Maternal Physio - GIT

Question 1

Organs displaced upward by the enlarging uterus

Answer 1

The stomach, appendix, and intestines

Question 2

Appendix position and implication

Answer 2

• Displaced upward and laterally
• Pain from appendicitis may occur much higher in the abdomen because the gravid uterus pushes the appendix up

Question 3

Gastric emptying time

• During pregnancy
• During labor

Answer 3

• During pregnancy
  
  • Unchanged
• During labor
  
  • Prolonged during labor and administration of analgesic agents

Question 4

Gum changes

Answer 4

• May be hyperemic and softened
• Epulis of pregnancy
  
  • focal, highly vascular swelling of gums but regresses spontaneously after delivery

Question 5

Effects of progesterone in GIT

Answer 5

• ↓ lower esophageal sphincter tone → heartburn
• ↓ bowel peristalsis → constipation → hemorrhoids

Memory aid:

• Progesterone has a somehow relaxing effect
  
  • Relaxed ES tone
  • Relaxed bowel → ↓ bowel peristalsis

Question 6

Mechanism for hemorrhoid development

Answer 6

Constipation and elevated pressure in veins below the level of the uterus

Question 7

Liver enzyme(s) with increased activity

Answer 7

• Alkaline phosphatase activity in serum almost doubles during pregnancy
• Total albumin
• Serum globin

Question 8

Liver enzyme(s) with decreased activity

Answer 8

• ALT
• AST
• GGT
• Bilirubin
• Serum albumin

Question 9

Albumin levels in pregnancy

Answer 9

Serum albumin ↓, but total albumin ↑ because of a greater volume of distribution

Question 10

Liver size in pregnancy

Answer 10

Remains the same

Question 11

Why are pregnant women prone to cholestasis?

Answer 11

• Progesterone inhibits CCK-mediated smooth muscle stimulation → impairs gallbladder contraction → increased residual volume and cholestasis
• Estrogen inhibits intraductal transport of bile acids → contributes to cholestasis
• Memory aid:*
• Progesterone – relaxing effect – inhibits CCK – impaired GB contraction

Question 12

Cholestasis with increased lipids and cholesterol leads to

Answer 12

Higher incidence of gallstones, cholecystitis, and biliary obstruction