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178 Cards in this Set
- Front
- Back
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How do you drain the left ovary / testis?
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Left gonadal vein → Left renal vein → IVC
(Left gonadal vein takes the Longest way) |
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How do you drain the right ovary / testis?
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Right gonadal vein → IVC
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What are the characteristics of the drainage of the left spermatic vein?
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Enters the left renal vein at a 90° angle, so flow is less continuous on the left than on the right →
- Left Venous pressure > Right Venous pressure → - Varicocele more common on left |
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Which testes is more likely to have a varicocele? Why?
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Left spermatic vein enters the left renal vein at a 90° angle, so flow is less continuous on the left than on the right →
- Left Venous pressure > Right Venous pressure → - Varicocele more common on LEFT |
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What lymph nodes drain the ovaries and testes?
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Para-aortic lymph nodes
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What lymph nodes drain the distal vagina, vulva, and scrotum?
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Superficial inguinal lymph nodes
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What lymph nodes drain the proximal vagina and uterus?
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- Obturator lymph nodes
- External iliac lymph nodes - Hypogastric lymph nodes |
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What ligament connects the ovaries to the lateral pelvic wall?
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Infundibulopelvic ligament (Suspensory Ligament of the Ovaries)
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What ligament connects the cervix to the side wall of the pelvis?
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Cardinal ligament
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What ligament connects the uterine fundus to the labia majora?
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Round ligament of the uterus
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What ligament connects the uterus, fallopian tubules, and ovaries to the pelvic side wall?
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Broad ligament
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What ligament connects the medial pole of the ovary to the lateral uterus?
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Ovarian ligament
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What does the infundibulopelvic ligament (suspensory ligament of the ovaries) connect? What structures are contained in this ligament?
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- Connects ovaries to lateral pelvic wall
- Contains ovarian vessels |
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What does the cardinal ligament connect? What structures are contained in this ligament?
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- Connects cervix to the side wall of the pelvis
- Contains uterine vessels |
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What does the round ligament of the uterus connect? What structures are contained in this ligament?
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- Connects fundus to labia majora
- Does not contain any structures |
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What does the broad ligament connect? What structures are contained in this ligament?
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- Connects uterus, fallopian tubules, and ovaries to pelvic side wall
- Contains ovaries, fallopian tubes, and round ligaments of uterus |
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What does the ovarian ligament connect? What structures are contained in this ligament?
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- Connects medial pole of ovary to lateral uterus
- Does not contain any structures |
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Which vessels do you ligate during an oophorectomy to avoid bleeding? How do you find these vessels?
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- Ligate ovarian vessels
- Contained within infundibulopelvic ligaments (suspensory ligament of the ovaries) |
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What can compromise the safety of the ureters?
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Ureters may be damaged during ligation of ovarian vessels (during oophorectomy) andduring ligation of uterine vessels (during hysterectomy)
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What female ligaments are derived from the gubernaculum?
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- Round ligament of the uterus
- Ovarian ligament |
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What is the relative location of the round ligament of the uterus?
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- Travels through the round inguinal canal
- Above the artery of Sampson |
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What are the components of the broad ligament?
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- Mesosalpinx: contains fallopian tubes
- Mesometrium: connects to uterus - Mesovarium: contains ovaries |
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What type of epithelium is in the vagina?
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Stratified squamous epithelium, non-keratinized
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What type of epithelium is in the ectocervix?
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Stratified squamous epithelium, non-keratinized
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What type of epithelium is in the endocervix?
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Simple columnar epithelium
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What type of epithelium is in the transformation zone?
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Squamocolumnar junction (most common area for cervical cancer)
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What type of epithelium is in the uterus?
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Simple columnar epithelium with long tubular glands
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What type of epithelium is in the fallopian tubules?
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Simple columnar epithelium, many ciliated cells, a few secretory (peg) cells
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What type of epithelium is in the ovary (outer surface)?
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Simple cuboidal epithelium (germinal epithelium covering surface of ovary)
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What are the phases of the female sexual response cycle?
