The menstrual cycle is regulated by the hypothalamus, pituitary gland, and ovaries. It typically lasts 28 days and is divided into the follicular phase and luteal phase. During the follicular phase, follicle stimulating hormone (FSH) causes follicles to mature in the ovaries with one becoming dominant. Around day 14, luteinizing hormone (LH) surges causing ovulation of the dominant follicle. The remaining follicle cells form the corpus luteum which secretes progesterone to prepare the endometrium for potential implantation. If implantation does not occur, progesterone and estrogen levels fall, causing menstruation and the start of a new cycle.
Physiology Of Menstruation
By: Nur Afiqah Binti Jasmi (11-2013-031) & Luqman Hakim Bin Mohd Jais (11-2013-170)
Dokter Pembimbing: Dr. Harianto Wijaya Sp.OG
Physiology Of Menstruation
By: Nur Afiqah Binti Jasmi (11-2013-031) & Luqman Hakim Bin Mohd Jais (11-2013-170)
Dokter Pembimbing: Dr. Harianto Wijaya Sp.OG
AnswerThe hormones and structuresorgansPituitary glandFemal.pdfanandanand521251
Answer:
The hormones and structures/organs:
Pituitary gland
Female reproductive organs, fallopian tubes, ovaries and uterus
Anatomy & layout of pituitary:
In vertebrates, this is the endocrine gland with no ducts and looking like a small pea weighing
0.5 grams. It has anatomically protruded from hypothalamus & referred as “hypophysis” at the
base of brain. This gland is meticulously rests on hypophysial fossa & center to the middle
cranial fossa attaché to sphenoid bone & bony cavity i.e. sella tercica.
It composed of three main lobes:
Anterior pituitary (adenohypophysis): release stress hormones, growth hormones, FSH, LH
Intermediate lobe: cell synthesize melanocyte-stimulating hormone release into blood portal
system
Posterior pituitary (neurohypophysis): This is connected to hypothalamus as described below
with median eminence, releases vasopressin, oxytocin
Gonadotrophin releaseing hormone (GnRH) formally released from GnRH neurons located
within the hypothalamus. This hormone travels through hypophyseal portal system and
stimulates adenohypophysis of pituitary gland to release gonadotrophins such as, androgen
release (testosterone synthesis hormones) follicle stimulating hormone and leutinizing hormone
(LH).
Positive feedback mechanism is defined as the output response produced by the activity of input
signal trough a specific amount of stimulus on the organ during the process of homeostasis.
Positive feedback in isolation is not sufficient to maintain homeostasis because of set point
alterations triggered by the stimulus.
Positive feedback cycle in reproductive cycle: Female reproductive system controlled by the two
phases predominantly one follicular phase from day 1 to day 14 and in this phase, follicle growth
is going be observed controlled by follicle stimulating hormone. The predominant stages
involved here primordial ell become primary followed by secondary in which one will mature
one with structures such as zona pellucida, theca follicle along with estrogen formed at day 6.
Feedback mechanism involves the following events
Stimulus: It produced on effector cells and this variable be regulated
Receptor activity: The stimulus activates receptors such as nuclear receptors to trigger gene
expression
Input via afferent nerves: Information passes through afferent nerves to the control center
Output via efferent nerves: Output effect produce by the control center via efferent pathway
Response: Finally, response in the form of either positive or negative produced via cellular
organs
Ovulation takes place on day 14 due to the stimulus given by leutinizing hormone.
Higher levels of estrogen are during the last follicular phase produces a positive feedback
mechanism on leutinizing hormone and gonadotrophic hormone and further leading to formation
of corpus luteum.
Hormones such as gonadotrophins (FSH, LH) released from the anterior pituitary are responsible
for the regulation of ovarian and uterine menstruation cycle further leading to elev.
Ovary: Structure and hormonal regulationN K Agarwal
Slides describe the structure of ovary, folliculogenesis, hormonal control of female reproductive cycle, mechanism of ovulation, female sex hormones and their function.
