SDR Lectures Flashcards
primary follicle
oocyte is surrounded by differentiated and metabolically active granulosa cells
Stress invokes what to inhibit the reproductive system?
Opioid neurons - ß-endorphins and CRH containing neurons
secondary follicles
6-10 primary ones
multiple layers of granulosa cells
an outer layer of theca cells
fluid-filled antrum
Primordial follicles consist of
an oocyte surrounded by a flat layer of epithelial-like cells (granulosa precursors)
tertiary follicle
Graffian follical 1 secondary one larger antrum multple layers of granulosa cells multiple layers of theca cells (theca interna and externa)
Theca cells produce
androgens from cholesterol in response to LH
granulosa cells produce
estradiol 17ß from androgens in response to FSH
with aromatase
luteal cells are made from
left over theca and granulosa after oocyte release
luteal cells secrete
estradiol but less than the follicle did
When does corpus luteum stop secreting progesterone and estradiol?
after sitting for ten days it becomes whitish scar tissue = corpus albicans
Where does estrogen bind to kisspeptin for + feedback?
MPOA
When does estrogen turn into + feedback?
2–pg/ml for 36 hrs
What does LH do on the granulosa cell?
increase release of progesterone intra-follicularly to increase proteolytic enzymes like collagenase that weak the follicular wall
high progesterone causes
increase in collagenase (proteolytic enzymes)
follicular hyperemia or blood movement into the follicule
intrafollicular prostaglandin sythase increasing P F2 alpha increasing fluid moving in follicle and adds progesterone receptor
lead to follicular rupture and ovulation
First 14 days of ovarian cycle is what in the uterus?
proliferation (follicular) phase
What causes proliferation in the uterus (endometrial growth and myometrial thickening)
estrogen
What does estrogen do in the uterus
endometrial growth
myometrial thickening
lengthening of uterine glands and arteriole vessels
water rention (and cervical mucus thinning)
uterine contractions
When does progesterone increase in level over estrogen?
After ovulation
What is the 2nd 14 days of the ovarian cycle in the uterus?
the secretory phase
ran by progesterone
What does progesterone do to the uterus?
stops endometrial growth stimulates uterine gland branching lengthening of spiral arteries cervical mucus thickening increase body temperature
What does inhibin act on
FSH
It’s inhibition allows for the 1st small surge of FSH to recruit follicles
What happens to spiral arteries without pregnancy?
low estrogen and progesterone cause them to retract
What causes necrosis and sloughing and bleeding
decrease in O2 to the tissues from spiral arteries retracting
insulin causes
thecal cells to increase androgen production
what do adipose tissue convert androgens to with their aromatase?
estrone - disrupting LH/FSH cycle
What does estrone do to LH/FSH
increaess LH so there is more androgen secretion
Decreases FSH so no aromatase work in granulosa cells
wedge resection:
androgen amount stays
but less barrier around ovary
What happens in puberty?
GABA decreases, glutamate increases
menarche
age when first surge of LH happens from enough estradiol and progesterone formation
Why are periods erratic in menapoase at first
follicles are not robust so less estrogen build up regularly
but sensitivity to - feedback decreases to that sometimes a surge can happen (compensation)
What produces hCG
trophoblasts 8 days after ovulation
what does hCG do?
binds to LH receptors and keeps ovary functioning and corpus luteum lives (to produce progesterone, estriol)
When does hCG stop rising?
after week 9 (month 3)
b/c placenta can produce its own prog/estriol
When is prog dominant vs estr
progest: during pregnancy
estr: at the end
What causes estrogen to increase over prog at the end of pregnancy
placenta producing a large amount of CRH -> fetal pituitary products ACTH -> fetal adrenal DHEA -> to placenta that aromatizes it to estrogen
What does estrogen do to prostaglandin synthetase
increases production of PGF2 alpha
What strengthens contractions caused by estrogen?
baby head in cervix -> hypothalamus oxytocin secretion from posterior pituitary on SM and more PG
also stress of labor -> sympathetics -> NE/E
estrogen on breast growth
increases ductile growth
increases fat deposition
What does progesterone do on the mammary gland?
-> growth of alveolar structures
What does baby suckling do?
