HUMAN ANATOMY & PHYSIOLOGY

BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG

REPRODUCTIVE SYSTEM  ovaries
 fallopian tubes
 uterus
 vagina
 vulva
 mammary glands and breasts.

These organs are involved in the production and transportation

of gametes and the production of sex hormones.

The female reproductive system is designed to carry out

several functions.
The internal reproductive anatomy includes:  produces the female egg cells necessary for reproduction,
 Uterus called the ova or oocytes.
 two ovaries  The system is designed to transport the ova to the site of
 two fallopian tubes fertilization
 Urethra
 Pubic bone Human fertilization
 Rectum.  is the union of a human egg and sperm, usually occurring
in the ampulla of the fallopian tube.
The uterus contains an inner lining called the endometrium  The process of fertilization involves a sperm fusing with
(which builds ups and sheds monthly in response to hormonal an ovum.
stimulation)  The most common sequence begins with ejaculation
The Female Reproductive System during copulation, follows with ovulation, and finishes with
fertilization

Common site of fertilization

 The first segment, closest to the uterus, is called the
isthmus.
 The second segment is the ampulla, which becomes
more dilated in diameter and is the most common site for
fertilization.
 The final segment, located farthest from the uterus, is the
infundibulum.

Male Reproductive System

Fertilization and Implantation

The purpose of the organs of the male reproductive system is

to perform the following functions:
 To produce, maintain, and transport sperm (the male
reproductive cells) and protective fluid (semen)
 To discharge sperm within the female reproductive tract
during sex.
Site of Fertilization
 Both male and female reproductive organs have internal
and external structures.
 Reproductive organs are considered to be either primary
or secondary organs.

The primary reproductive organs are:

gonads (ovaries and testes)=>which are responsible for
gamete (sperm and egg cell) and hormone production

The female reproductive system includes:

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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
Menstrual cycle
 Provides important body chemicals, called hormones, to
keep body healthy
 A cycle is counted from the first day of 1 period to the first
day of the next period. The average menstrual cycle is 28
days long.
 Cycles can range anywhere from 21 to 35 days in adults
and from 21 to 45 days in young teens
 Menstruation is the technical term for getting your period.
 About once a month, females who have gone through
puberty will experience menstrual bleeding.
 This happens because the lining of the uterus has
prepared itself for a possible pregnancy by becoming
thicker and richer in blood vessels.
 If pregnancy does not occur, this thickened lining is shed,
accompanied by bleeding. Bleeding usually lasts for 3-8
days.
 For most women, menstruation happens in a fairly regular,
predictable pattern.
 The length of time from the first day of one period to the
first day of the next period normally ranges from 21-35
days.
The menstrual cycle is controlled by a complex orchestra of
hormones produced by two structures in the brain
 pituitary gland & hypothalamus
 along with the ovaries.
General overview of the menstrual cycle:
 The menstrual cycle includes several phases.
 The exact timing of the phases of the cycle is a little bit
different for every woman and can change over time.
The menstrual cycle has three phases:
1. Follicular Phase (Days 1-14)
 This phase of the menstrual cycle occurs from
approximately day 1-14.
 Day 1 is the first day of bright red bleeding, and the end of
this phase is marked by ovulation.
 While menstrual bleeding does happen in the early part of
this phase, the ovaries are simultaneously preparing to
ovulate again.
 The pituitary gland (located at the base of the brain)
releases a hormone called FSH – follicle stimulating
hormone.
 This hormone causes several ‘follicles’ to rise on the
surface of the ovary.
 These fluid filled “bumps” each contain an egg.
 Eventually, one of these follicle becomes dominant and
within it develops a single mature egg; the other follicles
shrink back.
 If more than one follicle reaches maturity, this can lead to
twins or more.
 The maturing follicle produces the hormone
estrogen=>which increases over the follicular phase and
peaks in the day or two prior to ovulation.
Ovulation
 is the release of an egg from your ovary, into your
fallopian tube.
 typically happens about 13–15 days before the start of
each period
 the timing of ovulation can vary cycle-to-cycle
The lining of the uterus (endometrium) becomes thicker and
more enriched with blood in the second part of this phase (after
menstruation is over)=>in response to increasing levels of
estrogen.
 High levels of estrogen=>stimulate the production of
gonadotropin-releasing hormone (GnRH)=> which in turn
stimulates the pituitary gland to secrete luteinizing
hormone (LH).
 On about day 12, surges in LH and FSH=> cause the egg
to be released from the follicle.
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
 The surge in LH also causes a brief surge in
testosterone=> which increases sex drive, right at the
most fertile time of the cycle.
2. Ovulatory Phase (Day 14)
 The release of the mature egg happens on about day 14
as a result of a surge in LH and FSH over the previous
day.
 After release, the egg enters the fallopian tube where
fertilization may take place, if sperm are present.
 If the egg is not fertilized, it disintegrates after about 24
hours.
 Once the egg is released the follicle seals over and this
is called the corpus luteum.
Corpus luteum
 is a mass of cells that forms in an ovary and is responsible
for the production of the hormone progesterone during
early pregnancy.
 The role of the corpus luteum depends on whether or not
fertilization occurs.
 plays an integral role in regulation of the menstrual cycle
and early pregnancy.
 forms from cells of the ovarian follicle wall during
ovulation.
3. Luteal Phase (Days 14-28)
 After the release of the egg=> levels of FSH and LH
decrease. The corpus luteum produces progesterone.
 If fertilization has occurred, the corpus luteum continues
to produce progesterone which prevents the endometrial
lining from being shed.
 If fertilization has not occurred, the corpus luteum
disintegrates, which causes progesterone levels to drop
and signals the endometrial lining to begin shedding.
What is normal bleeding?
 There is a range of normal bleeding – some women have
short, light periods and others have longer, heavy periods.
 Your period may also change over time
Menorrhagia
-is menstrual bleeding that lasts more than 7 days. -It can also
be bleeding that is very heavy.
Metrorrhagia
-Bleeding from the uterus between menstrual periods
Menometrorrhagia
-is actually a combination of two menstrual disorders:
Menorrhagia=> which is heavy uterine bleeding that occurs at
regular intervals.
Metrorrhagia=> which is irregular bleeding.
Normal menstrual bleeding has the following features:
-period lasts for 3-8 days
-period comes again every 21-35 days (measured from the first
day of one period to the first day of the next)
The total blood loss over the course of the period is around 2-3
tablespoons but secretions of other fluids can make it seem
more
Most women will lose less than 16 teaspoons of blood
(80ml) during their period
=average being around 6 to 8 teaspoons.
 Heavy menstrual bleeding is defined as losing 80ml or
more in each period, having periods that last longer than 7
days, or both.
 Beyond simple calendar tracking, there are a few ways to
figure out the timing of your own personal menstrual
cycle.
 Separately or used together, these can be used to help
determine when and whether you are ovulating.
Three methods used to help determine when and whether you
are ovulating.
 cervical mucus testing
 basal body temperature monitoring,
 ovulation prediction kits.
What is cervical mucus?
 The cells lining your cervical canal secrete mucus.
 The consistency of this mucus changes over your cycle.
 When you are fertile=> mucus changes to a consistency
and structure that permits the sperm’s travel on its way
towards the egg.
When you are most fertile it will be:
 clear
 abundant
 stretchy
To give you an idea of the consistency, this type of fertile
mucus is sometimes abbreviated as EWCM – egg-white
cervical mucus.
When you are not fertile the mucus is:
 sticky
 cloudy
 doesn’t stretch.
How do I test my cervical mucus?
Watching the changes in the amount and consistency of your
cervical mucus can help you understand your cycle.
How it works:
 check your secretions before and after urinating by wiping
with toilet paper. Alternatively you can insert a clean finger
into your vagina to obtain a sample of mucus.
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
 Observe (and record) the consistency of the mucus, and
use this chart to identify where you are in your cycle.
 Mucus can be cloudy, white, yellowish, or clear.
 It can have either a sticky or stretchy consistency.
 Use your thumb and forefinger to see if the mucus
stretches.
Basal Body Temperature
 Your basal body temperature is your lowest body
temperature when you are at rest.
 It is typically measured after several hours of sleep.
 As soon as you are up and about, your temperature
increases slightly.
How does the basal body temperature method of fertility
tracking work?
 This method takes a few months of daily tracking to
establish the specific patterns happening in your body.
 Your body temperature changes slightly in response to
hormonal changes related to ovulation.
Before you ovulate:
 body temperature is usually between 36.2°C and 36.5°C.
 The day after you ovulate, your temperature will increase
by at least 0.5°C (36.7°C to 37.1°C for example) and stay
at this temperature until menstruation.
 To use this method, measure and record your body
temperature as soon as you wake up, after at least 6
hours of sleep/rest.
 This means taking your temperature before you get out of
bed and before eating or drinking anything.
 Take your temperature at about the same time every day.
If you like to sleep in on the weekend you might have to
set an alarm!
 You will see the half-degree increase in temperature the
day after you ovulate.
 This method will help you determine if you are ovulating,
how regular your cycle is, and how long your cycle is.
 If your temperature doesn’t change over the course of
your cycle, and your periods are irregular=> it is possible
that you may not be ovulating.
 You may want to get in touch with your health care
provider
Ovulation Prediction Kits
 measure the concentration of the Luteinizing Hormone
(LH) in your urine.
 This hormone is always present in small amounts in your
urine but increases in the 24-48 hours before ovulation
occurs.
 More advanced kits also measure estradiol, a form of
estrogen that peaks on the day of ovulation.
Gestation
 is the period of time between conception and birth.
 During this time, the baby grows and develops inside the
mother's womb.
 means carrying, to carry or to bear.
 is the carrying of an embryo or foetus inside the female’s
womb in mammals and non- mammalian species.
 Gestation is 40 weeks long and is divided into three
trimesters.
Pregnancy
 is the process and series of changes that take place in a
woman’s body and tissues as a result of the developing
foetus.
 During a pregnancy, there can be one or more gestations
occurring simultaneously; for example in case of twins.
The first trimester
 includes conception and organogenesis.
The second trimester
 baby's organs become fully developed during the second
trimester. -baby can also start to hear and swallow.
 Small hairs become noticeable.
 Later on in the second trimester, the baby will begin to
move around.
The third trimester
 most weight gain as well as the final development of
organs and bodily systems.
STAGES OF GESTATION
Typical pregnancy lasts 40 weeks from the first day of your last
menstrual period (LMP) to the birth of the baby.
It is divided into three stages, called trimesters:
 first trimester
 second trimester
 third trimester
The fetus undergoes many changes throughout maturation.
Gestation period:
 Fetal development period from the time of conception until
birth.
 For humans, the full gestation period is normally 9
months.
 The word "gestation" comes from the Latin "gestare"
meaning "to carry or to bear."
HOW HUMAN BODY IS FORMED?
 Fertilization happens when a sperm meets and penetrates
an egg.
 Within about three days after conception=> the fertilized
egg is dividing very fast into many cells.
 It passes through the fallopian tube into the uterus=>
where it attaches to the uterine wall. The placenta, which
will nourish the baby, also starts to form.
Placenta
 is an organ that develops in your uterus during pregnancy.
 provides oxygen and nutrients to your growing baby and
removes waste products from your baby's blood.
 attaches to the wall of your uterus, and your baby's
umbilical cord arises from it.
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
Galactopoiesis
 is the maintenance of milk production.
 This stage requires prolactin and oxytocin

When your baby's mouth touches the nipple=> nerve cells will
send a signal to your brain=> causing the release of the
hormone oxytocin.

