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3rd Year > Case 17 > Flashcards

Case 17 Flashcards

0
Q

Metabolic abnormalities secondary to alcohol consumption

A

Hypertriglyceridaemia
Ketoacidosis
Fasting hypoglycaemia
Hyperuricaemia

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1
Q

Alcohol metabolism

A

Ethanol to acetaldehyde via ADH and MEOS

Acetaldehyde to acetic acid via ALD

Acetic acid to acetyl CoA

First two steps confined to the liver

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2
Q

How is osmolarity calculated?

A

2Na + glucose + urea

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3
Q

Biochemical markers of alcohol abuse

A

Gamma GT
Carbohydrate deficient transferrin
Increased MCV

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4
Q

Intimate partner violence

A

A pattern of assaultive and coercive behaviour including physical, sexual, psychological and economic aspects.

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5
Q

Blastocyst attachment and implantation

A

Zona pellucida hatches

Apposition of blastocyst and endometrium

Decidual cells become epithelial-like and form the primary decidual zone

Local vascular permeability

Reduction in the number of desmosomes and apoptosis of endometrial epithelial cells facilitates trophoectodermal invasion of the secondary decidual zone

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6
Q

What makes up the chorionic sac?

A

Trophoblast and extra embryonic mesoderm

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7
Q

Functions of the syncytiotrophoblast

A

Invasion of endometrium and 1/3 of myometrium to form secure attachment

Proteolytic breakdown of spiral arteries to form lacunae which will later form the intervillous spaces

Secretion of hCG

Syncytiotrophoblasts express Fas ligand and do not express MHC

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8
Q

Development of chorionic villi

A

Under the influence of extraembryonic mesoderm, cytotrophoblastic cells invade the syncytioteophoblast cell mass and form primary villi.

Secondary villi are formed when extraembryonic mesoderm invades the cytotrophoblast layer to form an inner mesodermal core.

Tertiary villi are formed when the extraembryonic mesoderm becomes vascularised with capillaries.

Cytotrophoblastic cells extend beyond the syncytiotrophoblasts to form the cytotrophoblastic shell

Some villi become attach to the cytotrophoblastic shell and become anchoring villi

Branch or terminal grow into the intervillous space

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9
Q

Regions of the decidua

A

Basalis
Parietalis
Capsularis

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10
Q

Fetal components of the placenta

A

Chorion frondosum - chorionic plate and villi

Chorion laeve

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11
Q

Macrophages present in the placenta

A

Hoffbauer cells

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12
Q

Placental circulation

A

Closed fetal circulation
Open maternal circulation

Maternal blood enters the intervillous space, regulated by cytotrophoblastic cell plugs.

Exchange between maternal and fetal blood occurs

Maternal blood is drained to the uterine veins

2 umbilical arteries, 1 umbilical vein. Umbilical vein has an internal elastic lamina

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13
Q

What makes up the placental barrier?

A

Endothelial cells and their basal lamina

Cytotrophoblast and syncytiotrophoblast cells and their basal lamina

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14
Q

Fetoplacental estrogen synthesis

A

The placenta synthesises progesterone which the fetal adrenal cortex converts to DHEA, DHEAS and cortisol. The placenta uses DHEA/S to form estrogens

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15
Q

Placental hormones

A 
Progesterone
Estrogen
Placental lactogen
Relaxin
Placental PTH-RP
16
Q

Role of the decidua in immunotolerance

A

Infiltrating leukocytes secrete IL-2

Prostaglandin secretion inhibits activation of NK cells

17
Q

Effects of pregnancy on maternal physiology

A 
Increased tidal volume
Increased maternal blood volume
Increased GFR
Increased mammary gland growth and development
Increased nutrient requirements
Increased uterine size
18
Q

Mammary gland development

A

In utero: the nipple forms first, followed by the mammary bud, an ectodermal downgrowth. The buds give rise to solid mammary cords which later develop into lactiferous ducts.

Birth to puberty: few lactiferous ducts, no glands, fibrocollagenous tissue

Puberty: epithelial downgrowth and increased complexity of ductal system. Adipose tissue is laid down.

19
Q

Protective factors in breast milk

A 
IgA
Lactoferrin
Lysozyme
Oligosaccharides 
Mucins
20
Q

Inactive mammary gland

A

Sparse glandular component
Mainly duct elements lined by low columnar epithelium
Sparse myoepithelial cells

21
Q

Pregnant mammary gland

A

Epithelial hypertrophy, lobules enlarge
Protein, sugar and fat containing vacuoles within glandular epithelium
Lymphocytes and plasma cells in the stroma
Colostrum may be present in glandular lumen later in pregnancy

22
Q

Initiation of lactation after parturition

A

Rise in cortisol during birth induces enzymes needed for milk production

Rapid decline in estrogen levels overcomes dopamine inhibition to stimulate maternal prolactin secretion

23
Q

Control of prolactin secretion

A

Dopamine secreted by the hypothalamus inhibits prolactin secretion

Suckling inhibits dopamine release via a neural reflex allowing prolactin release

Cessation of suckling stimulates to be released again, blocking prolactin release

24
Q

Milk ejection

A

Suckling stimulates neurons in the hypothalamus to cause release of oxytocin from the neurohypophysis

Oxytocin stimulates myoepithelial cell contraction

25
Q

Facial anomalies in FASD

A 
Short palpebral fissures
Ptosis, strabismus
Epicanthal folds
Short upturned nose
Depressed nasal bridge
Smooth philtrum
Thin upper lip
26
Q

CNS anomalies in FASD

A 
Microcephaly
Mental retardation
Hypotonia
Poor coordinaton
Hyperactivity
Sleep disorders
Seizures
Hydrocephalus
27
Q

Palliative care definition

A

An approach that improves the quality of life of patients and their families facing life-threatening illness through the relief and prevention of suffering by means of early identification and treatment of pain and physical, psychosocial and spiritual problems

28
Q

Aspects of palliative care

A

Provides relief from pain and distressing symptoms

Affirms life and regards dying as a normal process

Integrates spiritual and psychological aspects of patient care

Offers support to help patients to live as actively as possible

Offers a support system to help the family cope
Uses a team approach

Enhances QOL

Applicable early in the course of illness

29
Q

WHO analgesic ladder

A
  1. Non-opioid +/- adjuvants
  2. Weak opioids +/- non-opioids +/- adjuvants
  3. Strong opioids +/– non-opioids +/- adjuvants
30
Q

Analgesics

A

Step 1: paracetamol, aspirin
Step 2: tramadol
Step 3: morphine

31
Q

FASD spectrum

A

FAS
Partial Fetal Alcohol Syndrome
Alcohol Related Neurodevelopmental Disorder
Alcohol Related Birth Defect

32
Q

Fetal alcohol syndrome definition

A

Specific pattern of facial features with pre/post natal growth deficit and CNS dysfunction with a positive history of maternal drinking during pregnancy

33
Q

Risk factors for FASD

A 
Higher age, gravidity, parity
Lower SES and income. Rural residence
Timing - daily drinking, binge drinking
Partner consumes alcohol
Tobacco use
Poor nutrition
Metabolism

3rd Year (7 decks)

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