Term
| Day you start period is Day 1 of Cycle. There is the menses phase, followed by the proliferative/follicular phase, and then the secretory/luteal phase. During the proliferative/follicular phase estrogen is rising, and then half way through cycle (day 14), there is a huge surge of LH (and less so of FSH). This LH surge causes ovulation and is the beginning of the secretory/luteal phase. Progesterone predominates during the secretory/luteal phase, this is the ideal time to get pregnant. |
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Definition
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Term
| Ovulation tests look for __. |
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Definition
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Term
| Bcp: constant levels of estrogen and progesterone that tell brain not to cause LH and FSH, so ovulation does not occur |
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Definition
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Term
| The proliferative/follicular phase is from day _ to __. On day __ the dominant follicle starts producing ___. |
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Definition
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Term
| Day 14 is the average day of ovulation which occurs b/c of the __ feedback of __ which leads to the __ surge. |
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Definition
- positive feedback
- estradiol
- LH surge |
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Term
| The secretory/luteal phase lasts about __ days. This phase begins after ovulation. The estrogen and progesterone from the __ __ stimulate ___. Glands become __ and __ fluid. The corpus luteal cyst pumps __ which maintains pregnancy and stabilizes the endometrium. |
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Definition
- 14 days
- corpus luteum
- vascularization
- coiled and secrete
- progesterone |
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Term
| If pregnancy does not occur during the secretory/luteal phase, the corpus luteum __, the __ thins, the spiral arteries __. Ultimately the __ necroses causing spiral arteries to __ due to the __ withdrawal. ___ are secreted by the endometrium which produce bleeding and necrosis. |
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Definition
- regresses
- endometrium thins
- coil
- endometrium necroses
- hemorrhage
- estrogen withdrawal
- Prostaglandins |
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Term
| Hypopituitary-Ovary Axis: |
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Definition
| Arcuate nucleus> (pulsatile GnRH)> Anterior pituitary> FSH and LH |
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Term
| After the LH surge, the __ release of __ begins again. Follicles are already being recruited around day 15 to 16. |
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Definition
| - pulsatile release of GnRH |
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Term
| The proliferative/follicular phase, which lasts from day 5-16, restores endometrial function from preceeding menstruration. |
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Definition
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Term
| The most variable portion of the cycle: |
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Definition
| Proliferative/follicular phase |
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Term
| The secretory/luteal phase lasts __ days and prepares the uterus for __. |
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Definition
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Term
| most consistent part of cycle: |
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Definition
| secretory/luteal phase (14 days) |
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Term
Progesterone
Think “PRO-GESTATION”
Ovaries
Primarily secreted by corpus luteum and the placenta (during luteal phase large amounts are secreted by the corpus luteum cause ovarian secretion to increase 20-fold)
Uterus
Thickens endometrium
Breasts
C/V
Other |
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Definition
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Term
Estrogen
Primarily secreted by ovaries
Ovaries
Stimulates ovarian follicles
Decrease FSH secretion
Inhibit LH secretion sometimes
Increase LH secretion sometimes
Uterus
Increase uterine blood flow
Increases uterine muscle and it’s contractive proteins
Breasts
Breast enlargement at puberty primarily
Cause pigmentation of areolas
C/V
Cholesterol lowering action
Produce vasodilation (posibly due to increase in nitric oxide)
Large doses of estrogens also promote thrombosis
Other
May increase libido
May slow Alzheimer’s progression
Cause salt and water retention
Inhibit comedones from being formed
(2nd sex characteristics are primarily due to absence of androgens more so than presence of estrogens) |
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Definition
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Term
|
Definition
| absense of periods for 6 months, pregnancy most common cause |
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Term
|
Definition
| too many periods in a year |
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Term
|
Definition
| too few periods in a year (less than 5) |
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Term
| Bartholin's glands are at the 5 and 7:00 positions. Use a __ __ for cysts of these glands. |
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Definition
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Term
| Marsupialization for bartholin's cyst: |
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Definition
| sew open the gland b/c of recurrent cysts |
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Term
| The pre-puberty cervix should be featureless smooth pink __ epiethelium. There should NOT be features suggesting columnar epithelium, such as __ __ or __ __. |
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Definition
- squamous
- gland openings
- Nabothian cysts |
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Term
| The Transformation Zone is a geographic area b/w the original squamous epithelium (before puberty), and the current ___ junction. It may contain __ __, __ __, and islands of columnar epitherlium surrounded by metaplastic squamous epithelium. This is the most common area for __ __. |
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Definition
- squamocolumnar junction
- gland openings
- Nabothian cysts
- cervical cancer |
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Term
| Columnar epithelium of the cervix: |
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Definition
single-cell layer, mucous producing, tall epithelium
extends between the endometrium and the squamous epithelium
Columnar epithelium appears red and irregular with stromal papillae and clefts.