Oxytocin => causes tiny muscle cells within the breasts to

contract, squeezing milk from the milk-producing cells down the
WHAT HAPPEN DURING GESTATION? milk ducts toward small sacs or sinuses near the nipples
 Your uterus begins to support the growth of the placenta
and the fetus RECAP
 your body adds to its blood supply to carry oxygen and
nutrients to the developing baby, and your heart rate
increases.

These changes accompany many of the pregnancy symptoms

such as:
 Fatigue
 morning sickness TRIMESTERS
 headaches
 constipation.

A baby develops rapidly during the first trimester.

 The fetus begins to develop a brain and spinal cord, and
the organs begin to form.
 The baby's heart will also begin to beat during the first
trimester.(120-160 b/min.)
 By the end of the first trimester, the baby's sex organs
have formed.
 Human pregnancy begins with fertilization of an egg and
proceeds through the three trimesters of gestation.
 The second trimester continues the development of all of
the organs and systems.

The labor process has three stages :

 contractions,
 delivery of the fetus
 expulsion of the placenta

Pregnancy
 It all starts with sperm cells and an egg.
 If semen gets in the vagina, the sperm cells can swim up
through the cervix and uterus and into the fallopian tubes,
looking for an egg.
 They have up to 6 days to find an egg before they die.

 When a sperm cell joins with an egg=> it's called

fertilization
 A man may ejaculate 40 million to 150 million sperm,
which start swimming upstream toward the fallopian tubes
on their mission to fertilize an egg.
 Fast-swimming sperm can reach the egg in a half an hour,
while others may take days.
Lactation
 describes the secretion of milk from the mammary glands
and the period of time that a mother lactates to feed her
young.
 is the process by which milk is synthesized and secreted
from the mammary glands of the postpartum female
breast in response to an infant sucking at the nipple.
 The process occurs in all female mammals, although it
predates the origin of mammals.

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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
OBJECTIVE SIGNS
Chadwick sign
 is a bluish discoloration of the cervix, vagina, and labia
resulting from increased blood flow.
 It can be observed as early as 6 to 8 weeks after
conception, and its presence is an early sign of
pregnancy.
cervix
A cervical mucus plug (operculum)
 is a plug that fills and seals the cervical canal during
pregnancy.
 It is formed by a small amount of cervical mucus.
IMMUNOLOGICAL TESTS
 This hormone is only released by trophoblastic tissue
produced by a growing fetus and its associated placenta.
 HCG is present in the maternal circulation as eitther an
intact dimer, alpha or beta sub unit, and degraded form, or
beta core fragment
 Detection of HCG in maternal serum and urine is evident
only 8-10 days after conception
 hCG is detectable in the serum of approximately 5% of
patients 8 days after conception and in more than 98% of
patients by day 11
 Diagnostic levels in Urine seen only about 23-24 days
after conception
 Levels peak at 10-12 weeks’ gestation and then plateau
before falling
Blood tests for HCG
 Used only in special cases (bad obstetric history,
suspicion of ectopic, etc.)
 Require special labs and expertise
Currently, 4 main hCG assays are used,
1. Radioimmunoassay
2. Immunoradiometric assay
3. Enzyme-linked immunosorbent assay (ELISA)
4. fluoroimmunoassay
Ultrasound
 Intra decidual gestational sac is identified as early as
29-35 days of gestation
 Gestationaal sac & yolk sac - 5 menstrual weeks
 Fetal pole and cardiac activity - 6 weeks
 Embryonic movements - 7 weeks
 Doppler effect of US can pick heart rate reliably by 10th
week
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
Diagnosis in the second trimester (13-28 weeks)
Symptoms:
1. Amenorrhea
2. Morning sickness and urinary symptoms gradually
decrease
3. “quickening”: perception of fetal movements by the
pregnant woman:
a) 18-20 weeks in primigravida
b) 16-18 weeks in multipara
4. Abdominal enalrgement

Abdominal examination
Inspection:
 Linea nigra extending from symphysis pubis to
ensiform cartilage
 20th week
 STRIAE (both pink and white) visible in the lower
abdomen more towards the flanks

Palpation:
 Fundal height- increased with progressive
enlargement of the uterus

1. The uterus is abdominaly felt (ovoid). The uterus feels soft

and elastic
2. Braxton Hicks contractions; intermittent painless
contractions detected by abdominal examination.
3. Active fetal movements can be felt at intervals by placing
the hand over the uterus as early as 20th week
4. External ballottement: elicited at 20 week through
abdominal examination
5. Palpation of the fetal parts and palpation of fetal
movements by the obstetrician at 20 weeks.

Auscultation:
 Auscultation of FHS as early as 20-40 weeks by
Pinard stethoscope
 Auscultation of funic/fetal souffle => due to rush of
blood through the umblical artery
 Auscultation of uterine souffle (soft blowing and
systolic murmur heard low own at the sides of the I. Presumptive evidence of pregnancy
uterus) => synchronous with the maternal pulse Presumptive Symptoms
1. Nausea — with or without vomiting
Investagation: 2.Disturbance in Urination (Nocturia 8-10weeks AOG)
3.Faigue,Lassitude (first few weeks AOG)
4. Perception of fetal movements (quickening)
5. Breast tenderness and tingling sensation (Mastodynia-first
few weeks of AOG)

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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
B. Presumptive Signs
Presumptive Signs
1.Cessation of menstruation (Amennorhea)
2. Anatomical breast changes (glands of Montgomery
tubercle-6-8weeks AOG) 3. Changes in the vaginal mucosa
( chadwick’s sign -6-8weeks AOG)
4. Skin pigmentation changes (Chloasma)
5. Thermal signs
Montgomery's tubercles
-are sebaceous (oil) glands that appear as small bumps around
the dark area of the nipple. Studies have found between 30 and
50 percent of pregnant women notice Montgomery's tubercles.
-Their primary function is lubricating and keeping germs away
from the breasts.
-non pigmented nodules (12-20) around the areola in 2nd
month (enlarged sebaceous glands or rudimentary lactiferous
ducts).
Chadwick sign
-is a bluish discoloration of the cervix, vagina, and labia
resulting from increased blood flow. It can be observed as early
as 6 to 8 weeks after conception, and its presence is an early
sign of pregnancy.
Chloasma
-is a common skin condition among pregnant women.
-usually presents as dark, brownish patches of skin, mostly on
the forehead, nose, upper lip, and cheeks
II. Probable Evidence of Pregnancy
1. Enlargement of the abdomen (6weeks AOG
2. Changes in the size,shape,consistency of the uterus
(Hegar’s sign-6 to 8weeks AOG) 3. Anatomical changes in the
cervix (Goodell’s sign-6-8weeks AOG)
4. Braxton-Hicks contraction (early AOG & more perceivable
towards 28weeks AOG) 5. Ballotments (Bounced back-20th
weeks AOG)
6. Physical outlining of the fetus (doing Leopold’s maneuver)
7. Positive results of Endocrine test (hCG present 8-9days after
ovulation
HEGAR’S sign
-is a non-sensitive indication of pregnancy in women — its
absence does not exclude pregnancy.
It pertains to the features of the cervix and the uterine isthmus.
-demonstrated as a softening in the consistency of the uterus,
and the uterus and cervix seem to be two separate regions.
Goodell sign
-is an indication of pregnancy.
-It is a significant softening of the vaginal portion of the cervix
from increased vascularization.
This vascularization is a result of hypertrophy and
engorgement of the vessels below the growing uterus.
III. Positive Evidences of Pregnancy
1. Identification of fetal heart tones (120-160b/min) stethoscope
18weeks AOG doppler=as early as 10-12 weeks AOG
2. Perception of active fetal movement by examiner (doing
Leopold’s maneuver on 20weeks AOG)
3. Recognition of embryo or fetus by ultrasound or by x-ray
Pregnancy week by week
Pregnancy weeks are grouped into three trimesters, each one
with medical milestones for both you and the baby.
First trimester
 A baby grows rapidly during the first trimester (weeks 1 to
12). The fetus begins developing their brain, spinal cord,
and organs. The baby’s heart will also begin to beat.
 During the first trimester, the probability of a miscarriage
is relatively high. According to the American College of
Obstetricians and Gynecologists (ACOG), it’s estimated
that about 1 in 10 pregnancies end in miscarriage, and
that about 85 percent of these occur in the first trimester.
 Seek immediate help if you experience the symptoms of
miscarriage.
Second trimester
 During the second trimester of pregnancy (weeks 13 to
27), your healthcare provider will likely perform an
anatomy scan ultrasound.
 This test checks the fetus’s body for any developmental
abnormalities. The test results can also reveal the sex of
your baby, if you wish to find out before the baby is born.
 You’ll probably begin to feel your baby move, kick, and
punch inside of your uterus.
 After 23 weeks, a baby in utero is considered “viable.”
This means that it could survive living outside of your
womb.
 Babies born this early often have serious medical issues.
 Your baby has a much better chance of being born
healthy the longer you are able to carry the pregnancy.
Third trimester
 During the third trimester (weeks 28 to 40), your weight
gain will accelerate, and you may feel more tired.
 Your baby can now sense light as well as open and close
their eyes. Their bones are also formed.
 As labor approaches, you may feel pelvic discomfort, and
your feet may swell.
 Contractions that don’t lead to labor, known as
Braxton-Hicks contractions, may start to occur in the
weeks before you deliver.
 As pregnancy progresses, continue to produce increasing
amounts of discharge. The discharge will also tend to
become thicker and occur more frequently.
 It’s usually heaviest at the end of your pregnancy.
 During the final weeks of pregnancy, discharge may
contain streaks of thick mucus and blood.
 This is called “the bloody show.” It can be an early sign
of labor.
 You should let your doctor know if you have any bleeding.
Normal vaginal discharge, or leukorrhea
 is thin and either clear or milky white. It’s also
mild-smelling.
 If discharge is yellow, green, or gray with a strong,
unpleasant odor, it’s considered abnormal.
 Abnormal discharge can be a sign of an infection or a
problem with your pregnancy, especially if there’s redness,
itching, or vulvar swelling.
Pregnancy and urinary tract infections (UTIs)
Urinary tract infections (UTIs)
 are one of the most common complications women
experience during pregnancy.
 Bacteria can get inside a woman’s urethra, or urinary tract,
and can move up into the bladder.
 The fetus puts added pressure on the bladder, which can
cause the bacteria to be trapped, causing an infection.
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
Symptoms of a UTI usually include: Birth crowning
pain and burning or frequent urination.  which is when your baby's head starts to emerge bit by bit
during each contraction, occurs during the second stage
May also experience: of labor.
 cloudy or blood-tinged urine pelvic pain  (A contraction is when the uterine muscle tightens and
 lower back pain relaxes to help your baby pass from the uterus into the
 fever birth canal.)
 nausea and vomiting
Episiotomy
Danger signs to be observed during Pregnancy  also known as perineotomy, is a surgical incision of the
1.Vaginal bleeding perineum and the posterior vaginal wall generally done by
2.Persistent vomiting a midwife or obstetrician.
3.Chills and fever  is usually performed during second stage of labor to
4.Escape of fluid from vagina 5.Abdominal pain quickly enlarge the opening for the baby to pass through
6.Swelling of face & fingers 7.Blurring of vision 8.Continuous
headache 9.Dysuria Episiotomy
10.Marked changed on intensity of fetal movement a surgical cut made at the opening of the vagina during
childbirth, to aid a difficult delivery and prevent rupture of
Differential Diagnosis tissues.
 Uterine fibroid
 Cystic ovarian tumour (Amenorrhoea absent firm, hard,
positive sign absent, USG)
 Encyted tubercular peritonitis (H/O Koch’s infection,
swelling ill defined, positive signs absent, USG)
 Haematometra
 Distended urinary bladder (catheterisation solves the
problem)
 Pseudocyesis

