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Medicine year 2 semester 1 > Case 14- Hormones and Anatomy > Flashcards

Case 14- Hormones and Anatomy Flashcards

1
Q

Stages of the ovarian cycle

A
  • Day 0-14= follicular phase, there are developmental follicles. It is the initiation of menstruation. It lasts 14 days and is the most variable part of the cycle
  • Day 14= Ovulation, release of a mature ovum
  • Days 14-28= Luteal phase, when the corpus luteum is formed. In the late Luteal phase there is low ovarium hormone production which causes GnRH to act on the anterior pituitary causing the release of FSH and LH.
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2
Q

FSH/LH and oestrogen

A

There is an increase of FSH at day 0 of the ovarian cycle which is needed for the development and recruitment of follicles. The follicles produce oestrogen. As oestrogen secretion increases, FSH secretion decreases through negative feedback. Oestrogen normally inhibits LH secretion by negative feedback to the anterior pituitary via GnRH. When Oestrogen levels are high it acts on a different set of receptors called GnRH2 which increase LH production by positive feedback

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3
Q

Hormone levels through the menstrual cycle

A
  1. FSH conc increases due to a low oestrogen conc (day 0)
  2. This stimulates follicular growth
  3. These follicles release oestrogen
  4. At day ~11 there is a peak in oestrogen conc
  5. This stimulates the LH surge, on day 14
  6. The LH surge results in ovulation
  7. The ovarian follicle becomes luteinised (corpus luteum formation)
  8. The Corpus luteum secretes progesterone and oestrogen increasing their concentrations. The CL is programmed to secrete these hormones for 14 days and if not pregnant it undergoes leutolysis.
  9. The corpus luteum will regress and stop making progesterone and oestrogen if the egg is not fertilised. Becomes corpus albicans which is an inactive fibrous tissue mass.
  10. Low oestrogen levels feed back on the Hypothalamus to release more GnRH causing the anterior pituitary to release more FSH and LH.
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4
Q

What happens to the corpus leuteum if pregnant

A

Implantation interrupts the integrate ovarian and menstrual cycles. HCG is released from the developing placenta and maintains the function of the Corpus Luteum until the placenta takes over steroidogenesis (sex hormone production) at week 13 of gestation. The corpus luteum then regresses and forms the corpus albicans. Progesterone is secreted by the corpus leuteum

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4
Q

What happens to the corpus leuteum if pregnant

A

Implantation interrupts the integrate ovarian and menstrual cycles. HCG is released from the developing placenta and maintains the function of the Corpus Luteum until the placenta takes over steroidogenesis (sex hormone production) at week 13 of gestation. The corpus luteum then regresses and forms the corpus albicans. Progesterone is secreted by the corpus leuteum

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5
Q

oestrogen and progesterone small

A

In the follicular phase of the ovarian cycle there is only oestrogen secretion, after ovulation there is Progesterone and Oestrogen secretion.

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6
Q

Stages of the uterine cycle

A
  • Menses (day 0-5)= shedding of the endometrium
  • Proliferative phase (day 5-14)= growth of endometrium
  • Secretory phase (day 14-28)= preparation for implantation, produces secretions to nourish the embryo
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7
Q

Order of the layers of the endometrium of the uterus (from top to bottom)

A
  • Stratum compactum
  • Stratum spongiosum
  • Stratum basalis
  • Myometrium
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8
Q

The stratum compactum and Stratum spongiosum

A

They are shed during menses. The endometrium is lined by pseudostratified columnar ciliated epithelium. The stroma contains numerous tubular glands and is highly vascular (with spiral artery’s and straight artery’s). The stratum compactum and Spongiosum respond to hormones and go through the monthly cycle of proliferation and shedding. The Stratum basalis is where the functional layer arises from.

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9
Q

What happens to the endometrium in the proliferative stage

A

In the Proliferative phase increased Oestrogen initiates proliferation of the endometrium, the stroma proliferate becoming thicker and richly vascularised. The tubular glands appear with increased mitotic activity. As the tubular glands lengthen they begin to convolute.

