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

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

00:04 There are a lot of hormones here.

00:06 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.

00:24 But it has a function, it helps to maintain the corpus luteum, which causes stabilization of the endometrial lining.

00:31 That's where the progesterone comes from.

00:33 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.

00:44 But remember, progesterone relaxes things.

00:47 So it stops the uterus from contracting, it keeps everything calm.

00:51 Let's also talk about estrogen.

00:53 It also suppresses FSH and LH, which again is important, but it helps to increase vascularity.

01:00 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. Get it? Prolactin. Prolactogenesis. Did you put all that together? Important.

01:22 Oxytocin is actually produced by the posterior pituitary gland.

01:27 Maybe you've heard of oxytocin if someone has talked about an induction of labor.

01:31 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.

01:45 So it allows the milk to come out.

01:47 So prolactin makes milk, oxytocin lets it come out.

01:54 Now, here's the one that's pretty hard to say.

01:56 And this hormone is released by the placenta, and it's called the Human chorionic somatomammotropin.

02:02 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.

02:18 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.

02:28 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.

02:50 So feel free to go back and look at the handout if you want to know more.

02:55 Now, let's talk about changes in the gastrointestinal system, or the GI system, as I like to call it.

03:02 Now the changes, 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.

03:13 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.

03:23 That's a big thing that it does. What's the problem with that? Well, our intestines are responsible for moving food through our gut.

03:31 Imagine what would happen if our motility and our peristalsis slows down, that would make us really uncomfortable.

03:38 Sometimes this is what happens during pregnancy.

03:41 It also relaxes our esophageal tone.

03:45 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? Think about our sphincters that helped 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.

04:05 Also, when we think about the gallbladder.

04:08 Progesterone can also lead to reduced gallbladder activity.

04:12 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.

04:23 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 talk about mucous membranes, remember, everything is going to be affected.

04:50 So if you think about estrogen, estrogen makes things fluffy.

04:55 So there's lots of extra blood flow going to our gums, to our nasal cavity, and anywhere we have mucous membranes.

05:02 It's going to make things more tender, it's going to make them what we call friable, which means it's easier for it to start bleeding.

05:12 Because of the relaxation of all the vessels, then you might find an outpouching of the intestines around the anus, and that may cause hemorrhoids.

05:21 Another wonderfully uncomfortable sign of pregnancy.

05:25 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.

05:34 Specifically, I want to talk about appendicitis.

05:36 So typically, symptoms of appendicitis include nausea and vomiting, and pain.

05:42 Nausea and vomiting is a normal sign of pregnancy, which we'll talk about in our lecture on pregnancy discomforts.

05:47 But one of the assessment, one of the hallmark assessments that we do is to check for McBurney's point.

05:52 And usually in the lower white quadrant, we will assess for pain and tenderness.

05:58 Well during the second and third trimester because of the uterus McBurney's point is moved.

06:04 So a pregnant client with an appendicitis may actually present with mid-abdomen pain on the right side.

06:11 So make sure, you're aware of the movement of MC Burney's point.