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Life Cycle > Uterine tubes and Cervix > Flashcards

Uterine tubes and Cervix Flashcards

1
Q

What changes occur to the uterus and cervix?

A

POSTNATAL
maternal steroids increase size of neonatal uterus

INFANCY
uterus grows with height during infancy

PUBERTY and MENSTRUAL CYCLE

  • myometrium is E2-dependent
  • Uterine corpus undergoes a bigger increase in size that the cervix
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2
Q

What is the function of the 3 muscular layers in the myometrium?

A

Allows dynamic muscular contraction in various directions

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3
Q

How does the myometrium change during development?

A

CHILDHOOD
outer muscular myometrium gradually grows

PUBERTY
myometrium rapidly increases in size and configuration

MENSTRUAL CYCLE
changes in size at various points in cycle

PREGNANCY
capable of vast expansion

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4
Q

How are the muscular fibres arranged in the 3 layers of the myometrium?

A

INNER layer
circular fibres

MIDDLE layer
spiral fibres (figure of 8)

OUTER layer
longitudinal fibres

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5
Q

How does the endometrium change through development?

A

CHILDHOOD
very thin, begins to thicken at puberty

MENSTRUAL CYCLE
thickness dependent on steroids, will change throughout cycle
P causes mainly differentiation of glandular and epithelial tissue in secretory phase

most endometrium lost during periods

post-menstruation - stromal matrix with small columnar cells with glandular extensions (2-3mm thickness)
Glands are simple and straight

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6
Q

How does the corpus luteum support endometrial differentiation during the luteal phase?

A

(= secretory phase)

CL secretes progesterone

P promotes differentiation of upper layer of endometrium and angiogenesis (creating tortuous vessels - spiral arteries)

this provides an enriched vascular supply to the endometrium

and heightens the secretory gland activity

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7
Q

What is the endometrial proliferative phase?

A

[Days 5-14]
= follicular phase of ovary

stimulates by E2 from growing follicle

endometrial changes (max. days 12-14):
stromal cell division
ciliated surface
glands expand and become tortuous due to angiogenesis

when endometrium >4mm:
induction of P receptors
small muscular contractions in myometrium

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8
Q

What maintains the corpus luteum in the secretory phase?

A

LH-R signalling on the CL
which then allows CL to make P

However, P secretion acts via negative feedback to suppress LH release (from ant. pituitary)

This loss of LH eventually leads to CL atresia (14 days after ovulation)

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9
Q

What is the endometrial secretory phase?

A

[days 15-28]
= luteal phase of ovary

2-3 days after ovulation
gradual increase in P causes reduction in cell division (of endometrium)

glands become more tortuous and distend
-> secretion of glycoproteins and lipids

PG action (?)

  • > oedema
  • > increased vascular permeability
  • > arterioles contract and grow tightly wound

myometrial cells enlarge and movement is suppressed

blood supply increases

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10
Q

When doe corpus luteum regression occur?

A

CL stimulated by LH from ant. pituitary during luteal phase

fertilised oocyte becomes and blastocyst and produces hCG which binds to the LH-R (and therefore maintains CL)

However, if oocyte is not fertilised then loss of P secretion from CL causes atresia and then menstruation

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11
Q

Where is hCG synthesised?

A

from trophoblast cells in the fertilised embryo (blastocyst)

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12
Q

What causes menstruation?

A

reduction in P causes release of PGs

(vasoconstrictory F2a and Tx) PG release causes spiral arteries to constrict

these are end-arteries so cause hypoxia and then necrosis

proteolytic enzymes are released from the dying endometrial tissue

outer layer of endometrium is shed (50% lost in 24h)

basal (stromal) layer remains, then covered by extension of glandular epithelium

E2 from follicle (next follicular phase) imitates cycle again

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13
Q

What is normal menstruation pattern?

A

can vary vastly
3-5 days, usually 4+

<80ml is considered normal

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14
Q

What are the 3 layers of the uterine tube?

A

Mucosa (inner)
Muscularis (middle)
Serosa (outer

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15
Q

What does the uterine tube mucosa contain?