Pseudocyesis
 is a condition in which the patient has all signs and
symptoms of pregnancy except for the confirmation of the Types of Episiotomy
presence of a fetus.
 The literature on delusions of pregnancy in schizophrenia
is however scanty.

Abdominal distension
 is the most common physical symptom of pseudocyesis
(63– 97% of women are found to experience this).
 The abdomen expands in the same manner as it does
during pregnancy, so that the affected woman looks
pregnant.
 This phenomenon is thought to be caused by buildup of
gas, fat, feces, or urine. Mediolateral episiotomy
incision can be performed on either side and is generally 3-4
Labor cm in length.
 Childbirth, the process of delivering a baby and the The anatomic structures involved in a mediolateral episiotomy
placenta, membranes, and umbilical cord from the uterus include:
to the vagina to the outside world. -vaginal epithelium
 During the first stage of labor (which is called dilation), the -transverse perineal muscle
cervix dilates fully to a diameter of about 10 cm (2 inches). -bulbocavernosus muscle
 Also known as parturition and childbirth -perineal skin.

The four stages of labor A deep or large mediolateral episiotomy may expose the
First stage of labor. ischiorectal fossa
 Thinning (effacement) and opening (dilation) of the cervix.
 During the first stage of labor, contractions help your
cervix to thin and begin to open.

Second stage of labor.

baby moves through the birth canal.

