Phase 2 KPH - Week 4 (Puberty) Flashcards
List the key lifestyle influences associated with cancer
- Obesity
- Smoking
- Exercise
- Alcohol
- Diet
- UV exposure
List examples of diseases and injuries caused by alcohol
- Mouth and oropharynx cancers
- Oesophageal cancer
- Liver cancer
- Epilepsy
- Alcohol use disorders/alcohol dependence and harmful use
- Haemorrhagic stroke
- Cirrhosis of the liver
- Motor vehicle accidents
- Drownings
- Poisonings
- Self-inflicted injuries
- Homicide
What is one of the most effective strategy for reducing alcohol-related harm?
Minimum unit selling price - no less than 50p per unit
How can attitudes to alcohol consumption be changed?
- Control availability - advertising, price
- Legislation
- Make excessive consumption abnormal
- Brief interventions in a range of settings
- Educate professionals
- Evaluate local initiatives
- Research on risk of deprivation and alcohol
Explain the effects of minimum unit pricing
- Makes drinks with highest alcohol content most expensive
- Impacts most on harmful drinkers - those who regularly drink more than the lower risk drinking guidelines
- Results in
1. Decrease in alcohol related deaths
2. Decrease in hospital admissions
3. Decrease in harmful drinking, especially by those living in poverty
List the problems with alcohol specifically associated with older people
- Alcohol related brain injury - causes problems with memory, learning and other cognitive skills, occurs with long-term heavy alcohol consumption but is reversable
- Falls - lead to disability and loss of independence
- Social isolation
- Depression and anxiety
- Exacerbation of incontinence problems
- Adverse interaction with prescribed medications
Why can alcohol problems be more difficult to detect in older people?
- More likely to try to hide the problem due to shame/embarrassment
- Difficult to distinguish the symptoms of alcohol problems from the physical and mental symptoms of ageing
- Lack of awareness about problem in professionals, may not ask patients
Which illicit drugs cause the highest rates of mortality?
- Heroine or morphine
- Benzodiazepines
- Cocaine
- Amphetamines
List the classes of drugs by their effects
- Opioids
- Stimulants
- Empathogens
- Psychedelics
- Dissociatives
- Cannabinoids
- Depressants
Effects of opioids
‘Invincible’
- Confident, pain-free, safe, euphoric, constricted pupils, addiction, hallucinations, withdrawal, overdose
- E.g. heroin, morphine
Effects of stimulants
‘Uppers’
- Increased energy, increased heart rate, euphoria, dilated pupils, paranoia, anxiety, sexual arousal, sexual impotence, comedowns
- E.g. cocaine, amphetamines
Effects of empathogens
‘Loved up’
- Connectedness, warmth, understanding, sweating, arousal, mood swings, depression
- E.g. MDMA
Effects of psychedelics
‘Trips’
- Spiritual connection, heightened senses, visual of auditory hallucinations, anxiety, panic, mental health issues
- E.g. LSD
Effects of dissociatives
‘Out of body’
- Euphoric, floaty, disconnected, relaxed, numb, scared, unable to move, in a ‘hole’
- E.g. ketamine
Effects of cannabinoids
‘Stoned’
- Calm, munchies, chilled out, floaty, giggly, sensual, paranoid, dry mouth, anxiety, lazy, mental health issues
Effects of depressants
‘Buzzing’
- Euphoric, confident, relaxed, risk-taking, withdrawal, unconsciousness, coma, vomiting, death
- E.g. alcohol
List the social impacts of drug addiction
- Marriage/relationships
- Home/family life
- Education
- Employment
- Health and wellbeing
- Personality
- Financial issues
- Law and order
What effects does addiction have on a person’s mental health and behaviour?
- Behaving out of character - self-harm, lie, cheat or steal, place need for addiction above family and friends
- Paranoia, restlessness, low self-esteem of lack of trust in themselves and anyone else
- Arrogant/uncaring manner - place their needs above anyone else’s
- Withdraw from family and friends - anxiety and depression
What is the leading cause of preventable death in the world?
Smoking related deaths
Why is tobacco use considered an epidemic?
