Reproductive - FA Anat/Phys p610 - 623 Flashcards
Venous Drainage of R and L testis
Left ovary/testis –> left gonadal vein–> left renal vein -> IVC. Right ovary/testis –> right gonadal vein –> IVC.
lymph drainage of ovaries testes
para-aortic lymph nodes.
Drains to Ext iliac nodes
Body of uterus/cervix/superior bladder
Drains to Int iliac nodes
Prostate/cervix/corpus cavernosum/proximal vagina
Drains to sup inguinal nodes
Distal vagina/vulva/scrotum/distal anus
Drains to deep inguinal nodes
Glans penis
Why is varicocele more common on the L?
Because the left spermatic vein enters the left renal vein at a 90° angle, flow is less laminar on left than on right left venous pressure > right venous pressure varicocele more common on the left.
Ligate where during oophorectomy to avoid bleeding.
Infundibulopelvic ligament (suspensory ligament of the ovary) - contains ovarian a/v. cxt ovaries to lat pelvic wall
ureter at risk during ligation of gonadal vessels in hysterectomy - which ligament?
Cardinal ligament - has uterine a/v
Pathomech of ovarian torsion?
Twisting of ovary and fallopian tube around infundibulopelvic ligament and ovarian ligament –> compression of ovarian vessels in infundibulopelvic ligament –> blockage of lymphatic and venous outflow.
Continued arterial perfusion –> ovarian edema –> complete blockage of arterial inflow –> necrosis, local hemorrhage.
Pathway of ejaculate
SEVEN UP: Seminiferous tubules Epididymis Vas deferens Ejaculatory ducts (Nothing) Urethra Penis
What leads to anterior and posterior urethral injury?
Presentation?
Ant - perineal straddle injury, blood at urethral meatus and scrotal hematoma
Post - pelvic fracture, blood at urethral meatus and high riding prostate
Which n. control emission and ejaculation?
Emission—Sympathetic nervous system (hypogastric nerve). Ejaculation—visceral and Somatic nerves (pudendal nerve).
Mech of erection?
Erection—Parasympathetic nervous system (pelvic nerve): NO –> INC cGMP –> smooth muscle relaxation –> vasodilation –> proerectile. Norepinephrine –> INC [Ca2+]in –> smooth muscle contraction –> vasoconstriction –> anti-erectile.
Which cells line seminiferous tubules or are in interstitia?
Line seminiferous tubules - Spermatogonia, Sertoli cells (all S) Interstia - Leydig cells
Sertoli and leydig cells - analogue in female?
Sertoli - Homolog of female granulosa cells Leydig - Homolog of female theca interna cells
Sertoli vs Leydig - which is temp sensitive?
Leydig - unaffected by temperature. Sertoli - DEC sperm production and inhibin B w/ INC temp
Fxn of Sertoli cells
- Secrete inhibin B –> inhibit FSH.
- Secrete androgen-binding protein –> maintain local levels of testosterone.
- Produce MIF.
- Convert testosterone and androstenedione to estrogens via aromatase
- Support and nourish developing spermatozoa. Regulate spermatogenesis.
Fxn of Leydig cells
Secrete testosterone in the presence of LH; LH = (+) Leydig (both Ls)
Which cells make the blood testis barrier?
Tight junctions between adjacent Sertoli cells form blood-testis barrier isolate gametes from autoimmune attack.
Which of the developmental stages of spermiogenesis are haploid v diploid?
Diploid - Spermatogonium, primary spermatocyte Haploid - 2ndary spermatocyte, spermatid, mature spermatozoon
What occurs in spermatogenesis vs spermiogenesis?
Spermatogenesis - diploid spermatogonia undergo meiosis I and II to become haploid spermatids
Spermiogenesis - spermatids –> loss of cytoplasmic contents, gain of acrosomal cap –> mature spermatozoa
Source and types of estrogen - and potency?
Ovary (17β-estradiol), placenta (estriol), adipose tissue (estrone via aromatization). estradiol > estrone > estriol
Fxn of estrogen?
- Development of genitalia and breast, female fat distribution.
- Growth of follicle, endometrial proliferation, myometrial excitability.
- Upregulation of estrogen, LH, and progesterone receptors
- feedback inhibition of FSH and LH, then LH surge;
- stimulation of prolactin secretion.
- INC transport proteins, SHBG;
- INC HDL; DEC LDL.
How does pregnancy affect estrogen levels?
50-fold INC in estradiol and estrone 1000-fold INC in estriol (indicator of fetal well- being)
Source of progesterone
Corpus luteum, placenta, adrenal cortex, testes.
Effect of progesterone on ovulation and lactation
Fall in progesterone after delivery disinhibits prolactin –> lactation. INC progesterone is indicative of ovulation.
Fxn of progesterone
Stimulation of endometrial glandular secretions and spiral artery development.
Maintenance of pregnancy.
DEC myometrial excitability.
Production of thick cervical mucus, which inhibits sperm entry into uterus.
INC body temperature.
Inhibition of gonadotropins (LH, FSH).
Uterine smooth muscle relaxation (preventing contractions).
DEC estrogen receptor expression. Prevents endometrial hyperplasia.
When do 1’ oocytes begin meiosis I and complete it?
1° oocytes begin meiosis I during fetal life and complete meiosis I just prior to ovulation.
