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77 Cards in this Set
- Front
- Back
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suspensory ligament
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ovaries to lateral pelvic wall
ovarian vessels |
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cardinal ligament
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cervix to side wall of pelvis
uterine vessels |
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round ligament
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uterine fundus to labia majora
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broad ligament
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uterus, fallopian tube, ovaries to pelvic side wall
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ligament of ovary
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ovary to lateral uterus
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describe the pathway of the ureter from the kidney to the bladder relative to the gonadal artery/vein, external iliac artery, and internal iliac artery
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1. ureteres run under the gonadal artery/vein "water runs under the bridge"
2. runs over the external iliac artery and enters true pelvis. at this point they are also medial to the gonadal a. as they enter the true pelvis. 3. enter true pelvis lateral to internal iliac a. |
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lymphatic drainage for:
-ovaries/testes -distal 1/3 of vagina/vulva/scrotum + anal canal under pectinate line -proximal 2/3 of vagina/uterus |
-ovaries/testes = para-aortic lymph nodes
-distal 1/3 of vagina/vulva/scrotum = superficial inguinal -proximal 2/3 of vagina/uterus = obturator, external iliac, hypogastric nodes |
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female reproductive histology:
ovary fallopian tube uterus endocevix exocervix vagina |
ovary: simple cuboidal
fallopian tube: simple columnar uterus: simple columnar, psuedostratified, tubular endocevix: simple columnar exocervix: stratified squamous vagina: stratified squamous |
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nerves responsible for:
erection emission ejaculation |
erection = pelvic nerve (parasymp)
emission = hypogastric (symp) ejaculation = pudendal (symp) |
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6 functions of sertoli cells
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secretes 3 things:
androgen binding protein (binds testosterone and keeps it concentrated in the seminiferous tubules) inhibin anti-mullerian hormone regulates spermatogenesis/supports and nourishes spermatozoa makes blood/testes barrier |
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what occurs in meiosis II in spermatogenesis
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secondary spermatocyte (haploid - 2N) becomes spermatid (haploid N)
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what 4 structural changes occur in spermiogenesis
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spermiogenesis = spermatid --> spermatozoan
-condense chromatin/lose cytoplasm -get centriole tail -get acrosomal gap from golgi -midpeice from mitochondria |
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What does LH and FSH act on in men
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LH --> leydig cells --> testosterone
FSH --> sertoli cells --> spermatogenesis stuff, ABP, AMH, inhibin |
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What does LH and FSH act on in women
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LH --> theca interna, where cholesterol is converted to androstendiene by desmolase.
FSH --> granulosa cells, where androstendione is converted to estrogen by aromatase. |
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what hormone causes myometrial excitability and incrases SHBG, and increases HDL, decreases LDL
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estrogen
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what hormone inhibits FSH, LH and causes uterine smooth muscle relaxation
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progesterone *maintains pregnancy, causes endometrial glandular secretion.
*decreased progesterone leads to decreased fertility |
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when does meiosis I occur in oogenesis
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primary oocytes are arrested in PROPHASE I until they are chosen to ovulate. Right before they ovulate, they complete meiosis I and subsequently get stuck in METAPHASE II, until they are fertilized.
*only under fertilization do oocytes complete meiosis II. |
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what induces lactation
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after labor, the decrease in progesterone induces lactation.
suckling is required to maintain milk production, by increasing oxytocin and prolactin. |
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where is hCG made in the 1st trimester?
where is hCG made in the 2nd and 3rd trimester? |
In the first trimester, the synctiotrophoblasts maintain the corpus luteum by acting as LH. Thus, the corpus luteum continues to make hCG through the first trimester.
In the 2nd and 3rd trimester, the placenta synthesizes its own estroil and progesterone and the corpus luteum degeneraties. |
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what is the best test to confirm menopause?
