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Mod 4 C&D
GI, META, FLUID, & MUSCULO
148
Pathology
Graduate
08/29/2013
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Term
Which of the pregnancy hormones is an appetite stimulant?
 Definition
progesterone
Term
The Gastrointestinal tract changes during pregnancy under the influence of ____ ____ and the pressure exerted by ____ ____ ____.
 Definition
Pregnancy Hormones
and
The Growing Uterus
Term
Metabolism changes to accomodate?
 Definition
The demands of all the physical changes and the fetus.
Term
______ is a hormone secreted by adipose and the placenta.
 Definition
Leptin (Adipokine)
Term
Leptin (Adipokine) is needed for regulation of maternal ____ ____ ____.
 Definition
Increased energy needs
Term
In nonpregnant indiviuals Leptin functions with _____ in the hypothalamus to regulate ____ & ____ ____.
 Definition
Receptors

Regulate Satiety and body weight
Term
In obesity ____ resistance occurs, thereby promoting over eating and more weight gain.
 Definition
Leptin resistance
Term
Changes in saliva and the N&V of pregnancy may increase the risk of?
 Definition
Dental Caries
Term
Dental Plauge, Calculus, and debris deposits increase during pregnancy and are associated with _______.
 Definition
Gingivitis
Term
During pregnancy there may be a transient increase in ______ mobility
 Definition
Tooth
Term
Pregnancy may exacerbate existing periodontal disease with an increase in _____ _____ _____ during gestation.
 Definition
Peridontal Pocket Depth
Term
Periodontal disease has been associated with ____ ____ and an increased risk of preterm birth and ___ ____ _____.
 Definition
Intrauterine infection

and low birth weight risk
Term
Preterm birth and low birth weight in regards to periodontal disease may be due to maternal or fetal immune responses or the translocation of oraal bacteria to the ____ and colonization & inflammation of the ______.
 Definition
Uterus

Placenta
Term
Increased protaglandin synthesis mediated by proinflammatory _____ from inflammed ginivial tissues or via release of ____ _____ could intiate labor onset.
 Definition
Cytokines

Bacterial Endotoxins
Term
Ginivitis occurs in ___ to ___ % of pregnant women beginning in the 2nd trimester and peaking in the middle of the 3rd trimester.
 Definition
30 to 80 %
Term
What part of the mouth is most affected by gingivitis?
 Definition
Anterior
Term
Ginival Tissue contains both ___ and ___ receptors.
 Definition
Estrogen and Progesterone receptors
Term
_____ increases blood flow to the oral cavity and accelerates turnover of gum epithelial lining cells.
 Definition
Estrogen
Term
Gum tissue becomes highly ____, ____, and _____.
 Definition
Vascularized, Hyperplastic, and Edematous.
Term
True or False
Pregnancy does not result in demineralization of maternal teeth.
 Definition
True
Term
____ and Estradiol may stimulate located inflammation via the production of _____ and dereased levels of inflammatory inhibitors.
 Definition
Progesterone

Prostaglandins

Development of gingivitis may be related to this inflammation with increased intensity of local irritation or changes in connective tissue metabolism.
Term
_____ gum tissues may bleed easily or cause discomfort when chewing.
 Definition
Friable Gum Tissues
Term
______ when brushing teeth occurs more frequently during pregnancy,
 Definition
Bleeding
Term
The incidence of gingivitis is higher with Increased ____ ____ and _____, preexisting ____ ____ and poor dentition.
 Definition
Maternal Age and Parity, preexisting Periodontal Disease and poor Dentition.
Term
5% of pregnant women will develop an ____.
 Definition
Epilus - can be up to 2cm in diameter
Term
Epilus formation is characterized by severe and advanced _____.
 Definition
Gingivitis
Term
A mass that is purplish red to dark purple, very friable, bleeds easily, and interferes with chewing.
 Definition
Epilus
Term
An Epilus is usually painless unless _____ occurs.
 Definition
Ulceration
Term
An Epilus usually ______ spontaneously after delivery but may ____ in the same location in subsequent pregnancies.
 Definition
Regresses

but may recur
Term
_____ becomes more acidic with alterations in electrolytes and microorganism load during pregnancy.
 Definition
Saliva
Term
In pregnancy the volume of saliva is __ ___ even though the sensation may exist.
 Definition
Not Increased
Term
Only a few will have excessive salivation which is known as ______.
 Definition
Ptyalism
Term
Ptyalism is uncommon but can occur as early as _ ____ and ends at _____.
 Definition
2 weeks

