Case 13-Female Reproductive System Flashcards Preview

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Flashcards in Case 13-Female Reproductive System Deck (96):
1

Glucocorticoids function

1. Intermediary metabolism
2.Protein Matabolism
3. Cardiovascular
4. Bone and calcium metabolism
5. Immunological and inflammatory suppression
MENSTRUAL IRREGULARITIES, HIRSUTISM, PSYCHIATRIC PROBLEMS

2

Urogenital triangle (external genitalia)

Mons pubis
Labia majora
Labia minora
Clitoris
Vestibule of vagina

3

Perineal body

Behind vagina and anterior to anus

4

Labia majora

Lateral skin folds bearing skin, sebaceous glands and sweat glands
Meets superiorly to form mons pubis

5

Labia minora

Medial skin folds which bear no hair or glands and surround the vestibule of vagina
Join to form prepuce of the clitoris

6

Vestibule space

Between labia minora and contains urethral orifice and vaginal orifice

7

Uterus parts

Body
Fundus
Isthmus
Cervix

8

Cervical canal

The external and internal os are the distal and proximal openings of the cervical canal

9

Round ligament

Cord like structure attached to the posterior part of the uterus and extends laterally towards labia majora

10

Broad ligament

Continuos with the peritoneum of the abdominal cavity
Double layered
Joins ovaries to uterus
Contains uterine veins and arteries

11

Nerve supply of uterus

Hypogastric plexus
Splanhnic nerves

12

Uterine tube

Infundibulum
Ampulla
Isthmus
Intramural part

13

Ligament of ovary

Joins ovaries to the uterus

14

Suspensory ligaments

Joins the ovaries to the pelvic wall

15

Broad ligament

Continuos with the peritoneum of abdominal cavity

16

Perineum

Contains urogenital and anal triangle
These are separated by an imaginary line that runs between the ischial tuberosities

17

Pelvic diaphragm

Coccygeus muscle and levator ani

18

Levator ani nerve supply

Pudendal nerve
S234

19

Levator ani

Pubococcygeus
Puborectalis
Iliococcygeus

20

Puborectalis muscle

Maintain faecal continence and it relaxes during defecation

21

Perineal body

Is a fibromuscular mass in middle of perineum at the junction between urogenital triangle and anal triangle

22

Middle episiotomy

Incision from vagina straight towards anus

Less painful
Reduced blood loss
Improved healing
Less pain during sexual intercourse

But can extend to anal muscle and lead to faecal inconntence

23

Mediolateral episiotomy

Incision extends from vagina at 45 degree angle to vaginal orifice

Less likely to cause anal tear

Greater blood loss
Slow healing
Difficulty and pain during sex (dsypareunia)

24

Endometriosis

Endometrial tissue grows anywhere else besides uterine cavity

25

Uterosacral ligament

Support the uterus and hold it in place

26

Urogenital diaphragm

Sphincter urethrae
Deep transverse perineal muscles

27

Stroma of ovary

Contains spindle shaped cells called atonal cells with fine collagen fibers and ground substance

28

Atretic follicles

Completely degenerated follicles
Are present post ovulation

29

Superficial cortex

The superficial cortex is more fibrotic than deep cortex and is called the tunica albuginea

30

Ovary lining

Germinal epithelium called mesothelium

31

Follicular development process(overview)

20 primordial follicles are activated
One follicle will ovulate while others become atretic

32

Primordial follicle

Contains the primary oocyte
Surrounded by a single layer of flattened follicular cells

33

Primary oocyte

It has a large nucleus with granular chromatin
Prominent nucleoli
Little cytoplasm

34

Primary follicle

Larger than primordial follicle
The follicular cells now become cuboidal cells (known as granulosa cells)

35

Zona pellucida

Thick layer of glycoproteins and proteoglycans develop between oocyte and granulosa cells

36

Theca cells

A layer of cells which stromal cells organize into
Are separated from the granulosa cells by a basement membrane

37

Granulosa cells

Surrround the oocyte
Continue to proliferat to form a layer of cells known as the zona granulosa

38

Secondary follicles

Situated deeper in the ovarian cortex
The oocyte is almost full size and is situated in the cumulus oophorus

39

Zona granulosa

Within it appears small fluid spaces
Later fuse to form the Antrum

40

Theca cells

Differentiate into 2 layers.
The theca interna composed of spindle shaped cells
The theca externa composed of spindle shaped cells which merges with surrounding stroma

41

Theca interna

Take on the appearance of steroid secreting cells
Secrete oestrogen and progesterone
Secrete oestrogen precursors

