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Repro > uterus, uterine tubes and the cervix > Flashcards

uterus, uterine tubes and the cervix Flashcards

1
Q

route of sperm to the oocyte

A

sperm enters cervix to the uterus
sperm swims up uterine tube
around region of ampulla, sperm meets the oocyte

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2
Q

why is the uterus of a newborn larger than that of a four year old

A

uterus (endometrium and myometrium) responds to oestrogen.
During pregnancy maternal oestrogen increases size of newborn uterus.
after birth, these high oestrogen levels are no longer present so uterus shrinks.

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3
Q

what is myometrium

A

the smooth muscle tissue of the uterus.

makes up body of uterus

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4
Q

what is endometrium

A

the mucous membrane that lines the inside of the uterus, which is shed every month

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5
Q

what is the myometrium dependent on

A

oestradiol

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6
Q

what are the characteristics of nulliparous uterus

A

is uterus of woman that hasn’t given birth
is quite large,
bc there is a lot of growth of it once menstrual cycle kicks in

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7
Q

what are the characteristics of a parous uterus

A

is uterus of woman that has given birth

is larger than nulliparous due to higher levels of oestrogen during pregnancy

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8
Q

what are the characteristics of a post-menopausal uterus

A

oestrogen is v low and uterus shrinks back to prepubertal size

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9
Q

what are the three layers of the uterus

A
  • endometrium
  • myometrium
  • perimetrium
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10
Q

what is the perimetrium

A

is the outer serosa layer of the uterus,

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11
Q

what are the three layers of the myometrium

A
  • An inner layer, which is made of circular fibres
  • A middle layer which is made up of figure-of-8 or spiral fibres
  • An outer layer that is made up of longitudinal fibres
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12
Q

how many types of muscle fibres does the myometrium have

A

3

so is v dynamic and well developed

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13
Q

where do uterine fibroids develop

A

in the myometrium

are also responsive to oestrogen

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14
Q

what are uterine fibroid

A

muscular tumors that grow in the wall of the uterus (womb)

usually benign

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15
Q

how does myometrium change through life

A
  • grows gradually throughout childhood

- increases rapidly in size &configuration during puberty.

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16
Q

how does myometrium change during the menstrual cycle and pregnancy

A

menstrual cycle - changes size

pregnancy - capable of vast expansion

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17
Q

how does endometrium change through life

A

thin in childhood and begins to thicken at puberty

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18
Q

how is blood supply arranged in the developed endometrium

A

arteries supplying endometrium arranged in spirals .’. increased surface area.
dense capillary network
heavily vascularised

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19
Q

what happens to endometrium when reaching full receptivity (~week after ovulation)

A

develops uterine glands which secrete substances (eg growth factors, adhesion molecules) onto luminal surface of uterus

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20
Q

what is the endometrium dependent on

A

steroids.

.’. responds cyclically to hormone changes

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21
Q

how does endometrium change through the menstrual cycle

A

1 - glandular cells changes
2 - epithelial cell changes
1st half = oestrogen domominated = proliferation of stromal layer
after ovulation = C.Luteum makes progesterone dominated = differentiation/maturation/become receptive of the endometrium, the coiling of the arteries and development of glands
when C.Luteum dies, endomedium shed back down to stromal matrix.

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22
Q

what is the stromal matrix left after ater menstruation

A

consists of small columnar cells
with glandular extensions 2-3mm thick
glands are simple and straight

23
Q

what are the two phases of the menstrual cycle (endometrium related)

A

1 - proliferative phase

2 - secretory phase

24
Q

what hormone stimulates the proliferative phase of menstrual cycle

A

oestradiol

released from dominant follicle

25
Q

what happens in the proliferative phase of menstrual cycle

A

E2 released from dominant follicle.
high oestrogen = proliferation of endometrium:
stromal cell division, development of the ciliated surface, glands expand + become tortuous, increased vascularity.
by day 12-14 = maximum cell division. gonadotrophins low due to -ve feedback.
when endometrium = more than 4mm, = induction of progesterone receptors on endometrium
sustained high oestrogen = switch to +ve feedback .’. LH surge and ovulation

26
Q

what happens in endometrial secretory phase

A

gradual rise in progesterone from C.Luteum
= reduction in cell division
= endometrium starts differentiating/maturing
glands become more tortuous and distend. secrete glycoproteins and lipids. Odema seen due to inc. vascular permeability. arterials become coiled. myometrial cells enlarge, movement suppressed and blood supply increases.
C.Luteum secreted progesterone whilst stimulated by LH. when LH falls, C.Luteum dies so progesterone falls = menstruation.
fertilised oocyte here is blastocyst which produces hCG =binds to LHr .’. maintains c.luteum,

27
Q

why does the C.Luteum die

A

whilst CL is secreting progesterone it is stimulated by LH pituitary (luteal phase). -ve feedback of progesterone produced causes decrease in LH .’. corpus luteum dies.