Delivery
Term
Ptyalism primarily occurs during _____ hours and may be caused by ____ or ___.
 Definition
Daytime hours

Nausea or Gerd
Term
The action of _____ on smooth muscles _____ intestinal tone and motility.
 Definition
Progesterone

Decreases
Term
Decreased motility during pregnancy may not necessarilybe the direct effect of progesterone, it may be due to inhibition of _____ _____.
 Definition
Plasma Motilin
Term
The height of the duodenal villi increases during pregnancy increasing ____.
 Definition
Absorption
Term
The change in the duodenal villi along with the influence of ______ on intestinal transit time and increased activity of ___ ____ ____ increases absorption of ____ ____ ___ ___ and ___.
 Definition
Progesterone

Brush Border Enzymes

Calcium, Glucose, Sodium, Chloride and Water
Term
_____ absorption of iron ____ nearly 2 fold by late pregnancy.
 Definition
Duodenal

Increases
Term
This duodenal increase of iron is in response to a ____ in maternal iron stores.
 Definition
Reduction
Term
Due to decreased intestinal motility, ___ and ____ tend to remain in the intestinal lumen for longer periods of time.
 Definition
Nutrients and Fluids
Term
This extra time in the intestinal lumen facilitates increased absorption of nutrients such as ____ and ____.
 Definition
Iron and Calcium
Term
The amount and efficacy of intestinal calcium absorption increase is mediated by increased ___________.
 Definition
1,25 Dihydroxyvitamin D
Term
Progesterone may enhance absorption of ____, ____, and ____ and increases the net secretion of _____.
 Definition
Calcium, Sodium, and Water

Secretion of Potassium
Term
The reduced motility and increased transit time in the large intestines increase water and sodium absorption in the _____, contributing to _____.
 Definition
Colon

Constipation
Term
Weight gained during pregnancy can be divided into 3 main parts. What are these parts and what is the percentage of weight gain attributed to each?
 Definition
Maternal 64%

Fetal 25%

Placental 11%
Term
Lactation may facilitate postpartum weight and body fat loss as ___ ___ ___ are catobilzed to use as energy for milk production.
 Definition
Maternal Tissue Stores
Term
What are the concerns regarding food and fluids during labor for low risk women?
 Definition
It is thought that because of delayed gastric emptying and increased levels of gastrin and decreased lower esophageal sphincter tone would allow stomach contents in an unconcious woman to passively move into the pharynx and into the lungs.
Term
What are the effects on perinatal outcomes if maternal BMI is low?
 Definition
Increased risk of preterm and small for gestational age infants. Benefits are decreased macrosomia, preeclampsia, and cesarean birth.
Term
What are the effects on perinatal outcomes if the maternal BMI is high?
 Definition
Increased spontaneous abortion, congenital anomalies, intrauterine death, destational diabetes, hypertensive disorders, preeclampsia, thromboembolic complications and cesarean birth. Benefits are decreased risk of SGA and growth restricted infants.
Term
What 2 hormones associated with the stress of labor will cause water and sodium retention and weight gain?
 Definition
Adrencortical Hormone
and
Arginine Vasopressin
Term
Sally 35 wks EGA is troubled by constipation. How would you explain why this is happening? What can she do to relieve the constipation?
 Definition
Explain that the hormone changes of pregnancy cause the intestines to be much slower in emptying and it is using all of the fluid for other functions in the body. She needs to increase her water and fiber intake, exercise more such as walking and if needed take stool softeners.
Term
Jane 30 wks EGA is having right upper quadrant pain and she thinks it is a gallbladder problem. What can the APRN tell her about the risk for gallstones in pregnancy?
 Definition
Muscle tone and motility of the gallbladder decrease during pregnancy due to progesterone effects on smooth muscle. The gallbladder volume is increased and the emptying is decreased esp. in 2nd and 3rd trimesters. Bile is more dilute and had a decreased ability to solubilize cholesteral so crystals and sludge increasing the risk for stone formation. Alterations in gallbladder tone lead to a tendency to retain bile salts leading to pruritis.
Term
Mary 19 wks EGA is more prone to gingivitis during pregnancy. Explain why and how to prevent gingivitis.
 Definition
Because gingival tissue contains both estrogen and progesterone receptors. Estrogen increases blood flow and progesterone can stimulate inflammation. Good oral hygiene including flossing, brushing, and using mouth wash can reduce the risk. Bleeding can be treated with salt water and hydrogen peroxide. Reduction in sweets and increased water facilitates good oral hygiene.
Term
Pregnancy is primarily an ____ state in which food intake and appetite are _____.
 Definition
Anabolic state