42

The granulosa cells

Produce oestrogen from the precursors produced by the theca interna

43

Graafian follicle

Growth of oocyte ceases and meiosis 1 is completed
It contains secondary oocyte and commences meiosis 2
First polar body forms
Follicular antrum enlarges
The cumulus oophorus diminishes to leave the oocyte surrounded by a layer of corona radiata
Remains attached to the granulosa cells by a layer of bridge cells which breaks before ovulation

44

Ovulation

Intervening stroma becomes avascular and degenerates
Secondary oocyte is ejected with zona pellucida and corona radiata
Second meiosis division is not completed until the ovum is penetrated by spermatozoa

45

Corpus luteum

Ruptured follicle fills with a blood clot to form corpus luteum
Serves as endocrine gland
Granulosa cells and theca cells remain
LH causes granulosa cells to increase in size and secrete progesterone
Acquire characteristics of steroid secreting cells and are known as granulosa lutein cells
Theca cells increase and secrete oestrogen and are now known as theca lutein cells
The basement membrane between theca interna and granulosa cells breaks down

46

Corpus albicans

If there is no implantation due to low LH suppressed by progesterone
Is an inactive fibrous tissue mass

47

Uterine tube

Has many folds which provides an environment for fertilization
Prominent in ampulla region
Lined by columnar epithelium
Which is ciliated and non-ciliated(peg cells)

48

Uterus

The endometrium is the mucosal lining of the uterus
Columnar ciliated epithelium
Endometrial stroma has plump, spindle shaped nuclei and scanty cytoplasm

49

Endometrium
(2 layers)

Basal layer is adjacent to the myometrium
It is not shed during menses
Blood is from straight arteries

Functional layer
Shed during menses
Receives blood from spiral arteries (spasm)

50

Proliferative phase

Glands start off straight and fairly sparse
The stroma becomes oedematous

51

Secretory phase

Coiled glands become more pronounced
Vacuolisation
The glands take on a saw-tooth appearance
Cytoplasmic vacuoles

52

Cervix

Links uterine cavity to vagina

53

Endocervix

Lined by columnar mucous secreting cells

54

Transformation zone

An area where abrupt change from simple columnar to squamous epithelium occurs
Located in the external os
Where metaplasia occurs and is susceptible to carcinoma

55

Ectocervix

Lined by stratified squamous epithelium to protect it from acid

56

Ovulation

Oocyte undergoes its secondary meoitic division
Haploid but double chromosome
Oocyte surrounded by zona pellucida and corona radiata

57

Menses

Decrease oestrogen and progesterone
Prostaglandins release cause spiral arteries spasm
This causes iscahemia thus hypoxia to functional laye. Causes death of tissue.

Dysmenorrhea- overproduction of PGs

58

Proliferative phase

Coincides with follicular phase
Proliferation of epithelial cells, glands and blood vessels
Increases the size of the lining

59

Secretory phase

Luteal phase
Progesterone further thickens oestrogen primed endometrium
Endometrial glands secrete glycogen

60

Mucus in cervix

Facilitates movement of sperm
Also plugs up the cervix to prevent bacteria entry

61

Adrenal gland

Zona glomerulosa- Mineralocortcoids (aldosterone)

Zona fasciculata--Glucocorticoids (cortisol)

Zona reticularis~~ Androgens (DHEA)

Medulla~~cathecholamines (adrenaline and noradrenaline)

62

Corticosteroids synthesis

Plasma lipoproteins (LDL) are the major source of adrenal cholesterol
Acute response to a steroidogenic stimulus is mediated by the acute regulatory protein (stAR)
Rate limiting step: cholesterol to pregnenolone
Side-chain cleavage enzyme stimulated by ACTH

63

1. Cortisol Binding Globulin
2. Albumin

1. High affinity but low capacity carrier
2. Low affinity with high capacity carrier

***High oestrogen state increase CBG

64

Intermediary metabolism

Increases lipolysis, gluconeogenesis, increase blood glucose (insulin resistance)
Increases centripetal fat deposition
Increases appetite

65

Protein metabolism

Increases protein catabolism
Reduced muscle bulk
Poor wound healing

66

Glucocorticoids on CVS

Hypotension
Hypernatraemia
Hypokalaemic alkalosis

67

Bone and calcium metabolism

Inhibit bone formation
Increases bone resorption (osteoporosis)

68

Aldosterone

Angiotensin 2 is the major controller and also hyperkalaemia

69

Aldosterone II

Action through the mineralocorticoid receptor(MR)
Apical influx of sodium via the epithelial sodium channel (ENaC) stimulation
Excess cortisol production allows for interaction with MR
Aldosterone acts on MR

70

Cortisol

Antagonizes insulin in carbohydrate and protein metabolism

71

Steroid hormone biosynthesis

Steroid hormone are all produced by chemical modifications of cholesterol
Side chain cleavage--trimming of the side chain

