Exam 3 - reproductive system Flashcards Preview

PTH560 Pathology > Exam 3 - reproductive system > Flashcards

Flashcards in Exam 3 - reproductive system Deck (48):
1

Female:
Sex hormones are synthesized where?

ovary

2

What are the phases of the menstrual cycle?

-proliferative/follicular phase
-ovulation
-secretory/luteal phase

3

Brief hormone stuff about menstrual cycle.

Estrogen starts it all. Causes LH to spike. this spike causes ovulation.

4

Proliferative phase (menstrual cycle)

-aka follicular
- 1-14 days
-proliferation of glands
-mediated by estrogen. spike causes LH to peak and FSH (When LH goes up, so does FSH)

5

Ovulation

-at day 14-16
-mature follicle in the ovary releases an egg
-signs: inc temp, subnuclear vacuoles in endometrial cells, mittelschmerz "pelvic pain"

6

Luteal Phase

-at day 14/16-28 (depends on ovulation)
-mediated by PROGESTERONE
-histology: inc gland tortuosity and secretion, edema of stromal cells
-fertility work-ups: at day 21

7

Menses

-serum estrogen and progesterone drop
-causes endometrial cell apoptosis

8

What is FSH's function in the menstrual cycle?

-prepares follicle of the month - inc follicle size
-inc aromatase synthesis
-inc synthesis of LH receptors

9

What is LH's function in the menstrual cycle?

-testosterone synthesis: aromatase converts it to estradiol in granulosa cells
-LH surge: due to estrogen. causes ovulation when LH>FSH. moves follicle from meiosis I prophase to meiosis II metaphase

-progesterone synthesis (for secretory phase)

10

Pregnancy hormone changes: hCG

-hCG: human chorionic gonadotropin
-made in placenta
-analogue of LH (maintains corpus luteum)

11

Pregnancy hormone changes: progesterone

-until 10 weeks = made in corpus luteum
-after 10 weeks = made by placenta

-if progesterone drops: possible spontaneous abortion

12

How does OCPs work?

-usually mix of estrogen and progestins
-baseline estrogen prevents estrogen surge (prevents LH surge, prevents ovulation)
-progestins stop proliferative phase (gland atrophy, inhibit LH which prevents LH surge)

13

Menopause: definition and onset

Def: no menses for 1 year after age 40 (avg age =51)

onset: genetically determined. Earlier with smokers

14

Menopause physiology

-decrease in ovarian function.
-decreased estrogen levels overall

*she said this was all we need to know. slide 16)

15

What is the treatment for menopause? and why is it controversial?

-treatment = estrogen replacement. Helps inc overall levels

controversial: long-term severe risks of CAD, stroke, clots, etc. Should only do for a year or 2 at a time

16

Menorrhagia (Menstrual dysfunction)

>80 ml blood loss
excessive clots

17

Dysmenorrhea (Menstrual dysfunction)

-painful menses
-primary type (inc prostaglandins or uterine contractions)

18

Dysfunctional uterine bleeding

-abnormal. no anatomical cause
-typically hormone imbalances
-most are postmenarchal or perimenopausal
-90% anovulatory (no egg release)

19

Anovulatory DUB (dysfunctional uterine bleeding) causes

-excessive estrogen relative to progesterone (absent secretory phase)

-inadequate luteal phase (inadequate progesterone)

-irregular shedding of endometrium (persistent luteal phase)

20

menorrhagia DUB

-most common
-regular normal intervals
-excessive flow and duration

21

hypomenorrhea DUB

-regular normal intervals
-decreased bleeding

22

metrorrhagia DUB

(metro = "time")
- irregular intervals
-excessive flow and duration

23

menometrorrhagia DUB

-irregular or excessive bleeding during menstruation and btwn periods

24

oligomenorrhea DUB

-menses at intervals > 35 days

25

polymenorrhea DUB

-menses at intervals <21 days

26

What is primary amenorrhea?

-absence of menses by 16 y/o
-constitutional (growth) delay = most common cause

27

What is secondary amenorrhea?

-no menses for >6 months in pt who has had normal menses
-MCC = pregnancy

28

Amenorrhea: Pathology

-hypothalamic or pituitary disorder (dec LH and FSH synthesis => Dec estrogen and progesterone)

-ovarian disorder (dec estrogen and progesterone synthesis. FSH and LH inc)

-end-organ disorder (blood flow obstruction (normal FSH, LH, progesterone, estrogen)

29

Polycystic ovary syndrome: disease associations and clinical findings

-obesity
-insulin resistance
-acanthosis nigricans (skin stuff, skin folds)

Clin find: oligomenorrhea, hirsutism(hair)- due to inc testosterone, infertility, obesity, DM etc

30

Polycystic ovary syndrome: pathology

*** increased LH secretion by anterior pituitary (**LH/FSH > 3)

*** dec pituitary FSH secretion

31

FSH and LH as male sex hormones

-FSH = stim spermatogenesis (seminiferous tubules)

-LH = stim testosterone (leydig cells)

32

Male hormones: testosterone

-sex characteristics
-enhances spermatogenesis
-inc libido

33

Male hormones: sex hormone binding globulin

-binds testosterone and estrogen (greater affinity for testosterone)
-made in liver

34

Hypogonadism: pathogenesis

-dec testosterone production
-resist to testosterone

-primary or secondary

35

Primary hypogonadism (what causes, hormone effects)

-Testicular dysfunction
(leydig cell, seminiferous tubule)
- dec testosterone secretion
-( dec T, inc LH)

36

secondary hypogonadism (what causes. hormone effects)

-pituitary (tumor) or hypothalamic (Kallmann's syndrome) dysfunction
- (dec T, dec or normal LH)

37

Infertility causes

-decreased sperm count (leydig, seminiferous tubule, pituitary, or hypothalamus dysfunction)

-end-organ dysfunction (obstruction, dysfunction of accessory organs/ejaculation)

38

Infertility labs: seminiferous tubule dysfunction

-testosterone = normal
-FSH = inc

39

Infertility labs: Leydig cell dysfunction

- testosterone = dec
- LH = inc

40

Infertility labs: pituitary dysfunction

-HYPOPITUITARYISM

-testosterone = dec
-LH = dec
-FSH = dec

41

Infertility labs: end-organ dysfunction

-normal hormone levels
-variable sperm count

42

What do you look for with a sperm analysis?

-volume
-count
-morphology
-motility

serum hormone levels

43

What are the 3 causes of ED?

-psychogenic (nocturnal penile tumescence test)

-dec testosterone

-vascular insufficiency (atherosclerosis, leriche syndrome - butt and genital area)

44

In what zones does benign prostatic hyperplasia occur?

-***transitional and periurethral zones

45

benign prostatic hyperplasia: pathology

-inc sensitivity of prostate to DHT (dihydrotestosterone)
-DHT causes hyperplasia
-get nodules due to hyperplasia of glandular and stromal cells. (yellow-pink, soft)

46

Prostate cancer

-most common cancer in adult males
-90% of 90y/o have it
-asymptomatic until advanced

-DHT -dependent and ***development in peripheral zone

47

pt has LBP, pelvic pain, obstructive uropathy, and possible spinal cord compression. what does he have?

Prostate cancer

48

Prostate cancer Treatment: early vs late

Early: surgery, radiation, radioactive seeds

Late: hormones, chemo, radiation.
-if you are old just watch.