W05: Applied Anatomy; Applied Embryology Flashcards
To understand the anatomical support of female pelvic floor
The pp I see = pELVIC FLOOR
PUBORECTALIS
PUBOCOCCYGEUS
ILIOCOCCYGEUS
COCCYGEUS
dysfunction results in:
Urinary incontinence
Fecal incontinence
Genitourinary prolapse
Pelvic pain
Sexual dysfunction
dt primary causes of pelvic floor dysfunction include pregnancy, obesity and menopause
To understand the main types of female urinary incontinence
(1) STRESS INCONTINENCE
Leakage of urine due to incompetent sphincter
Typically occurs when intra-abdo pressure rises e.g. coughing / laughing
Risk factors: increasing age, obesity
*Examine for pelvic floor weakness / prolapse
Common in pregnancy and following birth; occurs to some degree in 50% post menopausal women
> pelvic floor exercises
electrical stimulation
pessary ring
duloxetine
(2) URGE INCONTINENCE
Overactive bladder syndrome
*Urge to urinate, quickly followed by uncontrollable and sometimes complete
emptying of the bladder as detrusor contracts
In the elderly usually related to detrusor instability or organic brain damage (Pd, stroke, dementia)
Other causes: UTI, DM, diuretics
> oxybutynin
Describe the principles of diagnosis, investigations and management of female
incontinence
- assess perineum, vagina, rectum
What muscles become dysfunctional in uterine prolapse
These muscles are known as the pelvic floor, or the levator ani muscles. Ligaments and connective tissue also suspend the uterus and pelvic organs in place. If these muscles or connective tissues are weakened or damaged, the uterus can drop down into the vagina.
Describe the processes of conception, implantation, and placental development
a
Describe the development of the early embryo, including how multiple pregnancies occur
1) pronuclei formation
=> frst cell division
2) Morula formation
3) Blastocyst forms
4) HATCHING: zona is dissolved
5) APPOSITION: blastocyst adheres to epithilial layer of endometrium, hCG secretion starts
6) INVASION: crossing of the basement membrane. placenta formation, remodelling of uterine spiral arteries
Review the development of the urinary system and its links to the development of the reproductive system in males and females
urinary system arises from UROGENITAL RIDGE @ INTERMEDIATE MESODERM = kidney ureter gonads
- reproductive system share same ORIGIN
- urogenital ridge differentiates into gonadal ridge = gonad and nephrogenic cord
- urinary system develops ahead of the repro system.
= PRONEPHROS, MESONEPHROS, METANEPHROS
with kidney ascending from the pelvis by 12th week
- bladder and urethra (urogenital sinus)
Describe the embryology of germ cell migration and the formation of the indifferent gonad
(gonadal ridge)
a combination of germ cells and primitive sex cord, capable of developing into a testis or ovary
Describe the development of the testis and the male reproductive tract
- SRY (Y chromosome) - sex determining region Y = SRY PROTEIN (testis determining factor)
= acts on indifferent gonad
In the male the presence of AMH causes the paramesonephric ducts to regress and these do not form any part of the adult
Rest of the MESONEPHRIC duct only persists in the males under the effect of testosterone and forms the epididymis, vas deferens and seminal vesicles
Describe the development of the female reproductive tract
Gonads develop from the gonadal ridge. The indifferent gonad has germ cells which migrate from the yolksac and primitive sex cords.
*absence of AMH
In females, mesonephricduct regresses and remnants might remain as epoophoron,
paraophoron (small cystic structures lateral to ovary)
gartners duct cyst (benign lesions on the lateral vaginal wall)
Paramesonephric ducts grow medially and fuse =
* uterus
* upper 2/3rd of vagina
* fallopian tubes
Urogenital sinus =
* lower 1/3rd of vagina
Discuss the basis of some common anomalies of the reproductive system
MALE
* HYPOSPADIAS
* micropenis
* CRYTPOCHORDISM (undescended)
- absence
* absence of vas deferens (CF)
* absence of seminal vesicles
FEMALE
* commonly associated with renal tract anomalies
* uterine underdevelopment
* fusion defect
* resorption defect
- vaginal anomaly
- septa
- imperforate hymen
- vaginal agenesis
What prerequisite changes are specifically required for invasion to occur?
Stromal cell differentiation (elongated fibroblast like cells) converted into decidual( rounded epithelial cells).
Angiogenesis - new vessel formation, increase vascular permeability
Increased macrophages, lymphocytes and decidual leukocytes(uterine natural killer cells) for maternal immune tolerance
= These changes transform the endometrium into a vascular receptive tissue for blastocyst invasion.
Functions of the placenta
Acts as an immunological barrier
Gas exchange
Nutrient exchange
Waste excretion
Endocrine functions
Multiple Pregnancies occur via:
DIZYGOTIC = 2+ eggs fertilised and implanted (non-identical)
MONOZYGOTIC = single embryo split
(identical twins)
- commonest split results in MONOCHORIONIC DIAMNIOTIC
E,mbryological origins of urogenital components
BLADDER & URETHRA (UROGENITAL SINUS)
GONADS (GONADAL RIDGE from UROGENITAL)
KIDNEY & URETER (NEPHROGENIC CORD from GONADAL RIDGE from UROGENITAL RIDGE)
* KIDNEY ( metanephric mesenchyme)
* URETER (ureteric ducT)