Oogenesis and follicular development Part 2 I Endocrine Physiology IHM Learnings
Oogenesis and follicular development Part 2 I Endocrine Physiology I
The slides will be about:
1. Graafian follicle
2. Dominant follicle within the periovulatory period
3. Corpus luteum
SlideShare link of Oogenesis and follicular development Part 1I Endocrine Physiology I- https://www.slideshare.net/HMLearnings/oogenesis-and-follicular-development-part-1-i-endocrine-physiology-i
You can also watch the same topic on HM Learnings Youtube channel.
You can also follow HM Learnings on facebook, instagram and twitter for daily updates
Ovarian cycle (the guyton and hall physiology)Maryam Fida
Ovarian cycle
The germ cells that migrate into the ovaries during early embryonic development multiply, so that by about 5 months of gestation (prenatal life) the ovaries contain approximately 6 million to 7 million oogonia.
Most of these oogonia die prenatally through a process of apoptosis.
The production of new oogonia stops at this point and never resumes again.
The oogonia begin meiosis toward the end of gestation, at which time they are called primary oocytes.
Like spermatogenesis in the prenatal male, oogenesis is arrested at prophase I of the first meiotic division.
The primary oocytes are thus still diploidPrimary oocytes decrease in number throughout a woman’s life.
The ovaries of a newborn girl contain about 2 million Primary oocytes—all she will ever have.
Each Primary oocyte is contained within its own hollow ball of single layer of granulosa cells, the Primordial follicle.
By the time a girl reaches puberty, the number of Primary oocytes and follicles has been reduced to 400,000.
Only about 400 of these Primary oocytes will ovulate during the woman’s reproductive years, and the rest will die by apoptosis.
Oogenesis ceases entirely at menopause
Definition:
“Monthly rhythmical changes in the secretion of the female hormones and corresponding physical changes in the ovaries and other sexual organs”.
Duration: The duration of the cycle averages 28 days. It may be as short as 20 days ar as long as 45 days.
PHASES
Follicular Phase (Proliferative Phase) (1-14 Day)
Menstrual Phase (Day 1-5)
Preovulatory Phase. (Day 6-14)
Ovulation (Day 14)
Post Ovulatory Phase (Secretory Phase). (15-28 Day)
Leuteal Phase (Day 15-26)
Premenstrual phase. (Last 2 Day)
Concept of Hypothalamic-Pituitary-ovarian Axis
Overall, the most advanced follicle reduces the FSH supply to other follicles while at the same time it makes itself more sensitive to the FSH that remains.
The less developed, less sensitive follicles undergo atresia, while the most developed follicle attains a diameter of up to 2.5 cm. This follicle, called a mature (graafian) follicle, protrudes from the surface of the ovary like a blister.
As the follicle matures, the primary oocyte completes meiosis I and becomes a secondary oocyte.
This cell begins meiosis II but stops at metaphase II. It is now ready for ovulation.
FSH and estrogen also stimulate the maturing follicle to produce LH receptors, which are important to the next phase of the cycle
Female reproductive functions can be divided into two major phases:
preparation of the female body for conception and pregnancy and
(2) the period of pregnancy itself.
This lecture is concerned with preparation of the female body for pregnancy, and presents the physiology of pregnancy and childbirth
Although the events that regulate the ovarian and endometrial cycles are complex, a clear understanding of the basic physiology of the cycle will improve the management of menstrual disorders.
AnswerThe hormones and structuresorgansPituitary glandFemal.pdfanandanand521251
Answer:
The hormones and structures/organs:
Pituitary gland
Female reproductive organs, fallopian tubes, ovaries and uterus
Anatomy & layout of pituitary:
In vertebrates, this is the endocrine gland with no ducts and looking like a small pea weighing
0.5 grams. It has anatomically protruded from hypothalamus & referred as “hypophysis” at the
base of brain. This gland is meticulously rests on hypophysial fossa & center to the middle
cranial fossa attaché to sphenoid bone & bony cavity i.e. sella tercica.
