Reproductive System Flashcards
The cervix has ____ qualities so it is less likely to have an infection above the cervix
Antibacterial
The endometrium layer of the cervix secretes ____
Hormones
The ____ is the muscle layer of the uterus
Myometrium
The cervix connects to the ___ ___
Fallopian tubes
The ____ (perimetrium) gives shape to the myometrium and keep the boundaries of the uterus and holds it in place
Cervosa
The egg flows through the ___ ___ to get to the uterus
Fallopian tubes
The ____ contain eggs
Ovaries
The female reproductive system is driven by ____ function
Endocrine
The hypothalamus releases gonadotropin-releasing hormone, which then stimulates the anterior pituitary to release what two hormones?
-Luteinizing hormone
-Follicular stimulating hormone
Luteinizing hormone and follicular stimulating hormone stimulate the ovary to release ____ and ____ to prepare the uterus for pregnancy
Estrogen and progesterone
Estrogen and progesterone provide negative feedback to the ____ and ___ ___ to stop production of these hormones during most of the female cycle
Hypothalamus and anterior pituitary
It is only during days ___-___ of the menstrual cycle that estrogen and progesterone provide positive feedback to increase production of the hormones
12-14
Gonadotropin-Releasing Hormone stimulates synthesis and secretion of the gonadotropins in the _____
Pituitary
What are the gonadotropins that are released from the pituitary?
-Follicle-stimulating hormone
-Luteinizing hormone
Luteinizing hormone binds with and stimulates the ____ cells of the ovaries which leads to androstenedione production
Theca
Follicular stimulating hormone stimulates the ____ cells of the ovaries and leads to increased production of estadiol
Granulosa
Androgens get converted to ____
Estrone
____ is the most common estrogen and is produced in the ovaries and a small amount by the cortex of the pituitary
Estradiol
____ is the metabolite of estradiol and estriol
Estrone
____ is a risk factor for many reproductive cancers because fat cells produce hormones and estrogen
Obesity
Estrogen has effects on the brain and is important for ____ formation and retention
Memory
Estrogen stimulates ____ development as well as milk production
Breast
Estrogen also regulates _____, so it has an impact on the heart and the liver
Cholesterol
Estrogen also helps to preserve ____ ____
Bone density
Estrogen regulates proliferation of _____ cells
Squamous
Secretion of the vagina promotes ____ and ____ of sperm to increase rate of pregnancy
Motility and movement
____ is an ovarian hormone that the ovaries and the adrenal gland produce at a steady rate
Progesterone
Progesterone is increased during _____ which helps prepare the uterus to lay the egg into the clinging and mature the growing fetus
Pregnancy
8 weeks into pregnancy, the ____, instead of the uterus, begins making progesterone
Placenta
Progesterone prevents ____ labor
Premature
Roles of progesterone:
-Relaxation of myometrium
-Thickening of myometrium
-Promotes development of breast tissue
Adrenal hormones (androgens) are released from the ____ ____
Adrenal cortex
Androgens are precursors to ___ and ___
Estrogen and progesterone
Androgens contribute to ____ growth during pregnancy
Skeletal
Androgens are also responsible for the development of _____ sex characteristics
Secondary
Hormone release during the menstrual cycle is related to ____ changes
Tissue
The menstrual cycle is ____ days on average
28
Levels of follicular stimulating hormone and luteinizing hormone are higher in the first half of the cycle (follicular phase) and peak right before ____
Ovulation
High levels of ___ ___ trigger ovulation
Luteinizing hormone
Levels of estrogen are also highest before ____
Ovulation
Levels of ____ increase after ovulation
Progesterone
_____ occurs early in the menstrual cycle
Menstruation
The endometrium increases in ____ over the cycle
Thickness
The first half of the menstrual cycle is the ____ phase and the second half is the ____ phase
Follicular; luteal
____ occurs due to the cessation of ovarian function
Menopause
During menopause, there is a gradual decrease in the size of the ____
Ovaries
Menopause usually occurs between ages ___ and ___
45-52
There will be variability in the frequency and flow of menstruation ____ years prior to menopause
10
Mechanism of menopause:
-Atresia of oocytes
-Decreased estrogen and progesterone from the ovaries
-Increased production of follicular-stimulating hormone and luteinizing hormone
-Estrogen is still produced in the adrenal cortex and adipose tissue (conversion to androstenedione)
During menopause, estrogen secretion is insufficient to maintain ____ sexual characteristics
Secondary
Manifestations of menopause:
-Headaches and hot flashes
-Teeth loosen and gums recede
-Risk of cardiovascular disease
-Backaches
-Hair becomes thinner
-Bones lose mass and become more fragile
-Breasts droop and flatten
-Nipples become smaller and flatten
-Skin and mucous membranes become dried and develop a rough texture
-Abdomen loses some muscle tone
-Stress of urge incontinence
-Vaginal dryness, itching, and shrinking
___ ___ ___ may alleviate some symptoms of menopause, but it increases the risk of coronary heart disease
Hormone replacement therapy
Who should take hormone replacement therapy?