- Leading preventable cause of death in the world
- Responsible for the death of one in ten adults worldwide
- Only risk for all four major non-communicable disease categories
- Cause of death in those who use and others due to second-hand smoke
- Mortality rates rising
- Consumption is decreasing in developed countries but rising in developing countries
List the factors associated with smoking
- Individual
- Knowledge
- Skills
- Educational attainment
- Self-esteem/self-image
- Beliefs/attitudes/values
- Personality
- Gender - Personal environment
- Friends
- School
- Resources
- Relationships
- Social activities
- Family
- Social support - Social and cultural environment
- Media
- Religion
- Tobacco promotion
- Availability
- Price
- Social disadvantage
- Ethnicity
- Culture
- Social attitudes and norms
There are substantially higher rates of smoking among 15 year olds associated with…
- Parent or elder sibling who smokes
- Living with single or step parent
- Lower levels of parental supervision + more nights out with friends
- Truanting, excluded from school, juvenile offending
List the legislation in place to control tobacco use
- Smoking, health and social care act (Scotland) - smoking banned in majority of enclosed public places
- Minimum purchasing age for tobacco = 18 (increased from 16)
- Graphic health warnings on all tobacco products
- Any retailer selling tobacco must sign up to Scottish tobacco retailers register
- Tobacco display ban
- Ban on self-serving cigarette vending machines
- No smoking on NHS grounds
- No smoking in vehicles carrying anyone under age of 18
- All tobacco products sold in plain packs
Describe the components of tobacco
- 4000 chemicals , of which 60 are known carcinogens
- Nicotine = addictive part
- Carbone monoxide - poisonous gas, binds to haemoglobin
- Tar - thick, sticky
Define addiction
- Compulsive physiological and psychological need for a habit-forming substance
- Characterise by compulsive drug seeking and use even in the face of negative health consequences
What effect does nicotine have?
- Stimulates adrenal glands to release adrenaline
- Increases heart rate, BP, breathing
- Releases glucose, suppresses insulin
- Binds to nicotinic acetylcholine receptors, stimulates ‘reward pathway’
- Perceived rush of acetylcholine, receptors up-regulated
- Release dopamine - pleasure pathway, enjoyment
- If not activated - cravings
- Tolerance develops
Which receptors does nicotine bind to?
Alpha 4 - beta 2 nicotinic acetylcholine receptors in the ventral tegmental area of the brain
List the symptoms associated with nicotine withdrawal
- Anxiety
- Irritability
- Poor concentration
- Increased appetite
- Cravings
- Restlessness
- Headache
- GI upset
- Sleep disturbed
- Depression
- Weight gain
- Urges to smoke
List examples of health problems associated with smoking
- Stroke
- COPD
- Asthma
- Lung cancer
- Stomach ulcers
- Gangrene
What are E-cigarettes?
Aka electronic nicotine delivery systems
- Intended to deliver nicotine without the concentrated toxic compounds found in tobacco smoke
- Generally accepted to be less hazardous and toxic than traditional cigarettes
What do E-cigarettes contain?
- Nicotine
- Propylene glycol of glycerol (produces vapour)
- Flavourings
- Medicinal ingredients
How do E-cigarettes work
- Battery operated
- On inhalation the cartridge is heated and a fine mist is produced (known as vapour)
- Vaporised substances are administered to the bronchia, lung and bloodstream
- Some odourless vapour is released into air as used exhales
List the health problems associated with secondhand smoke exposure
- Sudden infant death syndrome
- Asthma
- Lower respiratory tract infections, pneumonia, bronchitis
- Glue ear
- Bacterial meningitis
- Heart disease
- Vascular disease
- Stroke
- Lung cancer
- Chronic obstructive pulmonary disease
Describe the cycle of change
- Pre-contemplation
- Contemplation
- Ready to change
- Action
- Maintenance
- Relapse
Define puberty
The period during which adolescents reach sexual maturity and become capable of reproduction
- Development of regulatory competence
- Many aspects of physical, cognitive and social development
How is puberty triggered?
- Controlled by several factors
- Nocturnal increase in the amplitude and pulsatility of gonadotrophin-releasing hormone (GnRH) secretion from the hypothalamus is first change evident at puberty
- GnRH stimulates the secretion of pituitary hormones - FSH + LH
What is the first sign of puberty in females?
Beginning of breast development
When does puberty begin in females
Age 8-13
When does breast development occur in females during puberty?