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- Excitement
- Plateau - Orgas - Resolution |
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What happens during the excitement phase of the female sexual response cycle?
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- Uterus elevates
- Vaginal lubrication |
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What happens during the plateau phase of the female sexual response cycle?
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Expansion of inner vagina
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What happens during the orgasm phase of the female sexual response cycle?
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Contraction of uterus
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What mediates the female sexual response cycle? Other consequences?
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Mediated by Autonomic Nervous System
- Also causes tachycardia and skin flushing |
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What is the pathway of sperm ejaculation?
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SEVEN UP:
- Seminferous tubules - Epididymis - Vas Deferens - Ejaculatory ducts - Nothing - Urethra - Penis |
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What mediates an erection in a male? What nerve?
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Parasympathetic nervous system (via pelvic nerve)
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How does the parasympathetic nervous system mediate an erection?
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Pelvic nerve → NO → ↑ cGMP → smooth muscle relaxation → vasodilation → pro-erectile
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How does the parasympathetic nervous system inhibit an erection?
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Pelvic nerve → NE → ↑ [Ca2+]in → smooth muscle contraction → vasoconstriction → anti-erectile
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What mediates an emission in a male? What nerve?
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Sympathetic nervous system (via hypogastric nerve)
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What mediates an ejaculation in a male? What nerve?
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Visceral and somatic nerves (via pudendal nerve)
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What drugs can help mediate an erection? Mechanism?
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Sildenafil and Vardenafil → inhibit cGMP breakdown → smooth muscle relaxation → vasodilation → erection
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What kind of cells are in the seminiferous tubules?
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- Spermatogonia (germ cells)
- Sertoli cells - Leydig cells |
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What is the function of the spermatogonia? Location?
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- Maintains the germ pool
- Produces 1° spermatocytes - Lines the seminiferous tubules |
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What is the function of the Sertoli cells?
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- Secrete inhibin (inhibits FSH)
- Secrete androgen-binding protein (maintains T levels) - Blood-testis barrier (via tight junctions between Sertoli cells to protect gametes from auto-immune attack) - Support and nourish developing spermatozoa - Regulate spermatogenesis - Produce MIF |
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How does temperature affect the Sertoli cells?
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Temperature sensitive: ↓ sperm production and ↓ inhibin with ↑ temperature
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What is the location of the Sertoli cells and Leydig cells?
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- Sertoli cells: lines seminiferous tubules
- Leydig cells: interstitium |
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Where is the enzyme aromatase? Function?
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Within Sertoli cells and Leydig cells
- Converts Testosterone and Androstenedione to Estrogen |
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What is the source and function of Inhibin?
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- Secreted by Sertoli cells
- Inhibits FSH |
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What is the source and function of androgen-binding protein?
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- Secreted by Sertoli cells
- Maintains local levels of testosterone |
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What forms the blood-testis barrier? Importance?
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- Tight junctions between Sertoli cells (lining seminiferous tubules)
- Isolates gametes from auto-immune attack |
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What is source of Müllerian Inhibiting Factor?
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Sertoli cells
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What supports and nourishes the developing spermatozoa?
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Sertoli cells
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What conditions are associated with increased temperature in the testes? Potential consequences?
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- Varicocele and Cryptorchidism
- Leads to ↓ sperm production and ↓ inhibin (removes inhibition of FSH) |
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What are the functions of Leydig cells?
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- Secretes Testosterone in the presence of LH
- Also contains aromatase (converts Testosterone and Androstenedione to Estrogen) |
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How are the Leydig cells affected by temperature?
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Unaffected, Testosterone secretion does not change with temperature changes
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What is the source of estrogen? What type of estrogen is made by each source?
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- Ovary: 17β-estradiol
- Placenta: estriol - Adipose tissue: estrone via aromatization |
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What is the relative potency of the types of estrogens?
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Estradiol > Estrone > Estriol
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What female development is regulated by estrogen?