Third stage of labor

Afterbirth
Fourth stage of labor.
Recovery
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
Lithotomy position
 is often used during childbirth and surgery in the pelvic
area.
 The position is named for its connection with lithotomy, a
procedure to remove bladder stones.
Contraceptives method
There are different methods of contraception, including:
-long-acting reversible contraception, such as the implant or
intra uterine device (IUD)
-hormonal contraception, such the pill or the Depo Provera
injection.
-barrier methods, such as condoms.
-emergency contraception.
-fertility awareness.
Methods of emergency contraception are:
-copper-bearing intrauterine devices (IUDs) -emergency
contraceptive pills (ECPs).
A copper-bearing IUD is the most effective form of emergency
contrac
 You can get the Paragard IUD inserted or take ella up to 5
days (120 hours) after unprotected sex.
 (Plan B)=Take levonorgestrel morning-after pills work
best when you take them quickly after unprotected sex.
 They'll work best up to 3 days (72 hours) after unprotected
sex.
Surgical sterilization methods for birth control include:
-Tubal ligation ("tubes tided")
-Vasectomy.
Barrier birth control methods include:
 Diaphragms.
 Condoms.
 Cervical caps.
 Spermicides.
Diaphragm
 It covers your cervix during sex to prevent pregnancy.
 is a form of birth control that’s a shallow cup shaped like a
little saucer that's made of soft silicone.
Introduction
Menopause is the end of menstruation
The word menopause came from the Greek word mens
meaning "monthly" and pausis • meaning cessation.
Menopause is a part of a women's natural ageing process
when her ovaries produce lower level of the estrogen and
progesterone and when she no longer able to become
pregnant.
Definition
Menopause is the permanent cessation of menstruation at the
end of reproductive life due to loss of ovarian follicular activity.
Phases of menopause
The phases of menopause is usually broken into four
categories:
Pre-menopause:
The broad definition of pre-menopause is the time prior to
menopause. The occurrence of menopause before the age of
40 years.
Peri menopause:
A period of women's life characterized by the physiological
changes associated with the reproduction capacity and
terminating
end with of the completion of menopause also called
climacteric.
Menopausal phase:
It is the end of menstruation. The age of menopause ranges
between 45 - 55 years, average being 50 years.
Post-menopausal:
It is defined formally as the time after which a women has
experienced 12 consecutive
monta of amenorrhea without period.
Incidence
Physiologic menopause:
The normal decline in ovarian function due to ageing begins in
most women between ages 45 and 55 on average 51 and
result in infrequent ovulation, decreased menstrual function
and eventually cessation of menstruation
Pathologic menopause:
The gradual or abrupt cessation of menstruation before 40
years occur idiopathically in about 5% of women in USA.
Cause of menopause
Menopause occurs when the ovaries are totally depleted of
eggs and no amount of stimulation from the regulating
hormones can force them to work.
Physiological changes
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HUMAN ANATOMY & PHYSIOLOGY
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The lack of estrogen and progesterone causes many changes
in women's physiology that affect their health and well-being.
The symptoms of menopause due to changes in the
metabolism of the body.
Increased cholesterol level in the blood:
Hyperlipidemia or an increase in the level of cholesterol and
lipids in the blood is common. This lead to gradual rise in the
risk of hearth disease and
stroke after menopause
Osteoporosis:
Calcium loss from the bone is increased in the first five years
after the onset of menopause, resulting in a loss of bone
density. The calcium moves out of the bones, leaving them
weak and liable to fracture at the smallest stress
Digestive system:
Motor activity of the entire digestive tract is diminished after
menopause. The intestine tend to be sluggish resulting in
constipation
Urinary system:
As the estrogen level decreases after
menopause, the tissue lining the urethra and the bladder
become drier, thinner and less elastic. This can lead to
increased frequency of passing urine as well as an increased
tendency to develop UTI
CHANGES IN THE GENITAL ORGANS
Uterus: The uterus become small and fibrotic due to atrophy
of the muscles after the menopause. The cervix become
smaller and appears to flush with vagina. In older women the
cervix may be impossible to identify separately from vagina.
The vaginal and cervical discharge decreases in amount and
later disappear completely.
Ovaries: The ovaries become smaller and shriveled in
appearance. The ovaries which produce little androgen during
reproductive life begin to produce it in increasing amounts.
Vagina: The vaginal mucous membrane becomes thin and
loses its rugosity after the menopause. Decreased secretion
make vagina dry. Sexual intercourse become painful and
difficult due to pain from the dry vagina.
Vulva or external genital organs: The fat in the labia majora
and the Mons pubis decreases and pubic hair become spare.
Breast: In thin built women the breast become flat and
shriveled while in heavy built women they remain flabby and
pendulous.
CHANGES IN THE GENERAL APPEARANCE
Skin: The skin loses its elasticity and becomes thin and fine.
This is due to the loss of elastin and collagen from the skin
Weight: weight increase is more likely to be the result of
irregular food habit due to mood swing. There is more
deposition of fat around hips, waist and buttocks.
Hair: Hair become dry and coarse after menopause. There
may hair loss due to the decreasing level of estrogen.
Voice: Voice become deeper due to thickening of vocal cords
CHANGES IN THE VASOMOTOR SYSTEM
Hot flashes: Hot flashes are incidents where the women in
menopause gets a sudden feeling of warmth and flushing that
starts in the face and quickly spread all over the neck and
upper body. This hot flashes' can occur at any time of the day
or night. They vary in number from 1 in every one hour to as
one in every 15 mints. The hot flashes are often associated
with profuse sweating.
Night sweat: Night sweat are closely related to hot flashes.
Both usually occur simultaneously. Sweat can occur any time
of the day or night, they are more common at night The sweat
can be severe enough to wake up the women from a sound
sleep and may make it difficult for her to go back to sleep. The
sudden waking up from sleep can cause palpitation and
sometimes panic attacks.
PSYCHOLOGICAL CHANGES
 The psychological changes are mainly manifested by
frequent headache, irritability, fatigue, depression and
insomnia. Although these are often said to be due to
changes in the hormonal levels, they are more likely to be
related to the loss of sleep due to night sweat.
 Diminished interest in sex may be due to emotional upset
or may be secondary to painful intercourse due to a dry
vagina.
SOCIAL CHANGES DURING MENOPAUSE
The feeling that a women holds about herself and her social
relationship as well as the symptoms she experiences can be
defined by the culture in which she live. Women vary in there
subjective experiences of symptoms. Not all of the women's
perceive changes in the body are reflected in the mirror; some
are derived from women's perception of herself based on the
account of other expectation vary and are adjusted to actual
experience.
TREATMENTS
 NON-HORMONAL TREATEMENT
 There are variety of menopausal treatments both natural
and medical that can alleviate the symptom of
menopause:
 Dressing in light layers can alleviate hot flashes and night
sweats; avoiding caffeine, alcohol and spicy foods can
also minimize these symptoms.
 Menopause and weight gain tend to go together due to life
style changes than to the hormonal changes. Reducing
dietary fat intake and regular exercise help to combat
weight gain during menopause.
 Menopause can lead to osteoporosis Calcium,
magnesium and vitamin D can help restore bone density,
which naturally deteriorates after age 30 due to reduced
estrogen level.
 Menopause decreases vaginal elasticity, leading to
vaginal dryness. Vitamin E can help as can kegal
exercises which help restore elasticity. Using water based
lubricants during sexual intercourse minimizes discomfort
related to vaginal dryness.
 Menopause often lead to dry, itchy skin, and weak thin
hair that breaks and that has lots of split ends . Flax seed
oil(found in poultry, dairy, red meat and whole grains) can
help restore hair and skin's healthy appearance , as can
vitamin E.
HORMONE REPLACEMENT THERAPY
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HUMAN ANATOMY & PHYSIOLOGY
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Hormone Replacement Therapy(HRT) is indicated in
menopausal women to overcome the short-term and long-term
consequences of estrogen deficiency.HRT can be
administered orally( in pill form), vaginally( as a cream),or
transdermally (in patch form) because it replaces female
hormones produced by the ovaries, hormone replacement
therapy minimize menopause symptoms. It can be used before,
during and after menopause.
INDICATION OF HRT
1. Relief of menopausal symptoms
2. Prevention of osteoporosis
3. To maintain the quality of life in menopausal years.
Special group of women to whom HRT should be
prescribed.
1. Premature ovarian failure
2. Gonadal dysgenesis
3. Surgical or radiation menopause
TYPES OF HRT
Estrogen and progesterone: The most common type of HRT
involves both estrogen and progesterone. More than 8 million
women are currently taking combination HRT and it is designed
specifically for women who have a uterus. During this therapy,
estrogen is given regularly while progesterone is added in on a
supplementary basis These two hormones are given in
combination in order to prevent the overgrowth of uterine
lining . Estrogen alone may irritate this lining which could lead
to endometrial cancer.
Estrogen only: Estrogen therapy alone is usually given to
women who have ost their uterus due to surgical menopause .
Because no uterus is present the need for progesterone is not
as great.
Progestin only: Progestin-only therapy is not prescribed very
often. Progestin does seem to provide excellent relief for
women plagued with hot flashes.
AVAILABLE PREPARATIONS FOR HRT
 The principle hormone used in HRT is estrogen. This is
ideal for a women who had her uterus removed already.
But, a women with intact uterus, only estrogen therapy
leads to endometrial hyperplasia and even endometrial
carcinoma. Addition of progestin for last 12-14 days each
month can prevent this problem.
 Commonly used estrogen are conjugated estrogen
(0.625-1.25mg/day). Progestin used are
medroxyprogesterone (100-300 mg/day).Considering the
risks, hormonal therapy should be used with the lowest
effective dose and for a short period of time. Low dose of
oral conjugated estrogen 0.3 mg daily is effective and has
got minimal side effects.
Oral estrogen regime
-estrogen conjugated equine estrogen 0.3 mg or 0.625 mg is
given daily for woman who had hysterectomy.
estrogen and cyclic progestin
-For a women with uterus estrogen is given continuously for 25
days and progestin is added for last 12 - 14 days.
Continuous estrogen and progestin therapy
-Continued combined therapy can prevent endometrial
hyperplasia.
Sub dermal implants
-Implants are inserted subcutaneously over the anterior
abdominal wall using local anaesthesia.17ß ostradiol implants
25 mg, 50 mg or 100 mg are available and can be kept for 6
month.
Percutaneous estrogen gel
-1 gm applicator of gel delivering 1 mg of estradiol daily is to be
applied onto the skin over the anterior abdominal wall or thigh.
Effective blood level of ostradiol (90-120 pg/ml) can be
maintained
Transdermal patch
-It contains 3.2 mg of 17ß estradiol releasing about 50ug of
oestradiol in 24 hrs.It should be applied below the waist line
and changed twice a week.
Vaginal cream
-Conjugated equine vaginal estrogen cream 1.25 mg daily is
very effective specially when associated with atrophie vaginitis
Women with symptoms of urogenital atrophy and urinary
symptoms and do not like to have systemic HRT, are suitable
for such treatment.
Progestin
-Patient with history of breast carcinoma or endometrial
carcinoma, progestin may be used It may be effective in
suppressing hot flushes and prevent osteoporosis. Medroxy
progesterone acetate 2.5 -5 mg/day can be used.
Tibolone
-Tibolone is a steroid having weakly oestrogenic progestogenic
and androgenic properties. It prevents osteoporosis, atrophic
changes of vagina and hot flashes. It increases libido. A dose
of 2.5 mg per day is given.
DURATION OF HRT
Generally, use of HRT for a short period of 3-5 years have
been devised. Reduction of dosage should be done as soon as
possible.
RISKS OF HRT
1. Endometrial cancer: when estrogen is given alone to a
women with intact uterus, causes endometrial
proliferation, hyperplasia and carcinoma.
2. Breast cancer: combined estrogen and progestin
replacement therapy , increases the risk of breast cancer
slightly
3. Venous thromboembolic disease (VTE): It has been
found to be increased with the use of combined oral
estrogen and progestin.
4. Lipid metabolism: An increased incidence of gallbladder
disease has been observed following ERT due to rise in
cholesterol (in bile).
5. Dementia, Alzheimer disease are increased.
DISADVANTAGES OF HRT
Estrogen and progesterone over a long periods is known to
stimulate cell division, and this seem to increase the risk for
breast cancer by upto 9%. HRT also appears to increase your
risk of heart disease by 24% . Women taking HRT to reduce
the risk of Alzheimer's disease actually increased their risk by
small percentage. In order to prevent increasing your risk of
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
certain disease suggested that you use HRT for not more than
5 years.
SURGICAL MENOPAUSE
Surgical menopause is a type of induced menopause in which
both ovaries are surgically removed. Surgical menopause can
occur at any age before natural menopause occurs. The
symptoms of surgical menopause generally more intense than
when menopause occurs naturally. Induced menopause due to
abrupt cutoff ovarian hormones, causes the sudden onset of
hot flashes and other menopausal symptoms such as dry
vagina and a decline in sex drive
-Hormonal therapy may be used to treat the symptoms of
induced menopause. It stops or reduce the short-term changes
of menopause such as hot flashes, disturbed sleep and vaginal
dryness
What is amenorrhea?
 is the absence of menstruation — one or more missed
menstrual periods.
 Women who have missed at least three menstrual periods
in a row have amenorrhea, as do girls who haven't begun
menstruation by age 15
 Amenorrhea is when menstruation is absent during the
reproductive years, between puberty and menopause
Causes and risk factors for amenorrhea include:
 Obesity.
 Having very low body fat (less than 15 to 17 percent body
fat)
 Deficiency of leptin, a hormone that regulates appetite.
 Polycystic ovarian syndrome (PCOS)
 Overactive thyroid gland.
 Extreme emotional stress.
 Excessive exercise.
Types of amenorrhea
The most common cause of amenorrhea is pregnancy.
 Primary amenorrhea means you never start your periods.
Primary amenhorrea is when periods do not start during
puberty.
 Secondary amenorrhea means you have had periods,
and then they stop, especially for more than 3 months.
This is when periods start, but then they cease to occur
Possible causes include:
-pregnancy
-hormonal changes
-losing or gaining a lot of weight quickly.
A common cause of primary amenorrhea => a family history of
delayed menstruation.
However, sometimes there is a genetic problem.
Genetic conditions that can stop the ovaries from working
properly include:
 Turner syndrome
 androgen insensitivity syndrome, which leads to high
levels of testosterone
 Müllerian defects
Müllerian defect
 is a malformation of the reproductive organs.
 The uterus and fallopian tubes do not form as they should.
 There may be a structural problem relating to the genitals
that is present from birth. Occasionally, the uterus and
fallopian tubes may be missing. Sometimes, there are
problems of fusion, in which the tubes do not come
together correctly.
Müllerian agenesis, or Mayer-Rokitansky-KusterHauser
(MRKH) syndrome
-the ovaries, breasts, and clitoris form correctly, but there is no
vaginal opening, and the cervix and uterus may not be properly
formed
Secondary amenorrhea
Menstruation may stop for a number of reasons.
These include:
-a gynecological disorder
-serious illness
-physical stress
-having a very low body mass index (BMI)
When BMI falls below 19, the risk of developing secondary
amenorrhea increases significantly.
-Weight loss, exercise, and stress
-Serious weight loss can result from a physical illness or an
eating disorder.
-Stringent exercise can cause secondary amenorrhea. It is
common among competitive long- distance runners and
professional ballet dancers.
-Severe emotional upheaval or extreme stress can also cause
a woman's periods to stop
Medications
Some medications, such as progesterone-only contraceptives
and a number of psychiatric drugs may cause periods to stop.
Other medications that affect menstruation include:
-antipsychotics
-cancer chemotherapy
-antidepressants
-blood pressure drugs
-allergy medications
Long-term health conditions
Amenorrhea can also result from a long-term illness, such
as:
-polycystic ovary syndrome (PCOS)
-premature ovarian failure
-thalamic pituitary problems
Pituitary problems or an underactive thyroid =>can lead to
a hormone imbalance, and this can result in menstrual
problems.
These could be due to:
-a benign or cancerous tumor in the pituitary gland
-an over- or under-active thyroid gland
Hormonal birth control can also contribute to secondary
amenorrhea.
 Depo-Provera, a hormonal birth control shot, and
hormonal birth control pills, may cause you to miss
menstrual periods.
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
 Certain medical treatments and medications, such as  will nourish the embryo, then the fetus, for the remainder
chemotherapy and antipsychotic drugs, can also trigger of its stay in the uterus.
amenorrhea  The embryo has developed a head and a trunk.
 Amenorrhea for several months may be a sign of a  Structures that will become arms and legs, called limb
disease or chronic condition that can contribute to buds, begin to appear.
infertility  A blood vessel forms which will later develop into the
heart and circulatory system.
 Genetic or inborn conditions =>are the most common
causes of primary amenorrhea.
 Amenorrhea may result from disorders of the ovaries,
pituitary gland, hypothalamus, or uterus.
 Intensive exercising, extreme weight loss, physical illness,
and stress can all result in amenorrhea.

Secondary amenorrhea can occur due to natural changes

in the body.
For example:
the most common cause of secondary amenorrhea is
pregnancy. Breastfeeding and menopause are also common,
but natural, causes

Initial workup of primary and secondary amenorrhea

includes :
-pregnancy test
-serum levels of luteinizing hormone
-follicle-stimulating hormone
-prolactin
-thyroid-stimulating hormone.

Patients with hypothalamic amenorrhea should be evaluated

for eating disorders and are at risk for decreased bone density.

COMMON DRUGS FOR REPRODUCTIVE DISORDERS

Some of the more commonly used hormones include:
-gonadotropin-releasing hormone
-follicle-stimulating hormone
-human chorionic gonadotropin
-equine chorionic gonadotropin
-estradiol compounds
-progesterone
-synthetic progestins
-testosterone
-prostaglandins

Organ system development

 Just four weeks after conception, the neural tube along
your baby's back is closing.
 The baby's brain and spinal cord will develop from the
neural tube.
 The heart and other organs also are starting to form.
 Structures necessary to the development of the eyes and
ears develop.

3 stages of fetal development

There are three stages of prenatal development:
-germinal
-embryonic
-fetal.

