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EDAIC PART II > Physiology (Special) > Flashcards

Physiology (Special) Flashcards

1
Q

What is the normal length of pregnancy ?

A

40 weeks

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2
Q

Physiological changes resulting from pregnancy?

A
  • Changes aiding oxygen delivery
  • Increase in uterine blood flow
  • Protecting against blood during delivery
  • Accommodation for enlarged uterus
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3
Q

CVS changes in pregnancy?

A
  • CO increases by 50%
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4
Q

Characteristics of changes in cardiac output in pregnancy ?

A
  • Majority of changes in the 1st trimester
  • Increase of 30% by 12 weeks
  • Peaks at 28 weeks at 50%
  • Increases in CO is due to increase in SV
  • May rise by 45% post-delivery
  • Increase may occur with uterine contraction
  • Risk of decompensation with cardiac history
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5
Q

Characteristics of changes in SV in pregnancy ?

A
  • Increased by 35%
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6
Q

Characteristics of changes in HR in pregnancy ?

A
  • Increased by 25%
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7
Q

Other changes in pregnancy include?

A
  • Decrease in SVR
  • Reduction in BP (SBP -10% & DBP-20%)
  • ECG - LAD, ST-depression, flat T-wave
  • Aorto-caval compression supine
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8
Q

Haematological changes?

A
  • Anaemia of pregnancy (Plasma > RBC )
  • RBC volume increase by 20%
  • Plasma volume increase by 45%
  • Increased WCC
  • Increased fibrinogen and clotting factors
  • Factor XI & XIII do not increase
  • Decreased platelet count
  • Reduced fibrinolysis
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9
Q

Respiratory changes?

A
  • Increased by 15%
  • RR stimulated by progesterone - CO2
  • Occurs in the 1st trimester
  • TV increases by 35%
  • FRC decreased by 20% at term
  • Reduced chest wall compliance
  • Reduced CO2 + Resp alkalosis
  • Increase 2,3-DPG
  • Airway mucosal oedema
  • Increased breast size
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10
Q

Respiratory changes?

A
  • Increased by 15%
  • RR stimulated by progesterone - CO2
  • Occurs in the 1st trimester
  • TV increases by 35%
  • FRC decreased by 20% at term
  • Reduced chest wall compliance
  • Reduced CO2 + Resp alkalosis
  • Increase 2,3-DPG
  • Airway mucosal oedema
  • Increased breast size
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11
Q

Renal and acid base changes ?

A
  • Increased plasma flow + GFR by 50%
  • Increased urea & creatinin clearance
  • Glycosuria & proteinuria
  • Reduced plasma osmolality
  • Increased bicarbonate excretion
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12
Q

Endocrine and metabolic changes ?

A
  • Increased size of pituitary gland
  • Increased TBG, thyroxine & triiodothyronine
  • Free thyroxine index is unchanged
  • Increased insulin production - Resistance >
  • Maternal hyperglycaemia
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13
Q

What substances do not cross the placenta?

A
  • Insulin
  • Transfer occurs via diffusion
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14
Q

Gestational diabetes?

A

Increased maternal blood sugar leads to increased fetal insulin production leading to fetal hypoglycaemia

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15
Q

GI & Heptaic changes?

A
  • Cephaled displacement of stomach by uterus
  • Increased intragastric pressure
  • Decrease LOS tone - Risk of reflux
  • Delayed gastric emptying
  • Elevated LFTs
  • Elevated ALP due to placental production
  • Reduced protein synthesis by 25%
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16
Q

Neurological changes?

A
  • Reduced volume of epidural space
  • Increased sensitivity to opioids & sedatives
17
Q

Pharmacokinetic changes?

A
  • Increased volume of distribution will result in prolonged elimination half-life of many drugs
  • Reduced plasma cholinesterase levels
18
Q

Pharmacodynamic changes ?

A
  • Reduced MAC
  • Reduced dose of drugs
19
Q

Changes in the placenta?

A
  • Increased in to 10% of cardiac output
  • Uterine blood flow increases from 50 to 700ml/min
20
Q

Draw a schematic of fetal circulation?

A

Saturation at various point are shown in the image

21
Q

Describe the fetal circulation?

A
  • Deoxygenated blood arrives the placenta via the Uterine Artery (45%)
  • Oxygenated and returned to fetus via umbilical vein (85%)
  • About 60% of blood bypasses liver via ductus venosus
  • Streams with venous blood from the body in the IVC & returns to LA via Foramen Ovale
22
Q

Neonatal physiology at birth?

A
  • At birth cessation of placental flow after clamping of cord
  • Reduction in PVR + commencement of resp
  • Blood flows through the lungs due to reduction in PA pressures and PVR
  • Increased pressure LA > RA - Functional closure of FO
  • Pressure in aorta increased as UV are clamped
  • Increased SVR and reverse flow - Aorta to pulmonary artery via patent ductus arteriosus
23
Q

What is oxygen consumption at rest ?

A

Approximately 250mls/min

24
Q

What is oxygen consumption during exercise?

A

Approximately 4000mls/min

25
Q

What is BMR ?

A

This is the amount of energy that is produced from breakdown of food per unit time. It is usually 40 Kcal/m-2/hr

26
Q

What is the Metabolic Equivalent (MET)?

A

This is the metabolic demand of activity

27
Q

What is oxygen debt?

A

This is a period of high oxygen consumption after a period of exercise. It is used to compensate for oxygen deficit during exercise which cause accumulation of lactic acid.

28
Q

What is VO2 max?

A

The maximal oxygen uptake achievable for an individual. It is limited by cardiovascular factors and increases with increasing fitness

29
Q

What is the anaerobic threshold ?

A

This is the point at which oxygen supply can no longer meet demand and thus energy production shifts from aerobic to anaerobic

30
Q

What is the pasteur point?

A

The partial pressure of oxygen below which oxidative phosphorylation cannot occur. This is 1mmHg

31
Q

What are the respiratory changes during exercise?

A
  • Increase TV & RR (Minute volume)
  • Ventilation increased due to stimulation of respiratory center from motor cortex and proprioceptors from moving limbs
  • PO2 at mitochondrial level is 20-30mmHg with extreme exercise
32
Q

What are the CVS changes during exercise?

A
  • Cardiac output increases 5 folds
  • Increased venous return (Increased muscular tone and decreased intrathoracic pressures)
  • Peripheral vascular resistance falls due to accumulation of lactic acid and CO2
  • Increase HR, SV and SBP
  • Increased pulse pressure
33
Q

Regional blood flow?

A

Read it - Exercise physiology

34
Q

What is the body’s response to high altitudes?

A
  • Hyperventilation
  • HPV
  • Shift of OHDC to the left
  • Polycythermia
  • Renal compensation
  • Increased cardiac output to increase DO2
  • Activation of RAA system + Na retention
  • Pulmonary oedema due to reduced hydrostatic pressures and hypervolaemia

EDAIC PART II (15 decks)

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