Age 9-10 to 12-18 years
Describe breast development in females during puberty
- Formation of breast buds, increase in areolar size
- From birth, breasts in dormant state until puberty - only lactiferous ducts, no alveoli
- At puberty increase in ovarian oestrogen causes development of lactiferous duct system
- Breasts continue to increase in size due to increased fat deposition
List the other changes which occur in females during puberty
- Growth of pubic and axillary hair
- Menstrual cycle begins
- Changes deposition of fat - hips become more rounded and waist more defined
- Increase in mucous production in vagina
Describe the growth of hair in females during puberty
- Hair initially sparse and light and straight
- Throughout course of puberty becomes coarser, darker and thicker
- Approx. 2 years after start of growth of pubic hair, hair begins to grow in axillary region
Describe the start of the menstrual cycle during puberty
- 1.5-3 years after breast growth begins
- Due to increase of FSH and LH
- Average = 13 years approx
- Ovulation initiated roughly 10 months after menarche
When do males begin puberty?
Begins 10-14, complete between 15-17 years
What is the first sign of puberty in males?
Increase in testicular size
Describe the growth in testicular size which occurs in males during puberty
- Increased LH stimulates testosterone synthesis by Leydig cells
- Increased FSH stimulates sperm production by Sertoli cells
- Spermatogenic tissue (Leydig + Sertoli cells) makes up majority of the increasing testicular tissue
- Scrotal skin grows + becomes thinner, darker and hangs lower
List the other changes which occur in males during puberty
- Penis growth
- Growth of body + facial hair
- Broader shoulders and chest
- Deeper voice
- Bigger muscles
Describe the growth of body and facial hair which occurs in males during puberty
Pubic hair first:
- At same time as growth of penis
- Often alongside testicular growth
- Hair often light, straight, thin then becomes dark, more curly, thicker and more widely distributed
2 years after - hair on legs, arms, axillae, chest and face grows
Describe penis growth in males during puberty
Grows in length then width
List the general changes which occur in males and females during puberty
- Increase in height, weight and strength
- Increase in sweating
- More oily skin
- Hormonal changes - sudden mood changes, emotional maturation, increase in sexual urges
Describe the hormonal control of puberty in females
- Hypothalamus stimulates pituitary to produce follicle-stimulating hormone (FSH) and luteinising hormone (LH)
- Stimulates ovaries to produce female sex hormones - oestrogen and progesterone
- Estradiol is primary oestrogen released from gonads and peripheral tissues - causes breast development, encourages female-typical fat distributions and long bone fusion during growth spurts, stimulates ovulation and menstruation
- Adrenal androgens cause pubic hair growth, body odour, oily skin and pre-pubertal growth
Describe the hormonal control of puberty in males
- Hypothalamus signals pituitary gland to produce FSH and LH
- LH stimulates testes to produce testosterone, and LH + FSH cause sperm development to occur
- Testosterone (primary androgen released from gonads) is responsible for genital development
- Adrenal androgens cause pubic hair growth, body odour, oily skin and pre-pubertal growth
Describe the phases of puberty in the development of males’ external genitalia
- Prepubertal
- Enlargement of scrotum and testes, scrotum skin reddens and changes in texture
- Enlargement of penis, further growth
of testes - Increased size of penis with growth in breadth and development of glands, testes and scrotum large, scrotum skin darker
- Adult genitalia
Describe the phases of puberty in the development of breasts in females
- Prepubertal
- Breast bud with elevation of breast and papilla, enlargement of areola
- Further enlargement of breast and areola, no separation of their contour
- Areola and papilla form a secondary mound above level of breast
- Mature stage: projection of papilla only, related to recession of areola
Describe the phases of puberty in the development of pubic hair in males and females
- Prepubertal (vellus hair similar to abdominal wall)
- Sparse growth of long, slightly pigmented hair, straight or curled, at base of penis or along labia
- Darker, coarser and more curled hair, spreading sparsely over pubic area
- Hair adult in type, but covering smaller area than adult, no spread to medial surface of thighs
- Adult in type and quantity, with horizontal distribution (‘feminine’)
Describe the location of the hypothalamus
- Inferior and lateral to anterior aspect of third ventricle
- Constricted anteriorly by optic chiasma and posteriorly by mammillary bodies
Describe the structure of the hypothalamus
- Inferior portion stretched into hollow stalk that attached to the pituitary gland (infundibulum)
- Consists of large number of neurosecretory cell bodies, divided into a number of small nuclei, all with varying functions
What is the general function of the hypothalamus?
