Reproductive System & Hormones

Reproductive System Purpose

• Production of gametes, including male sperm and female oocytes that unite to create new individuals.
• Spermatogenesis is the formation of sperm in the testes.
• Oogenesis is the formation of oocytes.
• Controlled by the autonomic nervous system (ANS) and hormones.

Female Sex Hormones in Reproduction

• Estrogen regulates the menstrual cycle.
• Estrogen facilitates breast development and skeletal growth, plus body hair.
• Estrogen maintains the uterine lining, which prepares the uterus for potential pregnancy.
• Estrogen supports ovulation.
• Progesterone thickens the uterine lining to nourish the embryo.
• Progesterone relaxes smooth muscles in the uterus to prevent embryo expulsion.
• Progesterone elevates core body temperature slightly, requiring it to be more elevated for successful implantation.
• Nausea and headache can result.

Hormones Involved in Reproduction

• The fusion of an oocyte and sperm creates a zygote (fertilized egg). Pregnancy involves 3 hormones.
• Human Chorionic Gonadotropin (hCG) is produced by the zygote.
• Pregnancy tests assess hCG levels in urine and blood, indicating the presence of a fertilized egg.
• Prolactin is responsible for lactation.
• Oxytocin stimulates contractions during labor and milk ejection during lactation.

Explaining Ovulation

• Ovulation occurs when a mature egg (ovum) is released from an ovary, ready for sperm fertilization, about 14 days before the next menstrual cycle which varies between 21 to 40 days.

Follicular Phase

• Onset of menstruation and development of a follicle (fluid-filled sac) in one of the ovaries containing an immature egg.
• An immature egg begins to grow in several ovarian follicles during the first half of the menstrual cycle from follicle-stimulating hormone, FSH
• As follicles mature, they produce estrogen and progesterone, which thicken the endometrium to prepare the uterus for possible pregnancy.
• Apoptosis (cell suicide) causes all but one follicle to die. The strongest follicle secretes high estrogen levels which causes the pituitary gland to reduce FSH production.
• Rising estrogen indicates readiness for ovulation by signaling to the hypothalamus and pituitary gland. This also stops other follicles from growing and thickens the endometrial lining (to help promote a more vascular bed for implementation).
• High estrogen levels cause a luteinizing hormone (LH) surge, leading to ovulation, which is the release of the mature egg into the fallopian tubes.

Luteum Phase

• After ovulation, the dominant follicle becomes the corpus luteum, producing large amounts of progesterone.
• Large amounts of progesterone tell the hypothalamus not to produce FSH or LH via a negative feedback system.
• If pregnancy happens, progesterone from the corpus luteum hormonally sustains the pregnancy until the placenta develops (around 14 weeks).
• Progesterone and estrogen decrease about 14 days after ovulation if pregnancy does not occur causing menstruation to begin.
• Progesterone and estrogen levels are assessed in people with infertility.

Growth of the Endometrium

• Proliferative phase is from the end of menstruation to ovulation, causing the endometrium to be thin
• Estrogen supports growth (proliferation) of the superficial endometrial layer that helps the endometrium becomes more receptive to a fertilized egg.
• Secretory phase the stage from ovulation to the start of menstruation.
• In addition to estrogen, progesterone further promotes proliferation of the endometrium, during the secretory phase.
• The lining thickens, becomes vascular and swollen, which allows the ovum (fertilized oocyte) to embed and becomes more suitable for implantation
• The menstrual phase involves disintegration of the corpus luteum resulting in stopping estrogen and progesterone, leading to shedding of the superficial endometrial layer (menstruation).

Male Reproductive Hormone Function

• Organs and tissues: testes, epididymis, vas deferens, seminal vesicles, prostate, and penis.
• The male genitourinary system is responsible for three things: urine elimination, sexual function, and reproduction.
• Androgens are a class of hormones linked to male development.
• Male hormone levels do not follow a pattern, unlike female hormones.

