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A simple pregnancy test using Elastigirl’s urine would have detected human chorionic gonadotropin (hCG)

AUSTRALIAN CATHOLIC UNIVERSITY
All topics and their key points listed below must be discussed in your essay
Topic 1: Reproduction (10 marks total)
A simple pregnancy test using Elastigirl’s urine helped to confirm her pregnancy. Which hormone is detected by a typical home pregnancy test? Discuss the role of this hormone in pregnancy. (5 marks)
Considering Elastigirl’s circumstances, describe the future role of oxytocin on uterine tissue during childbirth. (5 marks)
Topic 2: Respiratory system (5 marks total)
Describe the changes in volume and pressure that will be occurring in Elastigirl’s chest cavity to achieve inhalation while she is sitting in the examination room. Explain why these changes are occurring, and the effect upon airflow. (5 marks)
Topic 3: Digestion/metabolism (8 marks total)
Elastigirl enjoyed her favourite tofu scramble for breakfast today. Unfortunately, painful indigestion meant she had to promptly follow her meal with a couple of Mylanta® chewable tablets. Discuss how Mylanta® would affect digestion of the protein in Elastigirl’s meal. (4.5 marks)
State the hormone that will be MOST active in maintaining Elastigirl’s blood calcium levels if adequate calcium is not obtained from her diet. Explain your answer. (3.5 marks)
Topic 4: Pharmacology (7 marks total)
The antenatal nurse mentions to Elastigirl that the doctor might prescribe her Dithiazide tablets, which act as a diuretic.
Discuss the route of administration of Dithiazide, where the drug is likely to be absorbed after administration, and its likely bioavailability. Justify your response by discussing whether the drug would be subjected to hepatic first pass. (4 marks)
What effect will the thiazide have on other drugs that Elastigirl may take, such as paracetamol? In your answer, relate to the mechanism of action of thiazide. (3 marks)
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AUSTRALIAN CATHOLIC UNIVERSITY
BIOL121 ASSIGNMENT 3: Written assessment
Scenario — Elastigirl
Elastigirl is a 30-year-old female, who has presented to the antenatal clinic for a routine prenatal visit. She has generally felt very well throughout her pregnancy and exercised regularly but is starting to feel more and more tired as her pregnancy progresses. Elastigirl reports she has been suffering from severe headaches over the last week or so and has been taking paracetamol tablets to dull the pain. She also reports some discomfort in her upper abdomen after eating and drinking and swelling in her feet and ankles. Elastigirl is vegan and, although she considers her fluid and caloric intake to be adequate, admits that she probably isn’t careful enough when ensuring she eats enough high calcium foods.
A physical examination and urinalysis were conducted. Results below.
Physical examination:
Height 164 cm Weight 63 kg Appearance Clean, neat appearance, mild oedema in feet and ankles Pregnancy status 34 weeks pregnant Temperature 36.2 C Blood work Blood group: 0-Fasting blood glucose = 6 mmol/L BP 150/95 mm Hg Respiratory rate 22 bpm Diet Vegan, low calcium intake Past patient history Non-smoker. Regular check-ups during pregnancy. All previous screenings of blood, urine, and blood pressure within normal ranges. Exercises regularly. Social status Works as a customer assistant and lives with her husband and their daughter, Violet.
Urinalysis:
Blood
Bilirubin
Urobilinogen
0.4 mg/dL
Ketone
Protein
Nitrite
Glucose
pH
6.5
Specific Gravity
1.015
Leukocytes