It composed of three main lobes:
Anterior pituitary (adenohypophysis): release stress hormones, growth hormones, FSH, LH
Intermediate lobe: cell synthesize melanocyte-stimulating hormone release into blood portal
system
Posterior pituitary (neurohypophysis): This is connected to hypothalamus as described below
with median eminence, releases vasopressin, oxytocin
Gonadotrophin releaseing hormone (GnRH) formally released from GnRH neurons located
within the hypothalamus. This hormone travels through hypophyseal portal system and
stimulates adenohypophysis of pituitary gland to release gonadotrophins such as, androgen
release (testosterone synthesis hormones) follicle stimulating hormone and leutinizing hormone
(LH).
Positive feedback mechanism is defined as the output response produced by the activity of input
signal trough a specific amount of stimulus on the organ during the process of homeostasis.
Positive feedback in isolation is not sufficient to maintain homeostasis because of set point
alterations triggered by the stimulus.
Positive feedback cycle in reproductive cycle: Female reproductive system controlled by the two
phases predominantly one follicular phase from day 1 to day 14 and in this phase, follicle growth
is going be observed controlled by follicle stimulating hormone. The predominant stages
involved here primordial ell become primary followed by secondary in which one will mature
one with structures such as zona pellucida, theca follicle along with estrogen formed at day 6.
Feedback mechanism involves the following events
Stimulus: It produced on effector cells and this variable be regulated
Receptor activity: The stimulus activates receptors such as nuclear receptors to trigger gene
expression
Input via afferent nerves: Information passes through afferent nerves to the control center
Output via efferent nerves: Output effect produce by the control center via efferent pathway
Response: Finally, response in the form of either positive or negative produced via cellular
organs
Ovulation takes place on day 14 due to the stimulus given by leutinizing hormone.
Higher levels of estrogen are during the last follicular phase produces a positive feedback
mechanism on leutinizing hormone and gonadotrophic hormone and further leading to formation
of corpus luteum.
Hormones such as gonadotrophins (FSH, LH) released from the anterior pituitary are responsible
for the regulation of ovarian and uterine menstruation cycle further leading to elev.
Ovary: Structure and hormonal regulationN K Agarwal
Slides describe the structure of ovary, folliculogenesis, hormonal control of female reproductive cycle, mechanism of ovulation, female sex hormones and their function.
Oogenesis and follicular development Part 2 I Endocrine Physiology IHM Learnings
Oogenesis and follicular development Part 2 I Endocrine Physiology I
The slides will be about:
1. Graafian follicle
2. Dominant follicle within the periovulatory period
3. Corpus luteum
SlideShare link of Oogenesis and follicular development Part 1I Endocrine Physiology I- https://www.slideshare.net/HMLearnings/oogenesis-and-follicular-development-part-1-i-endocrine-physiology-i
You can also watch the same topic on HM Learnings Youtube channel.
You can also follow HM Learnings on facebook, instagram and twitter for daily updates
Ovarian cycle (the guyton and hall physiology)Maryam Fida
Ovarian cycle
The germ cells that migrate into the ovaries during early embryonic development multiply, so that by about 5 months of gestation (prenatal life) the ovaries contain approximately 6 million to 7 million oogonia.
Most of these oogonia die prenatally through a process of apoptosis.
The production of new oogonia stops at this point and never resumes again.
The oogonia begin meiosis toward the end of gestation, at which time they are called primary oocytes.
Like spermatogenesis in the prenatal male, oogenesis is arrested at prophase I of the first meiotic division.
The primary oocytes are thus still diploidPrimary oocytes decrease in number throughout a woman’s life.
The ovaries of a newborn girl contain about 2 million Primary oocytes—all she will ever have.
Each Primary oocyte is contained within its own hollow ball of single layer of granulosa cells, the Primordial follicle.
By the time a girl reaches puberty, the number of Primary oocytes and follicles has been reduced to 400,000.
Only about 400 of these Primary oocytes will ovulate during the woman’s reproductive years, and the rest will die by apoptosis.
Oogenesis ceases entirely at menopause
Definition:
“Monthly rhythmical changes in the secretion of the female hormones and corresponding physical changes in the ovaries and other sexual organs”.
