Block A4 Recap Batch 2013

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Block A4 - Genito-Urinary System


Questions[edit]

1[edit]

What follicle? FSH?

2[edit]

Aromatase changes DHEA into Estrogen. - Dehydroepiandrosterone on Examine.com

3[edit]

"The oxytocin receptor, also known as OXTR, is a protein which functions as receptor for the hormone and neurotransmitter oxytocin. In humans, the oxytocin receptor is encoded by the OXTR gene which has been localized to human chromosome 3p25." - Wikipedia.

"There was synthesis of both OT and the oxytocin receptor (OTR) within the testis, and both were markedly expressed within the Leydig cells. Expression of OT or neurophysin does not appear to be significant in the epididymis, though there appears to be synthesis of the receptor in some peritubular muscle cells of the epididymis and in the vas deferens. Receptors appear to be present in the myoid cells encompassing the glandular lobules and are presumably able to respond to systemic OT. " - Pubmed.

4[edit]

"The asymmetry within the abdominal cavity caused by the liver typically results in the right kidney being slightly lower than the left, and left kidney being located slightly more medial than the right." - Boundless Anatomy and Physiology.

"The kidneys are paired retroperitoneal structures that are normally located between the transverse processes of T12-L3 vertebrae, with the left kidney typically somewhat more superior in position than the right. The upper poles are normally oriented more medially and posteriorly than the lower poles." - Medscape.

5[edit]

Kidney anatomy

"The renal hilum (Latin: hilum renale) or renal pedicle is the hilum of the kidney, that is, its recessed central fissure where its vessels, nerves and ureter pass. The medial border of the kidney is concave in the center and convex toward either extremity; it is directed forward and a little downward. Its central part presents a deep longitudinal fissure, bounded by prominent overhanging anterior and posterior lips. This fissure is a hilum that transmits the vessels, nerves, and ureter. From anterior to posterior, the renal vein exits, the renal artery enters, and the renal pelvis exits the kidney."

6[edit]

"The mesonephric duct (also known as Wolffian duct) is a paired organ found in mammals including humans during embryogenesis. Wolffian structures are male urogenital structures that include the epididymis, vas deferens, and seminal vesicles that differentiate from this structure. In a male, it develops into a system of connected organs between the efferent ducts of the testis and the prostate, namely the epididymis, the vas deferens, and the seminal vesicle. The prostate forms from the urogenital sinus and the efferent ducts form from the mesonephric tubules. Precursor of the mesonephric duct is the intermediate mesoderm." - Wikipedia

7[edit]

"Biological hazards, also known as biohazards, refer to biological substances that pose a threat to the health of living organisms, primarily that of humans. This can include medical waste or samples of a microorganism, virus or toxin (from a biological source) that can affect human health. " - Wikipedia.

8[edit]

There are Five Levels of Empathy: (Truax and Carkhuff 1967 Communication Scale)

  • Level 1 - low level (little or no awareness of feeling).
  • Level 2 - moderately low level (some awareness).
  • Level 3 - reciprocal level of empathic responding (accurate reflection of client's message reflected at the level in which it was given - paraphrasing with the appropriate feeling word).
  • Level 4 - moderately high level of empathic responding (reflecting not only the accurate feeling but the underlying feeling).
  • Level 5 - high level of empathic responding (accurate reflection of feeling, plus underlying feelings in greater breadth and depth (also for some interpretation such a deep disappointment or long range goals).

Examples:

  • Level One: "You worry to much. You have to remember that university isn't the same as college."
  • Level Two: "I can see that you are upset, but you'll adjust after a while."
  • Level Three: "You're really unhappy here at university."
  • Level Four: "It sounds like you are not only disappointed with your university experience, but you are also feeling homesick."
  • Level Five: "It's clear you're disappointed. Your experience at university is not what you expected to be. I'm wondering if you're feeling a little self-doubt regarding your decision. It sounds like this disappointment has stirred up a lot of conflicting feelings for you about where you're heading."

9[edit]

"The autonomic nervous system (ANS) is a division of the peripheral nervous system that influences the function of internal organs. The autonomic nervous system is a control system that acts largely unconsciously and regulates bodily functions such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. This system is the primary mechanism in control of the fight-or-flight response and the freeze-and-dissociate response. Within the brain, the autonomic nervous system is regulated by the hypothalamus." - Wikipedia

10[edit]

"Prior to the physical stimulation, comes sexual desire. Largely mediated by emotion through the limbic system, activation of the amygdala can trigger penile erection, sexual feelings,(Georgiadis and Holstege, 2005) sensations of extreme pleasure (Olds and Milner, 1954), memories of sexual intercourse (Gloor, 1986), as well as ovulation, uterine contractions, and orgasm."

"Input travels from the basolateral nuclei of the amygdala along the amygdalofugal pathway to the ventral striatum, made up of the nucleus accumbens, putamen and parts of the caudate nucleus. The nucleus accumbens plays a role in pleasure and reward due to a large large of dopaminergic neurons from the VTA (ventral tegmental area)." - UNSW.