Increased food and appetite
Term
During pregnancy activity is _____, approx. 3.5kg of ____ is deposited, energy reserves are established and 900g of new ____ is synthesized by mother, fetus, and placenta.
 Definition
Decreased

Fat

Protein
Term
Anabolic aspects are most promenient during the _______.
 Definition
First two trimesters
Term
The Anabolic state is due to enhanced ____, accumulation of ____ ___ and increased blood volume that leads to Maternal weight gain.
 Definition
Lipogenesis

Maternal Fat
Term
In the anabolic state ____ and ____ synthesis increase in muscle, with increased glycogenolysis and decreased ____ in the liver.
 Definition
Protein and Glycogen

Glycolysis
Term
In the anabolic state ____ increases in response to glucose with normal to slight increase in peripheral ____ ____ and serum glucose levels.
 Definition
Insulin

Insulin Sensitivity
Term
In the anabolic state the increase in insulin results in uptake of ___ and Maternal ___ ____.
 Definition
Nutrients and Maternal
Fat Accumulation
Term
During the ___ trimester the mother's metabolic status becomes ______ as stored fat is used.
 Definition
3rd

Catabolic
Term
In the catabolic state ______ in the liver decreased and intestinal dietary fat absorption _____.
 Definition
Gluconeogenesis

Increases
Term
In the catabolic state _____ activity within the adipose tissue is enhanced with _____ in plasma free fatty acids and glycerol.
 Definition
Lipolytic activity

Increases
Term
In the catabolic state maternal ketone production is ______.
 Definition
Increased
Term
In the catabolic state counterinsulin hormones _____ leading to insulin _____.
 Definition
Increase

Resistance
Term
During the catabolicc state maternal weight gain is primarily due to ____ ____ and _____.
 Definition
Growing Fetus and Placenta
Term
The Fetus gains ____% of growth in the last half of pregnancy.
 Definition
90%
Term
___ ___ ___, _____, ____, and possibly ___ influence metabolic processes during pregnany by altering glucose utilization and insulin actions.
 Definition
Human Placental Lactogen,Estrogen, Progesterone and possibly Leptin
Term
Pregnancy is associated with major changes in ____ ____ and ____ ____.
 Definition
Metabolic Processes and
Endocrine Function
Term
Metabolic changes during pregnancy are aimed at providing substances (especially ___, ___, and ___ ___) for growth and development of the fetus.
 Definition
Glucose, Lipids, and Amino Acids
Term
The diabetogenic effects of pregnancy are brought about by the altering of glucose utilization and insulin action. They stimulate alterations in ___ and ___ metabolism and increase the availability of ___ and __ __ for transfer to the fetus, while providing alternative energy substrate to meet maternal needs and maintain homestasis.
 Definition
Lipids and Proteins

Glucose and Amino Acids
Term
The changes in ____ and ___ metabolism parrallel the energy need of the mother and fetus.
 Definition
Carbohydrate and Lipd
Term
Changes in maternal ___ and ___ metabolism occur early in pregnancy.
 Definition
Nitrogen and Protein
Term
The basal metabolic rate ____ during pregnancy.
 Definition
Increases
Term
The reason for the increased basal metabolism rate is suggested that the ___ might monitor a woman's prepregnancy energy stores and adjust or coordinate maternal metabolic resources.
 Definition
Leptin
Term
The pregnant woman meets energy demands of pregnancy by 1.__ 2.___ 3.__
 Definition
1. Increasing her intake