Duration: The duration of the cycle averages 28 days. It may be as short as 20 days ar as long as 45 days.
PHASES
Follicular Phase (Proliferative Phase) (1-14 Day)
Menstrual Phase (Day 1-5)
Preovulatory Phase. (Day 6-14)
Ovulation (Day 14)
Post Ovulatory Phase (Secretory Phase). (15-28 Day)
Leuteal Phase (Day 15-26)
Premenstrual phase. (Last 2 Day)
Concept of Hypothalamic-Pituitary-ovarian Axis
Overall, the most advanced follicle reduces the FSH supply to other follicles while at the same time it makes itself more sensitive to the FSH that remains.
The less developed, less sensitive follicles undergo atresia, while the most developed follicle attains a diameter of up to 2.5 cm. This follicle, called a mature (graafian) follicle, protrudes from the surface of the ovary like a blister.
As the follicle matures, the primary oocyte completes meiosis I and becomes a secondary oocyte.
This cell begins meiosis II but stops at metaphase II. It is now ready for ovulation.
FSH and estrogen also stimulate the maturing follicle to produce LH receptors, which are important to the next phase of the cycle
Female reproductive functions can be divided into two major phases:
preparation of the female body for conception and pregnancy and
(2) the period of pregnancy itself.
This lecture is concerned with preparation of the female body for pregnancy, and presents the physiology of pregnancy and childbirth
Although the events that regulate the ovarian and endometrial cycles are complex, a clear understanding of the basic physiology of the cycle will improve the management of menstrual disorders.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. What is the mean duration of the MC?
Mean 28 days (only 15% of ♀)
Range 21-35
What is the average duration of menses?
3-8 days
What is the normal estimated blood loss?
Approximately 30 ml
When does ovulation occur?
Usually day 14
36 hrs after the onset of mid-cycle LH surge
3. What regulate the phases of the MC & ovulation?
Interaction between hypothalamus, pituitary & ovaries
What is the mean age of menarche & menopause?
Menarche 12.7
Menopause 51.4
4.
5. The hypothalamus secretes GnRH in a pulsatile fashion
GnRH activity is first evident at puberty
Follicular phase GnRH pulses occur hourly
Luteal phase GnRH pulses occur every 90 minutes
Loss of pulsatility down regulation of pituitary receptors
secretion of gonadotropins
Release of GnRH is modulated by –ve feedback by:
steroids
gonadotropins
Release of GnRH is modulated by external neural signals
6. Ovulation divides the Mens. Cycle into
two phases:
1. Follicular/ pre-ovulatory ovarian phase/ Proliferative
phase
variable.
2. Secretory/ postovulatory endometrial phase.
constant.
7. At 20 weeks of gestational age- 6-7 million.
At birth- 2 million
At puberty- 4 lakh.
400 ovulate in entire reproductive life.
8. -Begins with menses on day 1 of the menstrual
cycle
& ends with ovulation
RECRUITMENT
FSH maturation of a cohort of ovarian
follicles
only one reaches maturity
10. Primordial follicle in the cortical stroma. A layer of flattened follicular
epithelial cells surrounds the oocyte with its large nucleus and prominent
nucleolus. The ooplasm is not stained
11. The granulosa cells become cuboidal and increase
in number to form a pseudostratified layer.
The decline in luteal phase estrogen, progesterone,
and inhibin-A production by the now-fading
corpus luteum from the previous cycle
The increase in FSH that stimulates this follicular
growth.
Hormone-mediated effects can be transmitted
throughout the follicle.
Oocyte begins secretion of an acellular coat known
as the zona pellucida.