28
Q

why can corpus luteum survive LH drop when there is fertilsation

A

fertilised oocyte becomes blastocyst by time LH falls.
blastocyst starts to produce hCG which binds to LHr (has a similar structure to LH).
so maintains stimulation

29
Q

what does endometrium release on response to progesterone fall

A

prostoglandins

30
Q

what effect does the endometrial release of prostoglandin (in response to progesterone drop) have

A

PG release = constriction of spiral arterioles .’. hypoxia and necrosis.
vessels then dilate and bleeding ensues.
dying tissues release proteolytic enzymes which help to break down tissue.

31
Q

what actually happens in menstruation

A

C.Luteum death = progesterone drop = endometrial cells release prostoglandins (PG).
PG = contriction of spiral arterioles = hypoxia and necrosis.
proteoltic enzymes released from dying tissue
vessels then dilate and bleeding ensues.

32
Q

what is shed in menstruation

A

initially = outer layer of endometrium (50% in 1st 24 hrs)
most of the endometrium is lost except for a few mm of the stomal matrix.
basal layer remains

33
Q

what does the uterine tube connect and what happens in it

A

connects ovary to uterus

is where fertilisation occurs .’. secretions of the uterine tube are critical for survival of early embryo

34
Q

what is the intramural section of the uterine tube

A

where the uterine tube meets the uterus.

35
Q

what are the two types of cell in the mucosa of uterine tube

A

1 - secretory -> secretes nutrients for the early embryo

2 - Columnar ciliated epithelium -> waft oocyte and embryo down the uterine tub

36
Q

how is mucosa distributed in the uterine wall

A

in isthmus - more secretory mucosa

in ampulla - secretory mucosa is convoluted to give a massive surface area

37
Q

where does sperm meet egg

A

~ampulla of uterine tube

38
Q

what hormones regulate endometrium

A

proliferates under oestrogen

differentiates under progesterone

39
Q

how do hormones affect the uterine tube

when there is pregnancy

A

at start of menstrual cycle oestrogen is high .’. differentiation of epithelial cells lining uterine tube.’. ciliated cells start wafting and secretory cells start to secrete.
mucosa increases in height. happens bc midcycle = ovulation .’. want secretions and cilia to receive the egg.

40
Q

how do hormones affect the uterine tube

when there is no pregnancy

A

if no fertilisation = no point in secretions and cilia wafting.
.’. few days after exposure to progesterone from C.Luteum = too late for fertilisation. so if not fertilised, the progesterone undifferentiates the uterine tube epithelium so secretion and cilia stop .’. decrease in height of mucosa

41
Q

Once the oocyte is in the uterine tube how is it transported along

A
  • The beating of the cilia, which have been/are stimulated to grow by oestrogen
  • Rapid contractions of muscular layer caused by oestrogen
42
Q

what may cause damage to the uterine tubes

A

infection, endometriosis, surgery or adhesions

43
Q

what may be the result of damage to the uterine tube

A
  • pain
  • infertility
  • ectopic pregnancy
44
Q

why may endometriosis cause ectopic pregnancy

A

in endometriosis there is growth of endometrial tissue in areas outside of the uterus, this will respond to oestrogen/progesterone and if this occurs in the uterine tube or bowel etc. it can block the tube when it sheds or the embryo may implant, an ectopic pregnancy

45
Q

what are the main to check if uterine tube is blocked

A
  • Laproscopy and Dye

- Hystero Salpingo-contrast Sonography (HyCoSy)

46
Q

what is laproscopy and dye

A
  1. uterine cannula goes through cervix and introduces dye into the uterus
  2. laproscope goes through abdominal wall, inside pelvic cavity.
  3. can see dye emerge out of the uterine tube (out of fimbrial end) if no blockage.
    if it doesn’t emerge, there is something blocking it
47
Q

what is Hystero Salpingo-contrast Sonography (HyCoSy)

A
  1. fill uterus with dye via vagina.
    only way out is through the uterine tube
  2. dye is opaque on ultrasound, can see progress of dye through tube.
48
Q

benefit of Hystero Salpingo-contrast Sonography (HyCoSy) over laryngoscopy and dye

A

is noninvasive

is cheaper

49
Q

how does mucous change in menstrual cycle

A

when ovulating - mucus thin+runny.’. sperm can swim with ease
during other times, mucous is thick +sticky so sperm cannot swim

50
Q

how does oestrogen in the follicular phase affect the cervix

A

increase in vascularity of the cervix
increase permeability of cervix .’. odema as transudate moves out.
cervical mucous = more watery

51
Q

how does oestrogen affect the mucous midcycle

A

high oestrogen = more runny mucous

- changed composition by having increased glycoproteins that align to form microscopic channels that sperm can swim up

52
Q

what is the effect of progesterone in the luteal phase

A
  • reduced secretion and more viscous mucous (decreased water content)
  • glycoproteins form a mesh structure that acts as a barrier
53
Q

how does mucous change in response to oral contraceptives

A

secondary mechanism - increase mucous thickness and composition so is more difficult for sperm to enter nucleus

54
Q

how is infection of vagina prevented

A
  • epithelial cell layers lining vagina are constantly shed & flow down with secretions
  • secretions from cervix and from vaginal epithelium.
  • secretions change with cycle and are generally acidic .’. has antimicrobial action

Repro (13 decks)

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