2. Decreasing her activity

3. Limiting fat storage
Term
If an underweight impoverished woman with limited food and poor fat stores and need for physical work cannot increase food intake or limit physical activity during pregnancy, what happens?
 Definition
Her body will respond by decreasing basal energy expeditures so that pregnant energy needs are similar to prepregnancy needs.
Term
A normal weight women in a developed country with fat stores before pregnancy and adequate nutrition during pregnancy, what happens?
 Definition
Her body will increase fat stores in pregnancy and will increase her basal metabolic rate slightly.
Term
An overweight woman in a developed country with her nutritional needs met what happens during pregnancy?
 Definition
Her basal metabolic rate increases by 20% or more perhaps to reduce additional fat deposition.
Term
Glucose production remains sensitive to ____ an increases up to ___% by 3rd trimester to meet fetal and placental needs.
 Definition
Insulin

30%
Term
The total energy required for pregnancy can be divided into 3 parts what are they?
 Definition
1. Obligatory energy for fetus, placenta, uterus, and breast.
2. Energy for maternal storage.
3. Energy maintenance of these new tissues.
Term
Maternal glucose levels are generally ___ to ___% lower than in nonpregnant women.
 Definition
10 to 20%
Term
During overnight and fasting periods materal plasma glucose levels fall ___ to ___mg/dl lower than nonprenant women.
 Definition
15 to 20mg/dl
Term
Decreased maternal glucose levels leads to lower insulin levels during postaborptive state (between meals & overnight)which leads to a tendancy towards ____ and ____.
 Definition
Hypoglycemia and Ketosis
Term
During the first 2 trimesters insulin secretion increases without increases in insulin resistance. In later pregnancy this reduces maternal glucose utilization and makes glucose more available for _____.
 Definition
The Fetus
Mom compensates by using fat stores to meet her energy needs with breakdown of glycerol to glucose.
Term
Insulin resistance in the later part of pregnancy is believed to be a result of a decrease in sensitivity of cell receptors that results from the insulin antagonism effects of ____, ____, and ____.
 Definition
Human Placental Lactogen (hPL), progestrone, and cortisol.
Term
In Carbohydrate Metabolism:
_____ augments insulin secretion, decreases peripheral insulin effectiveness, and increases insulin levels after a meal.
 Definition
Progesterone
Term
In Carbohydrate Metabolism:
____ increases the level of plasma ____ (an insulin antagonist) stimulates the B-cell hyperplasia (and insulin production) and enhances peripheral glucose utilization.
 Definition
Estrogen

Cortisol
Term
In Carbohydrate Metabolism:
Increased levels of both bound and free ___ decrease hepatic g;ycogen stores and increase hepatic ____ production.
 Definition
Cortisol

Glucose
Term
In Carbohydrate Metabolism:
____ levels correlate with fetal and placental weight and are higher in multiple pregnancies.
 Definition
hPL - Human Placental Lactogen
Term
hPL increases synthesis and availibility of ______, which can be used by the mother as an alternate fuel enhancing availibility and transfer of glucose and amino acids to the fetus.
 Definition
Lipids
Term
There is no consistent relationship between ___ levels and ___ requirements to the pregnant diabetic woman.
 Definition
hPL -Human Placental Lactogen levels and Insulin requirements
Term
Decreased serum ___ ___ and serum ___ levels are found in pregnancy.
 Definition
Serum Amino Acids and Serum Protein
Term
The Fetus uses some of the transfered amino acids from protein metabolism for ____ _____.
 Definition
Glucose Formation
Term
In Protein Metabolism:
Maternal plasma levels of amino acids such as ___, ___, ___, and ___ are reduced because of placental transfer for use by the fetus.
 Definition
Alanine, Threonine, Gluamate, and Serine
Term
Alterations in protein metabolism during pregnancy have a ___ pattern.
 Definition
Biphasic
Term
In Protein Metabolism:
In the first half of pregnancy Maternal protein storage ____ with a retention of nitrogen, which most is transfered to the fetus, but some is retained in maternal tissues.
 Definition
Increases
Term
In Protein Metabolism:
In the second half of pregnancy maternal ___ use is more economic, with decreased urinary ___ excretion thus conserving ___.
 Definition
Protein

