KIA Semester II.

PENGANTAR

FISIOLOGI REPRODUKSI

Kuliah 1

Rahmatina B. Herman

Bagian Fisiologi

Reproduction

Reproduction is process

to maintain

continuation of species

by which

-

new individuals

of a species are produced

-

genetic material

is passed from generation

to generation

Cell division in a multicellular organism is

necessary for growth and it involves passing of

genetic material from parent cells to daughter

cells

The Reproductive System

does not contribute to homeostasis

is not essential for survival of an individual

But still plays a i porta t i a perso ’s life,

e.g. the manner:

- in which people relate as sexual beings

contributes in significant ways to

psychosocial behavior

- how people

view themselves

The Reprodu tive Syste …..

Reproductive function also has a profound

effect on society:

- universal organization of societies into

family units provide a stable environment

that is

conducive for perpetuating

our

species

- on other hand,

population explosion

and its

resultant drain on dwindling resources

The Reprodu tive Syste …..

Reproductive capability depends on

intricate

relationship among hypothalamus, anterior

pituitary, reproductive organs, and target cells

of sex hormones

The Reprodu tive Syste …..

Sexual behavior and attitudes are deeply

influenced by emotional factors and

socio-cultural mores of the society in which the

individual lives

However, Reproductive Physiology will

The Reprodu tive Syste …..

The organ of male and female may be grouped

by function

Testes and ovaries (gonads), function in

production of gametes: sperm and ova

Gonads also secrete hormones

The ducts of reproductive systems transport,

receive, and store gametes

The Reproductive System

…..

In females, the breasts are also considered

accessory reproductive organs

The externally visible portions of reproductive

system are known as external genitalia

The production of gametes and fluid, and their

discharge into ducts classify the gonads as

exocrine glands

Secondary Sexual Characteristic

Secondary sexual characteristic are many external

characteristics

not directly involved in

reproduction

That

distinguish male and female

Development and maintenance governed by

testosterone in males and estrogen in females

Progesterone has no influence on secondary

sexual characteristic

Secondary Sexual Characteristic

..…

In some species, secondary sexual

characteristic are great importance in courting

a d ati g ehavior e.g. to attra t fe ale’s

attention)

Overview of Functions and Organs

of Male Reproductive System

The essential reproductive functions of

male

are:

1. Production

of sperm (spermatogenesis) by

testes (in skin-covered sac: scrotum)

2. Delivery

of sperm to female

–

semen by

- male reproductive tract: epididymis, vas

deferens, ejaculatory duct

- urethra (in penis)

3. Male

accessory

sex glands: providing bulk of

semen: seminal vesicle, prostate,

Overview of Functions and Organs

of Female Reproductive System

Female

’s role i reprodu tio is ore o pli ated:

1. Production of ova (oogenesis) by ovaries

2. Reception of sperm: vagina-cervix

3. Reception of sperm and ovum to a common site for union (fertilization or conception): Fallopian tube

4. Maintenance of the developing fetus until it can survive in outside world (gestation or pregnancy), including formation of placenta (organ exchange between mother and fetus): uterus

5. Giving birth to the baby (parturition)

Overview of Functions and Organs

of Fe ale Reprodu tive Syste …..

Product of fertilization:

embryo

During first 2 months of intrauterine

development when tissue differentiation is

taking place

Developing living being is recognizable as

human:

fetus

-

no further tissue differentiation

Overview of Functions and Organs

of Fe ale Reprodu tive Syste …..

Female

reproductive tract consists of:

Ovaries

Oviduct s (Fallopian tubes)

- pick up ova on ovulation and serve as fertilization site

Uterus, thick-walled hollow: responsible for

- maintaining fetus during development , and - expelling it at the end of pregnancy

Cervical canal

- small opening of cervix

- pathway for sperm to uterus then to oviduct - passageway for delivery of baby from uterus