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10
Q

How the secretory phase affects the endometrium

A

In the secretory phase the stroma are highly vascular. The glands have a saw-tooth appearance which contains lots of thick glycogen and glycoprotein-rich secretions. The glands have become highly convoluted. Glycogen is an important source of nutrition for the fertilised ovum.
In the menstrual phase Progesterone withdrawal induces shedding of the functional layer of the endometrium

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11
Q

Hormonal effects on the cervix

A

Oestrogen, which increases during ovulation causes the secretions to be thin, watery and full of electrolytes. The cervix becomes highly spinbarkeit (stretchable). When Progesterone levels increase after ovulation, it causes the secretions to become thick and viscid. The cervix has a low spinbarkeit (stretchability). This causes the sperm to get stuck and not enter the cervix.

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12
Q

Hormonal effects on the fallopian tubes

A

Oestrogen increases the transport speed of the gametes (increases during ovulation), whilst Progesterone decreases the transport speed of the ovum (increase after ovulation).

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13
Q

Course of the pudendal vessels (artery and vein)

A

The pudendal vessels travel with the pudendal nerve
• Exits the pelvis via the greater sciatic foramen, inferior to the piriformis
• Curves around the ischial spine and the sacrospinous ligament
• Re-enters the pelvis through the lesser sciatic foramen
• Travels through the pudendal canal (sheath derived from the fascia of the obturator internus muscle). In the lower lateral wall of the ischioanal fossae.
• Enters the perineal region. It gives off branches in the canal and the perineal region which supply structures in the perineum and the external genitalia

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14
Q

Branches of the internal pudendal

A

1) The inferior rectal artery (rectum)
2) Perineal artery which gives off:
- Posterior labial/scrotal arteries
- The dorsal arteries of the clitoris/penis
- The deep arteries of the clitoris/penis
- The artery of the vestibular bulb (female)/bulbourethral (males).

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15
Q

What is the pudendal nerve derived from?

A

Derived from the anteria rami of the S2/S3/S4 spinal nerves

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16
Q

Branches of the Pudendal nerve

A
  • Inferior rectal- supplies the rectum and external anal sphincter
  • Perineal- further divides into the Muscular (deep) branches, Superficial branch, Posterior scrotal/labial branch.
  • Dorsal nerve of penis/clitoris
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17
Q

Nerve supply to the pelvis

A

The Lumbosacral plexus which is the combination of the lumbar nerves (T12-L4) and the sacral nerves (L4-S4). The Lumbrosacral trunk connects the Lumbar plexus to the Sacral plexus

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17
Q

Nerve supply to the pelvis

A

The Lumbosacral plexus which is the combination of the lumbar nerves (T12-L4) and the sacral nerves (L4-S4). The Lumbrosacral trunk connects the Lumbar plexus to the Sacral plexus

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17
Q

Nerve supply to the pelvis

A

The Lumbosacral plexus which is the combination of the lumbar nerves (T12-L4) and the sacral nerves (L4-S4). The Lumbrosacral trunk connects the Lumbar plexus to the Sacral plexus

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18
Q

Nerves in the lumbar plexus

A

1) Iliohypogastric nerve
2) Ilio-inguinal nerve
3) Genitofemoral nerve
4) Lateral cutaneous nerve of the thigh
5) Femoral nerve
6) Obturator nerve
7) The genital branch of the genitofemoral nerve and the Ilio-inguinal nerve travel through the inguinal canal

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19
Q

Pelvic splanchic nerves

A

Arise from S2/S3/S4. Preganglionic nerve fibres which form the Parasympathetic section of the autonomic nervous system in the pelvis.

