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68 Cards in this Set
- Front
- Back
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Rectouterine pouch of Douglass
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Common site of ectopic PG
most inferior recess of abd. pelvic cavity in females location of culdocentesis - spinal needle placed through posterior vag. fornix |
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Suspensory ligament of ovaries
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ovaries --> lateral pelvic wall
Ovarian vessels |
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Transverse cervical (cardinal) ligaments
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Cervix --> side wall of pelvis
Uterine vessels |
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Round ligament of uterus
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Uterus --> labia majora
NO STRUCTURES CONTAINED WITHIN derivative of gubernaculum travels through inguinal canal |
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Broad ligament
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uterus, fallopian tubes, ovaries --> pelvic wall
contains Ovaries, fallopian tubes, round ligaments of uterus |
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Ligament of ovary
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ovary --> uterus
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Fallopian tube divisions
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1. Infundibulum - fimbriated, opens into peritoneal cavity
2. Ampulla - longest and widest part of tube; site of fertilization!!! 3. Isthmus 4. Intramural - opens into uterine cavity *3&4 receive blood from ovarian and uterine arteries thus increased hemorrhage if rupture PG in isthmus! |
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Pudendal Nerve
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S2-4
Sensory innervation to perineum and genitals Motor innervation to sphincter urethrae, external anal sphincter Nerve block here to provide anesthesia during childbirth - palpate intravaginal for ischial spinces to admin - USED IF LABOR TOO FAR PROGRESSED TO PROVIDE EPIDURAL ADMIN |
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Genitofemoral Nerve
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L1-L2
Courses on anterior surface of psoas muscle Splits into genital and femoral branches Genital = scrotum/labium majora Femoral = cutaneously innervating femoral triangle |
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Blood supply
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Paired uterine and ovarian arteries
Uterine arteries - arise from internal iliac arteries Ovarian arteries - arise from abdom aorta inferior to renal arteries - anastomose with uterine arteries in region of isthmus w/in mesosalpinx |
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Pathway of sperm
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Seminiferous tubules
Epididymis Vas deferens Ejac ducts N(othing) Urethra Penis |
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Hypospadias
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Abnormal constricted opening of urethra on ventral aspect
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Epispadis
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Abnormal opening on dorsal side of penis
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Paraphimosis
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forcible retraction of foreskin w/ vascular compromise
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Autonomic innervation of male sexual response
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1. Erection
- parasymp - pelvic n. 2. Emission - symp - hypogastric n 3. Ejaculation - visceral and somatic n - pudendal n |
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Sperm
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Final phase of spermatogenesis = spermiogenesis
Spermatid --> Spermatozoa Acrosome = derived from Golgi Flagellum = centrioles Middle piece = mitochondria Feeds on Fructose |
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Testes
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2 in 1 scrotum
dartos fascia = wrinkled appearance incompletely surrounded by tunica vaginalis (tunica albuginea underneath) 250 lobule divisions w/ 1-4 coiled semniferous tubules converging @ mediastinum |
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Epididymis
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Highly coiled duct, continuous w/ ductus deferens
Sperm maturation, motility, storage |
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Seminal vesicle
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Seminal fluids = 70% volume of ejac. semen
source of alk. phosphatase in semen to neutralize acidity of vag |
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Penis
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3 columns erectile tissue :
1 corpus spongiosum - contains urethra 2 corpus cavernosa - surrounded by tunica albuginea |
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Sertoli cells
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Secrete:
Inhibin --> Inhibit FSH ABP (androgen-binding protein) --> maintain testosterone levels Forms: BTB - blood testes barrier to isolate gametes from autoimmune attack Support: Developing spermatozoa and regulate spermatogenesis |
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Leydig cells
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Endocrine cells
Secrete testosterone --> augment sperm prod |
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Female Organ Histology
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Ovary
- simple cuboidal - germinal epithelium that transitions to peritoneum at broad lig of uterus Fallopian tube - simple columnar - ciliated cells to transport egg/embryo - peg cells (nutrients) Uterus - simple pseudostrat columnar - tubular glands - cyclic changes - div into fxna'l and basal layers |
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Female Organ histology
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Cervix
- simple columnar - strat sq - cervical glands - secretion undergoes cyclic changes --> less viscous during ovulation Vagina - strat sq non-kerat - glycogen |
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Spermatogenesis
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Begins at puberty