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Development of:
- Genitalia - Breast - Female fat distribution |
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What are the effects of estrogen on the female reproductive tract?
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- Growth of follicle
- Endometrial proliferation - ↑ Myometrial excitability |
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What are the hormonal effects of estrogens?
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- Up-regulation of estrogen, LH, and progesterone receptors
- Feedback inhibition of FSH and LH, then LH surge - Stimulation of prolactin secretion |
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What is the effect of estrogen on proteins and cholesterol?
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- ↑ Transport proteins (SHBG)
- ↑ HDL and ↓ LDL |
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What happens to the levels of the types of estrogens during pregnancy?
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- 50-fold increase in estradiol (ovary) and estrone (adipose)
- 1000-fold increase in estriol (placenta) - indicator of fetal well-being |
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What is an indicator of fetal well-being during pregnancy?
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1000-fold increase in estriol (source: placenta)
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Where are estrogen receptors? What happens to them when they bind estrogen?
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- Estrogen receptors expressed in cytoplasm of cells
- Translocate to nucleus when bound by ligand |
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What stimulates FSH and LH release?
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Pulsatile GnRH
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What is the function of FSH in females?
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Stimulates aromatase: converts androstenedione → estrogens in Granulosa Cell
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What is the function of LH in females?
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Stimulates Desmolase: converts cholesterol → androstenedione in Theca Cells
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What happens in Theca cells in females?
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LH stimulates Desmolase: converts cholesterol → androstenedione (which is exported to granulosa cells)
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What happens in Granulosa cells in females?
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FSH stimulates Aromatase: converts androstenedione (from theca cells) → estrogens (which is secreted)
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What is the source of progesterone?
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- Corpus luteum
- Placenta - Adrenal cortex - Testes |
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What are the functions of progesterone?
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- Stimulates endometrial glandular secretions
- Stimulates spiral artery development - Maintains pregnancy by preventing uterine smooth muscle contractions (↓ myometrial excitability) - Produces thick cervical mucus, which inhibits sperm entry into uterus - ↑ Body temperature - Prevents endometrial hyperplasia |
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What is the effect of progesterone on other hormones?
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- Inhibits LH and FSH (gonadotropins)
- ↓ Estrogen receptor expressivity |
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What leads to lactation after delivery?
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Fall in progesterone disinhibits prolactin → lactation
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What indicates ovulation?
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Increased progesterone
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What are the Tanner stages of sexual development?
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- I: Childhood (pre-pubertal)
- II: Pubic hair appears (pubarche); breast buds form (thelarche) - III: Pubic hair darkens and becomes curly; penis size/length ↑; breasts enlarge - IV: Penis width ↑, darker scrotal skin, development of glans; raised areolae - V: adult, areolae are no longer raised |
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What Tanner stage is a pre-pubertal child?
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Tanner Stage I
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What Tanner stage is a child with new pubic hair?
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Tanner Stage II
- Pubarche |
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What Tanner stage is a child when the breast buds begin to form?
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Tanner Stage II
- Thelarche |
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What Tanner stage is a child when the pubic hair darkens and becomes curly?
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Tanner Stage III
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What Tanner stage is a child when there penis size / length begins increasing?
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Tanner Stage III
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What Tanner stage is a child when the breasts begin enlarging?
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Tanner Stage III
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What Tanner stage is a child when the penile width increases?
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Tanner Stage IV
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What Tanner stage is a child when the scrotal skin becomes darker?
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Tanner Stage IV
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What Tanner stage is a child when the glans develops?
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Tanner Stage IV
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What Tanner stage is a child when the areolae are raised?
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Tanner Stage IV
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What Tanner stage is an adult?
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Tanner Stage V
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What Tanner stage is a person when the areolae are no longer raised?
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Tanner Stage V
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What is the length of the Follicular phase and Luteal phase of the menstrual cycle?
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- Follicular phase: varies in length
- Luteal phase: always 14 days |
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When is follicular growth fastest?