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20
Q

Hypogastric nerves

A

Form the other portion of the autonomic NS in the pelvis. Sympathetic nerves which join with the Pelvic splanchic nerves. They merge to form the inferior Hypogastric plexus which contains both Sympathetic and Parasympathetic nerve fibres

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21
Q

Nerve supply to the penis- Pudendal nerve

A

Most important nerve that supplies the penis divides into the posterior scrotal nerve and the Perineal nerve.
1) The posterior scrotal nerve supplies the more proximal parts of the penis.
2) The deep branches of the perineal nerve which supply the deeper areas of the penis.
3) The Dorsal nerve of the penis supplies the majority of the skin of the penis and the Glans penis.
The Ilioinguinal nerve and the genital branch of the genitofemoral nerve also supply the penis

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22
Q

Divisions of the Pudendal nerve in the penis

A

• Perineal:
- Muscular (deep) branches supply muscles within penis
- Superficial branch supplies skin
- Posterior scrotal supplies skin of scrotum
• Dorsal nerve of penis

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23
Q

Innervation of the vulva- pudendal nerve

A

1) Divides into the inferior rectal nerve (doesn’t supply the vulva)
2) The Perineal nerve
3) The posterior labial nerve (which comes off the Perineal nerve).
4) The muscular branches of the Perineal nerve (supplies muscles in the region).
5) The Dorsal nerve of the clitoris.
6) The Ilioinguinal nerve
7) The genital branch of the genitofemoral nerve also supply the vulva in the anterior region.

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24
Q

Divisions of the Pudendal nerve in the vulva

A

• Perineal:
- Muscular (deep) branches supply muscles
- Superficial branch supplies skin
- Posterior labial supplies skin of labia majora
• Dorsal nerve of clitoris

25
Q

Blood flow in the fetus

A

Blood crosses through the fetal heart ducts in the right to left direction with only a small percent going through the lungs

26
Q

Respiratory changes when the cord is cut

A
  • Placenta no longer works as lungs - ↓pO2, ↑pCO2, ↓pH
  • This stimulates the fetal aortic and carotid chemoreceptors, activating the respiratory centre in the medulla to initiate respiration
  • Lungs begin to exchange gases
  • First breath inflates lungs and causes circulatory changes
  • Lungs inflate - ↓ resistance to blood flow through lungs & ↑ blood flow from pulmonary arteries
  • Newborn Circulation is established
27
Q

Changes in the lungs after birth

A

Mechanical compression of the chest during the vaginal birth forces 1/3 of the fluid out of the fetal lungs. As the chest is delivered, it re-expands, generating a negative pressure and drawing air into the lungs. Passive inspiration of air replaces fluid. As the infant cries, a positive intrathoracic pressure is established which keeps the alveoli open, forcing the remaining fetal lung fluid into the lymphatic circulation. Over 90% of newborns have no issue with respiration, 1%require extensive resusitation

28
Q

What is needed for the babies respiratory system to function effectively

A
  • adequate pulmonary blood flow
  • adequate amount of surfactant
  • respiratory musculature strong enough to support respiration
29
Q

Cardiovascular adaptions in the new born

A
  • Increased aortic pressure and decreased venous pressure secondary to clamping the umbilical cord
  • Increased systemic pressure and decreased pulmonary artery pressure with initiation of respirations
  • In the fetus there is very high pressure in the lungs and pulmonary arteries.
30
Q

What 3 shunts close after birth

A

Ductus venosus (from umbilical vein to IVC), Ductus arteriosus (pulmonary artery and the aorta) and the Foramen ovale (right atrium and left atrium). The Ductus venosus closes instantly, the ductus arteriosus from 48-72 hours and the Foramen ovale closes within day 1.

31
Q

Changes to the heart after birth

A

The right sided heart pressure drops massively and the left heart pressure is high. Blood then flows from left to right, this can take 24-48 hours. The blood flows from the IVC into the right atrium -> right ventricle -> Pulmonary artery. Some blood then goes into the Aorta and is mixed, oxygen saturation is not 100%. Occurs in newborns when the ductus arteriosus is still open

32
Q

Factors that predispose a newborn to heat loss

A
  • Large surface area (especially head!)
  • Limited ability to control their metabolic rate
  • Blood vessels of the newborn are closer to the skin than adults
  • Decreased insulation due to less fat
33
Q