Through connections to limbic system, hippocampus, striatum and brainstem it regulates emotions, autonomic control, hunger, satiety, immunity, memory input and anger control
Infundibulum
- Narrow, hollow stalk that connects hypothalamus to pituitary gland
- Extends from between mammillary bodies and optic chiasma to posterior lobe of the gland
Mammillary bodies
- Pair of pea-sized white lumps protruding from posterior surface of hypothalamus
- Continuous superiorly with the fornix
- Function in recognition memory, especially smell memory
List the functions of the hypothalamus
- Autonomic control
- Emotional response
- Thermoregulation
- Control of endocrine system
- Hunger and satiety
- Water balance and thirst
- Sleep/wake cycle
Describe how the hypothalamus functions in autonomic control
- Regulates and controls output of the ANS
- Thus, is involved with regulation of visceral activities
Describe how the hypothalamus functions in emotional response
- Functions as part of limbic system and is involved with both positive and negative emotions
Describe how the hypothalamus functions in thermoregulation
- Functions as body’s thermostat, stimulating the ANS to promote or reduce heat loss
Describe how the hypothalamus functions in control of the endocrine system
- Secretes releasing and inhibiting hormones which either stimulate or inhibit release of hormones from anterior pituitary gland
- Neurones from hypothalamus produce hormones that travel along their axons to the posterior pituitary gland, stimulating it to release hormones
Describe how the hypothalamus functions in control of hunger and satiety
- Controls the feelings of hunger and fullness
Describe how the hypothalamus functions in control of water balance and thirst
Responds to increase in concentration of extracellular fluid, stimulating the feeling of thirst
Sleep/wake cycle
- When darkness is detected by retina, suprachiasmatic nucleus of hypothalamus stimulates the pineal gland to release melatonin
- Melatonin regulates the body clock by promoting sleepiness
Describe the location of the pituitary gland
- Pea-sized oval structure, suspended from underside of brain by pituitary stalk of the hypothalamus (infundibulum)
- Sits within a small depression in the sphenoid bone, known as sella turcica (Turkish saddle)
List the parts of the pituitary gland
- Anterior pituitary
2. Posterior pituitary
Where is the anterior lobe of the pituitary gland derived from?
Pharynx - Rathke’s pouch
Describe the structure of the anterior lobe of the pituitary
- Glandular epithelium
- 3 parts:
1. Pars anterior
2. Pars intermedia
3. Pars tuberalis
Pars anterior of the anterior pituitary
Largest part, responsible for hormone secretion
Pars intermedia of the anterior pituitary
Thin epithelial layer than separates pars anterior from posterior lobe
Pars tuberalis of the anterior pituitary
Upwards extension of the pars anterior that surrounds the anterolateral aspect of the infundibulum
How is release of hormones from the pituitary controlled?
By the hypothalamus - communicates via neurotransmitters secreted into the hypophyseal portal vessel (ensures hypothalamic hormones remain concentrated, rather than being diluted in the systemic circulation
List the hormones secreted by the anterior pituitary and their functions
- Prolactin - milk production in mammary glands
- Growth hormone - also known as somatrophin, stimulates general body growth
- Thyroid stimulating hormone - controls secretions and other activities of the thyroid gland
- Gonadotrophin - stimulates secretion of FSH and LH
- Corticotrophin - stimulates the adrenal cortex to secrete glucocorticoids such as cortisol
Describe the role of FSH in females
- Stimulates the ovaries to produce steroids - estradiol during follicular phase and progesterone during luteal phase
- Surge at mid-cycle, with LH, triggers ovulation
Describe the role of LH in females
- Stimulates ovaries to produce steroids
- Surge at mid-cycle triggers ovulation - turns follicle into corpus luteum
Describe the role of FSH in males
- Stimulates Sertoli cells to produce androgen-binding protein, stimulating spermatogenesis
- Stimulates Sertoli cells to produce inhibin, which provides negative feedback to the anterior pituitary to decrease FSH secretion
Describe the role of LH in males
Stimulates Leydig cells to produce testosterone - provides negative feedback to anterior pituitary and hypothalamus
Describe the structure of the posterior lobe of the pituitary gland
- Aka neurohypophysis
- Consists of nervous tissue
- Arises from embryonic forebrain
- Extension of hypothalamus
Which hormones are secreted by the posterior lobe of the pituitary gland?