Nitrogen

Protein
Term
Pregnancy results in marked alterations in lipid metabolism with increases in ___, ___, and ___.
 Definition
Triglycerides, Phospholipids, and Cholesteral.
VLDL, LDL, and HDL all increase
Term
Lipid Metabolism has __ ___ like carbohydrate and protein metabolism.
 Definition
Two Phases
Term
Lipid Metabolism:
During the first 2 trimesters ___ ___ and ___ ___ increases.
 Definition
Triglyceride Synthesis

and

Fat Storage
Term
Lipid Metabolism:
Basal Oxidation of fatty acids increases 70% in pregnancy leading to a relative ___.
 Definition
Hyperlipidemia
Term
Lipid Metabolism:
___ increases threefold in the 2nd and 3rd trimester.
 Definition
VLDL increases
Term
Lipid Metabolism:
___ decreases slightly initially followed by a progressive rise.
 Definition
LDL decreases
Term
Lipid Metabolism:
____ increases progressively to 24 weeks the ___ to 32 weeks and ___ for the remainder of pregnancy.
 Definition
HDL increases

Decreases

Stabilizes
Term
Lipid Metabolism:
____ Increase 40% by 18 weeks and ___% by term.
 Definition
Triglycerides

250%
Term
Lipid Metabolism:
By late pregnancy cholesteral levels are ___% higher than prior to pregnancy regardless of maternal dietary intake.
 Definition
50%
Term
Lipid Metabolism:
Maternal __ ___ is most prominent from 10 to 30 weeks before the peak of ___ energy demands.
 Definition
Maternal Fat Storage

Fetal Energy Demands
Term
Lipid Metaboism:
Promotion of lipogenesis and suppression of lipolysis during this phase are mediated by progressive increases in insulin responsiveness and enhanced by ___, ___, ___, and ___.
 Definition
Progesterone, Cortisol, Leptic, and Prolactin.
Term
Lipid Metabolism:
____ decrease lipoprotein lipase activity.
 Definition
Estrogens
Term
Lipid Metabolism:
The 3rd trimester has both ___ and ___ with breakdown of fat deposits.
 Definition
Lipogenesis and Lipolysis
Term
Lipid Metabolism:
The changes of lipogenesis and lipolysis are mediated by increase adipose tissue, lipolytic activity, and decreased lipoprotein lipase activity, due to _____.
 Definition
Estrogens
Term
Lipid Metabolism:
Increased lipolysis is due to the rise of ____ ____ with its antiinsulinogenic and lipolytic effects and the effects of ___, ___, and ___.
 Definition
hPL levels

effects of Cortisol, Glucogon, and Prolactin.
Term
Lipid Metabolism:
Fats are used by the mother as an alternative energy source, allowing them to conserve ____ for the fetus during the 2nd half of pregnancy.
 Definition
Glucose
Term
Fasting serum glucose levels are ___ in pregnancy because the catabolic state exceeds the anabolic state and the increased fetal use.
 Definition
Glucose levels are low
Term
Postprandial serum glucose levels ___ ___ and stay longer because of the absorptive state and insulin resistence
 Definition
Rise Higher
Term
What does Accelerated Starvaation Mean?
 Definition
For a nonpregnant woman it takes 14-18 hours fasting for the body to switch using glucose as primary fuel, In pregnancy the switch occurs after 2-3 hours.
Term
What does facilitated anabolism mean?
 Definition
It refers to the postprandial serum glucose spiking higher and remaining for an extended period of time which is longer than in nonpregnancy.
Term
Describe Glucose and Insulin requirements during Labor.
 Definition
Labor is hard work on the body. Maternal glucose consumption increases during labor and insulin requirement decrease, the exercising muscle (uterus) can use glucose without insulin.
Term
What is the role of Oxytocin in glucose metabolism in labor.
 Definition
Oxytocin (endogenous or exogenous) acts like insulin by stimulating glucose oxidation.
Term
In the overweight pregnant patient wanting to diet, what should she be told?
 Definition
Her body wil automatically adjust her Basal Metabolic Rate and a bablanced diet and moderate exercise would be better for her and fetus, breastfeeding is an excellant way to reduce weight after birth.
Term
Breastfeeding will facilitate ___ ___ in mother and is best for infant's nutritional needs.
 Definition
Weight Loss
Term
What is net retention of sodium during pregnancy?
 Definition
900-950mg
Term
Sodium retention occurs gradually with an ____ in late pregnancy.
 Definition
Increase
Term
What are 2 primary roles of the renin-angiotensin-aldosterone system (RAAS) during pregnancy?
 Definition
1. Fluid and Electrolyte Homeostasis

