Gynaecology - Anatomy of the female genital organs

Gestagene - Indikation

-Antikonzeption -Hormonsubstitution in Menopause -ovarielle Hemmung Gebaermutterblutung -Behandlung Dysmenorrhoe -Endometriose -fortgeschrittene Mamma- Uterus Nierenkarzinome -Unterdrueckung der Menstruation (bei Sportlerinnen)

Dopaminerge Antagonisten/Prolaktin-Inhibitoren

-Bromocriptin -Cabergolin -Lisurid -Metergolin Stimulation hypophysaerer Dopmainrezeptoren; hemmen Prolaktinfreisetzung

Oestrogene

-Estradiol!, Estron, Estriol - female sex hormone - development and growth of female reproductive structures - differentiation of ova in ovary (oogenesis) - enlargement breasts, growth of pubic/axillary hair, deposition of fat in thighs, onset of menstrual cycle - Einfluss auf Unterusschleimhaut - beeinflussen Stoffwechselvorgaenge in der Leber (Synthese von Lipoproteinen, Transportproteinen) - Aufbau Fettzellen, Anstieg Triglyceride im Blut - Eiweissaufbauend - hemmen Wachstum und Produktion von Talgdruesen - senken peripheren Widerstand - retinieren NaCl und Wasser (Mineralcorticoid-Wirkung und Bildung Angiotensinogen) - verstaerken Bildung von Serotonin-Rezeptoren - vermehrte Bildung HDL, Abnahme von LDL - gesteigerte Bildung von Gerinnungsfaktoren, in hoeheren Dosen verstaerken Blutgerinnung - in der Pubertaet Schulss Hypophysenfugen, beenden Laengenwachstum

Oestrogene - Indikation

-Hypoplasie Uterus und Folgeerscheinungen (Dysmenorrhoe) -Estrogenmangel infolge Ovarialinsuffizienz nach Ovarilaektomie, Klimakterium, postmenopausal -primaere und sekundaere Amenorrhoe in Kombination mit Gestagenen -primaere Laktationshemmung und Abstillen

Oxytocin

-hormone of posterior pituitary -birth hormone -contraction of uterine smooth muscles -initiation of milk ejection -released upon response of stimulation of uterine stretch receptors because of uterine distension during childbirth and suckling baby after childbirth

Prolaktin

-luteotrophic, lactogenic hormone -promotes development of mammary glands during pregnancy -stimulates lactation after childbirth -Release stimulated by prolaktin releasing hormone from hypothalamus and suckling infant -Secretion lowered by prolactin inhibiting hormone or dopamin and by an increased blood level of prolaktin (negative feedback) circadiane Rhytmik; max waehrend Schlaf mechanische Reizung Vagina, Cervix unterbinden ueber affernete Impulse zum Hypothalamus erhoehte Prolaktin Freissetzung Schwangerschaft/Stillzeit: Prolaktinspiegel erhoeht Erhoehte Prolaktinspiegel: Dopmain vermehrt ausgeschuettet, Prolaktinsekretion gedrosselt (Dopamin+Prolactin-release-inhibting hormone) Hyperprolaktinaemie: -Amenorrhoe, Galaktorrhoe -Libidoverlust, Potenzstoerunge -Infertilitaet

Relaxin

A polypeptide hormone produced by the placenta that causes softening in the collagen connective tissue of the symphysis pubis and sacroiliac by corpus luteum and placenta

vesicouterine pouch

Anteriorly, the Perimetrium continues over the bladder, covers bladder

Uterus - histology

Endometrium: innermost layer; highly vasculated; composed of inner columnar epithelium of ciliated secretory cells; lamina propria composed of areolar connective tissue; endometrial glands present near myometrium, is infolding luminal epithelium Endometrium functionally divided into stratum functionalis which is shed during mentruation and stratum basalis which is permanent and forms new stratum mentrualis Myometrium: middle layer; circular smooth fibers (fundus); longitudinal (body and cervix); oblique (body and cervix) Perimetrium: simple squamous epithelium, areolar connective tissue

