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Reproduction and the growing child > The breast (lactation anatomy and physiology) > Flashcards

The breast (lactation anatomy and physiology) Flashcards

1
Q

Prolactin is formed in the

A

Anterior pituitary gland

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2
Q

LH is released from

A

Anterior pituitary gland

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3
Q

hPL =

A

Human placental lactogen

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4
Q

Oestrogens role in mammary growth:

A

Growth of ductal system.

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5
Q

Progesterone role in mammary growth:

A

Full development of lobule-alveolar system.

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6
Q

The process of growth and development of the mammary gland in perparation for milk production

A

Mammogenesis

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7
Q

When does mammogenesis begin?

A

When mammary gland is exposed to oestrogen at puberty

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8
Q

Structures of the breast continue to bud until what age?

A

35 years

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9
Q

Mammogenesis at 4 weeks gestation =

A

2 milk lines form axilla to groin

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10
Q

Secretory units of glandular tissue/mammary gland =

A

Alveoli

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11
Q

Colostrum =

A

First milk, high in immunological factors and low volume

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12
Q

Colostrum can stimulate baby to do what?

A

Pass first stool (myconium)

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13
Q

At birth, baby’s breast tissue is…

A

Confined to the nipple area

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14
Q

During childhood the mammary gland

A

Undergoes limited general growth in line with size and stature of child

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15
Q

Mammary gland at puberty:

A

Alveoli mature
Fat deposition
Buds branch into acini/alveoli system

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16
Q

During pregnancy, what hormones are involved with the development of breast?

A

Progesterone
Oestrogen
Prolactin
hPL

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17
Q

What inhibits prolactin during pregnancy?

A

High levels of oestrogen and progesterone - stop milk let down

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18
Q

Serum placental lactogen role in mammogenesis =

A

Areola growth

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19
Q

Breast is located between which ribs?

A

2-6

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20
Q

Breast lies superiorly to what muscles?

A

Pectoralis major

Serratus anterior

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21
Q

Tissue extending towards the axilla =

A

Axillary tail of Spence

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22
Q

Function of tubercles of Montgomery =

A

Sebaceous glands attach to milk glands. Provide olfactory stimulus to help baby find breast

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23
Q

Mammary gland is an adapted

A

Sweat/eccrine gland

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24
Q

What opens into the nipple?

A

Lactiferous ducts

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25
Q

Ligment which attaches to dermis and pectroal fascia to secure breast

A

Cooper’s ligaments/Suspensory ligaments

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26
Q

What surrounds alveoli to allow milk let down?

A

Myoepithelial cells (smooth muscle)

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27
Q

What line alveoli and form milk?

A

Lactocytes

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28
Q

Blood supply to breast:

A

Internal mammary from perforating branches

Lateral thoracic from axillary artery

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29
Q

Breast lymphatics mainly drain into:

A

Axillary nodes

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30
Q

Innervation of breast:

A

Intercostal nerves (4-6)

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31
Q

When in pregnancy do women begin to secrete?

A

Late T1 early T2

32
Q

Transition from pregnancy to lactation

A

Lactogenesis

33
Q

Lactogenesis stage one time frame

A

Mid/late pregnancy –> 24/48 hrs

34
Q

Lactogenesis 1 is characterised by:

A

Production of colostrum

35
Q

Why is colostrum low volume?

A

Baby has immature kidneys, don’t want to fluid overload

36
Q

Lactogenesis 2 timeframe:

A

Day 3 –> Day 8

37
Q

Lactogenesis 2 is characterised by:

A

Copious volume of milk production

38
Q

Lactogenesis 3 timeframe

A

Day 9 –> Involution

39
Q

Involution occurs how long after last feed?

A

40 days

40
Q

Lactogenesis one is under what control?

A

Endocrine: prolactin

41
Q

What rises in lactogenesis 1?

A

Plasma concentration of lactose and lactaalbumin

42
Q

Lactogenesis 2 is triggered by what?