Hypothermia in newborns

A
  • Increased metabolic rate- results in Hypoglycaemia causing anaerobic glycolysis, decreases oxygen levels and the baby becomes acidotic. The baby then needs respiratory support.
  • Increases O2 consumption- increased respiratory rate causes pulmonary vasoconstriction, increasing O2 demand. Driving anaerobic glycolysis and causing acidosis. The baby will need glucose support through IV.
  • Increases stress on baby
34
Q

Newborn- temperature

A

When born the babies glucose levels drop very quickly, they need to switch to independent glucose production. Very important to keep baby warm, associates with mortality. Warm and dry the baby straight away

35
Q

The 3 main things that happen in the heart after birth (foetus)

A
  • increased aortic pressure
  • decreased venous pressure
  • shunts close, so heart can act as a double pump rather than a single one
36
Q

Transition

A

A process of physiological change in the newborn infant that begins in utero as the child prepares for transition from intrauterine placental support to extrauterine self maintenance.

37
Q

Transition

A

A process of physiological change in the newborn infant that begins in utero as the child prepares for transition from intrauterine placental support to extrauterine self maintenance.

38
Q

What does transition depend upon

A
  • Gestational age
  • Placenta health/condition
  • Maternal health- diabetes, pre-eclampsia
  • Any limitations to major organs
  • Physical defects/anomalies
39
Q

How does the infant prepare for transition

A
  • Fetal breathing (producing surfactant at 34 weeks)- reduces surface tension, preventing collapse of alveoli
  • Storing glycogen in the liver- sustains glucose production
  • Producing catecholamines
  • Depositing brown fat
40
Q

Feeding infants 0-6 months

A
  • Breastfeeding is the optimal method of infant feeding and exclusive breastfeeding is recommended for the first 6 months to ensure babies have the best start in life
  • By around 6 months of age, breast or formula milk alone will no longer be sufficient to meet a baby’s nutritional needs and the process of weaning onto solid foods should begin
  • The timing of introduction of solids should take into consideration the individual baby’s development as this can vary widely.
41
Q

What vitamins should babies receive at 6 months

A

From 6 months infants receiving breast milk as their main drink should be given liquid drops of vitamin A, C and D.

42
Q

Breast milk

A

Provides all the energy and nutrients a baby needs. Growth factors and immunological components protect the baby from infection i.e. Necrotising enterotitis. Composition changes with feed and time. Whey is the most abundant protein. Contains omega-3 and omega-6 long-chain polyunsaturated fatty acids (PUFAs).

43
Q

Substances present in breast milk but not formula

A

Contains transfer factors that are useful in growth and protection of the newborn infant. Also Nucleotides, Immunoglobulins, Anti-inflammatory, Hormones, Bifidus factors, Oligosacharides, Enzymes, White cells and Viral fragments.

44
Q

Composition of breast milk

A
  • 90% water
  • Fat is variable
  • Primary carbohydrate is lactose, trace amounts of other carbohydrates
  • Whey/Casein ratio changes according to infant needs
  • Whey components include alpha-lactalbumin, serum albumin, lactoferrin, immunoglobulins, and lysozyme
  • Low in vitamin D, adequate vitamin C & B complex
  • Iron absorption: 50-60%
45
Q

Colostrum- first milk mum makes

A
  • Small in volume
  • High levels of immunoglobulins
  • Strong anti-inflammatory effect
  • Stimulates gut growth
  • Acts as a laxative
  • High in Na and KcL
  • Creates acidic pH environment
  • Analgesic effect
46
Q

What is not breastfeeding linked to

A

Low education, lack of closeness with mother, tooth decay, dental malocclusion, gastroenteritis, obesity, sids, milk intolerance, sepsis.

47
Q

What do you palpate in a breast examination

A

The 4 quadrants and the axillary tail. The four quadrants are the upper inner, upper outer, lower inner and lower outer.