Fimbriae

Finger=like projections at the end of infundibulum; one is attached to ovary

Uterus - anatomy

Fundus: dome-shaped; superior to uterine tube Body: tapered central portion with uterine cavity Cervix: narrow inferior portion opens into vagina with cervical canal

Infundibulum

Funnel-shaped, open end close to ovary

weibliche Geschlechtsorgane - Antlitzdiagnose

Gesicht/Bereich Mund und Kinn unreine Haut, Pickel im Kinnbereich, Verfaerbungen weisen auf hormonelle Stoerungen hin braeunliche Pigmente, Verdickungen seitlich und unterhalb Unterlippe (DD: Lebererkrankugen) Kleine Steilfalten oberhalb Oberlippe/Verminderung seitlich Augenbrauen: nachlassende Oestrogenproduktion Oberlippenbehaarung Frauen: Unterfunktion Eierstoecke medialer Ziliarrand Unterlid: Ovarien und Hoden; senkrecht darunter Ei- und Samenleiter; roetliche Verfaerbung Entzuendung; Blaesse Insuffizienz dunke: organische Schaeden unterhalb und neben lateralem Ziliarrand: Myome, Prostata

Relationship sex hormones - stress hormones

High Cortisol decreases progesteron Cortisol and oestrogen trigger fat storage

Progesteron

Hormon of pregnancy Implanting fetus to uterine wall, forming placenta, regulating development of fetus in uterus Bereitet endometrium fuer Aufnahme der Frucht vor Vermehrte Wassereinlagerung in Gewebe Bereitet Milchbildung in Brustdruesen vor Unterstuetzt in Fruehschwangerschaft Einnistung und Wachstum von Embryo Senkt Zahl Estrogenrezeptoren Stimuliert Entwicklung von sekretorischer Uterusschleimhaut; hemmt Proliferation der Uterusschleimhaut erhoeht Viskositaet des Zervixschleim unterdrueckt LH Ausschuettung der Hypophyse und damit Ovulation foerdert Druesenbildung in Bruesten erhoeht Ruhetemperatur versterkt Wirkung Oestrogen auf Skelettsystem in hohen Dosen katabol Dominant hormone from day 14 to menstruation Peaks on day 21 and 28 of cycle Antianxiety Hormone, antidepression hormone, diuretic helps to burn fat instead of sugar to provide energy nur bei Frauen wirksam

Gestagene - Kontraindikation

Leberschaeden, Hyperbilirubinaemie, thromboembolische Erkrankungen

Female reproductive system -

Ovaries Fallopian tubes Uterus Vagina Vulva/external female genitalia Mammary glands

Ovulation

Process of maturation of the graafian follicle and release of the ovum

Oestrogen

Stimulates differentiation of ova (oogenesis) in the ovary Wiederaufbau Endometrium nach Menstruation Eiweissaufbauend Promotes development of accessory female sexual character such as enlargement of breasts, growth of pubic hair, deposition of fat in thighs and onset of menstrual cycle Steigern Sexualtrieb (Libido) Fluid retention Drive headaches, migraine Increase blood clotting Interferes with thyroid hormone production Supports cardiovascular health Supports bone growth Made in ovaries and adrenal glands (little) Abgebaut in liver (liver congestion leads to high levels of oestrogen in blood

Hypothalamus - Hormones

TRH: triggers release of thyoid stimulating hormone (TSH, thyrotropin) PRH (Prolaktin releasing hormone): prolactin from pituitary gland PIH (Prolaktin inhibting hormone): inhibits release of prolactin GHRH (growth-hormone-releasing hormone): release of growth hormone from anterior pituitary SS/GHIH: Somatostatin/growth hormone inhibiting hormone: inhibits release of GH from anterior pituitary GNRH (gonadotropin releasing hormone): triggers release of follicle stimulating hormone (FSH) and luteinizing hormone (LH) from anterior pituitary Corticotropin-releasing hormone: release of adrenocorticotropic hormone (ACTH)

Hormones secreted by gonads

Testosteron (testes) Oestrogen (ovaries) Progesteron (ovaries) Relaxin (ovaries)

Parametrium

The fibrous tissue that separates the supravaginal portion of the cervix from the bladder. The parametrium (called cervical stroma in some texts) lies in front of the cervix and extends laterally between the layers of the broad ligaments. The uterine artery and ovarian ligament are located in the parametrium.

