Pregancy/Child development/ Old age Flashcards
Describe the gynaecological ligaments of the pelvis.
Transverse cerical (cardinal) ligaments art of hypogastric sheath; runs from lateral pelvic wall to uterine cervix and vagina; transmits uterine artery and provides passive support for the uterus
Uterosacral ligaments - attach upper vagina, upper portion of cervix and uterus to the 3rd sacral vertebra
Round ligaments - attach uterus to mons pubis
Broad ligaments - attach uterus to medial aspect of the ilium
Uracus ligament - attaches bladder to umbilicus (formed from the remnants of the umbilican vein)
With reference to the development of a baby born prematurely at 30 weeks gestation:
a) Describe the possible effects on the lungs.
b) Describe the possible effects on feeding and nutrition
The most common lung problem in a premature baby is respiratory distress syndrome (RDS). or asthma/ pneumonia
Through an IV line. A baby who is born very prematurely will initially be fed through an IV line - or Through a tube.
Breatsfeeding is encouraged due to nutrients
a) Patients over 65 are found to have reduced nociception and to present more frequently with chronic pain. How might you account for these facts?
diminished numbers of specialized peripheral receptors combined with a deterioration of supporting tissues
peripheral nerves show a reduction of myelinated and unmyelinated fibers as well as signs of damage, including Wallerian degeneration
The number and size of sensory neurons in dorsal root ganglia (DRG) also increases throughout early adulthood, peaks at mid-life (13–18 months) and then decreases thereafter
together with increasing inflammation
Decreased numbers of opiate receptors (
b) List three common age related changes in skin. For TWO of these explain how their presence might these affect your management/ treatment of the patient.
Skin becomes more transparent as we age. This is caused by thinning of the epidermis
The loss of molecular integrity of the dermis leads to increased rigidity, diminished elasticity,Recovery from mechanical depression, in fact, is dramatically altered—observed in only minutes in young skin, but requiring more than 24 h in skin of aged individuals.
Skin becomes slack. The loss of the elastic tissue (elastin and collagen) in the skin with age causes the skin to hang loosely
Skin becomes more fragile as we age. This is caused by a flattening of the area where the epidermis and dermis (layer of skin under the epidermis) come together.
c) Side effects from drugs occasionally present as symptoms to the osteopath. Your 70 year old patient admits that he has been taking his wife’s prescribed anti-inflammatory drugs (diclofenac) weekly for the last five years. Explain THREE symptoms he might present with a as a result of this.
Gastrointestinal complaints are most often noted. The development of ulceration and/or bleeding
NSAIDs “are associated with adverse renal [kidney] effects caused by the reduction in synthesis of renal prostaglandins”
reported cases of severe hepatic reactions, including liver necrosis, jaundice,
What part does the thoracic lumbar junction have to play in your care of the obstetric patient?
trauma during pregnancy is one of the main causes of non-obstetric maternal death
It is compromised during pregancy.
Figure 1 (below) graphs the ‘V/Q ratio’ against ‘lung region’; the plot changes from ‘Youth’ to ‘Old age’. Explain this change and list the implications for the older patient.
Bones become thinner and change shape. This can change the shape of your ribcage. As a result, your ribcage cannot expand and contract as well during breathing.
The muscle that supports your breathing, the diaphragm, becomes weakened. This weakness may prevent you from breathing enough air in or out.
Muscles and other tissues
Aging also causes the air sacs to lose their shape and become baggy.
Changes to the nervous system:
The part of the brain that controls breathing may lose some of its function.
Nerves become less sesitive
- The normal function of the psoas muscle is vital if a patient is to have a physiological pregnancy and labour.
Discuss the above statement with reference to the mechanical changes that take place in pregnant patients.
During pregnancy, as the pelvis tilts forward (essentially flexing at the hip) and the abdominal muscles stretch to accommodate the weight of the growing baby, the psoas shortens and tightens. This contracted state of the psoas is responsible for several of the common discomforts in pregnancy
Review your understanding of the main cortical drives (factors in the person) that modulate the “descending pain pathways”.
Opioid pathways
Serotonergic pathways
When μ-opioid receptor-expressing RVM neurons were selectively eliminated, neuropathic pain behaviors in rats were reversed [69,70]. Overall, these findings demonstrate the importance of descending pain facilitation for hyperalgesia/allodynia and chronic pain after peripheral nerve injury
With reference to Figure 1 (below), give an overview of the possible musculo-skeletal changes that may accumulate with advancing years, giving potential implications.
bone volume and mass declines
. Loss of cartilage thickness in synovial joints with age contributes to osteoarthritis while decreasing structural integrity within the intervertebral discs (IVDs) leads to loss of disc height, and collapse and compression within the spine.
of muscles - Arteries become increasingly stiff and hard, due to changes in the vessel wall, where calcification and glycosylation are chiefly responsible.