-People under 47 years old
-Those with severe hot flashes
-Those with osteoporosis
Hormone replacement therapy should be given in the ____ effective doses for the shortest period time
Lowest
____ is the absence or suppression of menstruation
Amenorrhea
Primary amenorrhea is a failure of ____ (no onset of menses; age 14 if there is no sex characteristics, 16 if there is sex characteristics)
Menarche
What are the compartments of primary amenorrhea?
I: Uterus
II: Ovary
III: Anterior pituitary
IV: Hypothalamus
Amenorrhea caused by a defect in the ovaries is common in girls with ____ ____
Turner’s syndrome
Secondary amenorrhea is the absence of menstruation for ___ or more cycles or 6 months in women who have previously menstruated
3
Secondary amenorrhea is normal during…
-Early adolescense
-Peri-menopausal period
-Pregnancy
-Lactation
Secondary amenorrhea can be caused by…
-Diseases
-Dramatic weight loss (malnutrition, excessive exercise)
Pathophysiologic categories of secondary amenorrhea:
-Normal ovarian hormone secretion (pregnancy, uterine dysfunction->hysterectomy, adhesions)
-Increased ovarian hormone secretion (feminizing tumors, masculinizing hormones, PCOS)
Secondary amenorrhea can also be caused by decreased ____ hormone secretion
Ovarian
High ____ levels can cause secondary amenorrhea by stimulating menopause as well as acquired ovarian failure
Gonadotropin
What can cause acquired ovarian failure?
-Autoimmune disease
-Chemotherapy
-Resistance to gonadotropins
-Environmental toxins
Low gonadotropin levels can cause secondary amenorrhea by causing things like…
-Hyperprolactinemia
-Tumor or trauma to hypothalamus or pituitary
-Disorders extrinsic of H-P tract like starvation, stress, psychogenic disorder, and endocrine disease)
PCOS affects ___-___% of all women
5-10
PCOS is the leading cause of _____
Infertility
PCOS is diagnosed by 2 or more of what three symptoms?
-Oligo/anovulation
-Elevated adrogens
-Polycystic ovaries
The pathophysiology of PCOS is ___-___
Mult-factorial
____ may cause PCOS because it increases free testosterone levels
Hyperinsulinemia
High testosterone levels can…
-Suppress follicular apoptosis
-Cause excess androgen to be converted to estrogen
High estrogen continues to suppress what two hormones?