With acetic acid application and magnification, columnar epithelium has a grape-like or "sea-anemone" appearance. It is found in the endocervix, surrounding the cervical OS, or (rarely) extending into the vagina. |
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Term
| The squamocolumnar junction (SCJ) is a clinically visible line seen on the ___ which demarcates ___ ___tissue from __ tissue. This is an anatomical feature. |
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Definition
- ectocervix
- endocervical columnar tissue
- squamous |
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Term
| Squamous metaplasia is the physiologic process whereby ___ epithelium matures into ___ epithelium. Squamous metaplasia typically occupies part of the ___ ___. At the SCJ it appears as ghost white or white blue film with the application of __ __. It is usually sharply demarcated toward the cervical __ and has very diffuse borders ___. |
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Definition
- columnar epithelium
- squamous epithelium
- transformational zone
- acetic acid
- os
- peripherally |
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Term
| Peterson's= petite speculum |
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Definition
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Term
|
Definition
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Term
| Papanicolaou smear (PAP smear) is a __ test for __ and __ __. Colposcopy is the __ __ used to evaluate patients with an abnormal cervical cytology smear or abnormal appearing cervix. |
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Definition
- screening
- dysplasia
- cervical cancer
- diagnostic test |
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Term
| With a colposcopy, you paint the cervix with __ __, and whatever lights up you do a __ __, which is both diagnostic and therapeutic. |
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Definition
- acetic acid
- punch biopsy |
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Term
| An atypical transformational zone could be evidenced by painting the cervix with acetic acid. Whatever turns ___, a transient white apppearing epithelium. These areas correlate with __ __ __. |
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Definition
- acetowhite
- higher nuclear density |
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Term
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Definition
| compressed nitrogen gas flows through the cryo probe making the metal cold enough to freeze and destroy abnormal cervical tissue |
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Term
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Definition
| - large tissue around the cervix is excised for examination |
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Term
|
Definition
| melon ball scoop out of cervix |
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Term
| List the layers of the uterine wall from innermost to outermost: |
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Definition
| Endometrium (mucous)> Myometrium (muscular)> Perimeterium (serous) |
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Term
| Endometrium (mucous) characteristics; |
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Definition
- soft and spongy
- single layer of epithelium
- delicate and friable with tubular glands |
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Term
|
Definition
- thick
- continues with tubes and vagina and into ovarian, round and cordial ligaments
- outer weaker layer
- inner stronger layer intermingled with venous plexuses |
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Term
| Perimetrium (serous) characteristics: |
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Definition
- peritoneal covering
- thin and adhered to fundus |
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Term
| Water flows under the bridge: ureters flow under the fallopian tubes. |
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Definition
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Term
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Definition
7-8 cm long
4-5 cm wide
Larger in women who have had children
Smaller than prepubertal women |
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Term
| read about innervation and blood supply to uterus, abbreviations, and definitions |
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Definition
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Term
| During the proliferative/follicular phase (days 5-16), __ from follicles stimulate regeneration of the ___ and __ __ __. |
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Definition
- estrogen
- endometrium
- uterine glands lengthen |
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Term
| During the secretory/luteal phase (lasts 14 days, which is after ovulation, __ and ___ from the corpus luteum stimulate __ and glands become __ and __. |
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Definition
- estrogen and progesterone
- vascularization
- coiled and secrete |