11[edit]

DRE on OSCESkills.com.

12[edit]

"The reproductive organs are developed from the intermediate mesoderm. The permanent organs of the adult are preceded by a set of structures which are purely embryonic, and which with the exception of the ducts disappear almost entirely before the end of fetal life. These embryonic structures are the Wolffian and Müllerian ducts, also known as mesonephric and paramesonephric ducts, respectively. The Wolffian duct remains as the duct in males, and the Müllerian as that of the female." - Wikipedia.

13[edit]

"In males, Corpora cavernosa penis cut short. In females, Corpus cavernosum clitoridis. Both arise from an elevation which becomes clitoris or penis (genital tubercle)." - Wikipedia.

14[edit]

"The corpora cavernosa of the penis or clitoris and of the urethra arise from the mesodermal tissue in the phallus; they are at first dense structures, but later vascular spaces appear in them, and they gradually become cavernous." - Wikipedia.

15[edit]

"The tunica albuginea is the fibrous envelope of the corpora cavernosa penis. The tunica albuginea is directly involved in maintaining an erection; that is due to Buck's fascia constricting the deep dorsal vein of the penis, preventing blood from leaving and thus sustaining the erect state." - Wikipedia

"The tunica albuginea is also the fibrous covering of the testis. It is covered by the tunica vaginalis, except at the points of attachment of the epididymis to the testis, and along its posterior border, where the spermatic vessels enter the gland." - Wikipedia

"Tunica albuginea is also found on the surface of the ovary, where this tissue is much condensed, and forms a layer." - Wikipedia

16[edit]

"One of the most important roles of AVP (ADH=AVP=Vasopressin) is to regulate the body's retention of water; it is released when the body is dehydrated and causes the kidneys to conserve water, thus concentrating the urine and reducing urine volume."

Two main methods in how ADH conserves water:

  1. Increasing the water permeability of distal convoluted tubule and collecting duct cells in the kidney, thus allowing water reabsorption and excretion of more concentrated urine, i.e., antidiuresis. This occurs through insertion of water channels (Aquaporin-2) into the apical membrane of distal convoluted tubule and collecting duct epithelial cells. Aquaporins allow water to move down their osmotic gradient and out of the nephron, increasing the amount of water re-absorbed from the filtrate (forming urine) back into the bloodstream.
  2. Increasing permeability of the inner medullary portion of the collecting duct to urea by regulating the cell surface expression of urea transporters, which facilitates its reabsorption into the medullary interstitium as it travels down the concentration gradient created by removing water from the connecting tubule, cortical collecting duct, and outer medullary collecting duct.
  3. Acute increase of sodium absorption across the ascending loop of henle. This adds to the countercurrent multiplication which aids in proper water reabsorption later in the distal tubule and collecting duct.

- Wikipedia.

17[edit]

(What?)

18[edit]

"Physiologically, erection is triggered by the parasympathetic division of the autonomic nervous system (ANS), causing nitric oxide (a vasodilator) levels to rise in the trabecular arteries and smooth muscle of the penis. The arteries dilate causing the corpora cavernosa of the penis (and to a lesser extent the corpora spongiosum) to fill with blood; simultaneously the ischiocavernosus and bulbospongiosus muscles compress the veins of the corpora cavernosa restricting the egress and circulation of this blood. Erection subsides when parasympathetic activity reduces to baseline." - Wikipedia

19[edit]

"In the presence of mechanical stimulation, erection is initiated by the parasympathetic division of the autonomic nervous system (ANS) with minimal input from the central nervous system. Parasympathetic branches extend from the sacral plexus into the arteries supplying the erectile tissue; upon stimulation, these nerve branches release acetylcholine, which, in turn causes release of nitric oxide from endothelial cells in the trabecular arteries. Nitric oxide diffuses to the smooth muscle of the arteries (called trabecular smooth muscle), acting as a vasodilating agent. The arteries dilate, filling the corpora spongiosum and cavernosa with blood. The ischiocavernosus and bulbospongiosus muscles also compress the veins of the corpora cavernosa, limiting the venous drainage of blood.Erection subsides when parasympathetic stimulation is discontinued; baseline stimulation from the sympathetic division of the ANS causes constriction of the penile arteries, forcing blood out of the erectile tissue"

"A penis which is partly, but not fully, erect is sometimes known as a semi-erection (clinically: partial tumescence); a penis which is not erect is typically referred to as being flaccid, or soft." - Wikipedia

20[edit]

Origin of adult Leydig cells

"A pool of undifferentiated, self-renewing stem cells." - BiologyReprod

21[edit]

"Osmolality of blood increases with dehydration and decreases with overhydration. In normal people, increased osmolarity in the blood will stimulate secretion of antidiuretic hormone (ADH). This will result in increased water reabsorption, more concentrated urine, and less concentrated blood plasma. A low serum osmolality will suppress the release of ADH, resulting in decreased water reabsorption and more concentrated plasma." - Wikipedia

  • Salt intake increase during event of high plasma osmolarity: To increase net movement of water into the cell.
  • Active reabsorption of salt at ascending loop of Henle, passive diffusion of water in descending Loop of Henle.

