Repro Only

Pelvic nerve - nitric oxide here causes vasodilation and blood fills penis

Prevents cGMP breakdown that leads to corpus cavernosum smooth muscle relaxation, so the vessels fill

hypogastric nerve

Pudendal nerve - ejaculation is sympathetic!

Broad ligament

Pelvic wall, uterus

Cardinal ligament, suspensory ligament of ovary

Stratified squamous, simple columnar, ciliated columnar, simple cuboidal

Just know this

because right scrotom has less pressure b/c it brings blood RIGHT INTO IVC, left drains into left renal vein then IVC

Para aortic lymph nodes

just know that

Bicornuate uterus - leads to infertility and stuff

testis determining factor, which will make sertoli cells (which make MIF - mullerian inhibiting factor), Leydig cells - make testosterone (act on mesonephric ducts to make internal male genitals). Also makes 5 alpha reductase - converts testosterone to DHT which makes male external genitalia

Congenital gap in anterior bladder wall and abdominal wall infront of it.

Interior of bladder is open to outside world

-Associated w/ epispadias

FSH.

Stroll cells secrete:

1. MIF

2. Inhibin (decreases FSH)

3. ABP - androgen binding protein (which maintains level of testosterone in seminiferous tubules to help maturation of spermatogonia)

Finasteride slowly reduces DHT levels, used to treat BPH
S/Es: decreased libido, impotence, ejaculatory disorder

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Flutamide is a competitive inhibitor at testosterone receptor and used in prostate cancer

Ketoconazole inhibits desmolase,

Spiro inhibits steroid binding

S/Es: gynecomastia, amenorrhea

Androgen insensitivity - you don't have upper portion of vagina but you have lower portion, testes found in labia majora

Kallmann syndrome - female with primary amenorrhea or males with small testes

Testicular torsion

Cryptorchidism

seminoma

Embryonal carcinoma

Yolk sac tumor (aka aneodermal sinus tumor)

1. AFP -- Yolk sac tumor

2. hCG -- choriocarcinoma, Embryonal carcinoma

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Teratomas in males = MALIGNANT

Teratomas in females = benign

Choriocarcinoma

Leydig cell tumor (a non-germ cell tumor)

Sertoli cell tumors (a non-germ cell tumor)

testicular lymphoma

1. Hydrocele

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2. Spermatocele

Varicocele

dilated epididymal duct

Bowen's disease

Peyronie disease - due to inflammation and fibrous tissue formation of tunica albuginea

Young people - think chlamydia/gonorrhea (sexual),

Older think UTI bugs (ecoli, kelbsiella, proteus, enterobacter).

Tx older people with fluoroquinolones and TMP/SMX

relaxes prostate smooth muscle and improves urine flow

S/Es: Dizziness, postural hypotension, fatigue

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Selective alpha1AD blocker

Fewer side effects than the -osins (nonselective alpha1 blockers)

Tamulosni does not affect the alpha1b receptors in blood vessels so you get NO antihypertensive effect

Bone (you'd see increased alk phos).

Treat with flutamide/resections

--Flutamide is a testosterone receptive competitive antagonist

Estrone is made in periphery by fat cells via aromatase.

Estradiol - made in ovaries, abundant in women and gives women female characteristics.

Estriol found in placenta

Mid cycle pelvic pain associated with ovulation; caused by peritoneal irritation caused by serous fluid release

just know that

Patients with history of clot/stroke, smokers > 35, or those who have migraines with auras

DES - diethylstilbestrol

Medroxyprogesterone (depo-provera IM shot)

STDs - because you can push the infection into the wall and cause it to spread

(1) anterior wall, bladder bulges into vagina - cystocele. (2) Posterior wall - rectum bulges through - rectocele. (3) Tear at tope of vagina - small intestines bulge through, that's an enterocele

Vagina muscles in wall cramp up when touched, and that's really painful, then they cramp more and become more painful. Vestibulitis is if you touch skene ducts or bartholin glands at opening of vagina and patients have a TON of pain even though you're just touching (allodynia)

Bartholin duct or skene duct cyst

What do these glands do? -- vaginal lubrication production

Vulvar and vaginal intraepithelial neoplasia - very similar to CIN (all of these are pre-cancerous) but vulvular or vaginal. Associated with HPV (16, 18, 31, 33)