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Term
If no pregnancy, corpus luteum regresses
Endometrium thins
Spiral arteries coil
Endometrium necroses cause spiral arteries to hemorrhage
Prostaglandins are secreted by endometrium and produces necrosis and bleeding as well
CDTOG p 132 |
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Definition
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Term
Menstruation
75% arterial blood
Contains tissue, prostaglandins, and fibrinolysin
Fibrinolysin normally keeps menstrual flow from clotting, unless excessive
Avg blood loss is 30mL
>80mL is considered abnormal
Usually less than 28 days between periods
CDTOG p.130-2 |
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Definition
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Term
| READ Figure 3-4 on evaluating AUB |
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Definition
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Term
| List and describe the normal 3 stages of pubertal development for girls: |
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Definition
- Thelarche- breast development is first
- Pubarche- axillary and pubic hair
- Menarche- the first period (takes 12-18 months to become regular)
(avg age of 8-13 in US) |
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Term
| Look at tanner stages in figure 6-3 |
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Definition
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Term
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Definition
- no period by age 13 in absense of secondary sex characteristics
- no period by age 16 in presence of normal growth and secondary sex characteristics |
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Term
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Definition
Due to an early but otherwise normal pubertal pattern of gonadotropin secretion from pituitary
Often caused by lesions of hypothalamus or pinea
MCC is constitutional
important to stop this b/c growth plates start closing with puberty so growth would be stunted if not stopped |
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Term
| True precocious puberty is constitutional and is due to __ disorders involving the __ such as __, __, and __ __. |
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Definition
- cerebral
- hypothalamus
- tumors, infections, and developmental abnormalities |
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Term
| Precocious pseudopuberty means there is no __ or __ ___. Causes may be __ or __. |
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Definition
- spermatogenesis
- ovary development
- adrenal
- gonadal
Adrenal causes:
- congential virilizing adrenal hyperplasia
- androgen secreting tumors in males
- estrogen secreting tumors in females
Gonadal causes:
- interstitial cell tumors of testes
- granulosa cell tumors of the ovaries |
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Term
Precocious pseudopuberty
Development of 2° Sex Characteristics w/o gametogenesis
Caused by abnormal exposure of females to estrogen |
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Definition
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Term
True precocious puberty
Early development of 2° Sex Characteristics
Usually idiopathic
Can be caused by hypothalamic d/o’s |
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Definition
|
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Term
| constitutional precocious puberty treatment: |
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Definition
Constitutional Precocious Puberty
Premature but normal-appearing development
pubertal levels of FSH, LH and sex hormones
Responds to GnRH stimulation test
All other tests are normal
Treatment (return the patient to a prepubertal pattern of development)
GnRH analogs
leuprolide (Lupron)
nafarelin (Synarel)
desensitize the anterior pituitary gland to the normal pulsatile stimulation of hypothalamic GnRH.
release of FSH and LH is suppressed |
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Term
| see last slide of this lecture: |
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Definition
CNS and pituitary lesions
Varies with site and type
Gonadotropin-Secreting Tumors
secrete the b subunit of hCG or, in rare cases, the a subunit
usually surgical treatment required
Peripheral Precocious Puberty
development occurs despite low or prepubertal levels of FSH and LH
Treatment depends on the etiology.
McCune-Albright Syndrome
classic triad
polyostotic fibrous dysplasia
café au lait spots
precocious puberty
Requires medical and orthopedic management
Exogenous Sex Hormones
development of secondary sexual features in conjunction with suppressed FSH and LH levels
oral contraceptives can cause this in girls
girls develop dark-brown breast areolae and have not begun natural puberty will lack pubic hair
Contrasexual Development
premature or excessive pubic hair in girls
MCC’s
adrenal hyperplasia
premature or exaggerated adrenarche in peripubertal girls
polycystic ovaries in older girls |
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