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LIVERPUD NEPHRO

LIVERPUD NEPHRO

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1996 Integrated Body Function 536-022: Volume II2
nd
Year MedicineBy Duy ThaiPage 1 of 29
Integrated Body Function1996Volume II
CONTENTS
TOPIC 
 PAGE NO.
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1996 Integrated Body Function 536-022: Volume II2
nd
Year MedicineBy Duy ThaiPage 2 of 29
PREGNANCYBefore conception
 
Even before fertilization has occurred, progesterone and oestrogen secreted by the corpus lutetium (of menstruation)causes the endometrium to swell.
 
Oestrogen causes hypertrophy of the myometrium.
 
Progesterone cause growth of the decidual cells, enabling them to store extra glycogen, proteins, lipids and nutrients inpreparation for the conceptus.Establishment of pregnancy
 
The body must cope with enormous amounts of change due to the growing foetus. In effect, the mother's metabolismmust support 2 individuals.
 
Physical signs of pregnancy:
 
There is cessation of menstruation (amenorrhoea)
 
This is brought about by the secretion of human chorionic gonadotropin from the placenta whichkeeps the corpus lutetium alive (now called the corpus lutetium of pregnancy) after LH from thepituitary has diminished.
 
Since the corpus lutetium is still active in producing oestrogen and progesterone, sloughing off of theendometrium is prevented.
 
Normal menstruation is due to the removal of oestrogen and progesterone since the corpus lutetium isno longer active (since there is no LH to keep it alive).
 
Morning sickness
 
Increased frequency of urination
 
The foetus is also producing wastes which is handled by the maternal kidneys. Hence the mothermust worry about her own urine in addition to that of the foetus.
 
Also, growth of the foetus puts pressure on the bladder, causing the desire to urinate.
 
Increased size of the breasts
 
Due to growth of the lactiferous ducts.
 
This is promoted by oestrogen
 
Darkening of the areolae
 
Increased fatigue
 
Since the mother must support the metabolism of herself and the foetus, there is an increased demandon metabolism.
 
Physiological adaptations of pregnancy:
 
Increased blood volume
 
This is due to an increase in plasma volume as a result of fluid retention.
 
The increase in blood volume is due more largely to an increase in plasma volume, and hence theconcentration of RBC is reduced leading to apparent anaemia.
 
Increased blood volume can also lead to hypertension.
 
Increased cardiac output
 
Since the metabolic rate of the mother has increased, it is not surprising that there will be anincreased usage of blood.
 
An increased oxygen consumption will tend to increase the respiratory rate. This can often lead toloss of breath because of the extra breathing demands. To make things worse, the growing foetuspushes up on the diaphragm and hence decreases the chest cavity, making inspiration difficult.
 
Increased fluid retention
 
This is due to the effects of oestrogen.
 
Oestrogen stimulates the release of aldosterone which causes increased salt retention, andhence increased fluid retention.
 
Causes increased plasma volume which predisposes the mother to hypertension.
 
Can cause oedema, especially in the feet.
 
Enlarged uterus
 
This puts pressure on the bladder
 
The diaphragm is pushed up and hence decreases the chest cavity.
 
Pressure is placed on the GIT causing constipation
 
Increased metabolic demands
 
Increased heart rate, stroke volume
 
Need to eat more to maintain sufficient nutrients
 
Increased respiration
 
1996 Integrated Body Function 536-022: Volume II2
nd
Year MedicineBy Duy ThaiPage 3 of 29
 
Increase in body temperature.The placenta
 
The placenta has many functions:
 
It is the organ of exchange between mother and foetus
 
It is an endocrine organ of pregnancy
 
It is the substitute for the major foetal systems: cardio-vascular, respiratory, gastrointestinal and urinarysystems.
 
The placenta provides oxygenated blood to the foetus via the umbilical veins and removesdeoxygenated blood from the foetus via the umbilical artery.
 
Nutrients (and drugs) are also passed onto the foetus via the umbilical veins and foetal nitrogenouswastes are taken to the maternal blood via the umbilical artery. The foetus cannot excrete nitrogenouswastes along with its urine into the amnion, otherwise it would poison itself.Endocrine functions of the placenta
 
The endocrine function of the placenta is extremely important in:
 
Maintaining the uterine environment
 
Regulating foetal function
 
Maturation of the foetus
 
The major hormones produced by the placenta are:
 
Human chorionic gonadotropin (hCG)
 
hCG is produced very early by the trophoblastic cells and can be detected in the urine in as little as 8days after conception. This forms the basis of the pregnancy test.
 
hCG has a very similar role to LH. When the pituitary stops producing LH, the corpus lutetiumatrophies. If pregnant, however, hCG takes over LH's role to maintain the corpus lutetium. Thisenables progesterone and oestrogen to be secreted thus preventing menstruation.
 
The peak secretion oh hCG occurs at approximately 2 months after ovulation, after which itgradually begins to decline. After 5 weeks, the placenta is capable of producing its own progesteroneand oestrogen, hence hCG is no longer necessary to keep the corpus lutetium alive and so itinvolutes. hCG is still being secreted, however.
 
hCG, not surprisingly, has effects on the male foetus. It acts on the developing testes and stimulatesthe Leydig cells to produce testosterone (just like LH).
 
Oestrogen
 
The corpus lutetium of pregnancy produces this hormone until about the 5th week. Thereafter, it isproduced by the placenta.
 
The major form of the oestrogen produced by the placenta is estriol, which is not a very potent form.
 
Oestrogen is not able to be produced intrinsically by the placenta. It requires androgen precursorsfrom the mother (e.g. DHEA) and precursors from the foetus.
 
Oestrogen causes myometrial hypertrophy.
 
Oestrogen also stimulates uterine contractions (which is inhibited by progesterone).
 
Oestrogen, at parturition, increases the amounts of oxytocin receptors, thus heightening the uterus'ssensitivity to oxytocin.
 
Oestrogen is a synergist with progesterone to induce growth of the mammary glands and ductsystem.
 
Oestrogen leads to the resorption of Na
+
(via aldosterone), hence causing increased fluid retention -risk of hypertension and oedema.
 
Oestrogen can also relax the pelvic ligaments to prepare for parturition.
 
Progesterone
 
Its secretion is the same as that for oestrogen.
 
Progesterone is very important for maintaining the health of the uterus. It causes the decidual cells tobecome secretory, producing glycogen for the nourishment of the foetus.
 
It aids oestrogen in developing the lactiferous duct system of the breasts.
 
Progesterone relaxed the uterus, preventing contractions (opposes oestrogen). Hence progesteroneprevents expulsion of the foetus during pregnancy. At parturition, oestrogen levels exceedprogesterone and hence may lead to childbirth.
 
Human chorionic somatomammotropin
 
Also known as placental lactogen because it has a limited role in initiation of lactation (in animals).In humans, it is more likely that prolactin, oestrogen and progesterone have a more marked effect.
 
It is similar in structure to GH, and hence is also anti-insulin. Anti-insulin effects include:

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