Androgen - Male Hormones

• The endocrine system regulates androgen production through a complex feedback loop involving the hypothalamus, pituitary gland, and gonads (like a thermostat turning on or off based on needs).
• The hypothalamus releases gonadotropin-releasing hormone (GnRH), which stimulates the anterior pituitary to release LH and FSH.
• Luteinizing hormone acts on the interstitial endocrine cells (Leydig cells) in the testes, which is responsible for producing testosterone.
• Functions of testosterone includes sperm production and maturity, protein metabolic, muscle mass production, growth of hair, and voice deepening.
• FSH is secreted from the pituitary gland.
• FSH acts on Sertoli cells within the seminiferous tubules and when gonadotropin levels rise, causing them to secrete inhibin, suppressing gonadotropin secretion.
• Sertoli cells provide structural and nutritional support in spermatogenesis.

Spermatogenesis

• Spermatogenesis involves male germ cells (spermatogonia) undergoing developmental stages to form mature sperm cells (spermatozoa).
• This process occurs in the testes, in the seminiferous tubules
• Nurse cells support, by releasing sperm into the lumen.
• Sperm maturation takes about 60 days.
• Sperm transit: epididymis (reservoir), vas deferens (ductus deferens), and exit through the urethra.
• Temperatures or cryptorchidism (undescended testicles) can impair spermatogenesis.

Altered Reproductive Function

• Achieving pregnancy needs a complex interaction of ovulation, spermatogenesis, intercourse, ejaculation, fertilization, implantation, and development.
• Infertility is defined as not being able to get pregnant after 1 year of unprotected regular intercourse and can happen from problems in any of these steps
• Can be due to one or both partners

Factors Impacting Altered Reproduction

• Hormonal imbalance causes delay/absence of ovulation and low testosterone impairs sperm production.
• Impaired sperm motility caused by adhesions or pathway obstructions.
• Immune problems: antibodies against male sperm swiftly destroy sperm, preventing fertilization.

Clinical Manifestations & Diagnosis/Treatment

• Inability to conceive and maintain pregnancy is a universal clinical indicator for infertility.
• Males might not have any signs or symptoms.
• Females display: Amenorrhea (no periods), Anovulation, Dysmenorrhea (severe pain), Dyspareunia (painful intercourse) and Endometriosis.
• Diagnosing reproduction alterations depends on their ability to conceive or clinical manifestations.
• Identifying the underlying issue involves assessment of both partners.
• General treatment includes supportive counseling, education about intercourse frequency, avoiding lubricants (spermicidal), and health maintenance.
• Addressing possible lifestyle factors, such as obesity and other comorbidities, in both partners is an important part of ensuring optimal health and fertility
• Full medical history and physical assessment.
• Concept maps for: PID, PODS, Ovarian Cancer, Erectile Dysfunction, BPH.

Pelvic Inflammatory Disease (PID)

• PID is caused by sexually transmitted diseases like Chlamydia trachomatis and Neisseria gonorrhoeae or a combo of these.
• PID spreads: cervix, uterus, uterine tubes, ovaries, and peritoneal cavity.
• The microorganisms that binds to epithelial cells cause an immune response.
• Can have large amount of exudate and cause scarring (causing obstruction).
• Such scarring can result in complications and reduced the ability to get pregnant.
• Clinical manifestations include: pelvic/lower abdominal pain (most common), Purulent cervical discharge, Cervical motion tenderness, Fever, Malaise and being asymptomatic.
• Diagnosis/Treatment: History, pelvic exam, physical examination, and laboratory studies should be conducted. A indication of PID is Cervical motion tenderness during pelvic exam.
• Additional signs of PID includes purulent discharge from the cervix, increased erythrocyte sedimentation rate or C-reactive protein and positive blood cultures from a CBC.
• Treatment involves oral or IV antibiotics and hospitalization if pregnant or immunocompromised.

Polycystic Ovarian Syndrome (PCOS)

• Pathophysiology involves: hormonal imbalances (elevated androgens, abnormal LH/FSH ratio), ovarian dysfunction (anovulation, follicular arrest), and insulin resistance.
• Clinical Manifestations of it could be asymptomatic.
• Clinical Manifestations include: Menstrual irregularities, Excess androgen production, Polycystic ovaries (visible via ultrasound) and Prolonged menstrual periods.
• Excess androgen production leads to Hirsutism, Acne, Male-pattern baldness and Obesity.
• Rotterdam criteria should be used for diagnosis.
• Treatment manages clinical manifestations, suppresses androgens.
• injectable FSH and LH
• The first step to preventing pregnancy is to birth control.

