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reproductive system > session 3 > Flashcards

session 3 Flashcards

1
Q

Changes in the Male at Puberty

A

Genital development begins

  • Pubic hair growth (Adrenarche)
  • Spermatogenesis begins
  • Growth spurt (10cm/year)
  • Genitalia adult
  • Pubic hair adult
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2
Q

the change of puberty the male starts at age?

A

9

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3
Q

Changes in the Female at Puberty

A 
* Breast bud (Thelarche) – the first sign that
puberty has begun.
* Pubic hair growth (Adrenarche)
* Growth spurt (9cm/year)
* Onset of menstrual cycles (Menarche)
* Pubic hair adult
* Breasts adul
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4
Q

the change of the puberty at the female start at the age —–?

A

8

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5
Q

the physiological changes at puberty ?

A

Pulsatile GnRH secretion leads to rise in FSH and
LH

the start ofpuberty is associated with a steady rise in FSH and LH secretion.

-Rise in GnRH could be reduction in sensitivity to
–‘ve feedback by steroids, or (more likely) due
to ‘maturation’ of central mechanisms

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6
Q

why the GnRH hormone increase at the puberty

A

-Rise in GnRH could be reduction in sensitivity to
–‘ve feedback by steroids, or (more likely) due
to ‘maturation’ of central mechanisms

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7
Q

Critical weight is———- for menarche

A

47kg

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8
Q

Growth spurt start weight is——- for girls and—–for boys

A

30kg , 55kg

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9
Q

what is the important hormone release by the adipose tissue initiate secretion of the GrRH AND important for puberty

A

leptain

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10
Q

Adrenarche (Pubic and Axillary hair) occur dueto the effect of

A

adernogen in both sexs

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11
Q

the female are shorter than man why?

A

Oestrogen closes epiphyses earlier in girls.
Oestrogen is needed to initiate the growth spurt,
but once levels reach a certain point it causes the
epiphyses to fuse.

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12
Q

Growth Spurt depend on

A

growth hormones and steroids

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13
Q

Thelarche (Breast Development depend on

A

estrogen

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14
Q

the development of male genitalia in puberty depend on

A

testosterone

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15
Q

the tanner staging measure the puberty according to

A

breast,
genitals
and pubic hair development

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16
Q

Precocious Puberty

A

The development of the signs of

puberty before the age of 8 in Girls or 9 in Boys

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17
Q

there are two types of precocious puberty?

A

central (true ) and peripheral (pseud) precocious puberty

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18
Q

what is the True (central) precocious puberty

A

due to neurological causes. Early
stimulation of central maturation giving early, inappropriate
GnRH secretion. The cause of the majority is unknown, but
they can be due to neurological causes:
1-CNS tumors
meningitis
trauma

late treatment of CAH ( ACT AS trigger )

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19
Q

what is the peripheral precocious puberty

A

uncontrolled Gonadotrophin or steroid secretion like * Hormone secreting tumours or hormonal ingestion

-mc- cune - testotoxcosis 
adreanl tumors 
CAH IN male 
gonadal tumors 
HCG  secreting Hepatoplastoma 
]sex hormones ingestions (oral contraceptive )
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20
Q

Treatment for the precocious puberity

A

Explanation & reassurance n idiopathic causes
i
Stop the causative

drug——GnRH agonist

removalof tumor

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21
Q

what is the Pre-Menopause

A

it is the period after the 40 years and before the menopause

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22
Q

in the pre-menopause there is —–

  • decrease in fertility
  • increase in fertility
  • absence of fertility
A

decrease in fertlity

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23
Q

The Menopause

A

Cessation of menstrual cycles

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24
Q

in menopause the increase of FSH more than LH due to the effect of ——

A

decreae of the inhibin hormone

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25
Q

Effects of Menopause

A

( I ) Vascular
Hot flushes affect ~80% to some degree
Transient rises in skin temperature and flushes

II ) Oestrogen Sensitive Tissues
Uterus
   Regression of endometrium
     Shrinkage of myometrium
     Shrinks away into a very small organ
cervix thinning of cervix
Vagina rugae lost
             Thinner, less distensible
Breast Involution of some breast tissue
  Changes in skin
  Bladder Reduction in bladder tone

Bone mass reduces by 2.5% per year for several
years. Increased resorption relative to production
Osteoporosis

26
Q

Advantiges=of the hormonal replacement therapy

A

Relieves symptoms of the menopause
_Easy administration Orally or topically by patch or gel
_Can limit osteoporosis, but no longer recommended
for first line protection (Biphosphonates now recommended)
_Not advised for cardio-protection

27
Q

Disadvantages of HRT

A

HRT increases the risk of malignancy due to effect of estrogen specially
endometrial and breast malignancies

also cardiovascular diseases such as coronary artery diseases and thromboembolism (DVT)

28
Q

Menorrhagia

A

excessive (>80 ml) & /or prolonged

bleeding at regular intervals.

29
Q

Metrorrhagia

A

irregular menstrual bleeding.

30
Q

Menometrorrhagia

A

excessive, prolonged & irregular

bleeding.

31
Q

Oligomenorrhoea

A

infrequent menses occurring at >

35 days interval.

32
Q

Polymenorrhoea

A

frequent menses occurring at < 21

days interval.

33
Q

Intermenstrual bleeding

A

bleeding between normal

menstrual periods.

34
Q

Dysmenorrhoea

A

Painful menstruation

35
Q

Postmenopausal bleeding

A

bleeding that occurs > 1 yr after

menopause, or at irregular intervals while on HRT.

