Nm 602 Module 4 Study Guide/unit E

Front 1

Discuss the physiologic basis for increased incidence of gingivitis in pregnancy. What are the roles of estrogen and progesterone in this disorder? Does gingivitis subside in the postpartum period? If so, how long does it take to subside?

Back 1

Pg. 417- Gingivitis occurs in 30-80% of pregnant women. Gingival tissue contains both estrogen and progesterone receptors. Estrogen increases blood flow to the oral cavity and accelerates turnover of gum epithelial lining cells. The gums become highly vascularized, hyperplastic, and edematous. Progesterone and estradiol may stimulate located inflammation via production of PGs and decreased levels of inflammatory inhibitors. Development of gingivitis may be related to these alterations in the inflammatory process during pregnancy, with increased intensity of localized irritation, or to changes in connective tissue metabolism. These changes, along with the decreased thickness of the gingival epithelial surface, result in friable gum tissues that may bleed easily or cause discomfort with chewing. (Pg. 423) Gingivitis often disappears after delivery but may last for up to 6 months postpartum.

Front 2

What is epulis? Why may it occur in pregnancy? If it does occur, will it regress during the postpartum period?

Back 2

Pg. 418-An epulis or pregnancy tumor develops in up to 5% of pregnant women. Epulis formation generally occurs between the second and third month, but can occur later. Epulis may gradually increase in size, but rarely is larger than 2 cm in diameter. The etiology is unknown but is thought to relate to hormonal changes (epulis tissue has estrogen and progesterone receptors) and inflammation. Epulis formation is characterized by gingivitis that is advance and severe. There is a hyperplastic outgrowth that is generally found along the maxillary gingiva and often appears between the upper anterior maxillary teeth. This mass is purplish red to dark purple, very friable, bleeds easily, and often interferes with chewing. Epulis is usually painless, but may ulcerate and become painful in some women. Epulis usually regresses spontaneously after delivery, but may recur in the same locations with subsequent pregnancies. Occasionally these growths may need excising during pregnancy due to bleeding, interference with chewing, or increasing periodontal disease. Pg. 423- a scarred area will remain after regression in the postpartum period.

Front 3

What is ptyalism? What is thought to be the cause?

Back 3

Pg. 418- Ptyalism is excessive salivation. Saliva becomes more acidic during pregnancy, with alterations in electrolyte content and microorganism load, but it usuallly does not increase in volume. A few women do experience ptyalism as early as 2-3 weeks and ceases with delivery. ptyalism seems to occur primarily during the day. The pathogenesis is unknown, but it is thought to be due to increased saliva, the inability to swallow due to nausea, or activation of the esophagosalivary reflex during gastroesophageal reflux (GERD).

Front 4

Explain why pregnant women are at risk for heartburn and reflux. When during the postpartum period will these discomforts subside?

Back 4

Pg. 418-Lower esophageal sphincter (LES) tone decreases which is thought to be primarily due to the smooth muscle relaxant activity of progesterone. LES pressure decreases during pregnancy, with the magnitude of pressure change positively correlated with gestational length, reaching a nadir at about 36 weeks. (Pg. 423) LES pressure and tone return to normal bevels by 4-8 weeks postpartum.

Front 5

5. Why is there more constipation and flatulence during pregnancy?

Back 5

Pg. 419 The reduced motility and increased transit time in the large intestine increase water and sodium absorption in the colon. Stools are smaller with lower water content, which contributes to development of constipation during pregnancy. Increased flatulence may also occur due to decreased motility along with compression of the bowel by the growing uterus.

Front 6

What is the physiologic basis for increased absorptive capacity of the intestine for calcium, lysine, glycine, glucose, sodium, chloride, and water?

Back 6

Pg. 419 The height of the duodenal villi increases (hypertrophies) during pregnancy, which in turn increases absorptive capacity. This change, along with the influences of progesterone on intestinal transit time and increased activity of brush border enzymes, increases the absorptive capacity for these substances. (The action of progesterone on smooth muscles also decreases intestinal tone and motility. The decreased motility observed in pregnancy may not necessarily be a direct effect of progesterone but rather due to inhibition by plasma motilin. Decreased GI tone leads to prolonged intestinal transit time, especially during the second and third trimesters. Alterations in transit time increase with advancing gestation, paralleling the increase in progesterone.)

Front 7

Why is the absorption of niacin, riboflavin and vitamin B6 reduced during pregnancy?

Back 7

Pg. 419 Perhaps due to the influence of progesterone on enzymatic transport mechanisms.

Front 8

Why is duodenal absorption of iron increased in pregnancy?

Back 8

Pg. 419 Duodenal absorption of iron increases nearly twofold by late pregnancy, probably in response to a reduction of maternal circulating iron stores by the placenta and fetus. As a result of the decreased intestinal motility, nutrients and fluids tend to remain in the intestinal lumen for longer periods of time. This may facilitate absorption of nutrients such s iron and calcium.

Front 9

How does progesterone of pregnancy affect the gallbladder? What happens to the gallbladder during postpartum?

Back 9

Pg. 419 Muscle tone and motility of the gallbladder decrease during pregnancy, probably due to the effects of progesterone on smooth muscle. As a result, gallbladder volume is increased and emptying rate decreased, especially in the second and third trimesters.
(Pg. 424) Gallbladder contractility is enhanced postpartum, enabling the previously atonic gallbladder to empty a larger proportion of its volume and expel microgallstones that developed during pregnancy. Expulsion of these stones can lead to a gallstone pancreatitis.

Front 10

Albumin and total protein are decreased in serum during pregnancy. Why?

Back 10

Pg. 420 (table 12-2) The decrease in Albumin is a result of hemodilution and increased catabolism; leads to decreased protein for binding and increased concentrations of free substances. The decrease in total protein is primarily related to a fall in albumin; decreases protein- bound substance's and increases concentrations of free protein for transport across the placenta.

Front 11

Which of the following are increased or decreased during pregnancy and labor: fibrinogen, AST, ALT, alkaline phosphatase, cholesterol, triglycerides, and lipoproteins.

Back 11

Pg. 421 (Table 12-2) Fibrinogen, increases 50% in pregnancy; AST and ALT are normal during pregnancy increases during labor; alkaline phosphatase increases 2-4 fold, maximum change in 3rd trimester, increases further during labor (pg. 423); cholesterol, triglycerides and lipoproteins (pg. 600-601) increase during pregnancy with triglycerides increasing by 250% by term.

Front 12

When during the postpartum period will cholesterol, triglycerides and lipoproteins return to non-pregnant levels?

Back 12

Pg. 424- by about 10 days postpartum

Front 13

What is the main factor in delayed gastric emptying during labor?

Back 13

Pg. 423- The decrease is probably influenced by anxiety and pain as well as the effects of opioid administration. Opioids may be the main factor in delayed gastric emptying during labor

Front 14

Explain water and sodium retention during the first four days postpartum.

Back 14

(Pg. 423) The increased adrenocortical hormone and arginine vasopressin activity associated with the stress of labor tends to lead to water and sodium retention.

Front 15

When is a normal bowel pattern expected to resume postpartum?

Back 15

Pg. 424- Resumption of normal bowel patterns by 8-14 days.