FSH and LH

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23
Q

What occurs in the first 5 days of the menstrual cycle?

A

Menstrual phase, uterus sheds functional layer, blood/mucus/cells shed, decrease in progesterone at this time

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24
Q

What occurs from day 6-14 of the menstrual cycle?

A

Pre-ovulatory phase, uterus is in proliferative phase and under estrogen influence, FSH stimulating ovaries to grow secondary follicles, single follicle becomes dominant and have increase in estrogen/inhibin= decrease in FSH, dominant follicle forms blister like bulge on ovary

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25
Q

What occurs on ~day 14 of the menstrual cycle?

A

Ovulation occurs, mature follicle ruptures and releases oocyte into pelvic cavity, LH surge causes rupture

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26
Q

What occurs in day ~15-28 of the menstrual cycle?

A

Post-ovulatory phase, most consistent, uterus responds to progesterone and estrogen released by corpus luteum to allow for endometrial growth/thickening and if secondary oocyte not fertilized= decrease in progesterone= degeneration of corpus luteum= withdrawl bleed, menstruation restarts

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27
Q

What is the corpus luteum?

A

After menstruation, leftover cells in ovary become corpus luteum under LH influence and corpus luteum secretes estrogen, progesterone, inhibin and relaxin. If unfertilized, will degenerate

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28
Q

What occurs to the corpus luteum if there is a fertilized ovum?

A

Beta HCG rescues it from degeneration and allows it to continue to secrete estrogen and progesterone

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29
Q

What is the issue with straight estrogen?

A

Increase in endometrial lining proliferation that goes unchecked, could be risk for uterine cancer

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30
Q

What influence on hormones do the follicles have?

A

Stimulated by FSH and LH, as they mature they produce estrogen, peak in estrogen stimulates the LH secretion which results in LH surge= ovulation

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31
Q

What takes over the role of hormone secretion in the case of a fertilized ovum?

A

Placenta takes over after first trimester

32
Q

What are disorders of the menstrual cycle?

A

Dysmenorrhea (painful menstruation), amenorrhea (lack of menstruation), abnormal/dysfunctional uterine bleeding (heavy and irregular), and anovulation or oligo-ovulation

33
Q

What are some risks of dysmenorrhea?

A

Symptom vs. condition, low BMI, early menarche, smoking cessation, long cycles, irregular/heavy menses, pelvic inflammatory disease, family history, history of sexual assault, psychological comorbidities

34
Q

What occurs in dysmenorrhea?

A

Excessive prostaglandin secretion, can be r/t hypertonicity and progesterone stimulating prostaglandin synthesis

35
Q

What is the definition of primary amenorrhea?

A

Failure of first menarche by age 15

36
Q

What could be the cause of primary amenorrhea?

A

Hypothalamic disorders (failure of GnRH release), anterior pituitary disorders (adenoma, lack of LH/FSH), ovary disorders (lack of ova, inability to develop follicles), defects of outflow tracts (lack of vagina, imperforate hymen, etc.)

37
Q

What is the definition of secondary amenorrhea?

A

Absence of menstruation for >3 or more menstrual cycles for those who used to have regular cycles OR 6 months for those with irregular menses

38
Q

What are some potential causes of secondary amenorrhea?

A

Pregnancy, dramatic weight loss, stress, PCOS, excessive exercise, disruption of HPO system, hyperprolactinemia, hypothryoidism (TRH increases prolactin)

39
Q

What inhibits GnRH secretion?

A

Prolactin

40
Q

When should abnormal vaginal bleeding definitely be investigated?

A

During menopause

41
Q

What can cause anovulation or oligo-ovulation?

A

Normal to high FSH without LH (no surge), PCOS, ovarian failure

42
Q

What are some pelvic pain conditions?

A

Vulvodynia, dyspareunia, vaginismus, atrophic vaginitis, interstitial cystitis, endometriosis, prostatitis

43
Q

What is vulvodynia?

A

Diagnosis of exclusion, pain in vulva, burning pain +/- itching for 3-6 mo or longer, pain with touching and rubbing, no physical findings

44
Q

What is dyspareunia?

A

Pain with intercourse, can cause chronic pain

45
Q

What is vaginismus?

A

Spasm or involuntary contraction of vaginal muscles when penetration attempted

46
Q

What is atrophic vaginitis?

A

Thinning of vaginal and vulvular tissues, become prone to irritation and can lead to pain, associated with menopause and loss of estrogen

47
Q

What is interstitial cystitis?

A

Can imitate UTI, constantly assuming have bladder infection

48
Q

What is endometriosis?