Prenatal development is also organized into trimesters:

-the first trimester ends with the end of the embryonic stage,
-the second trimester ends at week 20
-third trimester ends at birth.

placenta

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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
Basic functions of the respiratory system are:
1. provides oxygen to the blood stream and removes carbon
dioxide
2. enables sound production or vocalization as expired air
passes over the vocal chords
3. enables protective and reflexive non-breathing air
movements such as coughing and sneezing, to keep the air
passages clear
4. control of Acid-Base balance
5. control of blood pH
Respiratory acidosis
 is a condition that occurs when the lungs can’t remove
enough of the carbon dioxide (CO2) produced by the
body.
 Excess CO2 causes the pH of blood and other bodily
fluids to decrease, making them too acidic.
 Normally, the body is able to balance the ions that control
acidity. This balance is measured on a pH scale from 0 to
14.
 Acidosis occurs when the pH of the blood falls below 7.35
(normal blood pH is between 7.35 and 7.45).
Respiratory alkalosis
-is a disturbance in acid and base balance due to alveolar
hyperventilation.
 Alveolar hyperventilation=> leads to a decreased partial
pressure of arterial carbon dioxide (PaCO2).
 In turn, the decrease in PaCO2 increases the ratio of
bicarbonate concentration to PaCO2 and=> thereby
increases the pH level; thus the descriptive term
Respiratory Alkalosis.
 The decrease in PaCO2 (hypocapnia) develops when a
strong respiratory stimulus causes the respiratory system
to remove more carbon dioxide than is produced
metabolically in the tissues.
Respiration Process
A collective term for the following processes:
Pulmonary Ventilation
 Movement of air into the lungs (inspiration)
 Movement of air out of the lungs (expiration)
External Respiration
 Movement of oxygen from the lungs to the blood
 Movement of carbon dioxide from the blood to the lungs
Transport of Respiratory Gases
 Transport of oxygen from the lungs to the tissues
 Transport of carbon dioxide from the tissues to the lungs
Internal Respiration
 Movement of oxygen from blood to the tissue cells
 Movement of carbon dioxide from tissue cells to blood
Pulmonary Ventilation
 The intercostal muscles and the diaphragm work together
 Inspiration, or inhalation – a very active process that
requires input of energy
 Air flows into the lungs when the thoracic pressure falls
below atmospheric pressure.
 The diaphragm moves downward and flattens while the
intercostal muscles contract.
 Expiration, or exhalation – a passive process that takes
advantage of the recoil properties of elastic fibers Air is
forced out of the lungs when the thoracic pressure rises
above atmospheric pressure.
 The diaphragm and expiratory muscles relax.
Diaphragm
 The most important muscle of inspiration is the diaphragm;
however, the external intercostals assist with normal quiet
breathing.
 Contraction of the diaphragm increases the space in the
thoracic cavity and the lungs fill with air from the external
environment

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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
Patterns of Breathing
 Apnea– temporary cessation of breathing (one or more
skipped breaths)
 Dyspnea– labored, gasping breathing; shortness of
breath
 Eupnea– normal, relaxed, quiet breathing
 Hyperpnea– increased rate and depth of breathing in
response to exercise, pain, or other conditions
 Hyperventilation– increased pulmonary ventilation in
excess of metabolic demand
 Hypoventilation– reduced pulmonary ventilation
 Orthopnea– Dyspnea that occurs when a person is lying
down
 Respiratory arrest– permanent cessation of breathing
 Tachypnea– accelerated respiration
 Pulmonary Ventilation– Volumes
Measures of Pulmonary Ventilation
 Respiratory volumes– values determined by using a
spirometer
 Tidal Volume (TV)– amount of air inhaled or exhaled with
each breath under resting conditions
 Inspiratory Reserve Volume (IRV)– amount of air that can
be inhaled during forced breathing in addition to resting
tidal volume
 Expiratory Reserve Volume (ERV)– amount of air that can
be exhaled during forced breathing in addition to tidal
volume
 Residual Volume (RV)– Amount of air remaining in the
lungs after a forced exhalation.
Spirometer
-is an apparatus for measuring the volume of air inspired and
expired by the lungs.
-measures ventilation, the movement of air into and out of the
lungs.
 The spirogram will identify two different types of abnormal
ventilation patterns, obstructive and restrictive.
 There are various types of spirometers which use a
number of different methods for measurement (pressure
transducers, ultrasonic, water gauge).
Reasons for testing
-Diagnose certain types of lung disease (such as asthma,
bronchitis, and emphysema)
-Find the cause of shortness of breath
-Measure whether exposure to chemicals at work affects lung
function
-Check lung function before someone has surgery
-Assess the effect of medication
-Measure progress in disease treatment
Formulas – Capacities
Vital Capacity
– maximum amount of air that can be expired after taking the
deepest breath possible (VC = TV + IRV + ERV)
Inspiratory Capacity
–maximum volume of air that can be inhaled following
exhalation of resting tidal volume (IC = TV + IRV)
Functional Residual Capacity
–volume of air remaining in the lungs following exhalation of
resting volume (FRC = ERV + RV)
Total Lung Capacity
–total volume of air that the lungs can hold (TLC = VC + RV)
Residual volume (RV) is the volume remaining in the lung after
a maximal voluntary
expiration
Control of Respiratory System
 Respiratory control centers – found in the pons and the
medulla oblongata
 Control breathing
 Adjusts the rate and depth of breathing according to
oxygen and carbon dioxide levels
 Afferent connections to the brainstem
 Hypothalmus and limbic system send signals to
respiratory control centers
Gas Exchange and Transport
 Alveolar Gas Exchange – the loading of oxygen and the
unloading of carbon dioxide in the lungs
 Oxygen is carried in the blood bound to hemoglobin
(98.5%) and dissolved in plasma (1.5%)
Carbon dioxide is transported in three forms
 Carbonic acid– 90% of carbon dioxide reacts with water
to form carbonic acid
 Carboamino compounds– 5% binds to plasma proteins
and hemoglobin
 Dissolved ga – 5% carried in the blood as dissolved gas
Systemic Gas Exchange
 Carbon dioxide loading -The Haldane Effect – the lower
the partial pressure of oxygen and saturation of it in
hemoglobin=> the more carbon dioxide can be carried in
the blood
 Oxygen unloading from hemoglobin molecules
Effects of Exercise on Respiratory System
 During exercise=> the muscle cells use up more oxygen
and produce increased amounts of carbon dioxide.
 The lungs and heart have to work harder to supply the
extra oxygen and remove the carbon dioxide.
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
 Your breathing rate increases and you breathe more
deeply.
Heart rate also increases in order to transport the oxygenated
blood to the muscles.
-is a condition in which the smooth muscles of the bronchus
contracts.
-muscle contraction causes the bronchus to narrow and restrict
the amount of air passing into and out of your lungs.

 Muscle cell respiration increases- more oxygen is used Bronchoconstriction usually occurs in:
up and levels of carbon dioxide rise. -asthma
 The brain detects increasing levels of carbon dioxide- -emphysema
a signal is sent to the lungs to increase breathing. -other lung diseases
 Breathing rate and the volume of air in each breath
increase- This means that more gaseous exchange takes ASTHMA
place. Pathophysiology:
 The brain also tells the heart to beat faster so that more -involves airway inflammation,
blood is pumped to the lungs for gaseous exchange. -intermittent airflow obstruction
 More oxygenated blood is gets to the muscles and more -bronchial hyperresponsiveness
carbon dioxide is removed
Antigen presentation by the dendritic cell with the lymphocyte
Disorders of the Respiratory System and cytokine response leading to airway inflammation and
Clinical Disorders and Diseases of the Respiratory System asthma symptoms.
 Hypoxia – deficiency of oxygen in a tissue or the inability
to use oxygen is a common pulmonary condition defined by:
 Oxygen Toxicity – excess oxygen, causing the build up of -chronic inflammation of respiratory tubes
peroxides and free radicals -tightening of respiratory smooth muscle
 Chronic obstructive pulmonary diseases – long-term -episodes of bronchoconstriction.
obstruction of airflow and a substantial reduction in =means ‘laboured breathing’ in Greek
pulmonary ventilation
 Chronic bronchitis – cilia are immobilized and reduced in The most common reasons for death are thought to be:
number; goblet cells increase their production of mucus -inadequate assessment of the severity of airway obstruction
→ mucus clogs the airways and breeds infection by the patient and/or clinician
 Emphysema – alveolar walls break down and the surface -inadequate therapy with inhaled or oral steroids
area of the lungs is reduced Factors to increase the incidence of this debilitating problem:
 Asthma – allergens trigger the release of histamine and -Air pollution resulting from industrial sources
other inflammatory chemicals that cause intense -smoking
bronchoconstriction -dietary
 Lung Cancer – cancer of the lung -other factors
 Acute Rhinitis – the common cold
 Laryngitis – inflammation of the vocal folds The two main causes of asthma symptoms:
 Pneumonia – lower respiratory infection that causes fluid 1.airway hyperresponsiveness
build up in the lungs 2.bronchoconstriction
 Sleep Apnea – Cessation of breathing for 10 seconds or
longer during sleep Hyperresponsiveness
 Tuberculosis – pulmonary infection with Mycobacterium -is an increased tendency of the airway to react to stimuli or
tuberculosis; reduces lung compliance triggers to cause an asthma attack.

Bronchodilation Bronchoconstriction
An expansion of the air passages through the bronchi of the -is a narrowing of the airways that causes airflow obstruction.
lungs.
Examples of asthma triggers
Allergens:
-Pollens, moulds, house dust mite, animals (dander, saliva and
urine)

Industrial chemicals:
Manufacture of:
-isocyanate-containing paints
-epoxy resins
-aluminium
-hair sprays
-penicillins
-cimetidine
Bronchoconstriction
Drugs:
-is the constriction of the airways in the lungs due to the
-Aspirin
tightening of surrounding smooth
-ibuprofen
muscle with consequent coughing, wheezing, and shortness
-prostaglandin synthetase inhibitors,
of breath.
-β-adrenoceptor blockers.
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HUMAN ANATOMY & PHYSIOLOGY
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Foods: PNEUMONIA
A rare cause but examples include:
-nuts
-fish
-seafood
-dairy products
-food colouring, especially tartrazine, benzoic acid and sodium
metabisulfite

Environmental pollutants:
-Traffic fumes
-cigarette smoke
-sulphur dioxide
Lung consolidation
Other industrial triggers: -occurs when the air that usually fills the small airways in your
-Wood or grain dust, colophony in solder, cotton, dust, grain lungs is replaced with something else.
weevils -Depending on the cause, the air may be replaced with: a fluid,
such as pus, blood, or water. a solid, such as stomach contents
Miscellaneous: or cells.
-Cold air, exercise, hyperventilation, viral respiratory tract
infections, emotion or stress, swimming pool chlorine

 Pollen from grass (prevalent in June and July) can lead to

seasonal asthma.
 The role of occupation in the development of asthma has
become apparent with increased industrialization

Drug induced asthma can be severe and the most common

causes are;
-beta-blocker drugs
-prostaglandin synthetase inhibitors

Aspirin and related non-steroidal anti-inflammatory drugs can

cause severe bronchoconstriction in susceptible individuals

COPD (Chronic obstructive pulmonary disease)

-characterised by poorly reversible airflow obstruction and an
abnormal inflammatory response in the lungs.
-abnormal inflammatory response represents the innate and
adaptive immune responses to long term exposure to noxious
particles and gases, particularly cigarette smoke

Long-term exposure to lung irritants that damage the lungs and

the airways usually is the cause of COPD.
-most common irritant that causes COPD is cigarette smoke.
-Pipe, cigar, and other types of tobacco smoke also can cause
COPD, especially if the smoke is inhaled.

