Module 9: Reproductive System Flashcards Preview

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Flashcards in Module 9: Reproductive System Deck (224)
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181

Physiologic effects of Menopause: Loss of Estrogen and Clinical Significance

• Atrophy of vaginal epithelium —> Senile vaginitis or atrophic vaginitis

• Decreased collagen content of the structures that support the uterus (ligaments), pelvic relaxation —> Uterine descensus or prolapse

182

Physiologic effects of Menopause: Loss of Estrogen and Clinical Significance (2)

• Decreased collagen in the endopelvic fascial tissue in the vaginal wall —> Cystocele, rectocele

• Atrophic changes in the urinary tract lining and loss of ureteral tone —> Urinary urge incontinence, urinary frequency, dysuria, and nocturia

183

LONG TERM EFFECTS OF MENOPAUSE: Cardiovascular Effects

– Risk of cardiovascular disease is increased after menopause
– Estrogen therapy DOES NOT decrease the risk of CV disease

184

Prevention of Bone loss in Postmenopausal Women

• Dietary calcium supplementation (1500mg/day)
• Vitamin D supplementation (1500mg/day)
• Weight-‐bearing exercise should be performed regularly
• Cigarette smoking and alcohol intake should be eliminated

185

Hormone Replacement Therapy: Benefits

– Decreases the vasomotor symptoms (hot flushes, sweating)
– Loss of bone density can be halted with stabilization of trabecular bone formation
– Produces acidic pH of the vagina – decreased incidence of atrophic vaginitis
– Decreases dyspareunia – thickens and cornifies vaginal epithelium

186

- most important source of sensory nerve signals for initiating the male sexual act
– Sensitive sensory end-organ system that transmits into the CNS that special modality of sensation >> sexual sensation
– Slippery massaging action on the glans >> pudendal nerve >> sacral plexus >> the sacral portion of the SC >> undefined areas of the brain
– Impulses may also enter the SC from areas adjacent to the penis (anal epithelium, scrotum, perineal structures)

Glans penis

187

(FEMALE SEXUAL RESPONSE)
• As is true in the male sexual act, successful performance of the female sexual act depends on __

both psychic stimulation and local sexual stimulation

188

(FEMALE SEXUAL RESPONSE)
• The glans of the __ is especially sensitive for initiating sexual sensations

clitoris

189

STAGES OF FEMALE SEXUAL ACT

1. Erection - clitoris
2. Lubrication
3. Female orgasm or female climax
4. Resolution

190

• bilateral Bartholin glands, vaginal epithelium, also from male urethra
• Necessary during intercourse to establish a satisfactory massaging sensation rather than an irritative sensation, which may be provoked by a dry vagina
• A massaging sensation constitutes the optimal stimulus for evoking the appropriate reflexes that culminate in both the male and female climaxes

Lubrication

191

When local sexual stimulation reaches maximum intensity, and especially when the local sensations are supported by appropriate psychic conditioning signals from the cerebrum, reflexes are initiated that cause the __

female orgasm, or female climax

192

Physiologic significance of orgasm (Female)

• Reflexes increase uterine and fallopian tube motility during the orgasm
• In many lower animals, copulation causes oxytocin secretion

193

FEMALE REPRODUCTIVE UNIT

• Single ovarian follicle
– One germ cell (oocyte)
– Surrounded by endocrine cells
• About every 28 days, gonadotropic hormones from the anterior pituitary cause about 8 to 12 new follicles to begin to grow in the ovaries
• One of these follicles finally becomes "mature" and ovulates on the 14th day of the cycle

194

• Normally takes place in the ampulla of one of the fallopian tubes soon after both the sperm and the ovum enter the ampulla
• Before a sperm can enter the ovum, it must first penetrate the multiple layers of granulosa cells attached to the outside of the ovum (the corona radiata) and then bind to and penetrate the zona pellucida surrounding the ovum

FERTILIZATION OF THE OVUM

195

Transport of fertilized ovum in the fallopian tube

• Before implantation, the blastocyst obtains its nutrition from the uterine endometrial secretions >> uterine milk

• Implantation of the blastocyst, invasion of cyto-and syncitio-tropho- Blasts >> formation of the placental hypothalamic-pitutiary axis

196

Blastocyst

- reaches the uterus (day 4-5)
- implants (days 5-7)

197

Early nutrition of the embryo

• When conceptusimplants in the endometrium, (+) continued secretion of progesterone >> endometrial cell swelling and storage of more nutrients
• These cells are now called decidual cells,and the total mass of cells is called the decidua
• Trophoblast cells invade the decidua–only means of nutrition during 1st week
• Embryo continues to obtain at least some of its nutrition in this way for up to 8 weeks, although the placenta also begins to provide nutrition after about the 16th day beyond fertilization (a little more than 1 week after implantation)

198

What happen to the spiral artery during pregnancy?