-FSH
-LH
The high estrogen (and low FHS and LH) perpetuates follicular _____ ____, but not maturation and ovulation
Tissue development
The accumulation of follicular tissue causes…
-Ongoing androgen secretion
-Ongoing cycle
There may be ____ and ____ factors that contribute to the development of PCOS
Genetic and lifestyle
Manifestations of PCOS:
-Acne
-Hirsutism
-Obesity
-Hormone irregularities
-Irregular menstrual cycles
-Infertility
-Insulin resistance
-Diabetes
-Dyslipidemia
-Endometrial carcinoma
-Cardiovascular disease
-Non-alcoholic liver disease
There are both ____-____ and ___ ___ related manifestations of PCOS
Hormone-driven; metabolic syndrome
With ____ ____ disorders, the endopelvic fascia and perineal muscles stretch and lose tone/strength
Pelvic relaxation
People with pelvic relaxation disorders are unable to maintain ____ in the proper position
Organs
Precipitating factors for pelvic relaxation disorders:
Anything that increases intra-abdominal pressure
____ helps to maintain elasticity of tissues
Estrogen
A ____ ____ is a descent of the cervix or entire uterus into the vaginal canal
Uterine prolapse
First-degree uterine prolapse is a descent of the cervix/uterus within the ____
Vagina
Second degree uterine prolapse is when the cervix protrudes through the ____
Introitus
Third-degree uterine prolapse is when the vagina is completed ____
Everted
The goal is to prevent uterine prolapse with ____ ___ (Kegel)
Muscular exercise
____ can be useful for those at risk for uterine prolapse post-manopause
Estrogen
A ____ can be used to prevent prolapse, and surgery can be done as a last resort
Pessary
____ is the descent of the bladder into the vaginal canal
Cystocele
Cystocele causes…
-Feelings of pressure
-Difficulty in completely emptying the bladder
-Can increase the risk of bladder infections
Cystocele can be treated with ____ exercises to strengthen the pelvic floor muscles or the use of a vaginal pessary
Kegel
_____ is usually caused by trauma to the fascia during childbirth
Rectocele
Chronic _____ contributes to the development of rectocele
Constipation
Rectocele causes symptoms like…
-Constipation
-Feelings of rectal fullness
-Difficult defecation
____ ____ ____ is inflammation caused by infection
Pelvic Inflammatory Disease
The incidence of pelvic inflammatory disease is ___ million per year and causes ____ cases infertility per year
1; 100,000
Consequences of pelvic inflammatory disease are associated with ____
Scarring
The etiology of pelvic inflammatory disease is mediated by a failure of normal ____ ____
Defense mechanisms
Pelvic inflammatory disease can cause…
-Inflammation
-Scar tissue formation with adhesions to nearby tissues and organs
-Can lead to necrosis and abscess formation
_____ is caused by the presence of functioning endometrial tissue outside of the uterus
Endometriosis
The endometrial tissue that is outside of the uterus also responds to ____ fluctuations in the menstrual cycle
Hormonal
There is a ___-___% incidence of endometriosis
3-15
___-___% of infertile women have endometriosis
30-40%
What are possible etiology/mechanisms of endometriosis?
-Retrograde flow (common in most women)
-Decreased immune response to endometrial cells outside of the uterus
-Genetic pre-dispositioin
In 80% of cases of endometriosis, uterine tissue implants in the ____
Ovary
Timeline of endometriosis:
-Bleeding adhesions
-Inflammation
-Pain, fibrosis, scarring
Manifestations of endometriosis:
-Dysmenorrhea
-Abnormal bleeding
-Pain with intercourse
-Constipation
-Infertility
____ cancer is the 2nd most common cancer in women worldwide (12,000 new cases and 4,000 deaths/year in the United States)
Cervical
There has been a dramatic decrease in incidence of cervical cancer (45%) since the ____ screening was developed
PAP
Infection with the ___ ___ virus is necessary for the development of cervical cancer
Human Papilloma
What are the two general types of HPV?
-Low-risk types
-High-risk types
Low-risk types of HPV are associated with…
-Genital warts
-Mild pap test abnormalities
High-risk types of HPV are associated with…
-Mild to severe Pap test abnormalities
-Cervical cancer
Most genital HPV infections are transient and ____, and have no clinical consequences
Asymptomatic
HPV ___ and ____ account for the majority of cervical cancer cases (all 3 vaccines fight against these two)
16; 18
HPV is also associated with what other types of cancers?
-Vagina
-Vulvar
-Penile
-Anal
-Oropharyngeal
What are three available HPV vaccines?