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increased FSH levels
*LH and GnRH will also be elvated |
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common causes of female and male psuedohermaphrodite
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female = CAH (21 or 11 hydroxylase deficiency) or exogenous administration of androgens during pregnancy
male = androgen insensitivity syndrome (no testosterone receptors) - have testicles, female external genitalia (bc no testosterone inhibits it) no female internal genitalia (because they have intact AMH from sertoli), no male external genitalia (no testosterone = no DHT) |
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painless vaginal bleeding + enlarged uterus in 4th/5th month of pregnancy.
if the karyotype is 46,XY what is the diagnosis, what about if 47XXY |
Hydatiform mole
complete = XX or XY (but all sperm + empty egg), VERY HIGH hCG, increased uterine size, risk of malignant transformation, NO fetal parts. Partial = 47, XXY (2 sperm + 1 egg), increased hCG, rare malignant transformation, yes fetal parts |
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what are the most common causes of miscarriages in:
1st weeks 1st trimester 2nd trimster |
1st weeks: low progesterone (hCG does not stimulate corpus luteum)
1st trimester: chromosomal abnormalities 2nd trimester: bicornuate uterus |
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when does pre-eclampsia or eclampsia generally present?
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20 weeks gestation (3rd trimester) up until 6 weeks postpartum.
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what is preeclampsia triad
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hypertension, edema, proteinuria
occurs from placental ischemia due to impaired vasodilation of spiral arteries, resulting in maternal increase in vascular tone. *risk factors = anything that causes ischemia (HELLP syndorme, HTN, diabetes, renal disease, autoimmune) eclampsia = preeclampsia + seizures |
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Rx for preeclampsia/eclampsia
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1. deliver baby asap
2. treat htn, IV magnesium silfate, diazepam |
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painful bleeding in 3rd trimester
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abruptio placentae: premature detachment of placenta from implantation site- fetal death
risks = DIC, smoking, HTN, cocaine |
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massive bleeding after delivery
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placenta accreta: placenta attaches to myometrium, no separation of placenta after birth.
risks = prior c section, inflammation, previous placenta previa |
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painless bleeding in any trimester
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placenta previa: attachment of placenta to lower uterine segment; may occlude cervical os.
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esophageal/duodenal atresia causes what amniotic fluid abnormality?
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polyhydramnios (high)
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renal agenesis causes what amniotic fluid abnormality?
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oligohydramnios (low)
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HPV 16, 18 viral proteins E6 and E7 cause what?
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E6 = deactivates p53
E7 = displaces transcription factors normally bound to Rb |
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risk factors for most common gynecological malignancy
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endometrial carcinoma
risk = anything that increases estrogen levels --> endometrial hyperplasia. ex: prolonged use of estrogens w/o progestrins, obesity, diabetes, HTN, nulliparity, late menopause, PCOS |
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most common benign tumor in females
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leiomyoma (fibroids)
do NOT transform to leiomyosarcoma, are estrogen senitive (change size w/ stimulation) may be asymptomatic, cause abnormal uterine bleeding, or miscarriage |
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PCOS has what serum levels
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HIGH LH!
low FSH high testosterone, high androgens |
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unruptured graafian follicle
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follicular cyst
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hemorrhage intopersistent corpus luteum
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corpus luteum cyst
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cyst associated with choriocarcinoma
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theca-lutein cyst (due to gonadotropin stimulation)
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blood containing cyst from ovarian endometriosis
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chocolate cyst
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ovarian germ cell tumor that has tumor markers hCG and LDH.
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dysgerminoma
*female equivalent to male seminoma, sheets of uniform cells. |
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who get choriocarcinomas
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50% after mole evacuation
25% after normal pregnancy 25% after abortion *see elevated hCG |
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ovarian germ cell tumor that is yellow, friable, and has schiller-duvall bodies (resemble glomeruli)
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yolk sac tumor
*aggressive malignancy- see elevated AFP |
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in women what are the teratomas you should worry about?
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immature teratoma = aggressively malignant
mature = dermoid cyst-benign *also struma ovarii which has functional thyroid tissue --> hyperthyroid |
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playing odds, what is the most common benign and malignant ovarian malignancy
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benign = serous cystadenoma
malignant = serious cystadenocarcinoma *both are frequently bilateral |
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intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor
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psuedomyxoma peritonei - can occur with mucinous cystadenocarcinoma
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triad of ovarian fibroma, ascites, and hydrothorax
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Meigs' syndrome - feel a pulling in the groin.