48
Q

Contents of the breast

A
  • Secretory lobe- important for milk production
  • Fibro-fatty tissue- supporting tissue, contains fibrous collagen which forms lobes
  • Lactiferous ducts- milk is produced in the secretory lobes then transported along the Lactiferous ducts
  • Lactiferous sinus- wider part of the lactiferous duct, may be a histological artifact with no role
  • Fatty tissue
  • Suspensory ligaments (of Cooper)- helps the breast to keep its shape, after pregnancy these are shaped and weakened, reducing support.
  • Aereola sebaceous glands (Montgomery’s tubercles)
  • Erectile smooth muscle- longitudinal and circular which surrounds the breast
  • Terminal ductule- near the back of the breast, where breast cancer tends to develop, associated with secretory alveoli.
49
Q

Divisions of the breast

A

There is one lobe per lactiferous duct, and there are 10-20 ducts per breast. Each lobule contains one terminal ductule. At the end of the terminal ductules you have secretory alveoli which is used in milk production.

50
Q

Changes to the breast during pregnancy

A

During pregnancy, the breast proliferates and more secretory alveoli are formed. In the lactating breast the alveoli are enlarged and full of milk, there is an increase in ducts and alveoli and decreased fat. After lactation the breast returns to its original structure though the lactiferous ducts may not completely.

51
Q

Structures surrounding the Lactiferous ducts

A

Fibrocollagen stroma surrounds the Lactiferous ducts. Within the Lactiferous sinus there is Proteinaceous fluid.

52
Q

Mammary lobules

A

Within the lobule you have intralobular fibro collagenous stroma which surrounds the intralobular terminal duct and the terminal duct. The stroma is surrounded by the extralobular fibrocollagenous tissue, outside that is the adipose tissue of the breast. The intralobular terminal duct leads into the terminal duct. The Myoepithelial cells form the walls of the terminal ductuals as well as the cuboidal/columnar cells

53
Q

Microanatomical changes during lactation

A
  • Hyperplasia
  • Expansion and distension of lobules (with milk)
  • Increase in size and complexity of interlobular terminal ductules
54
Q

Milk line cells

A

Mammary ridge ectoderm
All milk line cells have the potential to become breast tissue, they normally regress except for in the midthoracic region. At 6 weeks they extend from the upper limb bud to the lower limb bud

55
Q

Breast development

A
  • The primary bud ectoderm invades the underlying mesenchyme
  • A mammary pit forms which is the site of development for breast tissue. The primary bud proliferates and buds to form 15-20 secondary bud ectoderms
  • The lactiferous ducts form from these secondary buds, there is further branching to form the terminal ducts and secretory alveoli.
  • The development process at this point is the same in males and females (indifferent phase)
56
Q

Polythetila

A

Milk lines fail to regress. You get supernumerary nipples 7-10cm below typical nipple position. Cant occur outside the milk line.

57
Q

Polymastia

A

Supernumerary breast tissue, may present above typical breast position

58
Q

Amastia

A

Milk lines completely regress, amastia (no breast tissue forms including nipples) can be unilateral or bilateral. Associated with failure to develop pectoralis major.

59
Q

Gynecomastia

A

During puberty 30-60% of males have enlargement of breast tissue. In some men there is a large increase in size

60
Q

Lymphatic drainage of the breast tissue

A

75% to the axillary node, 25% to parasternal node.
Metastasis is most likely to spread through the axilla, it can spread from breast to breast via the parasternal nodes. It can also spread to the abdomen via the diaphragm, through seeding.

61
Q

Types of axillary lymph nodes

A

Apical axillary lymph node (2-3 level 3 nodes), Central axillary LN (5 Level 2 nodes), Lateral axillary LN (Level 1), Anterior axillary LN (Level 1) and the Posterior axillary LN (Level 1).

62
Q

Breast- the number of different types of lymph node

A

There are 12 level 1 nodes, 5 level 2 nodes and 2-3 level 3 nodes. The lymph travels from level 1, to level 2 to level 3.

63
Q

How can you use lymoh nodes to assess spread

A

You can tell how far the cancer has spread due to the lymph nodes it has reached, if it has reached level 3 it will have spread the most. Used in staging. This will then affect the surgical options and treatment. If they don’t know the level of spread they are likely to miss some of the cancer. You would remove the nodes affected

Medicine year 2 semester 1 (53 decks)

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