Sarcoma botryoides - these arise from bladder or vaginal wall

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Clear cell adenocarcinoma of the vagina

- Spreads locally

- Clinically staged

- Lateral invasion can block ureters, leading to renal failure

Endometriosis

---------------------------------

Endometrioma or endometriosis in general

Retrograde menstrual flow, hematologic/lymphatic spread,

direct spread,

or metaplasia

1. OCPs

2. Leuprolide (continuous GnRH agonist) as well 3. Danazol - mild androgenic medication to counteract estrogen and supress endometrial tissue

Adenomyosis - smooth muscle with endometrial glands inside of it on histology

Leimyoma (fibroid)

-Either asymptomatic or can cause bleeding

OCPS, leuprolide (continuous GNRH analog), ablation or hysterectomy

Leiomyosarcoma

Makes androstenedione from cholesterol via desmolase

PCOS

1. LH stimulates theca cells to make androgens (that's why you get hirsutism)

2. That stimulates estrogen production from granulosa cells (which feed back and inhbit FSH production) - that's why your ratio is greater (LH/FSH)

----------------

ANVOLUTION results from the dysregulation of these hormones

Spironolactone and OCPs or progesterone, or leuprolide in pulsatile fashion

Clinical use: anovulation, PCOS

MOA: Partial agonist at estrogen receptors in the hypothalamus --> relatively decreases the negative feedback of estrogen, therefore increases FSH

Side effects: hot flashes, vision changes, ovarian hyperstimulation & enlargement

marker for ovarian cancer, but not specific, so mainly used to monitor disease

BRCA1, 2, and lynch syndrome

- Uninterrupted ovulatory cycles

- Nulliparity

Epithelial, germ cell, stromal, and metastatic

Serous, mucinous, endometrioid, clear cell, Brenner, mixed

Serous cystadenoma

serous cystadenocarcinoma

mucinous cystadenoma or cystadenocarcinoma

This is intraperitoneal mucinous material that characterizes mucinous cystadenocarcinoma, also seen with cancers of the appendix

Brenner tumor

teratoma, dysgerminoma, endodermal sinus (yolk sac), and choriocarcinoma

Struma ovarii teratoma - can have functional thyroid tissue in it

- Teratomas in men = malignant

- Teratomas in women = benign

Dysgerminoma

Yolk sac tumor aka endodermal sinus tumor

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Lung

Fibromas, granulosa-theca cell, sertoli-leydig cell

---------------------

Sertoli-leydig tumor details:

-Rare, large

-Contain testicular structures that produce androgens --> virilization

Fibroma (benign ovarian tumor),

ascities (fluid in abdominal cavity), and

pleural effusion (hydorthorax)

Granulosa cell tumor

Krukenberg tumor metastasizing from GI (gastric cancer usually)

They are the fetal component of the placenta.

Cytotrophoblasts are the inner layer and contain stem cells.

The syncytiotrophoblasts make bHCG and they're the outer layer, important for nutrient and waste transmission

Base layer of endometrium making up the maternal component of the placenta

Connects fetal bladder to yolk sac. If it doesn't close you can have urine coming out of belly button, or outpouching of bladder into it

Connects fetus midgut to yolk sac. If it doesn't obliterate, you get meckel diverticulum or a fistula to the belly button

In trisomy 18 - ALL ARE LOW

In trisomy 21, hCG is high, AFP & estriol are low

---------------------

MCC of abnormal serum screening is incorrect dating

Increased AFP

Anastamosis leads to shunting of blood - donor baby is anemic, pale, growth restricted. Recipient baby has polycythemia, fatter, and has heart failure

hydatiform mole pregnancy

Complete: 46xx or 46xy

- REALLY REALLY HIGH hCG

- Large uterus

Partial : 69xxy or xxx or xyy

- not as high hCG

- normal uterine size

- can have some fetal parts

- lower risk of choriocarcinoma or malignant trophoblastic disease

Complete mole pregnancy

Mole pregnancies

fetal blood vessels covering cervix - massive risk of fetal hemorrhage if these tear

placental abruption - trauma/smoking/cocaine increase risk of this happening

Normal flow of amniotic fluid goes out of the baby (pee) and is swallowed by the baby, so if you have esophogeal issues or atresia, you can't swallow it and it builds up.

