CSB520 Lecture Notes - Lecture 10: Pelvic Pain, Anovulatory Cycle, Endometrial Hyperplasia

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Week 10 Lecture - Genital and Gestational Pathology
Monday, 6 June 2016 11:47 AM
Gestational Trophoblastic DiseaseGestational Trophoblastic Disease
Hydatidiform mole
Complete mole - androgeneis
Incomplete mole - polyspermia
Choriocarcinoma
In 50%, develops from hydatidiform mole
In 25%, develops from placental cells after abortion
In 25%, develops from normal placenta
Ectopic PregnancyEctopic Pregnancy
Implantation of embryo outside uterus
Mostly Fallopian tubes
Can also be ovaries and abdominal cavity
1/2 occur in normal tubes
4 outcomes:
Intratubal haemorrhage
Tubal rupture - intraperitoneal haemorrhage
Medical emergency
Spontaneous regression, resorption
Extrusion into abdominal cavity (tubal abortion)
Fate of Human ConceptionsFate of Human Conceptions
Between 70-80% of human conceptions are lost by spontaneous
abortion in the first 6-8 weeks of pregnancy, most as a
consequence of chromosomal abnormality
Chromosomal abnormalities are present in 3-5% of live-born
infants
MorphogenesisMorphogenesis
Normal development = co-ordinated process of differentiation,
growth, migration & apoptosis
E.g. fingers forming from a paddle-like structure with
apoptosis
Fetal growth regulation
Insulin is the major hormone stimulating growth - its action
mediated by growth factors
Growth hormone receptors are not present during most of
foetal life
Placental & thyroid hormones are also important
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TeratogensTeratogens
"monster formers"
Irradiation - radiation exposure
Radiation therapy targets rapidly dividing cells (e.g.
tumours) which includes foetus
Alcohol - good at passing through cell membranes (one of the
only ones that can be absorbed through stomach lining)
Drugs
Thalidomide
Folic acid antagonists
Anticonvulsants
Warfarin
Testosterone & synthethic progestagens
Infections
Embryonic DevelopmentEmbryonic Development
Female XX, male XY
Sperm decides
Indifferent until ~week 7
SRY protein encoded on Y chromosome
Testicular development
In short - protein on Y chromosome that starts to be made
induces testicular devleopment
Default development is female
Superfemales - no androgens, tall with long limbs
Hormones - MalesHormones - Males
Hypothalamus goes through anterior pituitary and stimulates it,
giving off:
LH
Stimulates interstital cells
Testosterone (negative feedback inhibits
hypothalamus)
Goes to seminiferous tubules
And secondary sex characteristics
Follicle stimulating hormones (FSH)
Goes to seminiferous tubules
FSH and testosterone act together to stimulatestimulate
spermatogenesisspermatogenesis
Hormones - FemalesHormones - Females
Hypothalamus goes through anterior pituitary and stimulates it,
giving off:
LH
Stimulates:
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Ovulation
Corpeus luteum, giving off:
Estrogen: development &
maintenance of female reproductive
structures
Progesterone: prepares
endometrium for implantation &
mammary glands for lactation
FSH
Stimulates:
Primary follicle, which goes to
Developing follicle
With corpeus luteum - development
& maintenance of female
reproductive structures
Ovarian CystsOvarian Cysts
Solitary - normally not any big problem - just picked up on an
ultrasound
Follicular cyst
Corpus luteum cyst
Multiple
Polycystic ovary syndrome
Hormonal disturbances
Female Genital Tract PathologyFemale Genital Tract Pathology
Hormonally induced lesions
Infections
STIs
Pelvic inflammatory disease (PID)
Tumours:
Cervix
Uterus
Ovaries
Placental
Hormonally Induced LesionsHormonally Induced Lesions
Anovulatory cycle - cycle but no ovulation, follicles aren't reaching
maturity and are not being ovulated
Anorexia nervosa (and bulimia)
Physical/psychological stress
Start of menarche - when the cycle starts, and is quite
unreliable
Menopause - can happen again towards the end
Endometrial hyperplasia - excessive bleeding & painful
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