A

3rd stage of labour

43
Q

What occurs after 3rd stage of pregnancy:

A

Sudden decrease in progesterone, oestrogen and hPL. Increase prolactin from APG

44
Q

What has a supportive role in lactogenesis 2?

A

Thyroxin
Insulin
Cortisol

45
Q

In the absence of … lactation won’t commence

A

TSH

46
Q

Ex of reasons lactation doesn’t occur:

A

Absence of TSH

Retained products of conception

47
Q

Milk in lactogenesis 2 is:

A

Copious

High fat content

48
Q

Maintenance of milk production =

A

Galactoporesis

49
Q

Milk production becomes what during galactoporesis?

A

Autocrine process

50
Q

2 hormones involved in milk letdown reflex:

A

Oxytocin

Prolactin

51
Q

Oxytocin stimulus:

A

Baby suckling

Sensory: sound, smell, tactile stimulus

52
Q

Oxytocin is made in…

A

Hypothalamus

53
Q

Oxytocin is secreted from

A

Posterior pituitary gland

54
Q

Oxytocin function:

A

Contraction of myoepithelium

55
Q

Prolactin is made by:

A

Lactotroph cells in anterior pituitary gland

56
Q

What inhibits formation of prolactin?

A

Dopamine

57
Q

Dopamine analogues:

A

Reduce lactational ability

58
Q

Dopamine agonists

A

Increase milk production

59
Q

Prolactin acts on:

A

Lactocytes

60
Q

Theories for how removal of milk increases milk production:

A
  • Prolactin receptor theory
  • Feedback inhibitor of lactation
  • Prolactin inhibitory factor (dopamine?)
61
Q

What is in formula milk:

A
  • Vitamins
  • Minerals
  • Water
  • Proteins
  • Carbohydrates
  • Fats
  • Water
62
Q

What is in breast milk:

A
  • Enzymes
  • Anti-inflammatory molecules
  • Transfer factors (assist absorbtion)
  • Viral fragments, WBCs, bifidus factor, antibodies
  • Horones
  • Water, vitamines, minerals, proteins, carbohydrates, fats, water
63
Q

Antibodies in maternal milk:

A

sIGA

64
Q

Bifidus factor:

A

Makes is more acidic (bacteria better in high pH)

65
Q

Hormones in breast milk:

A

Insulin
TSH
Growth hormone
Epidermal growth factor

66
Q

Problems with formula milk:

A
  • Sertilisation issues
  • First processed food
  • Atopic probelms: asthma, eczema
  • Cows milk allergy
  • Difficult to process
67
Q

Breast feeding pathology is related to what:

A
  • Poor positioning and attachment
  • Nipple tissue and trauma
  • Breastfeeding management
68
Q

Mastitis =

A

Inflammation of breast tissue

69
Q

2 types of mastitis =

A

Infective

Non-infective

70
Q

Most common type of mastitis =

A

Non-infective

71
Q

Cause of non-infective mastitis =

A

Poor positioning and attachment - inadequate milk removal - milk stasis - back pressure - inflammatory response

72
Q

Symptoms of non-infective mastits =

A 
Swelling
Warmth
Flu-like
Pyrexia 
Unilateral
Sudden onset
More painful before feed
73
Q

Treatment of non-infective mastitis =

A

Treat cause - support positioning and attachment

  • increase feed frequency
  • analgesics
  • gentle breast massage during feed
74
Q

Common causes of infective mastitis =

A

Staphlococcus aureus
Streptococcal
E.coli

75
Q

Signs and symptoms of infective mastitis:

A 
Pain, swelling, heat
More severe flu-like
Pyrexia (more than 40)
Rigors 
Discharge of pus or blood from nipple
76
Q

Management of infective mastitis =

A
  • Warm, moist compress
  • increase feed
  • positioning and attachment
  • analgesia
  • antibiotics
  • increase fluid intake
77
Q

Antibiotics effective against infective mastits =

A

Penicillins

Cephalosporins

Reproduction and the growing child (15 decks)

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