12. The stroma differentiates into the theca interna, which
is adjacent to the basal lamina, and the theca externa,
which abuts the surrounding stroma
Oocyte enlarges and is surrounded by a membrane,
the zona pellucida
Granulosa cells -> estrogen
13. Ovary—Secondary Follicle or Preantral Follicle
1 Follicular epithelium
2 Zona pellucida
3 Basal membrane
4 Theca folliculi
14. Ovary—Secondary Follicle or Preantral Follicle
1 Beginnings of a follicular antrum
2 Theca folliculi interna
3 Theca folliculi externa
4 Cortical stroma
5 Primordial follicle
15. Specific receptors for FSH are not detected on
granulosa cells until the preantral stage, needed
for androgen aromatase
16. MATURATION OF THE FOLLICLE (FOLLICULOGENESIS)
FSH primordial follicle
(oocyte arrested in the diplotene stage of the 1st meiotic
division surrounded by a single layer of granulosa cells)
Containing the ovum surrounded by a single layer of
flattened granulosa cells and are present at birth.
Growth not dependent on gonadotropins.
primary follicle
(oocyte surrounded by a single layer of granulosa cells
basement membrane & theca cells).
17.
18.
19. secondary follicle or preantral follicle
(oocyte surrounded by zona pellucida , several layers of
granulosa cells & theca cells).
Is hormone-independent and involves growth and
differentiation of primordial follicles to form primary
follicles.
The stimulus is not known at present.
20. During this phase the ovum undergoes
Its major growth,
The follicular cells acquire receptors for FSH and
estrogen in the granulosa cells and receptors for LH
appear on thecal cells.
Each cycle, 15-20 follicles are stimulated, granulosa
cells become taller, start to proliferate and secrete
E2 .
21. SELECTION
Selection of the dominant follicle occurs day 5-7
It depends on
- the intrinsic capacity of the follicle to synthesize
estrogen.
- high estrogen/androge ratio in the follicular fluid
As the follicle mature estrogen FSH
“-ve feed back on the pituitary” the follicle
with the highest No. of FSH receptors will
continue to survive.
The other follicles “that were recruited” will
become atretic.
22. Secondary follicle accumulate fluid in a cavity
“antrum”.
Oocyte is in eccentric position.
Surrounded by granulosa cells “cumulous
oophorus”.
23.
24.
25. Follicular fluid begins to collect between the granulosa
cells→ antrum.
Rapid increase in follicular size
The granulosa cells surrounding the oocyte are now
designated the cumulus oophorus
31. 2 Forms of Inhibin:
Inhibin A: Alpha-BetaA ( Corpus Luteum-Luteal Phase)
Inhibin B: Alpha-BetaB ( Granulosa Cells-Follicular Phase )
Inhibin: block the synthesis and secretion of FSH, reduce
the number of GnRH receptors present, promotes
intracellular degradation of gonadotropins.
FSH - Inhibin — a reciprocal relationship
Inhibin B: rises slowly but steadily, in a pulsatile fashion
(60–70 min periodicity) reaching peak levels in the early
and midfollicular phases, a nadir in the midluteal phase.
Inhibin A: suppression of FSH to nadir levels during the
luteal phase
32. Activin :
Prior to ovulation: supress Progesteron production
Stimulate FSH release and GnRH receptor number.
Circulating levels of activin increase in the late
luteal phase to peak at menses
34. The successful conversion to an estrogen dominant
follicle marks the “selection” of a follicle destined
to ovulate -> One Single Follicle Succeed ->
Dominant Follicle -> Estrogen
estrogen - FSH interaction (+ for maturing follicle)
estrogen - pitutary interaction (- feedback)
-> FSH ↓
Other cells entered Apoptosis -> TNF -> inhibit FSH
stimulation , estradiol secretion
35. Estrogens - LH (+ feedback) -> Luteinization of
the granulosa cells -> Progesterone &
Prostaglandin -> Initiation of ovulation
Plasminogen -> Proteolytic enzymes, plasmin
36. The dominant follicle protrudes from the ovarian cortex
Gentle release of the oocyte surrounded by the cumulus
granulosa cells
Mechanism of follicular rupture
1- Follicular pressure
Changes in composition of the antral fluid colloid
osmotic pressure
2-Enzymatic rupture of the follicular wall
LH & FSH granulosa cells production of
plasminogen activator
plasmin fibrinolytic activity breake down of F.