2. Maintaning Arterial Blood Pressure
Term
How does RAAS change during pregnancy?
 Definition
Increase in Renin, Angiotensin, Aldosterone and a decrease sensitivity to angiotensin II
Term
Changes in the RAAS system peak at ___ weeks.
 Definition
30-32 weeks
Term
Changes in the RAAS system are mediated by ___, ___, ___, and alterations in the renal processing of ___.
 Definition
Estrogens, Progesterones, Protaglandins
and the renal processing of Sodium
Term
Increased sodium is accompanied by increased 1.___ and 2. ___
 Definition
1. Fluid Retention

2. Potential for Edema
Term
How much fluid does a pregnant woman accumulate?
 Definition
6-7 Liters of water to meet her needs and the fetoplacental needs.
Term
Approximately _____% pf maternal weight gain is due to increase body water in the extracellular spaces.
 Definition
70-75%
Term
Interstitial fluid volume increases ____ L beginning at 6 weeks and peaks at 24-30 weeks.
 Definition
2-3 Liters
Term
Accumulation of more than ____ L of interstitial fluid is associated with edema.
 Definition
1.5 Liters
Term
The effects of ___, ___, and ____ lead to vasodilation and lower blood pressure during pregnancy.
 Definition
Estrogen, Progesterone, and RAAS
Term
What is Arginine Vasopressin?
 Definition
It is an antidiuretic hormone that effects renal reabsorption of water in response to changes in the baseline plasma osmolarity.
Term
What placental hormone along with AVP (Arginine Vasopressin) is thought to have a role in resetting the thirst and osmotat receptors during pregnancy?
 Definition
HCG - Human Chorionic Gonadotropin
Term
During Labor and birth changes in the ___ are important in the control of ___ ___ ___ and ___.
 Definition
RAAS are important in the control of Blood Pressure Homeostasis and Maintenance.
Term
Postpartum natriuresis and diuresis occurs on days ___ as the sodium and water retention of pregnancy if reversed.
 Definition
Days 2-5
Term
Diuresis is caused by the decrease in ___.
 Definition
Oxytocin
Term
Fluid and Electrolyte balance is generally restored to nonpregnancy homeostasis by day ___.
 Definition
Day 21
Term
What is a dangerous side effect of giving pitocin to women with preeclampsia and why?
 Definition
Water Intoxication because oxytocin is an antidiuretic.
Term
Pedal edema is associated with sodium retention and increases the risks for ___ and ___.
 Definition
Hypertension and Preeclampsia
Term
Maternal total serum ___ levels fall progressively beginning soon after fertilization and decrease by an average of 1-1.5mg/dl.
 Definition
Total Serum Calcium
Term
Calcium is needed for?
1. ___
2. ___
3. ___
 Definition
1. Muscle Contraction

2. Neurotransmitter Secretion

3. Hormonal Secretion
Term
_______, ___, and ___ are the major hormones involved in calcium homeostasis.
 Definition
Parathyroid Hormone (PTH), Vitamin D, and Calcitonin
Term
Mother meets fetal requirements for calcium primarily by ____ ____ calcium absorption.
 Definition
Increasing Itestinal Calcium Absorption
Term
Increased Phosphorus in the diet will increase the risk for ____ and ___ ___.
 Definition
Osteoporosis and Kidney Stones
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