COPD often progresses slowly over several years, but

complications may develop at any time.
These complications can be severe and even
life-threatening.
-shortness of breath.
-cough.
-chest pain
-fatigue
-fever

Spirometry:
If you are at risk for COPD or have symptoms of COPD, you
should be tested
-is a simple test of how well your lungs work.
-test can show how well your lungs are able to move oxygen
into your blood and remove carbon dioxide from your blood.

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HUMAN ANATOMY & PHYSIOLOGY
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Endocrine glands
-are ductless glands of the endocrine system that secrete
hormones directly into the blood.

The major glands of the endocrine system include:

-pineal gland
-pituitary gland
-Pancreas
-Ovaries
-testes
-thyroid gland
-parathyroid gland
-hypothalamus
-adrenal glands

Pineal gland
 is a small, pea-shaped gland in the brain.
 also called conarium, or epiphysis cerebri
-is a small endocrine gland in the brain of most
vertebrates
-produces melatonin, a serotonin-derived hormone which
modulates sleep patterns in both circadian and seasonal
cycles.

Pharmacological Treatment of Respiratory Disorders Its function:

Bronchodilators. =>These are the most frequently used inhaled
medications.
 Corticosteroids.
 Mast Cell Stabilizers and Anti-IgE Antibodies.
 Leukotriene Receptor Antagonists.
 Antihistamines and Epinephrine.
 Pulmonary Surfactants.
 Antimicrobials and Antivirals.
ENDOCRINE SYSTEM
-produces and regulates some hormones, including
melatonin=> a serotonin-derived hormone which modulates
sleep patterns
Melatonin
-is a hormone that regulates the sleep–wake cycle.
-is best known for the role it plays in regulating sleep patterns.
 It is primarily released by the pineal gland.
 As a supplement, it is often used for the short-term
treatment of trouble sleeping such as from jet lag or shift
work.
 Other names: N-acetyl-5-methoxy tryptamine

Benefits of taking Melatonin

-is also a powerful antioxidant
-provide a variety of other benefits:
 help support eye health
 treat stomach ulcers and heartburn
 ease tinnitus symptoms
 raise growth hormone levels in men.
 is the collection of glands that produce hormones that
regulate: What foods contain melatonin?
-metabolism There are a few excellent sources of naturally occuring
-growth and development melatonin in foods:
-tissue function
-sexual function Fruits and vegetables (tart cherries, corn, asparagus, tomatoes,
-reproduction pomegranate, olives, grapes, broccoli, cucumber)
-sleep
-mood, among other things Grains (rice, barley, rolled oats)
 is a chemical messenger system comprising feedback
loops of the hormones released by internal glands of an Nuts and Seeds (walnuts, peanuts, sunflower seeds, mustard
organism directly into the circulatory system regulating seeds, flaxseed)
distant target organs.
Serotonin
In humans, the major endocrine glands are: -is an important chemical and neurotransmitter in the human
-thyroid gland body.
-adrenal glands -believed to help regulate:
 mood and social behavior
 appetite and digestion
 sleep
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
 memory
 sexual desire and function
-There may be a link between serotonin and depression.

How does serotonin work in the brain?

-As a neurotransmitter serotonin helps to relay messages
from one area of the brain to another.
-This includes brain cells related to mood, sexual desire and
function, appetite, sleep, memory and learning, temperature
regulation, and some social behavior.
Pituitary gland
-is a part of your endocrine system.

Main function:
-secrete hormones into your bloodstream
often dubbed the “master gland” because its hormones control
other parts of the endocrine system, namely the thyroid gland,
adrenal glands, ovaries, and testes.

Through secretion of its hormones, the pituitary gland controls:

-Metabolism
-Growth
-sexual maturation
-Reproduction
-blood pressure and many other vital physical functions and
processes

Hormones produced by the pituitary gland:

-Adrenocorticotrophic hormone (ACTH)
-Thyroid-stimulating hormone (TSH)
-Luteinising hormone (LH)
-Follicle-stimulating hormone (FSH)
-Prolactin (PRL)
-Growth hormone (GH)
-Melanocyte-stimulating hormone (MSH)
-oxytocin
-vasopressin

Adrenocorticotropic hormone (ACTH)

-is a hormone produced in the anterior, or front, pituitary gland
in the brain.

Function of ACTH -is to regulate levels of the steroid hormone

cortisol, which released from the adrenal gland.
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
Thyroid-stimulating hormone
-(also known as thyrotropin, thyrotropic hormone, or
abbreviated TSH)
-is a pituitary hormone that stimulates the thyroid gland to
produce thyroxine (T4), and then triiodothyronine
(T3)=> which stimulates the metabolism of almost every
tissue in the body.
The normal range of TSH levels is 0.4 to 4.0 milli-international
units per liter.
 If you're already being treated for a thyroid disorder, the
normal range is 0.5 to 3.0 milli- international units per liter.
 A value above the normal range usually indicates that the
thyroid is underactive indicates hypothyroidism.
Low TSH levels indicate hyperthyroidism.
-also known as an overactive thyroid.
-If the thyroid gland is secreting levels of hormones that are too
high=>the pituitary gland produces less TSH.
Symptoms of hyperthyroidism include:
-irregular or rapid heartbeat
Thyroid makes hormones that regulate the way body uses
energy.
It also plays an important role in regulating:
-weight
-body temperature
-muscle strength
-mood.
TSH is made in a gland in the brain called the pituitary.
What foods are bad for thyroid?
it's a good idea to limit your intake of:
-Brussels sprouts
-cabbage
-cauliflower
-kale
-Turnips
-bok choy
=because research suggests digesting these vegetables may
block the thyroid's ability to utilize iodine=> which is essential
for normal thyroid function.
Luteinizing hormone
 (LH, also known as lutropin and sometimes lutrophin) is a
hormone produced by gonadotropic cells in the anterior
pituitary gland.
 In females, an acute rise of LH ("LH surge") triggers
ovulation and development of the corpus luteum.
 is produced and released in the anterior pituitary gland.
 considered a gonadotrophic hormone because of its role
in controlling the function of ovaries in females and testes
in males, which are known as the gonads.
 Luteinizing hormone, like follicle stimulating hormone, is a
gonadotrophic hormone produced and released by cells in
the anterior pituitary gland.
 It is crucial in regulating the function of the testes in men
and ovaries in women.
 In men, luteinising hormone stimulates Leydig cells in the
testes =>to produce testosterone, which acts locally to
support sperm production.
 In women, luteinising hormone carries out different roles
in the two halves of the menstrual cycle.
 In weeks one to two of the cycle, luteinising hormone is
required to stimulate the ovarian follicles in the ovary to
produce the female sex hormone, oestradiol.
 Around day 14 of the cycle, a surge in luteinising hormone
levels causes the ovarian follicle to tear and release a
mature oocyte (egg) from the ovary, a process called
ovulation.
 For the remainder of the cycle (weeks three to four) the
remnants of the ovarian follicle form a corpus luteum.
 Luteinising hormone =>stimulates the corpus luteum to
produce progesterone =>which is required to support the
early stages of pregnancy, if fertilization occurs.
Testosterone
also exerts effects all around the body to generate male
characteristics such as:
-increased muscle mass
-enlargement of the larynx to generate a deep voice
-growth of facial and body hair.
 The secretion of luteinising hormone from the anterior
pituitary gland is regulated through a system called the
hypothalamic-pituitary-gonadal axis.
 Gonadotrophin-releasing hormone is released from the
hypothalamus =>binds to receptors in the anterior
pituitary gland =>to stimulate both the synthesis and
release of luteinising hormone (and follicle stimulating
hormone).
 The released luteinising hormone=> is carried in the
bloodstream where it binds to
 receptors in the testes and ovaries=> to regulate their
hormone secretions and the production of sperm or eggs.
Follicle stimulating hormone
 -is one of the hormones essential to pubertal development
and the function of women's ovaries and men's testes.
 In women, this hormone stimulates the growth of
ovarian follicles in the ovary before the release of an egg
from one follicle at ovulation.
 It also increases oestradiol production
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HUMAN ANATOMY & PHYSIOLOGY
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What is a normal FSH level?

 Before puberty - 0 to 4.0 mIU/mL (0 to 4.0 IU/L)
 During puberty - 0.3 to 10.0 mIU/mL (0.3 to 10.0 IU/L)
 Women who are still menstruating - 4.7 to 21.5 mIU/mL
(4.5 to 21.5 IU/L)
 After menopause - 25.8 to 134.8 mIU/mL (25.8 to 134.8
IU/L)

Prolactin (PRL)
-also known as luteotropic hormone or luteotropin
-is a protein best known for its role in enabling mammals (and
birds), usually females, to produce milk.
-secreted from the pituitary gland in response to eating, mating,
estrogen treatment, ovulation and nursing.

What happens when prolactin levels are high?

Hyperprolactinemia
-is a condition of too much prolactin in the blood of women who
are not pregnant and in men.
-is relatively common in women.

In men, high prolactin levels can cause:

-galactorrhea(is a milky nipple discharge unrelated to the
normal milk production of breast-
feeding. Galactorrhea itself isn't a disease, but it could be a
sign of an underlying problem.
-impotence (inability to have an erection during sex)
-reduced desire for sex
-infertility

What causes high prolactin in females?

 High levels of prolactin are normal during pregnancy and
after childbirth during nursing.
 However, hyperprolactinemia can also be caused by:
-anorexia nervosa
-liver disease
-kidney disease
-hypothyroidism
 High levels of prolactin can also be caused by pituitary
tumors.

What foods increase prolactin?

 Calcium-rich dried fruits like figs, apricots, and dates are
thought to help with milk production.
 Apricots, like some other lactogenic foods on this list, also
contain tryptophan, which naturally boost prolactin levels

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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
Growth hormone (GH)
-also called somatotropin or human growth hormone
-peptide hormone secreted by the anterior lobe of the pituitary
gland.
-stimulates the growth of essentially all tissues of the body,
including bone.
Can you live without the pituitary gland?
 This is because it controls many other hormone glands in
the body.
 According to The Pituitary Foundation=> without it, the
body wouldn't reproduce, wouldn't grow properly and
many other bodily functions just wouldn't function.