wall
LH prostglandin E plasminogen activator
PG F2α lysosomes under follicular wall
38. Ovary—Graafian Follicle
Human follicles reach a
diameter of 20–25mm
1 Antrum folliculi
2 Cumulus oophorus
3 Granulosa epithelial cells
4 Theca folliculi
5 Radial corona cells
39. Oocyte-cumulus is released from
the follicle
Toward the end of the follicular
phase, estradiol levels increase
dramatically
Estradiol - Pituitary (+ Feedback)
Estradiol concentrations of 200
pg/mL for 50 hours →initiate a
gonadotropin surge
The mean duration of the LH surge
is 48 hours
40. A threshold of LH concentration must be maintained
for at least 14 to 27 hours in order for full maturation of
the oocyte to occur.
Usually the LH surge lasts 48 to 50 hours
Ovulation will occur in the single mature, Graafian
follicle 10 to 12 hours after the LH peak or 34 to 36 hours
after the initial rise in midcycle LH.
43. Gn surge -> Plasminogen activity ↑
Plasmin and collagenase-> follicular
wall thinning
Prostaglandin-> Ovary muscle
contraction
Extrusion of the oocyte only lasts a few
minutes
44. The remaining -> corpus
luteum
granulosa / theca cells
proliferate +
hypertrophy ->
granulosa-lutein cells /
smaller theca-lutein cells
Basement membrane
degenerates + vascularize
-> Capillary invasion
Progesterone Dominant ->
40 mg of progesterone per
day
Inhibin A -> low FSH level
45. 1 Granulosa lutein cells
2 Theca lutein cells
3 Connective tissue of the theca folliculi
46. LASTS 14 days
FORMATION OF THE CORPUS LUTEUM
After ovulation the point of rupture in the follicular wall
seals
Vascular capillaries cross the basement membrane & grow
into the granulosa cells availability of LDL-cholestrole
LH LDL binding to receptors
3α OH steroid dehydrogenase activity
progestrone
47. Marked in progestrone secretion
Progestrone actions:
-suppress follicular maturation on the
ipsilateral ovary
-thermogenic activity basal body temp
-endometrial maturation
Progestrone peak 8 days after ovulation (D22 MC)
Corpus luteum is sustained by LH
It looses its sensitivity to gonadotropins luteolysis
estrogen & progestrone level desquamation of the
endometrium “menses”
48. estrogen & progesterone FSH &LH
The new cycle starts with the beginning of menses
If pregnancy occurs hCG secretion maintain the
corpus luteum .
49. Luteal regression
Blood supply diminishes
E & P secretion drop
Luteal cells apoptosis -> fibrotic -> corpus albicans
50. Estradiol, progesterone, inhibin -> nadir
E & P decrease -> increasing GnRH pusatile
Inhibin A decrease + increasing GnRH pulsatile ->
FSH > LH
51.
52. The changes in the endometrium will be discussed in
five phases:
(1) The menstrual endometrium
(2) The proliferative phase
(3) The secretory phase
(4) Preparation for implantation, and finally
(5) The phase of endometrial breakdown.
53. Decidua functionalis
-intermediate zone (stratum spongiosum)
-superficial compact zone (stratum compactum).
Decidua basalis is the deepest region of the endometrium
54.
55. The glands :
narrow and tubular, lined by low columnar epithelium
cells.
Mitoses
Pseudostratification
A continuous epithelial lining facing the endometrial
cavity is formed.
57. All of the tissue components demonstrate proliferation,
which peaks on days 8-10 of the cycle, corresponding to peak
estradiol levels in the circulation and maximal estrogen
receptor concentration in the endometrium
Changes are most intense in the functionalis layer in the
upper two-thirds of the uterus, the usual site of blastocyst
implantation.
58. The endometrium grows from approximately 0.5 mm
to 3.5 to 5.0 mm in height
Restoration of tissue constituents has been achieved
by estrogen-induced new growth as well as
incorporation of ions, water, and amino acids.