Vaginal fornix

The fornices of the vagina (sing. fornix of the vagina or fornix vaginae) are the deepest portions of the vagina, extending into the recesses created by the vaginal portion of cervix. The word 'fornix' is Latin for 'arch'. There are three named fornices: The posterior fornix is the larger recess, behind the cervix. It is close to the rectouterine pouch. There are two smaller recesses in front and at the sides: the anterior fornix is close to the vesicouterine pouch. the lateral fornix.

Pouch of Douglas

The rectouterine pouch (or rectouterine excavation, rectovaginal, Ehrhardt-Cole Recess, cul-de-sac, cavum Douglasi or Pouch of Douglas) is the extension of the peritoneal cavity between the rectum and the posterior wall of the uterus in the female human body.

The broad ligament

The wide fold of peritoneum that connects the sides of the uterus to the walls and floor of the pelvis supports the uterus, holds uterus in place

Fallopian tubes

Uterine tubes Paired tubular structures 10 cm long Extend from sides of uterus Walls made of three layers of tissue: mucosa (inner; ciliated=transport and nonciliated=secrete nutrional fluid columnar epithelial cells), muscularis (inner circular smooth thicker muscles and outer longitudinal thinner muscles), serosa Fertilization in ampulla; any time up to 24h after ovulation To carry fertilized ovum (secondary oozyte) towards uterus (6-7 days)

estrogenregulierte Gewebe

Uteruns, Brustdruesen, Knochen, Hypothalamus, Hypophyse

weibliche Geschlechtsorgane - Head Zonen

Uterus, Adnexe, Hoden, Nebenhoden Th 11 - L 3 Verquellungen, Schmerz- Beruehrungsempfindlichkeit

Oestrogene - Kontraindikation

Uterus- und Mammakarzinom Endometriose Leberfunktionsstoerungen Hyperbilirubinaemie thromboembolische Erkrankungen Diabetes mellitus schwer einstellbarer Hypertonie, Hyperlipidaemie

weibliche Geschlechtsorgane - Irisdiagnose

Uterus- und Ovarsektor: 23 min und 37 min (rechte Iris: Uterussektor 23 min, Ovarialsektor 37 min; linke Iris umgekehrt) Hypophysenbereich: 60 min Mammae: rechte Iris 40 - 45 min; linke Iris 20 - 25 min Wische. Wolken, Linien: Unterfunktion/Organschwaeche helle weisse Zeichen: akute, entzuendliche Prozesse helle Zirkulaerfurchen, Reizfasern: Dysmenorrhoe

Internal organs of reproduction

Uterus: pear shaped, muscular organ, located at pelvic cavity between urinary bladder adn rectum; implantation site of fertilized ovum; pathway for sperm to reach uterine tube; site for discharge of menstrual flow; held in anteflexed position by series of ligaments

External organs of reproduction

Vulva: -Mons pubis (elevation of adipose tissue; on top of symphysis; covered with hair) -Labia majora (2 longitudinal folds of skin, extending posteriorly and exteriorly from mons pubis; adipose tissue; sebaceous glands; pubic hair; homologues to scrotum in males) -Labia minora (2 folds of skin between labia majora folds; sebaceous glands, sudoriferous glands; homologues to spongy urethra in male) -Clitoris (small cylindrical mass of erectile tissue and sensory nerve endings; at anterior junction of labia minora; homolgues to male penis) Urethral and vaginal orifices (openings; located in vestibule) -Bartholin glands (homologues to Cowpers glands in male; secret mucus; on either side of vaginal orifice)

paired broad ligament

attaches uterus to either side of pelvic cavity

uterosacral ligament

attaches uterus to sacrum

Ostreogen Biosynthese

aus Androgenen (insbesondere aus Testosteron und Androstendion) in Menopause aus dem in der Nebennierenrinde gebildeten Dehydroepiandrostenon