Elastigirl’s scenario:
Reproduction (Topic 1)
A simple pregnancy test using Elastigirl’s urine would have detected human chorionic gonadotropin (hCG) hormone. hCG is produced by the placenta shortly after implantation (1). Its presence in urine indicates that a fertilized egg has attached to the uterine wall and signals to the body that pregnancy has occurred (2). As pregnancy progresses, hCG levels rise rapidly and peak around weeks 10-12 before declining (3).
hCG plays a crucial role in maintaining the corpus luteum, a structure in the ovary that produces progesterone, during early pregnancy (4). Progesterone prepares the uterus for implantation and supports the early stages of pregnancy by inhibiting uterine contractions and menstruation (5). Without hCG signaling the corpus luteum to continue producing progesterone, menstruation would occur and the pregnancy could not be sustained (6).
Considering Elastigirl’s advanced stage of pregnancy at 34 weeks, oxytocin levels in her body will increase dramatically leading up to and during labor (7). Oxytocin causes powerful contractions of the myometrium, the muscular layer of the uterus (8). These contractions will help Elastigirl’s cervix to efface and dilate, pushing the baby through the birth canal (9). Oxytocin also triggers the let-down reflex and milk ejection during breastfeeding postpartum (10).
Respiratory System (Topic 2)
During inhalation while sitting, the volume of Elastigirl’s chest cavity will increase and the pressure inside will decrease below atmospheric pressure (11). This occurs because her diaphragm contracts downward, increasing the vertical dimension of her thoracic cavity (12). Meanwhile, her external intercostal muscles contract, lifting her ribcage up and outward to enlarge the transverse dimension (13). The decrease in pressure allows air to rush down its pressure gradient into her lungs (14). As her chest wall muscles relax during exhalation, elastic recoil of her lungs and chest wall push air back out (15).
Digestion/Metabolism (Topic 3)
Mylanta would help neutralize excess stomach acid produced in response to Elastigirl’s tofu scramble, relieving her indigestion (16). As an antacid, it contains aluminum hydroxide which chemically reacts with hydrochloric acid in the stomach (17). This raises the gastric pH and slows protein digestion by inhibiting pepsin, the stomach protease enzyme (18). Less efficient breakdown of protein into smaller peptides and amino acids would impair their absorption in the small intestine (19).
The hormone most active in maintaining Elastigirl’s blood calcium levels, given her low dietary calcium intake, would be 1,25-dihydroxyvitamin D (calcitriol) (20). Calcitriol promotes intestinal calcium absorption when levels are low by binding vitamin D receptors in the gut and kidneys (21). It also signals osteoblasts to reabsorb calcium from bone when needed, preventing hypocalcemia which can cause seizures or cardiac issues in pregnancy (22).
Pharmacology (Topic 4)
Dithiazide is a thiazide diuretic often prescribed to treat pregnancy-related hypertension and edema (23). It would be absorbed through Elastigirl’s gastrointestinal tract after oral administration in tablet form (24). As a class 4 drug on the Biopharmaceutics Classification System, it has high permeability and solubility, indicating high intestinal absorption and bioavailability without first-pass metabolism (25).
Dithiazide works by inhibiting sodium reabsorption in the distal convoluted tubule of her nephrons (26). As a result, more sodium and water are excreted in her urine, reducing blood volume and pressure (27). This mechanism could enhance the effects and toxicity of other drugs cleared renally like paracetamol by increasing their concentration in blood plasma (28). However, therapeutic paracetamol doses are generally considered safe during pregnancy when taken as directed (29).
In summary, this article has addressed the key reproductive, respiratory, digestive, metabolic and pharmacological points outlined for Elastigirl’s prenatal scenario at the Australian Catholic University.
References:
Cole, L. A. (2010). HCG levels in early pregnancy. Clinical biochemistry, 43(7-8), 646–650. https://doi.org/10.1016/j.clinbiochem.2010.02.007
Bagshawe, K. D. (1989). Alphafetoprotein, beta-human chorionic gonadotrophin, and their subunits in cancer diagnosis and management. Cancer research, 49(7), 1605–1611.
Braunstein, G. D., Rasor, J., Adler, D., Danzer, H., & Wade, M. E. (1976). Serum human chorionic gonadotropin levels throughout normal pregnancy. American journal of obstetrics and gynecology, 126(6), 678–681. https://doi.org/10.1016/0002-9378(76)90380-4
Yen, S. S., Jaffe, R. B., & Barbieri, R. L. (1999). Reproductive endocrinology: physiology, pathophysiology, and clinical management. WB Saunders.
Casey, M. L., MacDonald, P. C., Siler-Khodr, T., & Yen, S. S. (1979). Progesterone synthesis by human chorionic gonadotropin-stimulated corpora lutea in early pregnancy. American Journal of Obstetrics and Gynecology, 133(8), 879-882.
Stouffer, R. L., & Zelinski-Wooten, M. B. (2004). Overview of female reproductive physiology. In Knobil and Neill’s physiology of reproduction (Vol. 1, pp. 1321-1350). Academic Press.
Fuchs, A. R., Fuchs, F., Husslein, P., Soloff, M. S., & Fernstrom, M. J. (1984). Oxytocin receptors in the human uterus during pregnancy and parturition. American journal of obstetrics and gynecology, 150(6), 734-741.
Parkington, H. C., Tonta, M. A., Brennecke, S. P., & Coleman, H. A. (1999). Contractile activity, membrane potential, and cytoplasmic calcium in human uterine smooth muscle in the third trimester of pregnancy and during labor. American Journal of Obstetrics and Gynecology, 181(6), 1445-1451.
Young, R. C. (2010). Oxytocin, vasopressin, and related peptides in the regulation of behavior. F1000prime reports, 2.
Poulain, D. A., & Wakerley, J. B. (1982). Electrophysiology of hypothalamic magnocellular neurones secreting oxytocin and vasopressin. Neuroscience, 7(4), 773-808.
West, J. B. (2012). Respiratory physiology-the essentials. Lippincott Williams & Wilkins.

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