Full dev takes 2 months Replication: Spermatogonium (2N = diploid) --> 1* spermatocyte (4N = diploid) Meiosis 1: 1* spermatocyte (4N) --> 2* spermatocyte (2N = haploid) Meiosis 2: 2* spermatocyte (2N) --> Spermatid (haploid N) |
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Androgens
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Potency:
DHT > Testosterone > Androstenedione Adipose tissue & Sertoli Cells: Testosterone + Androstenedione --> ESTROGEN - via Aromatase |
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Estrogen
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Estradiol> Estrone > Estriol
In PG: 50x inc Estradiol & Estrone 1000 x inc Estriol (=fetal well-being) |
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Theca Cell
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Cholesterol --> Androstenedione
- via Desmolase (+LH) * Only Theca Interna cells do this Theca Externa cells DO NOT PARTICIPATE IN STEROIDGENESIS |
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Granulosa Cell
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Androstenedione --> Estrogen
- via Aromatase (+FSH) |
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Progesterone
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Source:
Corpus luteum, placenta, adrenal cortex, testes Elevation = ovulation Withdraw Progsterone --> apoptosis of endometrial cells Function: 1. stimulate endometrial glandular secretions, spiral artery dev 2. Maintain PG 3. Decrease myometrial excitability 4. Produce thick cervical mucus to inhibit sperm entry into uterus 5. Inc body temp 6. Inhib LH, FSH 7. Promote uterine relaxation, prevent contractions |
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Menstrual Cycle
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1. Proliferative Follicular Phase
- can vary in length - stim by estrogen - non branching non budding uniform glands evenly distrib in uniform stroma - tubular narrow glands - begins w/ menses, ends w/ ovulation (=rupture of maturing graafian follicle) |
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Menstrual Cycle
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2. Secretory Luteal phase
- always CONSTANT 14 d - corpus luteum secretes progesterone --> promotes secretory endothelium - larger coiled glands - glycogen rich mucus rel into glandular lumens - edematous stroma w/ spiral arteries - begins w/ ovulation, ends w/ menses |
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Mittelschmerz
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Blood from ruptured follicle causes peritoneal irritation that can mimic appendicitis
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Oogenesis
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Fetal life:
- 1* oocytes (4N = diploid) begin Meiosis I --> arrest in prophase for years until ovulation Meiosis II: arrest in metaphase until fertilization 2* oocyte = 2N, haploid Ovum = haploid (N) (+3 polar bodies) |
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Pregnancy
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Ferilization = upper end of fallopian tube; w/in 1d of ovulation
Implantation = wall of uterus w/in 6d fertilization; hCG secreted by trophoblasts detectable in blood 1wk after conception |
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hCG
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Prod by syncytiotrophoblasts of placenta
1. 1st trimester: LH-like function --> Maintain corpus luteum (thus maintain progesterone); abortion results if this does not happen 2. 2nd/3rd trimester: placenta takes over progesterone production --> corpus luteum degenerates |
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Menopause
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Dec estrogen
Inc FSH, LH (no surge), GnRH |
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Klinefelter's
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XXY male
Inc FSH, LH Barr body = inactivated X chr |
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Turner's
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XO female
Inc FSH, LH Streak ovaries (no estrogen prod), webbing of neck, preductal coarc of aorta (diminished fem pulses, enlarged intercostal aa), No Barr body, Lympedema (hands/feet), cystic hygroma (post triangle of neck) * most spontaneously abort (account for ~15% spontan abortions) |
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XYY
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normal male fertility
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Androgen insensivity syndrome
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46XY
- defect in androgen receptor --> normal looking female (external female genitalia, rudimentary vagina, absent uterus/uterine tubes) - develops testes (in labia majora) - high testosterone, estrogen, LH |
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5alpha reductase defic
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No testosterone --> DHT conversion
Ambiguous genitalia until puberty when inc testosterone causes growth of extn genitalia |
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Recurrent miscarriages
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1st weeks - low prog levels (poor/no response to hCG)
1st tri - chr abnorm's 2nd tri - bicornuate uterus |
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Preeclampsia/Eclampsia
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T: IV Mg-sulfate or diazepam
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PG complications
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1. Abruptio placentae - premat detachment of placenta from implant site --> fetal death & DIC
- inc risk w/ smoking, HTN, cocaine - painful 3rd trim bleeding 2. Placenta accreta - defective decidual layer --> placenta attaches to myometrium - predisp factors: C-section or inflam - massive post-part bleeding 3. Placenta previa - attach placenta to lower uterine segment (int. os) - prior C-section - painless bleeding in ANY trim |
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Polyhydramnios
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>1.5-2L amniotic fluid
- esoph/duodenal atresia - anencephaly - inability to swallow amniotic fluid |
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Oligohydramnios
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<0.5L amiotic fluid