Ovarian Cancer

• Genetic inclination to first-degree family members or presence of BRCA1 gene can increase the risk of developing ovarian cancer. In addition, environment contributes to the risk.
• Physical trauma to the ovaries and being postmenopausal may trigger cause.
• Ovarian cancer: arises from changes to the epithelial cells lining the ovary surface, which can lead to tumors.
• Spreads via local shedding into the peritoneal cavity with implantation.
• Staged from I to IV.
• Asymptomatic in the beginning phases, often.
• Ovarian Clinical Manifestations: Vague abdominal bloating. Large tumors result in: abdominal distention, pressure, or pain.
• Diagnosed using the patient's personal and family history, physical exam with bimanual palpation, surgical exploration, and analysis via Cytologic examination.
• May use tumor markers.
• Treatment options include debulking, radiation and chemotherapy.

Erectile Dysfunction (Men)

• Erectile Dysfunction: unable to maintain an erection for sexual performance.
• Often it occurs due to aging.
• Requires the complex interaction of arousal and parasympathetic nervous stimulation (S2-S4) to trap blood in the penis.
• Signs and symptoms can vary.
• Causes are Psychological factors, hormones and medications. Plus: Blood pressure/cardiovascular meds and stress.
• Treatment: Physical exam, history, plus - Labs: testosterone, luteinizing hormone, prolactin, and thyroid hormone (may see decrease testosterone level).
• Treatment ranges from Medications and Counseling.
• Medications include: Viagra, Cialis, and Levitra

Benign Prostatic Hyperplasia (BPH) (Men)

• BPH is a non-cancerous increase in size of the prostate.
• Prostate secretes a fluid which increases sperm motility and decreases vaginal acidity
• Usually caused by age or low testosterone levels.
• BPH isn't precursor to cancer.
• Symptoms may include: Urinary difficulties, increased urinary frequency, dribbling, hesitancy, incontinence, urgency, and retention.
• The diagnosis involves assessment of physical assessment, symptoms and medical background, as well as lab findings.
• The lab findings consist of DRE (digital rectal exam) of the prostate gland and PSA (prostate-specific antigen) analysis.
• TURP can be a form of treatment.

Fluids & Electrolytes

• Electrolytes are minerals carrying an electric charge in water, essential for nerve signaling, muscle contractions, and maintaining fluid balance. Examples are sodium chloride (NaCl) and potassium chloride (KCl).
• The human body's electrolytes: Sodium, potassium, calcium, magnesium, chloride, phosphate, and bicarbonate.

Electrolyte Transport

• The plasma membrane functions as a barrier between intra and extracellular compartments.
• Passive transport facilitates ion movement down concentration gradients via channels in the cell membrane.
• Active transport requires energy to move ions against their concentration gradients, ofter facilitated by pumps (sodium-potassium pump).
• The exchange of like-charged ions provides homeostasis to maintain acid-base and electrolyte levels.
• A Cation exchange is one positive charge and a anion exchange is one negative charge.

Fluid Transport (Active and Passive)

• Passive transport is the natural movement of fluid without energy and without energy and solutes such as osmosis and diffusion.
• Active transport requires energy.
• Osmolality is a measurement of the concentration of solutions, especially in correlation to water it contains.
• Normal osmolality of human blood plasma: typically around 275–295 mOsm/kg, which measures fluids in the body.. The higher the osmolality the higher the concentration

Electrolytes: Normal vs. Abnormal

• Sodium plays a crucial role in muscle contraction, fluid balance, and nerve function.
• Primarily extracellular, sodium works alongside electrolytes such as chloride and potassium.
• Sodium alteration impacts fluid as well as acid base level
• Sodium and neurological function are linked.
• The sodium-potassium pump uses ATP to move 3 Na+ ions out of the cell and 2 K+ ions in. Can be diffused in the cell.
• Sodium (normal range is 135-145 mEq) means neurological changes

Hyponatremia vs. Hypernatremia

• Hyponatremia: less than 135 mEq/L
• Hyponatremia causes: loosing volume, vomiting, diarrhea, and sweating.
• Hyponatremia Clinical Manifestations: Decrease urine, muscle twitching, Hypotension, lethargy and Tachycardia. In really bad cases a Seizure or Coma. .
• Hypernatremia: more than 145 mEq/L means not enough fluids and increase in salt plus medications..

