Changes of the Endocrine and Gastrointestinal System during Pregnancy (Nursing)

by Jacquelyn McMillian-Bohler

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    00:01 Now, let's talk about changes in the endocrine system.

    00:04 There are a lot of hormones here, but they're going to come up over and over again in each of our lectures, as we get to different complications of pregnancy.

    00:12 So, think about coming back to this section whenever you need to.

    00:16 First, let's talk about HCG.

    00:18 So, HCG is the hormone that's released from the conceptus and it lets us know that a pregnancy is there, but it has a function, it helps to maintain the corpus luteum, which causes stabilization of the endometrial lining, that's where the progesterone comes from.

    00:34 Next, let's talk about progesterone.

    00:36 Now, it continues to suppress FSH and LH, so that, we don't have another pregnancy, it helps to maintain the pregnancy, as we just discussed, but remember, progesterone relaxes things, so, it stops the uterus from contracting, it keeps everything calm.

    00:51 Let's also talk about estrogen, it also suppresses FSH and LH, which again, is important, but it helps to increase vascularity, so, when we think about getting extra blood flow to the uterus, to the breast to the kidneys, everywhere else that we need it, estrogen is primarily responsible for that.

    01:10 Serum prolactin is necessary to produce milk.

    01:13 Get it? Pro-lactin? Pro-lactogenesis? Did you put all that together? Important.

    01:23 Oxytocin is actually produced by the posterior pituitary gland, maybe you've heard of oxytocin, if someone has talked about an induction of labor, but did you know, your body actually makes oxytocin and it causes the contractions that we have, when we go into labor.

    01:39 Another really important thing that oxytocin does, is it stimulates the milk ejection reflex, so, it allows the milk to come out.

    01:48 So, prolactin makes milk.

    01:50 Oxytocin lets it come out.

    01:54 Now, here's the one that's pretty hard to say and this hormone is released by the placenta and it's called, the “Human chorionic somatomammotropin.” Wow, that's a lot.

    02:04 And this hormone actually helps to stimulate, breast growth and breast development, but it also plays a role in causing insulin resistance.

    02:13 So, we'll talk about this a lot, when we get to the lecture on gestational diabetes, so, remember this one.

    02:21 The final hormone I’m going to discuss is, insulin.

    02:24 So, insulin is really important for getting glucose into the cells, that's true for pregnant clients and clients that are not pregnant.

    02:32 But during pregnancy, all of our organs become insulin resistance, to allow the glucose to transfer from the pregnant person to the fetus.

    02:41 So, the insulin levels must increase to compensate for that insulin resistance.

    02:47 Now, there are a lot more hormones that change during pregnancy, so, feel free to go back and look at the handout, if you want to know more.

    02:56 Now, let's talk about changes in the gastrointestinal system or the GI system as I like to call it.

    03:02 Now, the functional changes, in the gastrointestinal system, occur throughout the entire course of the pregnancy, from the first trimester, all the way to the end and the biggest little trickster in this whole mix is progesterone.

    03:17 Remember what progesterone does, it relaxes things.

    03:20 So, it decreases intestinal motility, that's a big thing that it does.

    03:25 What's the problem with that? Well, our intestines are responsible for moving food through our gut, imagine what would happen, if our motility and our peristalsis slows down, that would make us really uncomfortable, sometimes this is what happens during pregnancy.

    03:41 It also, relaxes our esophageal tone, so, thinking about when you're eating, if you think about your esophagus, not really doing a good job of pushing food down, what that might feel like.

    03:54 Think about our sphincters that help to keep our food in our stomach, what that would feel like if it's relaxed, it would make it really easy for food to come back up, which often happens during pregnancy.

    04:06 Also, when we think about the gallbladder.

    04:08 Progesterone can also lead to reduced gallbladder activity, so, the possibility of producing what we call sludge in the gallbladder or having gall stones is actually going to be increased, as a response to normal pregnancy changes.

    04:24 We're also going to experience crowding of the organs.

    04:27 Take a look at this graphic and what you notice if someone's not pregnant, versus what happens, when that uterus begins to take over all the space, inside the abdomen.

    04:37 So, the stomach gets pushed up, the diaphragm gets pushed up and everything gets to be really, really tight.

    04:45 When we think about our mucous membranes, they're all going to be affected.

    04:49 Remember progesterone, is also going on at the same time, it makes things fluffy.

    04:55 So, when we think about the extra blood flow to our gums, to our nasal cavity, anywhere we have mucous membranes, it's going to make things, a little more tender, a little more what we call, “Friable,” which means, it's easier to cause it to bleed.

    05:10 If we're talking about the gums, then what you may notice is, bleeding every time you brush your teeth.

    05:16 You might be thinking, “Goodness, I have gingivitis” but actually, it's a normal change of pregnancy.

    05:23 Because of the relaxation of all the vessels, then you might find an out pouching of the intestines around the anus and that may cause, hemorrhoids, another wonderfully uncomfortable sign of pregnancy.

    05:36 I want to make a special observation for nurses, that are going to be working in the emergency department or places where someone may come in for an emergency problem.

    05:45 Specifically, I want to talk about appendicitis.

    05:47 So, typically symptoms of appendicitis include, nausea and vomiting and pain.

    05:53 Nausea and vomiting is a normal sign of pregnancy, which we'll talk about in our lecture on pregnancy discomforts.

    05:58 But one of the assessment, one of the hallmark assessments that we do, is to check for McBurney's point.

    06:04 And usually in the lower white quadrant, we will assess for pain and tenderness.

    06:09 Well, during the second and third trimester, because of the uterus, McBurney's point, is moved.

    06:15 So, a pregnant client with an appendicitis, may actually present with mid-abdomen pain on the right side, so make sure you're aware of the movement of McBurney's point.

    About the Lecture

    The lecture Changes of the Endocrine and Gastrointestinal System during Pregnancy (Nursing) by Jacquelyn McMillian-Bohler is from the course Physiological Changes in Pregnancy (Nursing).

    Included Quiz Questions

    1. Progesterone
    2. Estrogen
    3. Human chorionic gonadotropin
    4. Oxytocin
    1. Oxytocin
    2. Estrogen
    3. Serum prolactin
    4. Human chorionic somatomammotropin
    1. Intestinal motility decreases
    2. Organs are crowded
    3. Gallbladder activity increases
    4. Esophageal tone increases

    Author of lecture Changes of the Endocrine and Gastrointestinal System during Pregnancy (Nursing)

     Jacquelyn McMillian-Bohler

    Jacquelyn McMillian-Bohler

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