An important feature of this estrogen-dominant phase
of endometrial growth is the increase in ciliated and
microvillous cells
59. Early proliferative phase, the endometrium is
relatively thin (1–2 mm).
Initially straight, narrow, and short endometrial
glands → longer structures.
These proliferating glands have multiple mitotic
cells
Low columnar pattern → pseudostratified pattern
before ovulation.
Estrogen mitotic activity in the glands & stroma
endometrial thickness from 2 to 8 mm
(from basalis to opposed basalis layer)
60. Proliferative phase:
straight to slightly
coiled, tubular
glands are lined by
pseudostratified
columnar epithelium
with scattered
mitoses.
62. Early secretory phase:
48-72 hours after
ovulation:
Progesteron↑
coiled glands lined by
simple columnar
epithelium
glycogen containing
vacuoles
Apocrine secretion
Stroma edema
63. Progestrone - Mitotic activity is severely restricted
-Endometrial glands produce then
secrete
glycogen rich vacules
-Stromal edema
-Stromal cells enlargement
-Spiral arterioles develop, lengthen &
coil
64. Late secretory phase:
serrated, dilated glands
with intraluminal
secretion are lined by short
columnar cells.
2 days before menses:
PMN
infilitration→endometrial
stroma collapse
65. D-17: glycogen accumulates in basal portion of
glandular portion c/a subnuclear vacuolisation.- 1st
sign of ovulation i.e. histological evident.
D-18- vacuoles move to apical portion.
D19- these cells begin to secrete glycoprotein and
mucopolysaccharide.
D-21-24- stroma become edematous.
D23-28- predecidual cells surrounding spiral
arterioles.
66. The endometrium now demonstrates a combined reaction to
estrogen and progesterone activity.
Epithelial proliferation ceases 3 days after ovulation.
Total endometrial height is fixed at roughly its preovulatory
extent (5-6 mm) despite continued availability of estrogen.
This limitation is due to :
Progesterone interference with estrogen receptor expression
stimulation of 17beta-hydroxysteroid dehydrogenase and
sulfotransferase, which convert estradiol to estrone sulfate
(which is rapidly excreted from the cell)
67. Tissue components continue to display growth, but
confinement in a fixed structure leads to progressive
tortuosity of glands and intensified coiling of the spiral
vessels.
The first histologic sign that ovulation has occurred is the
appearance of subnuclear intracytoplasmic glycogen vacuoles
in the glandular epithelium on cycle days 17-18.
These structural alterations are soon followed by
- active secretion of glycoproteins and peptides into the
endometrial cavity
-Transudation of plasma
-immunoglobulins obtained from the circulation
The peak secretory level is reached 7 days after the midcycle
gonadotropin surge, coinciding with the time of blastocyst
implantation
69. By 13 days postovulation, the endometrium has differentiated
into three distinct zones.
1/4th of the tissue is the unchanged basalis, straight vessels
and spindle-shaped stroma.
The midportion (approx 50% of the total) is the lace like
stratum spongiosum,loose edematous stroma with tightly
coiled spiral vessels and dilated glandular ribbons.
the superficial layer of the endometrium (about 25% of the
height) called the stratum compactum, which has become
large and polyhedral stromal cell, forming a compact,
structurally sturdy layer.
70. The subepithelial capillaries and spiral vessels are engorged
At the time of implantation, on days 21-22 of the cycle, the
predominant morphologic feature is edema of the
endometrial stroma , due to increase in permeability under
the influence of steroids
72. Decidua functionalis
breakdown→menses
Sex steroids withdrawal:
spiral artery vascular
spasm →endometrial
ischemia.
Lysosomes breakdown
→proteolytic enzymes
→promote local tissue
destruction.
Prostaglandin F2α →
potent vasoconstrictor→
arteriolar vasospasm and
endometrial ischemia.
PGF2α also produces
myometrial contractions
73. In the absence of fertilization, implantation, and
the consequent lack of hCG from the trophoblast,
the fixed lifespan of the corpus luteum is
completed, and estrogen and progesterone levels
wane.