Cervix

Overview of Functions and Organs

of Fe ale Reprodu tive Syste ……

Vagina

- expandable tube

- connects uterus to external environment

Vaginal opening

- located in perineal region

- between urethral opening and anal opening

Hymen

- thin mucus membrane partially covering vaginal opening

• Labia minora and labia majora

- skin folds surrounding vaginal and urethral openings

• Clitoris

Sex Determination and Differentiation

Reproductive cells each contain a half set of

chromosomes

Gametogenesis is accomplished by

meiosis

The sex of and individual is determined by

combination of sex chromosomes

Parents with diploid (46 chr) somatic cells

Mother

Father

Meiotic division of germ cells

Meiotic division of germ cells

Haploid Ovum Haploid Sperm

Fertilization

Diploid fertilized Ovum

Mitosis

Ovum with X sex chromosome

Fertilized by

Sperm with Y sc Sperm with X sc

Embryo with XY sc Genetic sex Embryo with XX sc

Sex-determining region of Y chr (SRY) stimulates Production of H-Y antigen

In plasma membrane of undifferentiated gonad

H-Y antigen directs differentiation of gonads into testes

No Y chr, so no SRY and no H-Y antigen

With no H-Y antigen, undifferentiated gonads

develop into ovaries

Testosterone

Promotes development of undifferentiated external genitalia along male lines

(e.g. penis, scrotum)

Testes secrete hormone and factor

Phenotype sex Mullerian-inhibiting factor Dihydrotestosterone (DHT) Converted to Degeneration of Mullerian ducts

Transforms Wolfian ducts into male reproductive tract

(e.g. epididymis, ductus deferens, ejaculatory duct,

Absence of testosterone

Undifferentiated external genitalia along female lines

(e.g. clitoris. labia)

Ovaries does not secrete hormone and factor

Phenotype sex

Absence of Mullerian- inhibiting factor

Degeneration of Wolfian ducts

Errors in Sexual Differentiation

Genetic sex and phenotype sex are usually

compatible

Occasionally, discrepancies occur

between genetic and anatomic sexes

Errors i Se ual Differe tiatio …..

1. If testes in

a genetic male

fail to properly

differentiate and secrete hormones, the result

is the development of an apparent anatomic

female in a genetic male, who, of course will

be sterile.

Errors i Se ual Differe tiatio …..

2. Testosterone acts on Wolfian ducts to convert

them into a male reproductive tract;

If testosterone derivative dihydrotestosterone

(DHT) that responsible for masculinization of

external genitalia because of genetic deficiency

of the enzyme which converts testosterone

Errors i Se ual Differe tiatio …..

3. Adrenal gland normally secretes a weak

androgen, dehydroepiandrosterone in

insufficient quantities to masculinize females.

If, pathologically excessive secretion of this

hormone in a genetically female fetus during

critical developmental stages imposes

Errors i Se ual Differe tiatio …..

Sometimes, the discrepancies between genetic

sex and apparent sex are not recognized until

puberty, when discovery produces

psychologically traumatic gender identity crisis

For instance: a masculinized genetic female

with ovaries, but with male type external

Errors i Se ual Differe tiatio …….

Less dramatic cases of inappropriate sex

differentiation often appear as sterility

problems

Therefore, important to diagnose any

problems in sexual differentiation in infancy. It

can be reinforced, if necessary, with surgical

and hormonal treatment, so that psychosexual

development can proceed as normally as

Tugas

1. Hubungan sistem limbik (

limbic system

)

dengan pengaturan fungsi seks

DASAR-DASAR

BIOMOLEKULER

REPRODUKSI WANITA

Rahmatina B. Herman

Bagian Fisiologi

Fakultas Kedokteran Universitas Andalas

Sex Determination and Differentiation

Reproductive cells/gamete each contain a half

set of chromosomes (

haploid

)

Gametogenesis is accomplished by

meiosis

The sex of and individual is determined by

combination of sex chromosomes

Sexual differentiation along male or female

lines depends on the presence/absence of

Absence of testosterone

Undifferentiated external genitalia along female lines

(e.g. clitoris. labia)

Ovaries does not secrete hormone and factor

Phenotype sex

Absence of Mullerian- inhibiting factor Degeneration of

Wolfian ducts

Summary of 4 possible defects produced by maternal nondisjunction of sex chromosomes at the time of meiosis

The YO combination is believed to be lethal, the fetus dies in utero

/Ovarian agenesis/Turner syndrome

Female Reproductive System

Reproductive system of women shows regular cyclic

changes that may be regarded as periodic preparation for fertilization and pregnancy

In humans and primate, the cycle is a menstrual cycle and its conspicuous feature is periodic vaginal bleeding that

occurs with the shedding of uterine mucosa (menstruation)

In other mammal: the sexual cycle is called estrous cycle, no episodic vaginal bleeding occurs, but the underlying endocrine events are essentially similar

- in some species: ovulation occurs spontaneously - in other species: ovulation is induced by copulation

Ovaries

Primary female reproductive organs

Perform dual function:

- producing ova (oogenesis)

- secreting female sex hormones:

estrogen and progesterone which act together to: > promote fertilization of ovum

> prepare female reproductive system for pregnancy

Oogenesis

Undergo numerous mitotic divisions

± 7 month after conception, fetal oogonia

cease dividing

From this point on, no new germ cells are

generated

Still in the fetus, all oogonia develop into

Primary Oocyte

Begin a first meiotic division by replicating their DNA However, they do not complete the division in the fetus

Accordingly, all the eggs present at birth are primary

oocytes containing 46 chromosomes, each with two

sister chromatids

Cells are said to be in a state meiotic arrest

State meiotic arrest continues until puberty and the onset of renewed activity in ovaries

Only primary oocytes destined for ovulation will ever

Pri ary Oo yte…..