A

Non-malignant, estrogen-dependent, inflammatory chronic condition, endometrial tissue outside of uterus

49
Q

Where can endometrial tissue be found in endometriosis?

A

Many organs (not just reproductive)- lungs, bowel, etc.

50
Q

What are risk factors for endometriosis?

A

Prolonged exposure to endogenous estrogen, heavy flow, nulliparity, genetic component

51
Q

What is one current theory of endometriosis?

A

Retrograde menstruation (flows up through fallopian tubes and into pelvis vs. out), spread through blood and lymph?, immune/autoimmune component

52
Q

What is PCOS characterized by (at least two of them)?

A

Anovulation/oligoovulation, elevated androgen levels, clinical signs of hyperandrogenism, polycystic ovaries

53
Q

What contributes to the pathophysiology?

A

Insulin resistance, enhanced androgen production,

54
Q

How does insulin resistance contribute to PCOS?

A

Sex hormones bind to sex hormone binding globulin (SHBG) in the blood (reduces their availability), insulin decreases the circulating levels of SHBG and causes more free androgens

55
Q

Why does enhanced androgen PRODUCTION occur in PCOS?

A

Low FSH and LH due to abnormally rapid GnRH pulsations, FSH contributes to converting androgens to estrogen in ovaries, less FSH= production of ANDROGENS in ovaries

56
Q

What are some clinical manifestations of PCOS?

A

Amenorrhea/abnormal bleeding, hirsutism, acne and enlarged sebaceous glands, infertility

57
Q

What are some risks for breast cancer?

A

Nulliparity, increased estrogen exposure, increased breast density on mammogram, radiation exposure, weight, family hx, BRCA1 and BRCA2, exposure to chemicals, alcohol intake,

58
Q

What are benign breast diseases?

A

Non-cancerous changes that occur in ducts and lobules of the breast (ex: fibroadenomas and cysts)

59
Q

What is a non-proliferative breast lesion?

A

Fibrocystic lesions including cysts and solid lesions, can be felt on palpation, does not increase risk of breast cancer

60
Q

What is a proliferative without atypia breast lesion?

A

Proliferation of the ductal/lobular epithelium or surrounding connective tissue but the cellular structure is NORMAL, can include fibroadenomas, can increase risk of breast cancer

61
Q

What is a proliferative with atypia breast lesion?

A

Increase in the number of ductal or lobular epithelial cells with some variation in cell structure, starts to lose integrity of basement membrane= spread, can lead to breast cancer

62
Q

What is non-invasive breast cancer?

A

Breast cancer confined to duct/lobule it started, does not extend past basement membrane

63
Q

What are the two types of non-invasive breast cancer?

A

Ductal carcinoma in situ (80%) and lobular carcinoma in situ (20%, does not form palpable mass, harder to identify)

64
Q

What is invasive breast cancer?

A

Cells have penetrated beyond basement mebrane of duct/lobule and spread to surrounding tissue, can spread

65
Q

What is Paget disease?

A

Starts at nipple and looks like eczema, red/purple colour to skin, inflammatory breast cancer with poor prognosis

66
Q

What is the role of estrogen in breast cancer?

A

Known to fuel/stimulate self-proliferation, generate free radicals, etc.

67
Q

What are the two common types of cervical cancer?

A

Squamous cell carcinoma (90%) and adenocarcinoma (10%)

68
Q

What are the risks of cervical cancer?

A

HPV infection, becoming sexually active at young age, multiple sexual partners, smoking, multiparity, weakened immune system

69
Q

How does HPV result in cervical cancer?

A

Viral DNA incorporated into host genome, immortalizes epithelial cells and allows them to self-renew

70
Q

Which strains of HPV are a risk for cervical cancer?

A

Serotypes 16 and 18, lower risk with 31 and 45, 6 and 11 responsible for genital warts

71
Q

In those 35 and younger, infertility is defined as inability to conceive after how many months of unprotected sex?

A

12 months

72
Q

In those 35 and older, infertility is defined as inability to conceive after how many months of unprotected sex?

A

6 months

73
Q

What is the leading cause of infertility?

A

PCOS

74
Q

What is a leiomyoma?

A

Uterine fibroid, benign smooth muscle tumor in the myometrium. Most small, common, asymptomatic, clinically insignificant

75
Q

What are the most common cancers in men?

A

Lung is first, prostate is second

76
Q

What do the symptoms of prostate cancer resemble?

A

BPH

77
Q
A

Pathophysiology (12 decks)

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