In what phase on meiosis I are oocytes in?
Prophase until ovulation
2’ oocytes stay in what phase of meiosis II until fertilization?
Meiosis II is arrested in metaphase II until fertilization (2° oocytes).
Changes in ovulation
INC estrogen, INC GnRH receptors on anterior pituitary. Estrogen surge then stimulates LH release ovulation (rupture of follicle). INC temperature (progesterone induced).
Which phase of the menstrual cycle constant? How many days?
Follicular phase can vary in length. Luteal phase is 14 days.
maintains endometrium to support implantation.
Progesterone
stimulates endometrial proliferation.
Estrogen
What produces the estrogen surge in the luteal phase?
Corpus luteum
secrete hCG after implantation? How many days after conception can it be detected in blood/urine?
Syncytiotrophoblasts secrete hCG, which is detectable in blood 1 week after conception and on home test in urine 2 weeks after conception
Physiologic adaptations in pregnancy
- Inc cardiac output (inc preload, dec afterload, inc HR –> inc placental and renal perfusion)
- Anemia (big INC plasma, inc RBCs–> dec viscosity)
- Hypercoagulability (to dec blood loss at delivery)
- Hyperventilation (eliminate fetal CO2)
- Inc lipolysis and fat utilization
Difference between Placental hormonal secretion of hcG vs other hormones?
Placental hormone secretion generally increases over the course of pregnancy, but hCG peaks at 8–10 weeks.
Which hormone acts like LH in beg states of pregnancy? What happens if there is not luteal cell stimulation?
hCG - Maintains corpus luteum (and thus progesterone) for first 8–10 weeks of pregnancy by acting like LH (otherwise no luteal cell stimulation –> abortion).
hcG has identical alpha subunit to which other hormones? Inc hcG can lead to, therefore, which endocrine issue?
Has identical α subunit as LH, FSH, TSH (states of inc hCG can cause hyperthyroidism)
hCG inc/dec when?
hCG is INC in multiple gestations, hydatidiform moles, choriocarcinomas, and Down syndrome; hCG is DEC in ectopic/failing pregnancy, Edward syndrome, and Patau syndrome.
APGAR score - what does it stand for? Score below for what is cause for concern?
Apgar score is based on Appearance, Pulse, Grimace, Activity, and Respiration. Apgar scores
Infant development 0-12 mo - Motor, Social, cognitive
Toddler dev - 12 - 26 mo - Motor, Social, cognitive
Preschool 3-5 mo - Motor, Social, cognitive
What is contained in breast milk that aids in immunity? What additional supplementation is needed if a child is exclusively breastfed?
Contains maternal immunoglobulins (conferring passive immunity; mostly IgA), macrophages, lymphocytes. Exclusively breastfed infants require vitamin D supplementation.
Dec in which hormones post labor allows for lactation?
After labor, the dec in progesterone disinhibits PRL.
Why hirsuitism with menopause?
Source of estrogen (estrone) after menopause becomes peripheral conversion of androgens, INC androgens –> hirsutism.
Which hormone is inc with menopause?
INC FSH is specific for menopause (loss of negative feedback on FSH due to dec estrogen, but also inc LH
Inc risk of what cardio disease with menopause?
Coronary art disease
Menopause before 40 indicates what?
1° ovarian insufficiency (premature ovarian failure);
Which androgen responsible for closure of epiphyseal plate?
Testosterone –> converted to estrogen
What androgen responsible for prostate growth, balding, sebaceous glad activity?
DHT
What drug dec conversion of Testosterone –> DHT? Used to Tx what disease?
Finasteride, BPH, hair loss for men
Presentation of Androgenic steroid abuse in men/women
Men - who present with changes in behavior (eg, aggression), acne, gynecomastia, small testes (exogenous testosterone –> hypothalamic-pituitarygonadal axis inhibition –> dec intratesticular testosterone –> dec testicular size, dec sperm count, azoospermia).
Women - virilization, hirsuitism, acne, breast atrophy, male pattern baldness
impaired sperm mobility is seen with what type of disease?
Any ciliary disease - like ciliary dyskenesia, Kartagener syndrome
Coarse pubic hair sparing the thighs is what Tanner stage?
Stage 4 - once hair hits thighs, its stage 5
At which stage does pubic hair first appear?
Tanner stage 2
What stage is raised areola seen on breast mound?
Stage 4, when the areola flattens on a breast mound, stage 5
What stage does testicular enlargement occur?
Stage 2 (8-11.5)
What defines precocious puberty?
Appearance of 2° sexual characteristics (eg, adrenarche, thelarche, menarche) before age 8 years in girls and 9 years in boys.
Cause and sx of precocious puberty?
. Inc sex hormone exposure or production –> inc linear growth, somatic and skeletal maturation (eg, premature closure of epiphyseal plates –> short stature)
Causes of central precocious puberty?
(Inc GnRH secretion): idiopathic (most common; early activation of hypothalamic-pituitary gonadal axis), CNS tumors.
Causes of peripheral precocious puberty?
(GnRH-independent; Inc sex hormone production or exposure to exogenous sex steroids): congenital adrenal hyperplasia, estrogen-secreting ovarian tumor (eg, granulosa cell tumor), Leydig cell tumor, McCune-Albright syndrome.