72

Cushing' syndrome/ hypercortisolim

Cortisol overproduction
Overproduction of glucocorticoid

Sx: increased fat deposition (typically centripetal)~~trunk&abdomen; limbs are spared

Protein wasting
Osteoporosis
Hypertension, hypernatraemia, hypokalaemic alkalosis
Menstrual irregularities
Hirsutism
Psychiatric disturbances
Increased pigmentation (increased ACTH)

73

Cause of Cushing syndrome

Pituitary tumors producing excess ACTH
Ectopic ACTH production by non-pituitary tumor
Adrenal tumors
Iatrogenic

74

Primary hyperaldosteronism

Condition characterized by excessive, inappropriate secretion of aldosterone
Autonomous secreting tumor in the zona glomerulosa

75

Secondary hyperaldosteronism

Hypersecretion of aldosterone is secondary to renin stimulation

76

Hypoadrenalism

Adrenal cortex insufficiency
Cannot secrete aldosterone or cortisol (Primary)
OR
A lack of ACTH stimulation which leads to selective cortisol deficiency, leaving aldosterone intact.

77

Primary hypoadrenalism (Addison's disease)

Adrenal destruction by TB
Autoimmune disease
Metastatic tumor
Inherited enzyme deficiency(CAH)

78

Secondary hypoadrenalism

ACTH deficiency (hypopituitarism)

ACTH deficiency (clinically similar to Addison's disease)
Hypotensive
Hyponatraemic
Hyperpigmentation not a feature (low ACTH)

79

Congenital Adrenal Hyperplasia

Encompasses all inherited enzyme deficiencies of steroid hormone biosynthesis

Deficient steroid hormones (post enzyme step)
Intermediates accumulate (pre enzyme step)

80

21 hydroxylase deficiency

95% of CAH
Impaired ability to synthesize cortisol leads to increased ACTH which stimulates the growth of adrenal gland( adrenal hyperplasia)
Accumulation of the intermediates proximal to the block i.e 17-hydroxyprogesterone

Adrenal hyperplasia may be able to overcome the block and allow adequate cortisol production BUT at the cost of shunting excess 17-hydroxyprogesterone along the androgen synthetic pathway, leading to virilisation.

81

3 forms of 21 hydroxylase deficiency

1.Simple virilizing form
2.Severe salt-losing form
3.Late-onset non classical form

82

Simple virilizing form

Adrenal hyperplasia and accumulation of 17 hydroxyprogesterone allows adequate production of cortisol and Aldosterone.

83

Simple Virilizing form symptoms

Excessive androgen production (testosterone)
Masculinization of newborn girls
Ambiguous genitalia (clitoromegaly, labial fusion)
Male-precocious puberty
No salt wasting, hypotension, hyperkalaemia

84

Severe salt-losing form

Virilisation
Hypotension,shock,hyperkalaemia
This is due to inability to make adequate aldosterone

85

Late onset (non-classical form)

Enzyme defect is mild.
Does not cause neonatal masculinization
Presents in young adult woman as menstrual irregularities, hirsutism and infertility

86

Tx of 21 hydroxylase deficiency

Cortisol
Overtreat: Cushing syndrome
Undertreat : increase androgens, closure of epiphyses and stunted final height

87

11 hydroxylase deficiency

Present like 21 hydroxylase deficiency (ambiguous genitalia or virilisation)
Not salt losing
Hypertension
Accumulated 11 deoxycorticosterone( a precursor of aldosterone)
ACTH and androgens are increased
Elevated 11 deoxycortisol

88

Disorders of adrenal gland

Primary hyperaldosteronism

Primary hypercortisolism

Congenital adrenal hyperplasia

89

Addison's disease (primary adrenal hypofunction)

Impaired capacity to secrete cortisol and aldosterone

90

Secondary adrenal hypofunction

Iatrogenic due to rapid withdrawal of prolonged steroid therapy

91

Hypothalamic and pituitary disease(Addison disease)

Lack of ACTH
Cortisol deficiency
Intact aldosterone

92

Causes of Addison disease

Autoimmune (Hashimoto's thyroiditis, type 1 DM)
Adrenal haemorrhage
Infection: TB
Neoplastic infiltration
Haematochromatosis ; amyloidosis
Congenital adrenal hyperplasia

93

Addison's disease clinical representation

Fatigue, muscle weakness, weight loss
Pigmentation
Addison's crisis: hypotension, circulatory shock and pain

94

Tests for Addison's disease

Na and H2O loss (no aldosterone)
Hyperkalaemia and metabolic acidosis
Inability to secrete water load

95

Addison disease primary deficiency

High ACTH
Low cortisol

96

Addison disease secondary deficiency

Low ACTH
Metyrapone tesr (block final step in cortisol synthesis)
Relieves ACTH inhibition