22[edit]

Increased plasma volume.

Too much isotonic drink may cause:

  • Hypernatremia : Cause dizziness when changing position (vertigo), nausea, diarrhea.
  • Hyperkalemia : Cause heart arrhythmia, nausea, irregular pulse (fibrillation).
  • Hypercalcemia: Cause decrease in level of phosphorus, fatigue, lethargy, seizures.
  • >Magnesium : Muscular and neural damage, muscle weakness, confusion, arrhythmia.

23[edit]

"A decreasing parasympathetic innervation leads to the predominance of phosphodiesterase type 5 (PDE-5), which interrupts the signal transduction cascade. The concentration of cGMP decreases and the smooth muscle cells contract."

"Adrenergic stimulation of the penis through the following intermediate steps also leads to the termination of the erection: stimulation of adrenergic receptors, phospholipase C, inositol triphosphate (IP3) and DAG (diacylglycerol), protein kinase C, intracellular calcium influx with smooth muscle contraction." - Urology-Textbook.com.

"There are three phases of detumescence. The first entails a transient intracorporeal pressure increase, indicating the beginning of smooth muscle contraction against a closed venous system. The second phase shows a slow pressure decrease, suggesting a slow reopening of the venous channels with resumption of the basal level of arterial flow. The third phase shows a fast pressure decrease with fully restored venous outflow capacity. Erection thus involves sinusoidal relaxation, arterial dilatation, and venous compression." - PubMed.

24[edit]

Higher testosterone level in elderly:

  • Lost less muscle mass.
  • Reduced risk of cardiovascular event.

25[edit]

Instrument for simple gynecological exam:

  • Bimanual exam : Index and middle finger.
  • Taking smear sample : Speculum, cervical brush.

26[edit]

Ante Retro Flexi

27[edit]

Ligament from lateral pelvic to cervix : A pair of Cardinal ligament ( Mackenrodt's ligament / lateral cervical ligament / transverse cervical ligament) Location : base of Broad Ligament of Uterus; attached to lateral pelvic wall via attachment to Obturator Internus Muscle (Obturator fascia).

Other ligamentous support:

A) Round ligament : Anterior to fallopian tubes, cross external iliac vessels, enter the internal inguinal ring, insert in labia majora. Sampson's artery (branch of uterine artery run along this Round ligament)
B) Broad ligament : Double reflection of peritoneum (it drapes over the round ligaments). Cardinal ligament lies at the base of this Broad ligament.
C) Uterosacral ligament: Minor cervical support. Location is from upper posterior cervix - around rectum (bilaterally) - fan out to attach to 1-5th sacral vertebrae (thus : Utero-Sacral ligament)

28[edit]

"The reproductive organs are developed from the intermediate mesoderm. The permanent organs of the adult are preceded by a set of structures which are purely embryonic, and which with the exception of the ducts disappear almost entirely before the end of fetal life. These embryonic structures are the Wolffian and Müllerian ducts, also known as mesonephric and paramesonephric ducts, respectively. The Wolffian duct remains as the duct in males, and the Müllerian as that of the female." - Wikipedia.

29[edit]

Location of hormone receptor for genetic transcription: Steroid / thyroid hormone receptor (classified as transcription factors : due to ability to directly bind to DNA and regulate expression of adjacent genes). Found on plasma membrane, in cytosol and nucleus of target cells. Initiate signal transduction; leading to changes in gene expressions.

30[edit]

Hormone effector system that activates intracellular messenger:

  • Second messengers (intracellular signaling molecules) e.g. Cyclic AMP, cyclic GMP, diacylglycerol, calcium are released by cell in response to exposure to first messenger (extracellular signaling molecules).
  • The first messengers are often hormones or neurotransmitters e.g epinephrine, growth hormone, serotonin.
  • Steroid hormones can physically cross phospholipid bilayer (thanks to it being hydrophobic / lipophilic) and initiate changes within cells directly (see Q29)
  • But not Peptide hormones or neurotransmitter (they are hydrophilic / lipophobic).
  • So hormones that would need to activate intracellular messenger (or secondary messenger) in order to cause changes, are those like : luteinizing hormone, FSH, TSH, PTH, Antidiuretic, growth hormone, gonadotropin-releasing hormone ; in short - non steroid hormone.
  • List of second messengers: Colostate.edu.

31[edit]

Epididymis.

32[edit]

"Spermatozoa formed in the testis enter the caput epididymis, progress to the corpus, and finally reach the cauda region, where they are stored. Sperm entering the caput epididymis are incomplete—they lack the ability to swim forward (motility) and to fertilize an egg. It stores the sperm for 2–3 months. During their transit in the epididymis, sperm undergo maturation processes necessary for them to acquire these functions." - Wikipedia

33[edit]

Female reproductive anatomy

Cervix?

34[edit]

"The secondary oocyte is caught by the fimbriated end and travels to the ampulla of the uterine tube where typically the sperm are met and fertilization occurs." - Wikipedia