-Bivalent (Cervarix)
-Quadrivalent (Gardasil)
-9-valent (Gardasil 9)
Genital warts have a very high incidence; as many as ____ out of every 100,000 people have HPV-associated genital warts
100
Incidence of cervical cancer is about ___ people out of every 100,000
8.3
Transmission of genital HPV can be from…
-Anal
-Oral
-Vaginal
Transmission of HPV can occur from ____ and subclinical patients
Asymptomatic
Cervical cancer risk factors for women:
-Immune status
-Smoking as a co-factor
-Multiple births
-Long-term oral contraceptive use
-Chronic inflammation
-Poor oral hygiene (for oropharyngeal cancers)
With cervical cell abnormalities, the HPV infects stratified squamous epithelium and stimulates ____ ___
Cellular proliferation
Cervical cancer requires persistent ____ (many clear the infection, but there are some high risk types)
Infection
Grading systems for cervical cell abnormalities:
-Pap
-Colposcopy
-Bioposy
Cervical cancer symptoms:
-Usually asymptomatic in pre-invasive stages
-Abnormal vaginal bleeding
-Lower extremity bleeding due to pelvic lymph node obstruction
-Metastasis to bone and lung
_____ carcinoma arises from glandular epithelium of the uterine lining
Endometrial
Endometrial cancer is the most frequent cancer in the _____ and is responsible for 7% of all cancers diagnosed in females
Pelvis
The peak occurrence of endometrial cancer is between age ___ and ___
55 and 65
Each year, there are ____ new cases of endometrial cancer with 6,800 deaths
40,100
Risk factors for endometrial cancer:
-Unopposed estrogen (high levels)
-Insulin
-HNPCC
-Obesity
-Nuliparity
-Diabetes
-PCOS
____ ____ could possibly be protective against endometrial cancer by decreasing estrogen levels
Cigarette smoking
Manifestations of endometrial cancer:
-Asymptomatic
-Post-menopausal bleeding
-Late symptoms include cramping, pelvic discomfort, postcoital bleeding
-Large tumors may be necrotic and hemorrhagic
There are about ____ new cases of ovarian cancer per year with about 16,000 deaths per year
25,000
Ovarian cancer is the top cause of ____ related to gynecologic cancers
Death
1 in ____ women will develop ovarian cancer
70
What are some types of ovarian cancer?
-Epithelial
-Germ cell malignancies
-Stromal tumors
-Mucinous
-Endometrioid and clear cell
-Serous
____ endometrial cancer is the least common
Mucinous
Endometrioid and clear cell ovarian cancer are associated with _____
Endometriosis
Low-grade serous ovarian cancer is asymptomatic but ___-___
Chemotherapy-resistant
High-grade serous ovarian cancer accounts for ___% of tumors (only 5% are stage I at diagnosis); this is the most common and most lethal for of ovarian cancer
70
There is new evidence that ovarian tumors originate in the ___ ___
Fallopian tubes
What factors increase the risk of ovarian cancer?
-Age
-Family history of cancer
-Obesity
-Nulliparity (has not given birth)
-Increased number of lifetime ovulatory cycles
-Hormone replacement therapy
What factors decrease the risk of ovarian cancer?
-Oral contraceptive use
-Oopherectomy
-Hysterectomy
-Tubal ligation
-Lactation
-Salpingectomy
-Bilateral salpingo-oophorectomy
Manifestations of ovarian cancer:
-Urinary frequency and urgency
-GI upset (indigestion, constant feeling of fullness)
-Pelvic and/or abdominal pain or discomfort
-Pelvic and/or abdominal bloating or swelling
-Unexplained weight loss or gain
-Fatigue
-Abnormal postmenopausal bleeding
-Pain during intercourse
The ____ are located in the scrotum outside the body; they are composed of tightly coiled tubules that produce sperm
Testes
Testes produce what two hormones?