What is the main function of the growth hormone?
 The major role of growth hormone in stimulating body
growth is => to stimulate the liver and other tissues to
secrete IGF-I.
 IGF-I stimulates proliferation of chondrocytes (cartilage
cells)=> resulting in bone growth.
Insulin-like growth factor I (IGF-I)
-is a polypeptide hormone produced mainly by the liver in
response to the endocrine GH stimulus
 IGF-1 is a hormone found naturally in your blood.
-main job is to regulate the effects of growth hormone
(GH).
 Normal IGF-1 and GH functions include: tissue and
bone growth.
 IGF-1 is formed in different tissues as a result of GH in the
blood
What happens if your pituitary gland stops working?
 if the pituitary gland does not produce enough growth
hormone in a child=> they may have a permanently short
stature.
 If it doesn't produce enough follicle-stimulating hormone
or luteinizing hormone=> it might cause problems with
sexual function, menstruation, and fertility.
Pancreas
-has an endocrine function because it releases juices directly
into the bloodstream, and it has an exocrine function because it
releases juices into ducts.
Enzymes, or digestive juices, are secreted by the pancreas into
the small intestine.
-it continues breaking down food that has left the stomach

Melanocyte-stimulating hormone
 describes a group of hormones produced by the pituitary
gland, hypothalamus and skin cells.
 It is important for protecting the skin from UV rays,
development of pigmentation and control of appetite.

Melanin
 is a pigment that is produced by cells known as
melanocytes in the skin of most animals, including
What is the main function of the pancreas?
humans.
 The pancreas is an organ located in the abdomen.
 is produced as a response to UV radiation in order to
 It plays an essential role in converting the food we eat into
prevent damage to the DNA in the integument
fuel for the body's cells.
What stimulates release of MSH?
The pancreas has two main functions:
 As a consequence, the hypothalamus stimulates the
-an exocrine function that helps in digestion
pituitary gland to release more adrenocorticotropic
-endocrine function that regulates blood sugar
hormone to try and stimulate the adrenal glands to
produce more cortisol.
What causes pancreas problems?
 Adrenocorticotropic hormone can be broken down to
Gallstones and alcohol=> are common causes of acute
produce melanocyte-stimulating hormone=> leading to
pancreatitis.
hyperpigmentation of the skin.
Other causes include:
What are the symptoms of pituitary gland problems?
-high levels of fats in the blood
Signs and symptoms include:
-certain drugs
-Nausea and vomiting.
-certain medical procedures
-Weakness.
-some infections.
-Feeling cold.
-Less frequent or no menstrual periods.
Chronic pancreatitis
-Sexual dysfunction.
-is inflammation that gets worse over time and leads to
-Increased amount of urine.
permanent damage in the pancreas
-Unintended weight loss or gain.
How dangerous is pancreatitis?
What foods are good for pituitary gland?
 In severe cases, acute pancreatitis=> can cause bleeding,
A healthy diet is one which consists of an appropriate balance:
serious tissue damage, infection, and cysts.
-protein (meat, poultry, fish, eggs and pulses)
 Severe pancreatitis=> can also harm other vital organs
-carbohydrates (whole meal bread, cereals and potatoes)
such as the heart, lungs, and kidneys.
-fat (oils, diary products, nuts and fish)
 Chronic pancreatitis is long-lasting inflammation.
-essential ingredients such as vitamins and some minerals –
found in fruit and vegetables
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
What is the most common cause of pancreatitis?
 Eighty percent of cases of pancreatitis=> caused by
alcohol or gallstones.
 Gallstones are the single most common cause of acute
pancreatitis.
 Alcohol is the single most common cause of chronic
pancreatitis
Ovaries
Have two main reproductive functions in the body.
 They produce oocytes (eggs) for fertilisation
 They produce the reproductive hormones, oestrogen and
progesterone.
Ovaries are the female gonads
 the primary female reproductive organs produce the egg
cells, called the ova or oocytes.
 The oocytes are then transported to the fallopian tube
where fertilization by a sperm may occur.
 The fertilized egg then moves to the uterus, where the
uterine lining has thickened in response to the normal
hormones of the reproductive cycle.
What happens when you lose an ovary?
 If only one ovary is removed and not your uterus, you will
continue to be fertile and have menstrual periods. ...
 If both ovaries are removed=> you will experience
surgical menopause.
 Even if one ovary is retained=> you may have
menopause-like symptoms due to loss of blood supply to
the remaining ovary
TESTES
 The testicles are housed in the scrotum just behind the
penis.
 The testicles are the male gonads — the primary male
reproductive organs.
They have two, very important functions that are very important
to the male reproductive system:
 they produce gametes, or sperm, and they secrete
hormones, primarily testosterone
 The principal androgen produced by the testes is
testosterone.
 The production of testosterone by the testes is stimulated
by luteinizing hormone (LH), which is produced by the
anterior pituitary and acts via receptors on the surface of
the Leydig cells.
 Leydig cells, also known as interstitial cells of Leydig, are
found adjacent to the seminiferous tubules in the testicle.
 They produce testosterone in the presence of luteinizing
hormone (LH).
 In response, the pituitary gland releases follicle
stimulating hormone (FSH) and luteinizing hormone (LH)
into the male system for the first time.
 FSH enters the testes=>stimulating the Sertoli cells,
which help to nourish the sperm cells that the testes
produce, to begin facilitating spermatogenesis.
 Sertoli cell (a kind of sustentacular cell) is a "nurse" cell of
the testicles that is part of a seminiferous tubule and helps
in the process of spermatogenesis, the production of
sperm. It is activated by follicle-stimulating hormone (FSH)
secreted by the adenohypophysis, and has FSH receptor
on its membranes.
Pathophysiology of diabetes
 is related to the levels of insulin within the body, and the
body's ability to utilize insulin.
 The pathophysiology of diabetes involves plasma
concentrations of glucose signaling the central nervous
system to mobilize energy reserves.
Type 1 DM
 is the culmination of lymphocytic infiltration and
destruction of insulin-secreting beta cells of the islets of
Langerhans in the pancreas.
 As beta-cell mass declines=>insulin secretion decreases
until the available insulin no longer is adequate to
maintain normal blood glucose levels.
 Type 1 diabetes, once known as juvenile diabetes or
insulin-dependent diabetes
-is a chronic condition in which the pancreas
produces little or no insulin.
 Insulin is a hormone needed to allow sugar (glucose) to
enter cells to produce energy
Pathophysiology of type 2 diabetes mellitus
-is characterized by peripheral insulin resistance, impaired
regulation of hepatic glucose production, and declining β-cell
function, eventually leading to β -cell failure.
Mechanism:
 Diabetes mellitus (DM) is a set of related diseases in
which the body cannot regulate the amount of sugar
(specifically, glucose) in the blood.
 The blood delivers glucose to provide the body with
energy to perform all of a person's daily activities.
 The liver converts the food a person eats into glucose.
Possible complications include:
 Cardiovascular disease.
 Nerve damage (neuropathy).
 Kidney damage (nephropathy).
 Eye damage (retinopathy).
 Foot damage.
 Skin conditions.
 Hearing impairment.
 Alzheimer's disease.
 Type 2 diabetes is often a milder form of diabetes than
type 1
 Type 2 diabetes also increases your risk of heart disease
and stroke.
 With Type 2 diabetes, the pancreas usually produces
some insulin.
 But either the amount produced is not enough for the
body's needs, or the body's cells are resistant to it.
In nephrogenic diabetes insipidus
-the kidneys produce a large volume of dilute urine because the
kidney tubules fail to respond to vasopressin (antidiuretic
hormone) and are unable to reabsorb filtered water back into
the body.
Symptoms include: excessive thirst and excretion of large
amounts of urine.
DIABETES
 A disease in which the body does not properly control the
amount of sugar in the blood.
 As a result, the level of sugar in the blood is too high.
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
 Diet control and oral hypoglycaemic agents often
This disease occurs when the body does not produce enough sufficient control
insulin or does not use it properly.  Patients usually overweight
-is a chronic, incurable condition  Extreme hyperglycaemia causes hyperosmolar
-is the most common of the endocrine disorders hyperglycaemic state
characterised by hyperglycaemia=> due to impaired
insulin secretion with or without insulin resistance.
-classified according to aetiology, by far the most common
types being type 1 and type 2 diabetes

Type 1
 Type 1 diabetes is a disease characterized by the
destruction of the insulin-producing pancreatic β-cells, the
development of which is either autoimmune T-cell
mediated destruction (type 1A) or idiopathic (type 1B).
 β-cell destruction is associated with autoimmune disease.
 Type 1 diabetes usually develops in the young (below the
age of 30) although it can develop at any age and is
usually associated with a faster onset of symptoms DIFFERENT TYPES OF DIABETES
leading to dependency on extrinsic insulin for survival.  Pre-diabetes
 Type 1 (β-cell destruction, usually leading to absolute  Type 1 diabetes
insulin deficiency)  Type 2 diabetes
 Autoimmune  Gestational Diabetes
 Idiopathic
It is a condition that occurs when a person's blood glucose
Other specific types levels are higher than normal but not high enough for a
 Genetic defects of β-cell function diagnosis of type 2 diabetes.
 Genetic defects in insulin action  Having glucose intolerance
 Diseases of the exocrine pancreas  Not actual diabetes
 Endocrinopathies
 Drug or chemical induced, for example, nicotinic acid, Type 1 Diabetes
glucocorticoids, high-dose thiazides,  Often referred to as juvenile-onset diabetes or as
 pentamidine, interferon-α insulin-dependent diabetes mellitus 5-10% of diabetes
 Infections cases are type 1
 Uncommon forms of immune-mediated diabetes  It is characterized by the body’s inability to produce insulin,
 Other genetic syndromes sometimes associated with which is the hormone responsible for opening up the
diabetes body’s cells and allowing glucose to enter them.
 Gestational diabetes
The symptoms of type 1 diabetes are often subtle, but they can
Type 1 diabetes become severe. They include:
 β-cell destruction  Increased thirst
 Islet cell antibodies present  Increased hunger (especially after eating)
 Strong genetic link  Dry mouth
 Age of onset usually below 30  Nausea and occasionally vomiting
 Faster onset of symptoms  Abdominal pain
 Insulin must be administered  Frequent urination
 Patients usually not overweight  Unexplained weight loss (even though you are eating and
 Extreme hyperglycaemia causes diabetic ketoacidosis feel hungry)
 Fatigue (weak, tired feeling)
Type 2  Blurred vision
 Type 2 diabetes is more common above the age of 40  Heavy, labored breathing (Kussmaul respiration)
peak age of onset in developed countries between 60 and  Frequent infections of the skin, urinary tract or vagina
70 years.
 Type 2 diabetes may be an incidental finding, particularly Signs of an emergency with type 1 diabetes include:
when patients present with complications associated with  Shaking and confusion
the disease, for example, Heart disease.  Rapid breathing
 Type 2 disease often progresses to the extent whereby  Fruity smell to the breath
extrinsic insulin is required to maintain blood glucose  Abdominal pain
levels.  Loss of consciousness (rare)
Type 2 diabetes
 No β-cell destruction
 No islet cell antibodies present
 Very strong genetic link
 Age of onset usually above 40
 Slower onset of symptoms
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HUMAN ANATOMY & PHYSIOLOGY
BS PHARMACY 1B | 2nd SEMESTER-SEMIFINAL | ROGER S. BASINANG
Type II or Non-Insulin Dependent Diabetes Mellitus (NIDDM)
Magnesium (as well as calcium)
-Taking a supplement providing at LEAST the US RDA of
magnesium (about 350 mg) is vital.

