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Repro > Uterus and uterine tubes > Flashcards

Uterus and uterine tubes Flashcards

1
Q

what is the muscular body of the uterus called?

A

the myometrium

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2
Q

effect of maternal steroids?

A

increase the size of new-born uterus

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3
Q

oestrogen causes an increase in?

A

endometrium and myometrium size

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4
Q

what is the perimetrium?

A

on the outside

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5
Q

what originate from the myometrium layer?

A

uterine fibroids

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6
Q

what is the structure of the myometrium?

A

Inner layer - circular fibres
Middle layer - spiral fibres
Outer layer - longitudinal fibres

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7
Q

when does the outer muscular myometrium grow?

A

grows gradually throughout childhood

  • increases rapidly in size and configuration during puberty
  • changes in size through the cycle
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8
Q

what is the myometrium capable of?

A

vast expansion during pregnancy

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9
Q

what is renewed every month?

A

the endometrium

  • most of it is lost in menstruation
  • it responds to oestrogen and progesterone
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10
Q

what is the endometrium like in childhood?

A

very thin in childhood, and begins to thicken at puberty

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11
Q

what is left of the endometrium after menstruation

A

stromal matrix
(smallest the endometrium can get)
-small columnar cells with glandular extensions 2-3mm thick

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12
Q

what grows from the stromal matrix in response to oestrogen in the follicular phase?

A

endometrial layer

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13
Q

the CL produces progesterone to….

A

……maintain endometrium thickness

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14
Q

after ovulation what happens to the arteries

A

the arteries become more spiralled

-large SA which delivers a lot of blood and oxygen to the endometrium

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15
Q

no pregnancy means what?

A

CL dies, progesterone levels fall and the endometrium sheds

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16
Q

how is the endometrium made ready for embryo implantation?

A

-glands proliferate
-adhesion molecules and mucus secreted
this makes the surface receptive and sticky, ready for embryo implantation

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17
Q

endometrial proliferative phase

A
  • stimulated by oestrogen production from dominant follicle
  • stromal cell division
  • glands expand, become tortuous
  • increased vascularity, neoangiogenesis
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18
Q

in the proliferative phase, what happens when the endometrium >4mm?

A
  • progesterone receptors start to get expressed on the endometrium, ready for the second half of the cycle
  • small muscular contractions of the myometrium
19
Q

endometrial secretory phase

A
  • 2-3 days after ovulation
  • gradual rise in progesterone causes a reduction in cell division
  • increase in tortuosity of glands
  • secretion of glycoproteins and lipids
  • arterioles contract and grow tightly wound
  • myometrial cells enlarge and movement is suppressed
  • blood supply increases, makes endometrium very receptive
20
Q

regression of the corpus luteum

A
  • CL stimulated by LH from pit in luteal phase
  • no pregnancy, no beta-HCG
  • CL dies, no progesterone production
  • endometrium sheds, menstruation
21
Q

how is the CL saved?

A

-fertilised oocyte becomes a blastocyst and produces human chorionic gonadotrophin (beta hCG) which acts like LH ie on LH receptor, and ‘rescues’ the CL

22
Q

what are pregnancy tests based on?

A

beta-HCG levels

23
Q

what happens in menstruation?

A
  • endometrium releases prostaglandins, which constrict the spinal arterioles
  • hypoxia causes necrosis
  • vessels dilate, bleeding occurs
  • proteolytic enzymes released from dying tissue, further tissue degradation
  • basal layer remains, covered by extension of glandular epithelium
24
Q

how much of the endometrium is lost in he first 24 hrs of menstruation?

A

50%

25
Q

where does the embryo spend the first 5-6 days and how does it move?

A

the uterine tube

-moves along tube via peristalsis and cilia

26
Q

3 cell types in the uterine tube?

A

ciliated
non ciliated
secretory

27
Q

when is the only time the oocyte can move along the uterine tube and why?

A

mid cycle, in the ovulation period

  • oestrogen causes cilia to waft
  • activation of secretory cells
  • muscle layer contractions
28
Q

what happens in uterine tube before ovulation?

A

epithelial cells express estrogen receptors and differentiate in response to estradiol
-increase in height mid-cycle

29
Q

what happens in uterine tube after ovulation?

A

a few days of exposure to progesterone means the estrogen receptors are supressed
-estrogen effects are overcome causing decrease in epithelial cell height mid-luteal onward

30
Q

where does fertilisation occur?

A

the ampulla

31
Q

damage to uterine tube lining can cause?

A

pain
infertility
ectopic pregnancy - embryo doesn’t leave the tube

32
Q

name an infection that can block the uterine tube?

A

chlamydia

33
Q

what is tubal patency?

A

when a women’s fallopian tubes are not blocked

34
Q

what can tubal potency be demonstrated by?

A
  1. laparoscopy and dye
    - small incision made in the anterior wall, laproscope put through
    - a light on the end, gives a view inside the abdomen
    - air is pumped in so you can see
    - uterine cannula passed through the cervix, blue dye is injected into the uterus
    - expect the uterus to fill up with dye, dye will travel down the uterine tubes, emerging at the fimbrial end near the opening of the uterine tubes
  2. Hystero Salpingo-contrast Sonography
    - less invasive
    - put cannula through cervix, inject opaque dye that reflects ultrasound
    - ultrasound probe put on the abdomen, monitor progress of dye without entering the abdomen
35
Q

why would laparoscopy and dye be used?

A

in cases of endometriosis - visualise

36
Q

what is endometriosis?

A

when a cell in the endometrium escapes from the uterus and gets into the pelvis or somewhere else, and implants
-still responds to oestrogen and progesterone the same way they would if they were in the uterus (proliferate, differentiate, then shed)

37
Q

what is the cervix?

A

a muscular structure capable of great expansion

38
Q

endocervical mucosa?

A

mucosal lining of the cervix
3mm thick, lined with a single layer of columnar mucous cells which contains tubular mucous glands which empty viscous alkaline mucus into the lumen
-protective barrier to infection
-however has to allow passage of motile sperm

39
Q

what is the cervical mucus like?

A

-very viscous and stiff, blocks the cervix and prevents bacteria from entering
-also impenetrable to sperm
BUT during ovulation cervical mucus becomes less viscous, sperm can enter

40
Q

how does oestrogen affect cervical mucus?

A
  • early phase of the cycle glycoproteins form a mesh barrier that sperm can’t get through
  • becomes less viscous
  • change in mucous composition
  • glycoproteins align, form microscopic channels which sperm swim up
41
Q

what does progesterone in the luteal phase cause?

A
  • viscous mucous (reduced water content)
  • Glycoproteins form mesh structure, acts as barrier
  • One mechanism of action of oral contraceptives.
42
Q

vagina

A
  • thick walled tube lined with squamous epithelium cells
  • warm damp environment containing glycoproteins
  • susceptible to infection
43
Q

bartholins glands

A

located slightly posterior, to the left and right of the opening of the vagina

  • secrete mucus to lubricate vagina
  • homologous to bulbourethral glands in males.

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