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During 2nd week of proliferative (follicular) phase
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What stimulates endometrial proliferation?
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Estrogen
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What maintains endometrium to support implantation?
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Progesterone
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How does the amount of progesterone related to fertility?
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↓ Progesterone → ↓ Fertility
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What is the term for a menstrual cycle >35 days?
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Oligomenorrhea
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What is the term for a menstrual cycle <21 days?
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Polymenorrhea
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What is the term for frequent but irregular menstruation (intermenstrual bleeding)?
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Metrorrhagia
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What is the term for heavy menstrual bleeding (>80 mL blood loss or >7 days of menses)?
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Menorrhagia
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What is the term for heavy, irregular menstruation at irregular intervals?
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Menometrorrhagia
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What does the graafian follicle mature?
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During proliferative (follicular) phase
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When does ovulation occur?
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- After proliferative phase (follicular)
- Before secretory phase (luteal) |
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When does the corpus luteum develop?
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After ovulation, during the secretory (luteal) phase
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When does the corpus luteum regress?
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During menstruation, after secretory (luteal) phase before beginning a new proliferative (follicular) phase
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What stimulates the LH surge? Result?
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↑ Estrogen → LH surge → Ovulation
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What stimulates ovulation?
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↑ Estrogen → LH surge → Ovulation
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What does ovulation lead to?
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↑ Progesterone (from corpus luteum)
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What stimulates menstruation?
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Fall in progesterone levels → Menstruation
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What happens during menstruation?
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Apoptosis of endometrial cells
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What are the relative blood hormone levels during the proliferative (follicular) phase?
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- FSH, LH, and Progesterone remain relatively low and steady
- Estrogen begins increasing half way (~day 7) until it peaks at day 14 - Peak of estrogen → LH surge and FSH increases |
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What are the relative blood hormone levels during the secretory (luteal) phase?
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- LH and FSH drops down after peak and remain relatively low throughout
- Estrogen drops but remains elevated, until declining during menstruation - Progesterone increases to maintain fertility viability - Towards end of luteal phase Progesterone drops off, causing menstruation |
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What happens to your oocytes during fetal life?
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1° oocytes begin meiosis 1 and are arrested in prophase I
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When do your oocytes complete meiosis 1?
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- 1° oocytes that are arrested in prophase I, complete meiosis 1 just prior to ovulation
- Meiosis 2 is arrested in metaphase II |
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When do your oocytes complete meiosis 2?
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Meiosis 2 continues from where it was arrested in metaphase II until completion during fertilization (2° oocytes)
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How long does fertilization have to occur once the 2° oocyte is ovulated?
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Fertilization must occur within 1 day or the oocyte will degenerate
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In what stages are oocytes arrested? Until when?
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- Meiosis I is arrested in Prophase I (until ovulation)
- Meiosis II is arrested in Metaphase II (until fertilization) |
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What is the type and amount of genetic material in an oogonium?
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2N, 2C (diploid)
- 46 single chromosomes (2N) |
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What is the type and amount of genetic material in a 1° oocyte?
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2N, 4C (diploid)
- 46 sister chromatids (2N) |
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What is the type and amount of genetic material in an 2° oocyte (after ovulation)?
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1N, 2C (haploid)
- 23 sister chromatids (2N) *The other half (from meiosis I) becomes a polar body and degenerates or gives rise to 2 polar bodies |
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What is the type and amount of genetic material in an ovum (after fertilization)?
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1N, 1C (haploid)
- 23 single chromatids (1N) *The other half (from meiosis II) becomes a polar body and degenerates |
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How many polar bodies are made from a single oogonium?
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3 polar bodies
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What stimulates ovulation?
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- ↑ Estrogen surge → LH release → ovulation
- ↑ GnRH receptors on anterior pituitary |
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What happens during ovulation?
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Rupture of follicle
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How the temperature change during the menstrual cycle? Cause?
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Temperature increases during ovulation (due to progesterone)
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What is transient mid-cycle ovulatory pain called? What is it associated with?