Each daughter cells receives 23 chromosomes, each with 2 chromatids

One of the two daughter cells, secondary oocytes retains virtually all cytoplasm (other is first polar body)

Thus, the primary oocytes:

- Already as large as the egg will be

- Passes on to be secondary oocyte half of its

Secondary Oocyte

The second meiotic division occurs in a

fallopian tube after ovulation, but

only if the

secondary oocyte is fertilized (penetrated by a

sperm)

Daughter cells each receive 23 chromosomes,

each with a single chromatid

One of the two daughter cells, termed an ovum

retains

nearly all cytoplasm

(other is second

Final Result of Oogenesis

Net result of oogenesis is

that

each primary oocyte

can produce only one

Summary of Oogenesis

Birth Puberty Oogonia Chromosomes Per cell Chromatids Per cell

46 2

2 46

23

23 1

Summary of

Ooge esis…..

Oogonia: mitotic divisions until ± 7 month after conception

Mitosis of oogo iu → primary oocyte

Meiosis of primary oocyte, but do not complete

(beginning of the 1st eioti divisio → eioti arrest

Primary oocyte at birth containing 46 chromosomes

1st meiotic division is completed just before ovulation

→ secondary oocyte

2nd meiotic division occurs in a fallopian tube after

Comparison of Spermatogenesis and Oogenesis

Spermatogenesis

Three major stages:

1.

Mitotic proliferation

2.

Meiosis

3.

Packaging/ spermiogenesis

:

physically

reshaping/ remodeling

± 64 days, from spermatogonium to mature sperm

Up to

several hundred million sperm may reach

Follicle

From the time of birth, there are many

primordial

follicles

,

each containing 1 primary oocyte

Progression of some primordial follicles to

preantral and early antral stages occurs

- throughout infancy and childhood, and

- then during the entire menstrual cycle

Therefore, although most of follicles in ovaries are

still primordial, there are also always present

a

Menstrual Cycle

At the start of each

menstrual cycle, 10-25 the

follicles begin to develop into larger follicles

In humans, usually one of the larger follicles in one ovary starts to grow rapidly on ± the 6thday, becomes the dominant follicle

The dominant follicle continues to develop, and

others (in both ovaries) regress and become a

degenerative process called

atresia

(an example of

programmed cell death, or

apoptosis

)

Ovulation

Mature follicle (Graafian follicle): ± 1,5 cm in

dia eter, that it alloo s out o ovary’s surfa e

Ovulation occurs when the thin walls of follicle

and ovary at site where they are joined rupture

because of enzymatic digestion

Secondary oocyte surrounded by its tightly

Ovulatio …..

Occasionally, 2 or more follicles reach

maturity and more than 1 egg may be

ovulated

This is the most common of cause of

multiple births

In such cases, siblings are fraternal, not

LH

Follicular steroid hormones (progesterone)

Proteolytic enzymes (collagenase)

Follicular hyperemia and

Prostaglandin secretion

Weakened follicle wall Plasma transudation into follicle

Degeneration

of stigma Follicle swelling

Follicle rupture

Evagination of ovum

Indicators of Ovulation

A surge in LH secretion triggers ovulation

- Ovulation normally occurs ± 9 h after the peak of LH surge - The ovum lives for ± 72 h after ovulation, but it is

fertilizable for a much shorter time

Research shows:

> Intercourse on the day of ovulation: pregnancy 36% > Intercourse on days after ovulation: pregnancy 0

> Intercourse 1-2 d before ovulation: pregnancy 36%

> A few pregnancies resulted from intercourse 3-5 d before ovulation (8% on day 5 before ovulation)

I di ators of Ovulatio …..