Effect spinal afferent receptors -> hypothalamus -> dopaminergic neurons (↓prolactin) and oxytocin neurons (ejection of milk)
Prolactin acts to
lactogenesis
- feedback on dopaminergic neurons (to stop more prolactin)
Where are dopaminergic neurons?
in the acruate nucleus of the hypothalamus
some terminate at portal capillaries of the median eminence
Where does DA inhibit prolactin
anterior pituitary
DA also inhibits LHRH
how does prolactin give infertility
increases DA -> decrease GnRH -> decreases LH and FSH
b/c huge increase in prolactin in the beginning, not when it decreases (western countires)
Sheehan’s syndrome is caused by
large blood loss in delivery killing anterior pituitary (that’s when it needs blood)
Sheehans causes
no lactotrophs (can't lactate) no ACTH (no pubic hair and hypOtensive b/c no cortisol) no somatotrophs (hypoglycemia from low cortisol and GH) no thyrotrophs (no TH, fatigue and lethargy) No gonatotrophs (no LH/FSH infertility and amenorrhea)
Male LH acts on vs FSH
LH: leydig - testosterone
FSH: Sertoli - aid spermatogenesis, increase androgen binding protein
What does ABP do?
binds to testosterone to ensure that a high concnetration remains in the seminiferous tubules
Sertoli cells produce
ABP
Inhibit
What shapes FSH release?
Inhibin
What shapes LH release
testosterone
inhibin made up of
A and
A-B or B-B
2 beta subunits together = (ßb-A)
activin
what is activin
stimulates FSH production but works at lower rates than inhibin so control is mostly by inhibin
also resides in FSH producing cells of pituitary glands and exerts a pararine effect
how much of testosterone is circulating unbound?
3%
4 ways testosterone can act
- diffuse in cell
- convert to DHT and act (prostate and hair)
- Aromatize to estrogen
- On an plasma membrane receptor
What can testosterone do?
Fetal development of epididymis, vas deferns, seminal vesicles
Pubertal growth of penis, seminal vesicles, musculature, skeleton, larynx
Spermatogenesis
DHT does
Fetal development of Penis, penile urethra, Scrotum, Prostate
Pubertal growth of Scrotum, Prostate, Sexual hair, Sebaceous gland
Prostatic secretion
what does high early fetal exposure to testosterone do?
Eliminate the possibility of + feeback signaling.
Also a role in gender self-identification and gender preference
What does high testosterone do around birth
testicular descent
How does testosterone increase finally at puberty?
Excitatory glutaminergic inputs to LHRH and less GABA
Kallmans syndrome symptoms
Small phallus, small scrotum, muscle mass feminine, wide hips, frail looking, shy, socially withdrawn
Kallman’s syndrome physiology
failure of LHRH neurons to migrate to the hypthalamus
Normally olfactory bulbs develop and span LHRH neurons that migrate but some tissue damage stops it
Kallman’s syndrome treatment
give testosterone
More muscle at shoulderes, less fat at hips
How much folic acid should a woman have before conception?
800 micrograms
Exercise before conception?
30 min a day
Diabetes on pregnancy
birth defects
Eclampsia
heart malformations
blood levels sugar indicated by
HbA1c
First day of gestation
1st day of last menstrual period (LNMP, LMP)
- 2 weeks before = ovulation
When do diagnostics work?
blood test
urine test
ultrasound
8 days
day of menses
6 weeks, more at 9 weeks
Minimum gestation for baby to be healthy
24 (42, induce labor)
Vitamins to recomend: (6)
Folic acid Ca Vitamin D Iron 300 + calories prenatal vitamins
Foods to avoid (4)
Alcohol
unpasteurized milk and its cheese
raw meat
mercury containing fish
Smoking in pregnancy
cleft lip, heart defects, low growth
premature
stillbirth
sudden infant death
Assymetric FGR (fetal growth restriction)
head is normal, rest of the body is smaller
FASD to pregnancy
FGR
microcephaly + CNS defects
Upper lip, poor philtrum, palepbral fissures, short flat bridged nose
Obestity to pregnancy
Difficult becoming pregnant Gestational diabetes hypertensive disorders Deep vein thrombosis/pulmonary embolism Preterm devlivery (physician indused for elss complications; otherwise prolonged) C section Shoulder dystocia- erb's Palsy (waiter's tip) Stillbirth
Teratogens
Warfarin (Coumadin): blood thinner Valproic acid: anti-seizure Carbamazipine: anti-seizure Isotretinoin (Accutane) Ace inhibitor
weeks most sensitive to malformation
3-8
Uncontrolled Diabetes –> large baby?
hgih blood glucose, mother insulin doesn’t cross placenta so just acts as a growth factor
[also high sugar effects respiratory system and gives hypoxia]
Uncontrolled diabetes can cause
hypoglycemia hypoxia cardiac defects polyhydramnios preterm delivery neonatal respriatory distress syndrom stillbirth
Methotrexate
attakcs rapidly dividing cells
use in ectopic pregnancies and cancer
NOT in regular deliveries
Cause of preterm labor?