Hypernatremia

• Hypernatremia Clinical Manifestations: Agitation/Restless, thirst, Decreased LOC, Neurological damage or Hypertension, edema and events.
• A lot of medications can cause this.

Potassium Normal Range

• Potassium keep with your heart
• A normal potassium is (3.5-5.5 mEq).

Hypokalemia

• Dysrhythmias can happen if potassium range is too low or too high
• Hypokalemia is less than 3.5 mEq/L.
• Hypokalemia Causes: Caused by extreme loss due to diuretic use, severe vomiting, and diarrhea.
• Hypokalemia Clinical Manifestations: Dizziness and lack of volume, muscle weakness, arrhythmias and leg cramps.

Hyperkalemia

• Hyperkalemia greater than 5.0 mEq/L is usually found in those who have kidney issues.
• Iatrogenic medications, kidney failure and tissue trauma cause this.
• Hyperkalemia Clinical Manifestations: Muscle weakness, paresthesias plus anxiety, N/V/D,.

Calcium

• Normal Calcium values (8.5-10.2 mEq)- Think bones and muscles.
• Hypocalcemia causes: heparin, thyroid disorders, glucagon, burns, plus kidney failure and vit D deficiency.
• Hypocalcemia Clinical Manifestations: Muscle twitching/numbness, Cramps, irritability and Spasms, Laryngospasm, Anxiety.

Hypercalcemia

• Hypercalcemia: greater than 10.5 mg/dL.
• Hypercalcemia causes: excessive bone breakdown, overactive parathyroid gland, or excessive supplements such as calcium and vit D.
• Hypercalcemia Clinical Manifestations: N/V/D, Confusion, Excessive thirst/frequent urination, Lethargic.

Fluid Intake

• Thirst is the biggest component for fluid intake.
• Neurons in the hypothalamic thirst center responds due dehydration and decrease in blood volume.
• Other support: Stretch receptors sense BP chances.
• Hormone Angiotensin supports low BP.
• Antidiuretic regulates total body water.

Isotonic

• Isonic: 0.9 Normal Saline (same concentration of sodium as blood).
• Hypotonic solution 0.45% is used for DKA or severe dehydration. Hypertonic solution may be used to shrink cells and reduce swelling in TBI patients.
• Normal saline is given in vomiting cases.

Fluid Volume Deficit

• Fluid Volume Deficit involves both intracellular and extracellular volume.
• Caused by: fluid intake, Increased fluid output (Renal, GI and Insensible.
• Ascites can result from shifting fluid between compartments and.
• Identifying dehydration determines dehydration severity.

Dehydration

Signs include:

• Dry mucous membranes.
• Change in vital signs (tachycardia, hypotension)
• Dry or absent tears.
• Decreased level of consciousness.
• Decreased urine output.
• Medical background for dehydration and intake/output measurements.
• Asses Emesis, Sweat Characteristics, Stools and Urine.. Plus Look nutrition
• Check laboratory test results: BUN, CBC, BMP. Treatment includes:
• Questions to ask- weight loss, recent travel. .Fix electrolyte balances.
• Intravenous/Oral fluids.

Fluid Deficit - Hypovolemia

Clinical Manifestations

• dehydration
• hemorrhage
• Water Intoxication
• Fluid gets pulled out and sits in the interstitial space (third spacing).
• Symptoms include: thirst, dry mucus, high HR, decrease urine output, plus being hypotensive.
• Test BMP/ CBC or Urine to see what lab values are
• Hypervolemia - expansion of extracellular volume involving the interstitial or vascular space.
• Heart failure or kidney can cause it... - Expansion of cells!

Hypervolemia - Clinical Manifestations

Causes include:

• Lung failure (with less breath)
• Liver related issues
• Each are edema cases just in different causes...
• Kid causes
• Excess of fluid in the area.