-Testosterone (more potent and abundant)
-Androsterone
Production of testosterone throughout the lifecycle:
-Begins during fetal development and continues for a short time after birth
-Nearly stops during childhood
-Resumes at puberty
Testosterone is a steroid hormone and is responsible for…
-Growth and development of the male reproductive structures
-Increased skeletal muscle growth
-Enlargement of the larynx accompanied by voice changes
-Growth and distribution of body hair
-Increased male sex drive
Newly produced sperm is stored in the _____, which is just outside and to the rear of each testicle; this is where the sperm develops
Epididymis
The ___ ___ is a muscular duct that connects the epididymis and the ejaculatory duct; it carries sperm out toward the urethra during ejaculation
Vas deferens
The ___ ___ is the area formed by the union of the two vas deferens ducts (one from each testis) and the duct from the seminal vesicles
Ejaculatory duct
The ____ is the tube that runs through the penis and drains the excretory and reproductive systems
Urethra
____ ____ are a gland located behind the bladder and empty into the ejaculatory duct; mucous, amino acids, fructose, and prostaglandins are found making up the fluid; makes up 60% of semen volume
Seminal vesicles
The ____ ____ is a large gland that surrounds the upper portion of the urethra; it gives off a thin, milky secretion containing several enzymes; it neutralizes the acidic urine residue in the urethra and activates sperm
Prostate gland
The ___ is composed of 3 cylinders of spongey erectile tissue
Penis
Follicular stimulating hormone stimulates ____ cells to make sperm; this inhibits further FSH from being produced (negative feedback)
Sertoli
Luteinizing hormones stimulates ____ cells that make testosterone; this is also a negative feedback loop
Leydig
The ____ muscle raises and lowers the scrotum to help regulate temperature and promote spermatogenesis
Cremaster
In summary, the male reproductive system is all about supporting ____ production and its transport to the ovum
Sperm
____ cancer is responsible for only 1% of all cancers in men, but is the most common cancer in men who are between 15-35 years old
Testicular
Etiology and risk factors for testicular cancer:
-Cryptorchidism (undescended testes): 50% of cases
-Exogenous estrogen during mother’s pregnancy
-Trauma
-Infection
-Chromosomal abnormalities (loss of chromosome 11, 13, 18, abnormal chromosome 12p)
-The link between vasectomy and testicular cancer is weak; a vasectomy could increase the rate of progression of an existing, undetected tumor
Classifications of testicular cancer:
-Germ cell tumors (Seminoma, non-seminoma)
-Stromal (less common)
Manifestations of testicular cancer:
-Painless testicular enlargement
-Ache in abdomen/groin
-Heavy feeling in scrotum
-10% have acute scrotum pain
-5% present with gynecomastia
-Misdiagnosis as epididymitis (25%)
-10% have metastases at diagnosis (typical delay in diagnosis of 3-6 months)
___ ___ are used to identify metastases and to track response to treatment
Tumor markers
What tumor markers are used to identify testicular cancer?
-Alpha Feto-Protein: glycoprotein
-Human chorionic gonadotropin (HCG)
-Lactate dehydrogenase
Testicular cancer is extremely _____ (95% cure rate!)
Chemosensitive
___% of people with testicular cancer will have a recurrence and 99% can be cured if discovered and treated early
10%
Disease free survival of ___ years is indicative of cured testicular cancer
3
Negative prognostic indicators for testicular cancer:
-Presence of liver, bone, or brain metastasis
-Very high serum markers
-Primary mediastinal nonseminoma
-Large number of lung metastases
____ ___ ___ is an abnormal increase in the number of cells (hyperplasia) (NOT hypertrophy, or size of cells)
Benign prostatic hyperplasia
Benign prostatic hyperplasia is a ____ disease, most frequently affecting those aged 40-45
Common
Benign prostatic hyperplasia may be due to a metabolic product of testosterone called _____ if testosterone production is blocked
Dihydrotestosterone
Investigation of Benign prostatic hyperplasia is focused on levels and ratios of various ____ factors
Endocrine
With Benign prostatic hyperplasia, hyperplasia occurs near the ____ in the periurethral glands
Urethra
Manifestations of Benign prostatic hyperplasia:
-Firm, enlarged prostate upon rectal exam
-Decreased vigor of urinary stream, increased frequency, urgency, urinary hesitancy and dribbling, hematuria, infections
-Progressive bladder distension with diverticular outpouchings of the bladder wall
-Ureter obstruction (can lead to hematuria, infections, and bladder calculi)
-If untreated, urine backs into kidneys causing hydronephrosis and possible renal failure
____ cancer is the most frequently diagnosed cancer in men
Prostate
Prostate cancer is the ___ leading cause of cancer death in men
2nd
Prostate cancer is a disease of ___, and is often found on post-mortum exams
Aging
Etiology of prostate cancer:
-Adenocarcinoma with unknown etiology
Prostate cancer is an ____-sensitive tumor
Androgen
Prostate cancer may be due to an increased ___/___ ratio
Estrogen/Dihydrotestosterone
Risk factors for prostate cancer:
-Aging
-Hereditary/genetics
What are the four stages of prostate cancer? (These indicate the mitotic rate of the cancer cells)
-A
-B
-C
-D
___ ___ ___ can be used to screen for prostate cancer
Prostate screening antigen
Prostate cancer can lead to ____ ____ metastasis
Lymph node