The most prominent immediate effect of this
hormone withdrawal is a modest shrinking of the
tissue height and spiral arteriole vasomotor
responses.
74. The following vascular sequence occurs
With shrinkage of height, blood flow within the spiral
vessels diminishes, venous drainage is decreased, and
vasodilation ensues.
Thereafter, the spiral arterioles undergo rhythmic
vasoconstriction and relaxation.
Each successive spasm is more prolonged and profound,
leading eventually to endometrial blanching.
Within the 24 hours immediately preceding
menstruation, these reactions lead to endometrial
ischemia and stasis.
75. White cells migrate through capillary walls, extending
throughout the stroma.
During arteriolar vasomotor changes, red blood cells
escape into the interstitial space. Thrombin-platelet plugs
also appear in superficial vessels.
The prostaglandin content (PGF2 alpha and PGE2) in the
secretory endometrium reaches its highest levels at the
time of menstruation.
The vasoconstriction and myometrial contractions
associated with the menstrual events are mediated by
prostaglandins from perivascular cells and the potent
vasoconstrictor endothelin-1, derived from stromal
decidual cells.
76. In the first half of the secretory phase, acid
phosphatase and potent lytic enzymes are confined to
lysosomes, stabilized by progesterone, which are
released with waning of it’s level.
These active enzymes will digest their cellular
constraints, leading to the release of prostaglandins,
extravasation of red blood cells, tissue necrosis, and
vascular thrombosis
77. Endometrial tissue breakdown also involves a family of
enzymes, matrix metalloproteinases
The metalloproteinases include
collagenases that degrade interstitial and basement
membrane collagens;
gelatinases that further degrade collagens;
and stromelysins that degrade fibronectin, laminin, and
glycoproteins
78. Progesterone withdrawal from endometrial cells
induces matrix metalloproteinase secretion.
In a nonpregnant cycle, metalloproteinase expression
is suppressed after menses by increasing estrogen
levels.
79. Progesterone withdrawal is associated with an increase
in VEGF receptor concentrations in the stromal cells.
Although the VEGF system is usually involved with
angiogenesis, in this case these factors are involved in
the preparation for menstrual bleeding, perhaps
influencing the expression of matrix
metalloproteinases.
80. Eventually,Leakage occurs as a result of diapedesis, and
finally, interstitial hemorrhage occurs due to breaks in
superficial arterioles and capillaries.
As ischemia and weakening progress, the continuous
binding membrane is fragmented, and intercellular
blood is extruded into the endometrial cavity.
New thrombin-platelet plugs form intravascularly
upstream at the shedding surface, limiting blood loss.
Increased blood loss is a consequence of reduced platelet
numbers and inadequate hemostatic plug formation.
Menstrual bleeding is influenced by activation of
clotting and fibrinolysis
81. Blood loss is also controlled by constriction of the
spiral arteries, mediated by the perivascular cells,
myofibroblasts that surround the spiral arteries.
Myofibroblasts respond to progesterone withdrawal by
expressing prostaglandins and cytokines, causing
cycling vasoconstriction and vasodilation
82. Thrombin generation in the basal endometrium in
response to extravasation of blood is essential for
hemostasis.
The basalis endometrium remains during menses, and
repair takes place from this layer.
This endometrium is protected from the lytic enzymes
in the menstrual fluid by a mucinous layer of
carbohydrate products that are discharged from the
glandular and stromal cells.
83. A natural cleavage point exists between basalis and
spongiosum, and, once breached, the loose, vascular,
edematous stroma of the spongiosum desquamates
and collapses.
The process is initiated in the fundus and extends
throughout the uterus.
In the end, the typical deflated, shallow, dense,
menstrual endometrium results.
84. Within 13 hours, the endometrial height shrinks from
4 mm to 1.25 mm.
Menstrual flow stops as a result of the combined
effects of
Prolonged vasoconstriction of the radial arteries and the
spiral arteries in the basalis,
Tissue collapse,
Vascular stasis,
Estrogen-induced healing
In contrast to postpartum bleeding, myometrial
contractions are not important for control of
menstrual bleeding.