36
Q

Cryptomenorrhoea

A

menstruation occurs but not visible due

to obstruction in outflow tract

37
Q

Dysfunctional Uterine Bleeding(DUB)

A

Abnormal bleeding,

no obvious organic cause

38
Q

Amenorrhoea–

A

Absence of periods for at least 6 months

39
Q

Anovulatory Cycles

A

No ovulation/ Oligo/Amenorrhoea +/-

Menorrhagia

40
Q

Ovulatory Cycles

A

usually regular menstrual cycles +/-
Menorrhagia
+ dysmenorrhea/mastalgia (sore breasts)

41
Q

what actually occut imHypothalamic/Pituitary Amenorrhoea?

A

inadequate FSH hormones secretion leaf to inadequate ovaries stimulation which then fail to produce enough oestrogen to
stimulate the endometrium of the uterus

42
Q

Primary Hypothalamic Amenorrhoea causes

A
  • Constitutional delay: exclude other causes.
  • Kallmann Syndrome – Inability to produce GnRH ( LH & FSH
    subsequently
43
Q

Secondary Hypothalamic Amenorrhoea causes

A
  • Exercise or stress-related amenorrhoea
  • Eating disorders and weight loss ( anorexia or bulimia).

CNS neoplasm, trauma or infilterating disease such as TB or sarcoidosis .
* Drugs affecting HPG axis.

44
Q

what the drugs affect the HAG AXIS

A

progesterone , HRT and the dopamine antagonist

45
Q

Secondary Pituitary Amenorrhoea causes

A

Sheehan syndrome – –necrosis of piutary gland due to severe obstetric bleeding ——- Hypopituitarism

  • Hyperprolactinaemia (adenoma)(inhbiti release of FSH and LH )
  • Haemochromatosis – ‘Iron overload
46
Q

how hypothyroidism cause amenorrhea

A

thyroxine is important for the stimulation for the progesterone’s to release by the granulosa cells

the decrease of thyroxine lead to adverse effects

the decrease of thyroxine lead to to stimulate relase of TRH which increase level of the prolactin and cause decrease in the FSH and LH secretion

47
Q

how the hyperthyrodism lead to amenorrhea

A

it lead to trigger high sex -binding proteins production lead to decrease active estrogen that can act on endometrium of uterus .

48
Q

Gonadal/End-Organ Amenorrhoea

primary type causes

A

Primary Gonadal/End-Organ
Gonadal dysgenesis – e.g. Turner Syndrome (45, Xo)
Androgen Insensitivity Syndrome
Receptor abnormalities for FSH and LH

49
Q

Secondary Gonadal/End-Organ

causes of gonadal amenorrhea

A 
premature menopause (ovarian failure)
Polycystic Ovarian Syndrome
50
Q

IV. Outflow Tract Amenorrhoea

Primary Outflow Tract Obstruction

A
  • Uterine – Mullerian agenesis i.e. absent vagina & uterus
    (Rokitansky syndrome)=15% of primary amenorrhoea
  • Vaginal – Vaginal atresia or transverse septum, imperforate hymen
51
Q

Secondary Outflow Tract Obstruction

A
  • Cervical stenosis as in case of conization of the cervix
  • severe vaginal adhesion following vaginal surgery
  • uterine causes
  • Intrauterine Adhesions (Asherman’s syndrome)
  • Endometrial TB
52
Q

Rokitansky syndrome

A

Mullerian agenesis i.e. absent vagina & uterus

(Rokitansky syndrome)=15% of primary amenorrhoea

53
Q

(Asherman’s syndrome)

A

Intrauterine Adhesions

54
Q

Menorrhagia occur secondary to the

A

It isusually secondary to distortion of the uterine cavity,
leaving the uterus unable to contract down on open
venous sinuses in the zona basalis.

55
Q

causes of the menorrhagia

A

It may may be due
to dysfunctional uterine bleeding (DUB) & usually
ovulatory.

Other causes include organic, endocrine,
haemostatic

56
Q

Causes of the menorrhagia

A 
1-DUB / (Bleeding of Endometrial Origion)
2-Fibriod
3-adenomyosis
4-Endometrial polyp
5-Coagulation disorder (von Willebrands disease )
6-Pellvic inflammatory disease ( PID )
7-Thyriod disease
8- Drug therapy ( warfarin )
9-intrauterine contraceptive device
10-Endometrial /Cervical carcinom
57
Q

Anovulatory DUB

A

There is no corpus luteum formation & Progesterone
production. As a result E2 is produced continuously,
causing overgrowth of the uterine endometrium &
subsequent bleeding .

58
Q

difference in the causes between the perimenarchal adolescents,
vs
perimenopause

IN THE aovlatory DOB

A

it is due to immaturity ofHPG axis(unable to respond to E2 with an LH surge

In perimenopausal women it is due to declining
ovarian function.

59
Q

Ovulatory DUB causes

A

altered life span of corpus luteum
or abnormal progesterone production

Disordered endometrial prostaglandin
production also has been implicated, as have
abnormalities of endometrial vascular
development

60
Q

DIGNOSIS OF THE DOB

A

BHCG, TSH – Exclude pregnancy, thyroid
Coagulation workup
Smear if appropriate – Exclude cancer ( Cervical )
Sample endometrium ( D & C )

61
Q

Dysmenorrhea (painful periods)

ATEOLOGIES

A

endometriosis and adenomyosis;
• pelvic inflammatory disease;
• cervical stenosis and haematometra (rare).

reproductive system (3 decks)

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