A

secretory cells
columnar ciliated epithelial cells
non-ciliated peg cells

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16
Q

What does the uterine tube muscularis contain?

A

inner circular layer
outer longitudinal layer
blood vessels
lymphatic vessels

17
Q

What are the different regions of the uterine tube called?

A 
lateral:
- fimbriated infundibulum (nearest ovaries)
- ampulla
- isthmus
- intramural 
\: medial
18
Q

What is the nature of the intramural region of the uterine tubes?

A

most medially located

contains more muscular layers

19
Q

What is the nature of the ampullary region of the uterine tubes?

A

located most laterally (nearest to fimbriated infundibulum)

contains more glandular layers

20
Q

What changes occur to the uterine tube cells during follicular phase?

A

= proliferative phase

epithelial cells express high E2 receptors

undergo differentiation in responde to E2 increase in mid-cycle

21
Q

What changes occur to the uterine tube cells during ovulation?

A

oocyte can only pass down the tube at mid-cycle

cilia beat and secretory cells are active

this occurs along with muscular contractions down there uterine tube

these are all stimulated by E2

22
Q

What changes occur to the uterine tube cells during luteal phase?

A

= secretory phase

after few days expo to P , E2 receptors are suppressed and E2 levels drop (from mid-luteal onwards)

23
Q

How does oestrogen have different effects on different tissues in the uterus?

A

ENDOMETRIUM
E2 mediates proliferation

UTERINE TUBES
mediates differentiation

same hormone but different receptor isoforms (E3a vs E3b) ?

24
Q

What occurs during fertilisation?

A

fertilisation occurs most commonly in the ampulla of the uterine tube

embryo remains in the tube for ~5d

damage to tube lining by infection, endometriosis, surgery or adhesions

this can cause blockage or damage to ciliated epithelia, causing:

  • pain
  • infertility
  • ectopic pregnancy
25
Q

How may uterine tubal patency be examined?

A
  • laprascopy and dye
    (abdominal approach)
  • hysterosalpingo-contrast sonography (HyCoSy)
    (vaginal approach)
26
Q

What is the histological structure of the cervix?

A

= muscular structure capable of vast expansion

ENDOCERVICAL MUCOSA
~3mm thick
lined with single layer of columnar mucous cells
numerous tubular mucous glands

ECTOCERVIX
covered with non-keratinised stratified squamous epithelium
similar to the squamous epithelium lining vagina

27
Q

What is the function of the tubular mucous glands in the endocervical mucosa?

A

to secrete viscous alkaline mucus into the cervical lumen

  • protective barrier to infection
  • but allows passage of sperm
28
Q

What are the different regions of the cervix?

A 
[near corpus uterus]
- internal os 
- endocervical canal 
- endocervical mucsal 
- ectocervix 
- external os 
[vagina]
29
Q

Where are the vaginal fornices?

A

part of the vaginal cavity

corners surrounding the ectocervix

30
Q

What happens to the cervix during the follicular phase?

A

E2 causes change in cervical vascularity and oedema

PERI-OVULATION
mid-cycle E2 surge reduced cervical mucous viscosity
- glycoproteins in mucous align to form microscopic channels that allow sperm to swim up

31
Q

What happens to the cervix during the luteal phase?

A

P secretion causes:

  • reduced secretion of mucous
  • mucous become more viscous
  • glycoproteins now form mesh: barrier to sperm and microorganisms
  • one MoA for oral contraceptives (promote thick mucous plug)
32
Q

What is the histological structure of the vagina?

A

thick walled tube ~10cm in length
lined by squamous epithelial cells
warm, damp environment containing glycoprotein

33
Q

What mechanisms protect the vagina from infection?

A
  • layers of epithelium slough and flow downwards with secretions
  • cervical secretions and transudate
  • secretions change during cycle and are acidic (antimicrobial protection)
34
Q

What are the Bartholin’s glands?

A

located posterior and either side of the vaginal opening

secrete mucus to lubricate vagina

homologous to bulbourethral glands in males

Life Cycle (29 decks)

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