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Mittelschmerz
- Associated with peritoneal irritation (eg, follicular swellin/rupture, fallopian tube contraction) - Can mimic appendicitis |
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What is Mittelschmerz?
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*Transient mid-cycle ovulatory pain
- Associated with peritoneal irritation (eg, follicular swellin/rupture, fallopian tube contraction) - Can mimic appendicitis |
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What is the most common location for fertilization?
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Commonly in the upper end of the fallopian tube (ampulla)
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How soon after ovulation must fertilization occur?
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Must occur within 1 day of ovulation
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When does implantation of the fertilized egg occur?
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Implantation within the wall of the uterus occurs 6 days after fertilization
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What hormone is used for a pregnancy test? When does it become elevated? Source?
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hCG, secreted from Syncytiotrophoblasts, is used for pregnancy tests
- Detectable in blood 1 week after conception - Detectable in urine on home test 2 weeks after conception |
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What happens to the levels of hCG during pregnancy?
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- Peaks at about 10 weeks
- Dips until 20 weeks - Smaller peak again at 30 weeks - Drops until 40 weeks |
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What happens to the levels of Prolactin during pregnancy?
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Slowly increases throughout pregnancy, highest at 40 weeks
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What happens to the levels of Proesterone during pregnancy?
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Increases throughout entire pregnancy
- Faster increases during first 10 weeks and during weeks 30-40 - Plateaus a bit from weeks 10-30 |
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What happens to the levels of Estriol during pregnancy?
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Begins increases at around 8 weeks and steadily increases until 40 weeks; dips at birth
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What prevents lactation during pregnancy, despite elevated prolactin levels?
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Progesterone and estrogen inhibit lactation
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What allows lactation after labor?
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- ↓ in Progesterone and Estrogen disinhibit lactation
- Suckling is required to maintain milk production, since ↑ nerve stimulation → ↑ oxytocin and prolactin |
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What is the function of prolactin?
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Induces and maintains lactation and ↓ reproductive function
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What is the function of oxytocin?
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- Assists in milk letdown
- Also promotes uterine contractions |
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When is breast milk the ideal nutrition for infants?
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Until they are 6 months old
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What are the beneficial contents of breastmilk?
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- Contains maternal immunoglobulins (confers passive immunity, mostly IgA)
- Macrophages - Lymphocytes |
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What are the benefits of breastmilk to the infant?
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- Reduces infant infections
- Associated with ↓ risk for child to develop asthma, allergies, diabetes mellitus, and obesity |
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What is required of infants who are exclusively breastfed?
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Require vitamin D supplementation
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What kind of immunoglobulins are passed in breastmilk?
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Primarily IgA
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What are the benefits of breastmilk to the mother?
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- Decreases maternal risk of breast and ovarian cancer
- Facilitates mother-child bonding |
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What is the source of hCG?
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Syncytiotrophoblasts of placenta
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What are the functions of hCG?
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- Maintains corpus luteum in 1st trimester
- Used to detect pregnancy |
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When is hCG elevated?
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- During pregnancy and multiple gestations
- During pathologic states: hydatidiform mole, choriocarcinoma |
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How does hCG maintain the corpus luteum?
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During first trimester hCG maintains the corpus luteum by acting like LH (otherwise no luteal cell stimulation, and abortion results)
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When does the corpus luteum degenerate during a pregnancy? Why?
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- In the 2nd and 3rd trimesters, placenta synthesizes its own estriol and progesterone
- Previously hCG was maintaining corpus lutuem and thus progesterone |
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What are the subunits of hCG? Significance?
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- α subunit: structurally identical to those in LH, FSH, and TSH
- β subunit: unique to hCG and used to detect pregnancy |
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What causes menopause?
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↓ Estrogen production due to age-linked decline in number of ovarian follicles
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What is the average age of menopause in normal women? In smokers?
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- Average age: 51 years
- In smokers: earlier |
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What usually precedes menopause?