DIUETICS

• Increase urine - targeting the sodium!

Heart Failure vs. Cirrhosis

• Can't push lasics quickly, so it leads to ear problems.
• cirrhosis is Male Overweight 40-50's large stomach and alcoholics
• If there is shortness of breath and pressure on lungs it is Cirrhosis
• Cirrhosis is a form of liver cause from local blood getting in the way. So as it keeps tryna work.. It scars it and keeps going.
• Alcohol, fatty liver disease and hepatitis - can result in the portal, hypertension
• Complication: Ascites, can result in moderate-severe abdominal discomfort and Increased weight w/ increased girth.
• Severe sodium retention andHyponatremia - Renal - results renal failure. If so, what does someone do for this?

Cirrhosis: Next level

• History and physical and weight! Good to diagnose
• Look at girth or weight if you wanna is seeing changes take place!
• evaluate liver, renal, and cardiac function should be completed.
• Low Abumin can cause Ascites and
• Paracentesis/ Diuresis are types of treatments.

Regulation of Acid and Base

• Kidneys and Lungs can play a huge role in pH.
• if you have bad lungs and problems, it can affect your pH levels!

Acid/Base Balance

• Normal is pH 7.35-7.45. This pH is slightly alkaline.
• Each body fluid has a pH level as well
• Scale below 7 shows acidic while scales higher are alkaline pH shows how acidic or basic it is Buffers are what is used to balance them

Normal vs. Abnormal Blood

• Normal Blood pH = 7.35-7.45 (7.0 is perfectly neutral) (>70 too much acid!)
• Scale is from 7.35–7.45. Meaning it slightly on the alkaline side.
• When pH low (acid), there's more H+ in the blood body fluids
• (more H+ and below 7.35 - the solution is Acidic).

Anion Gap

• The difference between them! (Major measured negative and Major measured ions in blood)
• (Sodium+Potassium)–(Chloride+Bicarbonate)*

Normal range is < 14 and > 10!!! Important - diagnosis and acidity. Buffers are important - mix if acid to restore their balance.

Plasma

• The plasma buffer aids in pH balance - they stop changes to the blood
• Respiratory helps the body get rid of carbon using by how fast or slow you breath.
• If it is low pH , you need ventilation! High pH - stop or decrease ventilation - so you can reatin it!
• In conclusion, The HCO3 also can think kidneys.

Normal Blood Values

• What is good?
• Acid:
• ABG and CO3
• Values - what is the point for it to get to!!!!

Metabolic acidosis

Is either A to M acid (high acidity) or to L bicarbonate (low). Usually happens at the kidney.

• low pH: The kidney is thinking bicarbonate!
• signs - Seizure as well! DKA.
• Alkalosis - vomit. Need diuretics Body can't get rid of the carbon? Can cause to much acidity!

Immunity

• What do they do vs adapting! Host fail!

So... Many multiple Antigen - changes their surface and get harder to detect!

Allolmmunity

• You can react on this from like organ plants body fluid transfusions
• And or bodies are trying to reject it- but they have been found to treat it -

AIDS

• Acuire...
• When the virus enters the host cell - DNA. And then replicate

Symptoms AIDs

• Symptoms from flue become very immune come - which effects everything
• The way to treat is by Preventing the body to to look into what you need to test and fix
• Systemic - something happens!

Reaction

• what you already are, and repeat. Then it happens! Iguana bad! So it attacks!!!

Diagnosis what is it?!?

• Treatment - if patient is going to go die.. Inject the thing in the epi!

Lupus ERYTHEMATOSUS

1. When the patient is a women tend to get sick. Also it means multiple factors

• It will target its own tissues

2. If patient is Antigen, with antibody.. Then stimulates

• what is the treatment and the signs
• Joints swells bad and you may lose control.. Plus skin will look like butterflies!!

Isoimmunization:Rh

• Its usually means to cause to the first baby (usually doesn't happen)

2. If is the Baby gets it...

• Treat..
• what is at first, you must identify for the cause of the first risk

3. • Are negative pregnant should be the first step given to mother to keep from doing so

• At 78 weeks, that is where you must give treatment!

That is the conclusion!!!