- ADH - control of blood osmolality
- Oxytocin - parturition and milk let-down reflex
Describe the production of hormones which are secreted from the posterior lobe of the pituitary gland
- Produced in supraoptic and paraventricular nuclei of the hypothalamus
- Subsequently stored in posterior pituitary gland, ready for release
Describe the connection between the hypothalamus and the pituitary gland
- Results fro hormones released from hypothalamic neurones
- Two connections - connection to anterior lobe is via special portal blood system, connection to posterior lobe is directly via neurone
- Lowest part of the the hypothalamus that connects to the pituitary gland = median eminence
Hypothalamic nuclei
- Send axons to pituitary gland in two distinct areas:
1. Median eminence - axons terminate close to primary capillary network
2. Neurohypophysis - axons travel through the pituitary stalk into the posterior pituitary - Hypothalamic neurones release many different secretions - most act as hormones as they are released on close proximity to capillaries and enter bloodstream (known as neurosecretion)
- Neurosecretory cells in hypothalamic nuclei have a multitude of connections to the other parts of the brain and are influenced by many external stimuli such as stress + emotion
What is considered delayed puberty in females?
No breast development at 13 y/o
What is considered delayed puberty in males?
No growth of testes by 14 y/o
What is the typical measure of delayed puberty?
Outside 2.5 standard deviations of the population
List the causes of delayed puberty
- Constitutional delay - ‘clock running slow’
2. Pathology of hypothalamus/pituitary or gonads
Constitutional delay of puberty
- Normal variant, child eventually does hit puberty
- Often history of delayed puberty in siblings or parents - genetic component
- Bone age generally much lower than chronological age
- Usually thin
List the factors which can cause constitutional delay of puberty
- Chronic illness
- Malnutrition
- Excessive physical exercise
- Stress
- Diabetes
- Cystic fibrosis
- Coeliac disease
List examples of a pathological delay in puberty
- Hypogonadotrophic hypogonadism
2. Hypergonadotrohpic hypogonadism
Hypogonadotrophic hypogonadism
- Lack of serum gonadotrophin production or action, manifesting with an absence of spontaneous pubertal development
- Occurs in patients with hypothalamic-pituitary disorders and those with a functional delay (constitutional delay due to underlying chronic disease, malnutrition, excessive exercise etc.)
Hypergonadotrophic hypogonadism
- Resulting from gonadal disorders and manifesting with elevated serum gonadotrophin concentrations in the absence of pubertal signs at the appropriate age for puberty
- E.g. Klinefelter’s syndrome (XXY) in males and Turner’s syndrome (XXX) in females
How is puberty measured?
- Tanner’s five stages of puberty - 1 (no development) to 5 (adult development)
- Evaluates visible secondary sexual characteristics such as breast/genital development and pubic hair growth through physical examination
Or
- Pubertal development scale - questionnaire, less invasive than Tanner examination
Define median parental height
Value calculated to give an estimate a child’s predicted adult height using the heights of their parents
Median parental height for boys
(Mother’s height + father’s height +13)/2
Median parental height for girls
(Mother’s height + father’s height - 13)/2
Define bone age
Degree of maturation of a child’s bones
Describe the use of bone age in assessing development
- Current height and bone age can be used to predict adult height
- For most people bone age = biological age, but can be older or younger
- Those with advanced bone age typically hit growth early but stop growing early
- Those with delayed bone age hit growth spurt later than normal
How is bone age assessed?
- X-ray of left hand, fingers and wrist (easily x-rayed with minimal radiation and shows many bones in a single view)
- Compared to bones of standard
List the stimuli which the hypothalamus is responsive to
- Light - day length and photoperiod for regulating circadian and seasonal rhythms
- Olfactory stimuli including pheromones
- Steroids including gonadal steroids and corticosteroids
- Neurally transmitted information arising from heart, stomach and reproductive tract
- Autonomic inputs
- Blood-bourne stimuli e.g. angiotensin, insulin, cytokines, concentration of glucose and osmolarity
- Stress
- Invading microorganisms by increasing body temperature, resetting the body’s thermostat upwards