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4-5 years of abnormal menstrual cycles
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What is the source of estrogen (estrone) after menopause?
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- Peripheral conversion of androgens to estrogen
- ↑ Androgens → hirsutism |
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What lab value is specific for menopause?
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↑↑ FSH (loss of negative feedback on FSH due to ↓ estrogen)
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What are the hormonal changes in menopause?
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- ↓ Estrogen
- ↑↑ FSH - ↑ LH (no surge) - ↑ GnRH |
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What are the side effects of menopause?
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Menopause causes HAVOCS:
- Hot flashes - Atrophy of Vagina - Osteoporosis - Coronary artery disease - Sleep disturbances |
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What does menopause before age 40 suggest?
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Can indicate premature ovarian failure
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When does spermatogenesis begin? What is the first type of "sperm"?
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Puberty - spermatogenesis begins with spermatogonia
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How long does full development of sperm take? Where does it take place?
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2 months - takes place in seminiferous tubules
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What is the product of spermatogenesis?
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Spermatids that undergo spermiogenesis
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What happens in spermiogenesis?
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Spermatids lose cytoplasmic contents and gain an acrosomal cap to form mature spermatozoon
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What is the type and amount of genetic material in a spermatogonium?
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2N, 2C (diploid)
- 46 single chromosomes (X and Y) |
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What is the type and amount of genetic material in a 1° spermatocyte?
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2N, 4C (diploid)
- 46 sister chromatids (X-X and Y-Y) |
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What happens to a 1° spermatocyte after meiosis 1?
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Forms 2 x 2° Spermatocytes:
- 1N, 2C (haploid) - Each contains 23 sister chromatids (X-X or Y-Y) |
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What happens to a 2° spermatocyte after meiosis 2?
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Forms 4 x Spermatids
- 1N, 1C (haploid) - Each contains 23 single chromatids (2 X and 2 Y) |
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What happens to a spermatid after being formed by meiosis II?
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Spermiogenesis to form mature spermatozoon (haploid: 1N, 1C)
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What syndrome causes impaired tail mobility of a spermatozoon? Consequences?
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Ciliary Diskinesia / Kartagener Syndrome → infertility
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What are the types of androgens?
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- Testosterone
- Dihydrotestosterone (DHT) - Androstenedione |
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What are the sources of the androgen?
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- Testis: DHT and Testosterone
- Adrenal: Androstenedione |
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What is the relative potency of the androgens?
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DHT > Testosterone > Androstenedione
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What are the functions of testosterone?
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- Differentiation of epididymis, vas deferens, seminal vesicles (genitalia, except prostate)
- Growth spurt: penis, seminal vesicles, sperm, muscle, RBCs - Deepening of voice - Closing of epiphyseal plates (via estrogen converted from testosterone) - Libido |
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What structures differentiate via the action of testosterone?
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- Epididymis
- Vas deferens - Seminal vesicles |
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What structures have a growth spurt because of testosterone?
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- Penis
- Seminal vesicles - Sperm - Muscle - RBCs |
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What are the functions of Dihydrotestosterone (DHT)?
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- Early: differentiation of penis, scrotum, prostate
- Late: prostate growth, balding, sebaceous gland activity |
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What structures differentiate via the action of dihydrotestosterone (DHT)?
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- Penis
- Scrotum - Prostate |
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What are the late effects of DHT?
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- Prostate growth
- Balding - Sebaceous gland activity |
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What is the function of 5α-reductase?
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Convert Testosterone to DHT
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What drug inhibits 5α-reductase? Action?
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Finasteride (prevents conversion of T → DHT)
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What is the function of cytochrome P-450 aromatase?
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Converts androgens to estrogen (primarily in adipose tissue and testis)
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What are the effects of exogenous testosterone?
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- Inhibits hypothalamic-pituitary-gonadal axis
- ↓ Intratesticular testosterone → - ↓ Testicular size → - Azoospermia (absence of motile (and hence viable) sperm in the semen) |