- BL renal agenesis - post urethral valves (males) - inability to excrete urine - give rise to Potter's syndrome (appearance of fetus in womb) |
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Gynecological tumor epidemiology
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Incidence:
endometrial > ovarian > cervical Worst prognosis: ovarian > cervical > endometrial |
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PCOS
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Hypoth-pit-ovarian system abnorm
LH/FSH ratio > 3 = characteristic!! Theca cell hyperplasia --> excess androgen production --> hyperandrogenism Sx's: obesity, hirsutism, oligomenorrhea Assoc w/ insulin resistance (inc risk of dev DMII), lipid abnormal's (inc risk of dev CV dz) and inc risk of endometrial cancer tx: weight loss, OCPs, gonadotropin analogs, clomiphene (SERM) |
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OVARIAN germ cell tumors
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1. Dysgerminoma - malign; inc hCG
2. ChorioCA - commonly preceded by evac hyaditiform mole/abortion/PG/ectopic PG; can develop in F or BABY - syncytiotroph cells w/ inc freq theca-lutein cysts - no villi, inc hCG - vag bleeding - mets to LUNG (MC site) & vag walls - very sensitive to chemotx |
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OVARIAN germ cell tumors
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3. Yolk sac tumor - aggressive malig in ovaries/testes; sacrococcygeal area of young kids
- inc AFP 4. Teratoma - NOT IN UTERUS; recall the more numerous the neuroeopithelial elements in immature teratoma = the more malignant |
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OVARIAN non-germ cell tumors
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Inc CA-125 = general ovarian CA marker
Risk factors: BRCA1, HNPCC (lynch syndrome) 1. Serous cyadenoma 2. Serous cystadenoCA - malign 3. Mucinous cysadenoma 4. Mucinous cystadenoCA - malign; pseudomyxoma peritonei 5. Brenner tumor 6. Fibromas - spindle shaped fibroblasts; Meig's syndrome 7. Granulosa cell tumor - secrete estrogen --> precocious puberty; endometrial hyperplasia; Call Exner bodies (eosin) 8. Krukenberg tumors |
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Meig's syndrome
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Fibromas
Triad of: 1. ovarian fibroma 2. Ascites 3. Hydrothorax |
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Dilated sinusoids
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- endothelial hypertrophy of lymph nodes draining a cancer (reactive pattern)
- filled with histiocytes (macrophages) CD68 |
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Invasive lobular breast CA
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orderly row of single-file line cells
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ComedoCA
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ductal, caseous necrosis
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Mamillary duct ectasia
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Ductal dilation
Insipissated breast secretions + chronic granulomatous infiltration in peridcutal and interstitial areas |
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Malignant Mixed Mullerian Tumors (MMMT)
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Carcinosarcoma of uterus
epithelial (endometrial type glands) & mesenchymal (sarcomatous) elements not assoc w/ PG or inc hCG levels |
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Paget's Dz of breast
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NOT SAME THING AS PEAU D'ORANGE (inflammatory malig breast CA)
eczematous patches on nipple w/ Paget cells (large cells in epidermis w/ clear halo - UL erythema w/ scaly crust) SUGGESTS underlying carcinoma Can also be seen on vulva |
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Gynecomastia
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Hyperestrogenism
Klinefelter's Drugs: Some Drugs Create Awesome Knockers - Spironolactone - Digitalis - Cimetidine - Alcohol - Ketoconazole |
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Fibrocystic Dz
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MCC breast lumps >25y-menopause
- premen breast pain, mult lesions, BL - fluctuation in size of mass 1. Fibrosis 2. Cystic - blue dome 3. Sclerosing - inc. acini and intralobular fibrosis 4. Epithelial hyperplasia - inc # of epithelial cell layers in terminal duct lobule; inc. risk of CA if atypica cells |
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Chronic Prostatitis
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Abacterial more common than bacterial
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BPH
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HYPERPLASIA, not hypertrophy!!
resultant hydronephrosis and CRF if not promptly treated |
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Prostatic adenoCA
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Inc total PSA, dec fraction free PSA
Histology: back-to-back glandular pattern |
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Testicular germ cell tumors
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95% of testicular tumors
1. Seminoma 2. Embryonal CA 3. Yolk sac tumor - SchillerDuval bodies w/ inc AFP; typically presents in boys <3y 4. ChorioCA 5. Teratoma - unlike in F, if mature prob malign |
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Testicular non germ cell tumors
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5% of all testicular tumors
1. Leydig cell tumor - Reinke crystals; gynecomastia/precocious puberty in males 2. Sertoli cell tumor 3. Testicular lymphoma - MC testicular cancer in older men |
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Penile Pathology
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Bowen's dz - gray solitary plaque on shaft or scrotum; 10% progress to SCC
Erythroplasia of Queyrat - red velvet plaques Bowenoid dz - multiple papular lesions in younger males; usu does not progress to CA SCC - rare in circumcized men; usu assoc w/ HPV Peyronie's dz - bent penis due to acq fibrous tissue formation |
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Phimosis v. Paraphimosis
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Phimosis - congen or multiple balantitis episodes; scarring prevents retraction of foreskin
Paraphimosis - forcible retraction w/ vascular compromise and swelling; can lead to gangrene |