If you can't pee it out, you have oligohydramnios

----------------------------------------------------

Maternal diabetes is a huge predisposing risk factor for polyhydramnios

Potter syndrome

Preeclampsia - hypertension and proteinuria. Eclampsia = preeclampsia + seizures

----> see edema in face & upper extremities! (not diagnostic criteria, but a good tip)

Deliver baby and give IV magnesium sulfate for seizure risk

S/Es of Mg:

- Decreased DTRs

- Pulmonary edema

- Altered mental status

- Cardiac conduction defects

HPL - human placental lactogen - this is physiologically important because it increases maternal insulin resistance to leave more glucose in blood for baby, but when this is extreme, you get gestational diabetes.

Baby can have macrosomia and risk of stillbirth

First line -- try weight loss. Then use insulin

-------------------------------------

- Congenital heart defects -- transposition of the great vessels

- Neural tube defects

- Caudal regression syndrome -- poor formation of the lower spine w/ problems in bladder control

Ectopic pregnancy -- where is most common location?

Fallopian tube

Symptoms?

- Occurs in 1st trimester

- Positive hCG

- Abdominal pain (b/c of bleeding)

Risk factors? ... anything that can cause scarring

- Infertility

- Salpingitis, PID

- Ruptured appendix

- Endometriosis

- Prior tubal surgery

A - safe.

B - presumed safety based on animal studies.

C - no studies show adverse effect,

D - human risk but benefits may outweigh risk,

X - contraindicated, risk clearly outweights benefits

(1) Hyertension - methyldopa, hydralazine, labetalol

(2) Diabetes - insulin

(3) Epilepsy - AVOID VALPROIC ACID, but can use anything else but supplement with increased folic acid to prevent neural tube defects

(4) Hyperthyroidism - PTU in 1st trimester, MMU in 2nd/3rd

(5) Anticoagulation - heparin or enoxaparin

Indomethicin (cox inhibitor preventing stimulatory PGE formation),

Nifedipine - calcium channel blocker causes myometrial relaxation

Terbutaline, Ritrodine - B2 agonist on uterus and relaxes myometrium

Magnesium sulfate for seizure prophylaxis

--------

Give GCs (betamethasone, dexamethasone) to help increase fetal lung development

Prostaglandin anologs - dinoprostone, misoprostol and oxytocin

Synthetic steroid that's a competitive inhibitor of progesterone receptors

Used for abortions in addition to misoprostol (makes you contract) and methotrexate

1) Ace inhibitors - renal malformations, (2) aminoglycosides (eg gentamicin - ototoxicity ), 3 - Fluoroquinolones - cartilage damage, 4- tetracyclines - discolored teeth , 5- chlormphenicol - gray baby syndrome, 6 - valproic acid - neural tube defects , 7 - lithium - ebstein anomaly, 8 - isotretinoin - spontaneous abortion or really bad birth defects (category X) , 9 - DES (diethylstilbestrol) - vaginal clear cell adenocarcinoma 10 - statins - CNS/limb defects 11 - thalidomide - limb defects ,

Some Drugs Cause Awesome Knockers -

Spiro

Digoxin

Cimetidine

Alcohol (chronic)

Ketoconazole

Fibrosis - hyperplasia of breast stroma, or cysts (aka "blue dome cysts" - fluid filled)

just know that

Sclerosing adenosis

Looks like fat necrosis, scar with irregular shape, but it's benign but proliferative

Fibroadenoma,

Intraductal papilloma,

Phylllodes tumor

Fibroadenoma - NOT a precursor for breast cancer

Intraductal papilloma

Phyllodes tumor

Lymph node involvement

Ductal - arises from duct epithelium, Lobular - arises from lobules (glands)

(1) Comedocarcinoma - caseous necrosis, solid, cribiform, papillary, micropapillary

----------------------------

Dystrophic calcification

Paget disease of breast - assocated with UNDERLYING DCIS

LCIS - lobular carcinoma in situ

Invasive ductal carcinoma

invasive lobular carcinoma

Tamoxifen = selective estrogen receptor modulators (SERMs)

- Antagonist at ER in breast,

- Agonist in endometrial tissue, so increases risk of endometrial cancer

Raloxifene

Inhibits aromatase -- thus inhibiting production of estrogen

Used in post menopausal women with breast cancer.

Side effect - osteoperosis due to antagonistic effect on bones

Fibroadenoma

Invasive Ductal Carcinoma

Fibrocystic change of the breast

Invasive lobular carcinoma