*fibromas = bundle of spindle shaped fibroblasts |
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Call-exner bodies
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small follicles with eosinophilic secretions found in granulosa cell tumor (which secrete estrogen)
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small, mobile, firm mass with sharp edges in 23 yr old girl
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fibroadenoma
-not a breast cancer precursoe -estrogen changes size |
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serous or bloody nipple discharge, feel a small mass beneath aerola
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intraductall papilloma
*slight risk for carcinoma |
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large bulky mass of connective tissue and cysts- "leaf like" projections
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phyllodes tumor
-some may become malignant -most common in 6th decade |
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worst and most invasive, and most common breast carcinoma
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invasive ductal carcinoma
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orderly row of cells - breast tumor
how do they present? |
invasive lobular carcinoma
*often multiple, bilateral. |
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breast tumor that is fleshy, cellular, with a lymphocytic infiltrate
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medullary
*good prognosis |
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subtype of ductal carcinoma in situ that has caseous necrosis
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comedocarcinoma
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describe the apperance of paget cells
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large cells in epidermis with clear halo
*seen on nipple or in vulva |
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Most common cause of breast lumps from age 25 to menopause
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Fibrocystic disease
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4 histologic types of fibrocystic disease
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1. fibrosis: hyperplasia of stroma
2. cystic: fluid filled, blue dome 3. sclerosing adenosis- occurs at lobules, increased acini + intralobular fibrosis, often calcified 4. epithelial hyperplasia: increased epithelial cell layers in terminal duct lobule *increased risk of carcinoma with atypical cells |
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5 drugs that cause gynecomastia
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spironolactone
digitalis cimetidine alcohol ketoconazole |
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what two markers are associated with embryonal carcinoma of the testes
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AFP, hCG
*malignant, PAINFUL, worse prognosis than seminoma. |
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yellow mucinous tumor of testes with elevated AFP
what cell is characteristic of this tumor? |
yolk sac tumor- has Schiller Duval bodies which resemble primitive glomeruli
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golden brown tumor of the testes with Reinke crystals inside
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Leydig cell tumor- secretes testosterone - can cause gynecomastia in men, precocious puberty in boys
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most common testicular cancer in older men
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testicular lymphoma
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which has a higher risk of malignancy Bowen's disease or Bowenoid papulosis
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Bowen = gray solitary crusty papule on shaft of penis with 10% chance of SCC
Bowenoid = younger demographic multiple lesions, usually does not become invasive |
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used in pulsatile manner for infertility, used continuously for prostate cancer
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leuprolide
pulsatile = GnRH agonist continous = GnRH antagonist |
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cholesterol changes with exogenous testosterone
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increased LDL, decreased HDL
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competitive inhibitor of androgens - used in prostate cnacer
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flutamide
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inhibits androgen synthesis (inhibits desmolase)
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ketoconazole
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treatment for hirsutism, works by inhibiting steroid binding
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spironolactone
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3 risks of estrogen therapy
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1. risk of endometrial cancer
2. clear cell adenomcarcinoma of vagina in females exposed to DES 3. thrombi *thus, do not give to women with history of DVTs |
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mechanism of clomiphene
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partial agonist at estrogen, prevents normal feedback inhibition and increases LH/FSH --> ovulation
*treats infertility and PCOS -can cause hot flashes, ovarian enlargement, multiple babies*, visual disturbances* |
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antagonist on breast, agonist on bone, CV, endometrium
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tamoxifen
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Rx for osteoporosis via estrogen agonist
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raloxifene
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aromatase inhibitors used in postmenopausal women with breast cancer
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anastrozole/exemestane
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can treat endometrial cancer and abnormal bleeding, in addition to cause vascularization of endometrium
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progestins
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prostaglandin that dilates cervix and contracts uterus
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dinoprostone
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ritodrine
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beta-2 agonist relaxes uterus, reduces premature uterine contractions
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side effects of sildenafil
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headache, flushing, heartburn, blue/green colorblindness
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