Unknown
something with uterine overdistension, inflammation, infection, premature HPA axis activity
Give baby what in pretem labor?
steroids: fetal lung development
Magnesium Sulfate: protect the brain by reducing energy use and minimuze free radical production
Tocolytics: stall labor (not really proven to work)
Premature Rupture of Membranes (PROM)
Rupture of fetal membranes (water breaking) >1hr before labor onset
If after 34 weeks, induce labor
Placenta Previa
Placenta implants in the lower part of the uterus blocking the cervix
C section it
Placental Abruption
Premature separation of palcenta from uterine wall
Stillbirth at high degree
associated with contractions, cramping, and bleeding
Preeclampsia
BP > 140/90
proteinurea, low platelet count, impaired liver function, pulmonary edema
Eclampsia seizures treated with
magnesium sulfate to reduce neuroexcitity
Preeclamspia risks
heart attack stroke renal failure retinal injury death
If gestational diabetes
put patients on diabetic diet and closely monitor
Infancy stage:
Birth -2
Males have genital responses in utero and women are capable of vaginal lubrication from birth
Gender identify is forming
Early Childhood stage
2-5 exploration, independence, curiousity Teach kids to use proper names Don't shame Private parts for private places Gender stability Parents should watch kids
Stage 1 pregnancy
learning of pregnancy -> ultrasound Physical Sx memory impairment ambivalence especially when nervous aout pregnancy fear of miscarriage Task: acceptance
Stage 2 pregnancy
Ultrasound -> point of viability sharing news time of peace and fulfillment realization of life within best time for them Task: recognition of fetus as separate from self
Stage 3
Pt of viability -> birth Physical sx are back nesting behavior fear about birth process fear about baby's health Task: attachment
HPV
most common 8kb circular DNA with L1 (!) and L2 capsid proteins 7-8 genes total E1-5 - viral life cycle & interactions w/host E6,7: oncogenes
E6 in HPV
p53 tumor supressor binding
E7 in HPV
bind pRb for degredations - which transactivates genes in cell replication
Cancer inducing HPV
16,18 (70%)
Low grade HPVs
stil have E6,7 but can’t degrade tumor suppressors
can cause morbities like recurrent respiratory papillomatosis in newborns (requiring up to 100 ENT lesion excision to prevent suffocation)
HPV MA
haloes around the nuclei
swiss-cheese effect
brown nuclei = intracellular capsid protein production
HPV life cycle
abrasion -> access to basal cells at bottom of multi-layered squamous epithelium -> 10 replicated copies per cycle to shed and infect other cells/persons
In malignant infection, high risks trains break its circular genome and insert itself into the host DNA with intact E6,7 genes, cells become dysplastic and turn into carcinoma
Trichomonias
protozoanvaginitis > urethritis
transmitable tru items
see with PAP
Chlamydia
bacteria
can cause infertility
mostly women
triad: arthritis, conjunctivitis, urethritis
Gonorrhea
bacteria
treat with antibiotics
can cause sterility
Herpes
1 - oral
2 - genitals
no approved vaccine
Hepatitis B
virus
vaccine
Syphilis
bacteria
antibiotics
Chancroid
bacteria
developing countires and sex works
antibiotics
Koilocytosis
acute infection associated with with capsid protein synthesis
forms well-differentiated tumors
In productive time
Malignant progression of HPV
no koilocytes
nonreproductive
Where does HPV stuff happen
Cervix transformation zone w/transition from vaginal exocervial sqamous epithium and endocervical columnar/glandular epithelium
HPV resolved on own unless
chronic and precancerous lesion forms
Cervical intraepithelial neoplasias (CIN)
Cprecancerouslesion I-III
CIN I
1/3 of epithelium is dysplastic
koilocytosis is stil present at the surface
CIN II
2/3 of epithelium is dysplastic
CIN III
carcinoma in situ
stage 0 cervical cancer
entire depth is dysplastic
HPV detection
colposcopy
pap smears
hybrid capture - most sensitive
HPV destruction
detect and destroy with salicylic or trichloroacetic acid externally
ablate (cryotherapy), exise (conization w/LEEP), poison (pharmacotherapy) vaginally
HPV vaccine
IgG respose