• modify the spiral artery in such a way that it will become high-low-low resistant to increase blood supply
• replacement of smooth muscle (lumen will become more dilated)
• invasion of uterine cell

199

FUNCTIONS OF THE PLACENTA

1. Fetal gut in supplying nutrients
2. Fetal lung in exchanging O2 and CO2
3. The fetal kidney in regulating fluid volumes and disposing of waste metabolites
4. Endocrine gland synthesizing many steroids and protein hormones that affect both maternal and fetal metabolism

200

(HORMONAL FACTORS IN PREGNANCY)
In pregnancy, the placenta forms especially large quantities of the ff:

– Human chorionic gonadotropin
– Estrogens
– Progesterone
– Human chorionic somatomammotropin also known as human placental lactogen in lower forms of mammals

201

• Secreted by the syncytial trophoblast cells into the fluids of the mother
• First appears in maternal blood 7-9 days post- fertilization
• Peaks at 8-10 weeks (100,000 mIU/ml)
• Gradually falls to plateau at 18-22 weeks
• also known as the pregnancy hormone
• responsible for morning sickness

HUMAN CHORIONIC GONADOTROPIC (hcG)

202

• Prevents involution of the corpus luteum at the end of the monthly female sexual cycle
– If the CL is removed before approximately the 7th week, spontaneous abortion almost always occurs, sometimes even up to the 12th week
– Placenta secretes sufficient quantities of progesterone and estrogens to maintain pregnancy for the remainder of the gestation period
– CL involutes slowly after the 13th to 17th week of gestation
• Production of testicular estrogen in male fetuses

HUMAN CHORIONIC GONADOTROPIC (hcG)

203

• Enlargement of the mother's uterus
• Enlargement of the mother's breasts and growth of the breast ductal structure
• Enlargement of the mother's female external genitalia
• Relax the pelvic ligaments of the mother, so the sacroiliac joints become relatively limber and the symphysis pubis becomes elastic

ESTROGENS

204

• Causes decidual cells to develop in the uterine endometrium >> nutrition of the early embryo
• Decreases the contractility of the pregnant uterus
• Increases the secretions of the mother's fallopian tubes and uterus to provide appropriate nutritive matter for the developing morula
• Helps the estrogen prepare the mother's breasts for lactation

PROGESTERONE

205

• Secreted by the placenta at about 5th week
• Secretion increases progressively throughout the remainder of pregnancy in direct proportion to the weight of the placenta
• In lower animals, partial development of the animal's breasts and in some instances causes lactation >> formerly known as human placental lactogen
• Weak actions similar to those of growth hormone
• Causes decreased insulin sensitivity and decreased utilization of glucose in the mother >> making larger quantities of glucose available to the fetus.

HUMAN CHORIONIC SOMATOMAMMOTROPIN

206

Maternal adaptations to pregnancy

• Increased basal metabolic rate by about 15% during the latter half of pregnancy
• Increased cardiac output –increased Blood Flow to placenta;
• Increased minute ventilation –progestrone increased respiratory center’s sensitivity to CO2
• Increased Renal Blood Flow and GFR

207

PHYSIOLOGIC WEIGHT GAIN

1st trimester – 2 lbs
2nd trimester – 11 lbs
3rd trimester – 11 lbs

208

4 PERIODS OF INCREASE CARDIAC OUTPUT

• On 28th week – highest peak of cardiac load
• During labor – increased flow to heart from uterine squeezing, increased HR due to labor pains
• Immediately after labor – due to increased venous return
• During 1st week of puerperium – mobilization of interstitium

209

Maternal adaptations to pregnancy (No Change)

No Change in:
- Systolic Blood Pressure
- Lung Compliance

210

Maternal adaptations to pregnancy (Increase)

Increase in:
- Pulse Pressure
- Tidal volume
- Gastric Emptying Time
- Creatine clearance
- Renal Blood flow
- Blood coagulation factors
- Cortisol and aldosterone