Progesteron Biosynthese

aus Cholesterol im Corpus luteum, in Plazenta, Nebennierenrinde, Testes

cervical mucus

by secretory of cervical mucosa glycoproteins, lipids, inorganic salts, water, enzymes 20 - 60 ml/d during reproductive phase of life provides optimal environment to sperms

Oestrogene - Nebenwirkungen

erhoehen dosisabhaengig Thromboembolierisiko langdauernde Gaben: Atrophie Ovarien infolge Hemmung GnRH Ausschuettung Spannungsgefuehl Brueste, Gewichtszunahme, Oedembildung/Natriumretention, Hyperpigmentierung Haut Endometriumkarzinome

Vagina

fibromuscular tube 10 cm long between urinary bladder and rectum receptacle for penis during sexual intercourse passageway for menstrual flow and childbirth

Oestrogenspiegel/sekretion

gebaerfaehiges Alter: 25 - 100 microgramm /d Klimakterium: 5 - 10 microgramm/d Metabolismus: in Leber

Functions of uterus

implantation site of fertilized egg Nourishes and protects fertilized egg powerful rhythmic contractions to expel baby during labour

Internal os

junction of uterine cavity with cervical canal

Ampulla

longest and part of uterine tube

Testosteron

males sex hormone Development of male productive system; at puberty enlargement testes and penis Stimulates spermatogenesis in seminiferous tubules (im Verbund mit FSH) Development of accessory male sexual characters (growth of facial and chest hair, deepening voice, muscular development, bone grow) Glatzenbildung, Foerderung der Blutbildung, Stimulation des geschlechtstriebs, Aggressionsbereitschaft,

external os

opening of cervix into vagina

Histology of vagina

outer: areolar connective tissue middle: smooth muscles inner lining: stratified squamous epithelium Layers form a series of transverse folds (rugae); contain large stores of glycogen; glycogen provides acidic environment + vaginal flora which protects vagina from microorgansim from rectum

Ovarian Follicle

ova and surrounding tissue goes through different stages of development each ovarian follicle contains primary follicle (immature ovum) With development gains in size, shape and gets central region filled with fluid=antrum; now it is called secondary follicle Secondary follicle fully matured=graafian follicle; comes with increased oestrogen secretion Finally graafian follicle ruptures, release of matured ovum (ovulation); ruptured graafian follicle turns into corpus luteum, a yellow-coloured cyst that triggers oestrogen and progesteron secretion, eventually turns ionto corpus albicans , a white coloured cyst

Ovary

paired, oval shaped Production of secondary oocyte and oestrogen and progesteron in upper pelvic cavity each side of the uterus held in position by a series of ligaments

rectouterine pouch

perimetrium extends over fundus, body and cervix, forms a deep pouch that covers the rectum

Functions ovary

production of secondary oocyte (female gamete) secretion of oestrogen and progesteron

Gestagene - Nebenwirkungen

psychische und koerperliche Stoerungen bei langdauernder Anwendung (Kopfschmerzen, Uebelkeit, Spannungsschmerzen Brust, Gewichtszunahme)

lactotrophs

secretory cells secrete prolaktin

Gonadotrophs

secretory cells to secrete FSH and LH which regulate functions of gonads

Follicle-stimulating hormone

stimulates development of follicles in ovaries stimulates the follicular cells to secrete oestrogens males promotes development of testes and stimulates spermatogenesis Release stimulated by GnRH and suppressed by negative feedback

Luteinizing hormone

stimulates ovulation forms corpus luteum stimulates secretion of progesteron from corpus luteum stimulates secretion of oestrogen from ovarian cells together with LH In males also know as interstitial-cell-stimulating hormone (ICSH) because stimulates interstitial cells of Leydig in testes to synthesize and secrete male sex hormone testosteron Regulation by GNRH from Hpothalamus

Gondas - definition

structures that produce gametes and secrete hormones males: sperms females oocytes

perineal

the area between the anus and the scrotum or vulva

Hymen

thin membrane covering external vagina gets perforated separates external/internal reproductive organs

Isthmus

uterine becomes thick and narrow and gets attached to uterus