Type I (Juvenile Onset, Insulin Dependent)
B-Complex Vitamins - weaned off of insulin
Niacin/Niacinamide (one of the B-complex vitamins )
-1,500 to 2,500 mg of niacin or niacinamide may improve
carbohydrate tolerance in diabetics
-diminished the requirements of insulin needed to keep the
blood sugar of the diabetics within normal limits
Vitamin C
-reduce levels of complication-causing sorbitol in diabetics
also help to keep tiny blood vessels (capillaries) from bursting,
a major cause of diabetic complications
-increase the elasticity of these smallest of blood vessels
Diabetic people must avoid the ff:
 Sugar
 Milk
 Fluoride
 Caffeine
 Question Immunization
Gestational Diabetes
 A condition in which the glucose level is elevated and
other diabetic symptoms appear during pregnancy in a
woman who has not previously been diagnosed with
diabetes.
 About 4% of all pregnant women - about 135,000 cases in
the United States each year.
 It normally goes away on its own after giving birth to the
child.
 If gestational diabetes is not treated, it can cause serious
complications for both the mother and the baby
 is diabetes diagnosed for the first time during
pregnancy (gestation).
 Like other types of diabetes, gestational diabetes affects
how your cells use sugar (glucose).
While any pregnancy complication is concerning, there's good
news.
 Expectant mothers can help control gestational diabetes
by eating healthy foods, exercising and, if necessary,
taking medication.
 Controlling blood sugar can keep you and your baby
healthy and prevent a difficult delivery.

Type 2 Diabetes
-Also known as adult-onset diabetes or non-insulin-dependent
diabetes mellitus
-Type of diabetes, w/c the body produces insulin but is unable
to use it properly
-It is responsible for 90-95% of all diabetes cases.
 In women with gestational diabetes, blood sugar usually
May developed: returns to normal soon after delivery.
 Dehydration  But if you've had gestational diabetes, you have a higher
 Dry mouth risk of getting type 2 diabetes.
 Increased urine production  You'll need to be tested for changes in blood sugar more
 Increased appetite often.
 Slow recovery
 Skin irritation Symptoms
 Impaired vision For most women, gestational diabetes doesn't cause
noticeable signs or symptoms. Increased thirst and
more-frequent urination are possible symptoms.

Causes
 Researchers don't yet know why some women get
gestational diabetes and others don't. Excess weight
before pregnancy often plays a role.
 Normally, various hormones work to keep your blood
sugar levels in check.
 But during pregnancy, hormone levels change, making it
harder for your body to process blood sugar efficiently.
 This makes your blood sugar rise.

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Risk factors
Some women have a greater risk of gestational diabetes. Risk
factors for gestational diabetes include the following:
 Overweight and obesity.
 A lack of physical activity.
 Previous gestational diabetes or prediabetes.
 Polycystic ovary syndrome.
 Diabetes in an immediate family member.
 Previously delivering a baby weighing more than 9
pounds (4.1 kilograms).
 Race — Women who are Black, Hispanic, American
Indian and Asian American have a higher
 risk of developing gestational diabetes.
Complications
 Gestational diabetes that's not carefully managed can
lead to high blood sugar levels.
 High blood sugar can cause problems for you and your
baby, including an increased likelihood of needing a
C-section to deliver.
Complications that may affect your baby
If you have gestational diabetes, your baby may be at
increased risk of:
Excessive birth weight.
Higher than normal blood sugar in mothers can cause their
babies to grow too large. Very large babies — those who weigh
9 pounds or more — are more likely to become wedged in the
birth canal, have birth injuries or need a C-section birth.
Early (preterm) birth.
High blood sugar may increase women's risk of early labor and
delivery before the due date. Or early delivery may be
recommended because the baby is large.
Serious breathing difficulties.
Babies born early to mothers with gestational diabetes may
experience respiratory distress syndrome — a condition that
makes breathing difficult.
Low blood sugar (hypoglycemia).
 Sometimes babies of mothers with gestational diabetes
have low blood sugar (hypoglycemia) shortly after birth.
 Severe episodes of hypoglycemia may cause seizures in
the baby. Prompt feedings and sometimes an intravenous
glucose solution can return the baby's blood sugar level
tonormal.
Obesity and type 2 diabetes later in life.
Babies of mothers who have gestational diabetes have a higher
risk of developing obesity and type 2 diabetes later in life.
Stillbirth.
Untreated gestational diabetes can result in a baby's death
either before or shortly after birth.
Complications that may affect you
Gestational diabetes may also increase your risk of:
High blood pressure and preeclampsia.
Gestational diabetes raises your risk of high blood pressure, as
well as preeclampsia — a serious complication of pregnancy
that causes high blood pressure and other symptoms that can
threaten the lives of both mother and baby.
Having a surgical delivery (C-section).
You're more likely to have a C-section if you have gestational
diabetes.
Future diabetes.
If you have gestational diabetes, you're more likely to get it
again during a future pregnancy. You also have a higher risk of
type 2 diabetes as you get older.
Prevention
Eat healthy foods.
Choose foods high in fiber and low in fat and calories. Focus on
fruits, vegetables and whole grains. Strive for variety to help
you achieve your goals without compromising taste or nutrition.
Watch portion sizes.
Keep active.
Exercising before and during pregnancy can help protect you
from developing gestational diabetes. Aim for 30 minutes of
moderate activity on most days of the week. Take a brisk daily
walk. Ride your bike. Swim laps. Short bursts of activity — such
as parking further away from the store when you run errands or
taking a short walk break — all add up too.
Start pregnancy at a healthy weight.
If you're planning to get pregnant, losing extra weight
beforehand may help you have a healthier pregnancy. Focus
on making lasting changes to your eating habits that can help
you through pregnancy, such as eating more vegetables and
fruits.
Don't gain more weight than recommended.
Gaining some weight during pregnancy is normal and healthy.
But gaining too much weight too quickly can up your risk of
gestational diabetes. Ask your doctor what a reasonable
amount of weight gain is for you.
Diagnosis
 If you're at average risk of gestational diabetes, you'll
likely have a screening test during your second trimester
— between 24 and 28 weeks of pregnancy.
 If you're at high risk of diabetes — for example, if you're
overweight or obese before pregnancy or you have a
mother, father, sibling or child with diabetes — your doctor
may test for diabetes early in pregnancy, likely at your first
prenatal visit.
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Routine screening for gestational diabetes
Screening tests may vary slightly depending on your health
care provider, but generally include:
Initial glucose challenge test.
 You'll drink a syrupy glucose solution. One hour later,
you'll have a blood test to measure your blood sugar level.
A blood sugar level of 190 milligrams per deciliter (mg/dL),
or 10.6 millimoles per liter (mmol/L) indicates gestational
diabetes.
 A blood sugar below 140 mg/dL (7.8 mmol/L) is usually
considered normal on a glucose challenge test, although
this may vary by clinic or lab. If your blood sugar level is
higher than normal, you'll need another glucose tolerance
test to determine if you have the condition.
Follow-up glucose tolerance testing.
This test is similar to the initial test — except the sweet solution
will have even more sugar and your blood sugar will be
checked every hour for three hours. If at least two of the blood
sugar readings are higher than expected, you'll be diagnosed
with gestational diabetes.
Treatment for gestational diabetes includes:
 Lifestyle changes
 Blood sugar monitoring
 Medication, if necessary
Managing your blood sugar levels helps keep you and your
baby healthy. Close management can also help you avoid
complications during pregnancy and delivery.
Lifestyle changes
Your lifestyle — how you eat and move — is an important part
of keeping your blood sugar levels in a healthy range. Doctors
don't advise losing weight during pregnancy — your body is
working hard to support your growing baby. But your doctor can
help you set weight gain goals based on your weight before
pregnancy.
Healthy diet
 A healthy diet focuses on fruits, vegetables, whole grains
and lean protein — foods that are high in nutrition and
fiber and low in fat and calories — and limits highly refined
carbohydrates, including sweets.
 A registered dietitian or a diabetes educator can help you
create a meal plan based on your current weight,
pregnancy weight gain goals, blood sugar level, exercise
habits, food preferences and budget.
Scaling the Heights of Flexible Learning
Stay active
 Regular physical activity plays a key role in every
woman's wellness plan before, during and after
pregnancy.
 Exercise lowers your blood sugar, and as an added bonus,
regular exercise can help relieve some common
discomforts of pregnancy, including back pain, muscle
cramps, swelling, constipation and trouble sleeping.
Monitor your blood sugar
While you're pregnant, your health care team may ask you to
check your blood sugar four or more times a day — first thing in
the morning and after meals — to make sure your level stays
within a healthy range.
Medication
 If diet and exercise aren't enough, you may need insulin
injections to lower your blood sugar.
 Between 10% and 20% of women with gestational
diabetes need insulin to reach their blood sugar goals.
 Some doctors prescribe an oral medication to control
blood sugar, while others believe more research is
needed to confirm that oral drugs are as safe and as
effective as injectable insulin to control gestational
diabetes.
Close monitoring of your baby
 An important part of your treatment plan is close
observation of your baby. Your doctor may check your
baby's growth and development with repeated
ultrasounds or other tests.
 If you don't go into labor by your due date — or
sometimes earlier — your doctor may induce labor.
Delivering after your due date may increase the risk of
complications for you and your baby.
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Complications
 Excessive birth weight. Higher than normal blood sugar in
mothers can cause their babies to
 grow too large.
 Early (preterm) birth.
 Serious breathing difficulties.
 Low blood sugar (hypoglycemia).
 Obesity and type 2 diabetes later in life.
 Stillbirth.

Medications for Diabetes

Sulfonylureas (Glucotrol® and Micronase®)
-Helps your body make insulin

Biguanides (Metformin (Glucophage® )

-Helps the body use insulin more effectively.

Alpha-glucosidase inhibitors (Precose® and Glyset®)

-Its work by slowing down the absorption of sugar in your
digestive tract

Meglitinides (Repaglinide (Prandin®)

-Works by controlling blood sugar after meals

Thiazolidinediones
-(overall action of thiozolidinediones (TZDs) make cells more
sensitive to insulin

Insulin
 If oral medications do not control your blood sugar levels,
insulin may be used for diabetes
 treatment. A person with type 2 diabetes needs insulin
injections if his or her pancreas has stopped producing
insulin altogether.
 it is also the best management for gestational diabetes.

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