A change (usually rise) in

basal body temperature

caused by secretion of progesterone, since

progesterone is thermogenic

- The rise starts 1-2 d after ovulation

- Obtaining an accurate temperature chart should

use a digital thermometer and take oral/rectal

temperatures in the morning before getting out

of bed

Formation of Corpus Luteum

After mature follicle discharges its antral fluid and egg, it collapses around antrum and undergoes rapid transformation

Granulosa cells enlarge greatly, and entire glandlike structure formed, known as corpus luteum (CL)

CL secretes estrogen, progesterone, inhibin

If the discharged egg (now in a fallopian tube) is not fertilized, CL reaches its maximum development

within ± 10 days.

CL then rapidly degenerates by apoptosis

Granulosa Cell

Primordial follicles surrounded by a single layer of

granulosa cells

Granulosa cells secrete: - estrogen ,

- small amounts of progesterone just before

ovulation

- peptide hormone inhibin

During childhood granulosa cells secrete: - nourishment for ova

Gra ulosa Cell…..

Further development from primordial follicle stage is characterized by

- an increase in size of oocyte

- a proliferation of granulosa cells into multiple layers - separation of oocyte from inner granulosa cells by a

thick of material: zona pellucida

Gra ulosa Cell…..

Inner layer of granulosa cells remains closely

associated with oocyte by means of

cytoplasmic processes

that

traverse zona

pellucida

and form

gap junctions

with oocyte

Nutrients and chemical messengers

are passed

to oocyte through gap junctions

Theca Formation

As follicle grows by mitosis of granulosa cells,

connective tissue cells surrounding granulosa

cells differentiate and form layers known as

theca

Shortly

after theca formation

,

-

Primary oocyte

reaches

full size

(115



m in

diameter)

-

Antrum

(fluid-filled space) begins to for in

Process of Atresia

Atresia is not limited to just antral follicles, follicles

can undergo atresia

at any stage

This process is already occurring

in utero

so that

the 2-4 million follicles and eggs are present at

birth represent only a small fraction of those

present at earlier time in the fetus

Atresia then

continues all through pubertal life

so

that only 200,000-400,000 follicles remain when

active reproductive life begins.

Pro ess of Atresia…..

Sites of Synthesis of Ovarian Hormone

Estrogen is synthesized and released into blood:

- during follicular phase mainly by granulosa cells

- after ovulation, by CL

Progesterone is synthesized and released into

blood:

- in very small amounts by granulosa and theca

cells just before ovulation

- major source is CL (after ovulation)

Inhibin is synthesized and released into blood:

- by granulosa cells

Ovarian Cycle

1. The follicular phase:

- ovarian follicle growth

- ovulation

2. The luteal phase:

Uterine Cycle

1. Proliferative phase:

-

estrogen



estrogen phase

-

before ovulation

2. Secretory phase:

-

progesterone



progestational phase

-

after ovulation

3. Menstruation

Cyclical Changes in Cervix

The mucosa of cervix does not undergo cyclical desquamation

There are regular changes in cervical mucus:

- Estrogen makes the mucus thinner, watery, and more

alkali e → pro otes the survival a d tra sport of sper s

- At the time of ovulation the mucus is: > thinnest and fern-like pattern on slide

> its elasti ity i reases → a drop a e stret hed i to a long (8 - ≥ , a d thi thread

- Progesterone makes the mucus thick, tenacious, and cellular

Microscopic of patterns formed of cervical mucus on dried smeared slide. Progesterone makes the mucus thick and cellular.

In anovulatory, no progesterone is present to inhibit fern-like pattern

Estrogen:

fern-like pattern

Estrogen,

no progesterone: Fern-like pattern Progesterone:

Cyclical Changes in Vagina

Under influence of estrogen:

- the vaginal epithelium becomes cornified that

can be identified in the vaginal smear

Under influence of progesterone:

- secretion of thick mucus

- the vaginal epithelium proliferates and

becomes infiltrated with leukocytes

Cyclical Changes in Breast

Although lactation normally does not occur until the end of pregnancy, cyclical changes take place in the breasts during the menstrual cycle

Estrogens cause proliferation of mammary ducts

Progesterone causes: growth of lobules and alveoli

The breast swelling, tenderness, and pain experienced by many women during the 10 day preceding

e struatio ← due to diste tio of the du ts,

hyperemia, and edema of the breast interstitial tissue

Normal Menstruation

Menstrual blood is predominantly arterial, only 25% of the blood being of venous origin

Containing tissue debris, prostaglandins, and relatively large amount of fibrinolysin from endometrial tissue

Fi ri olysi lyses lots → o lots i e strual lood

Usual duration is 3-5 d, but 1-8 d can occur normally The average amount of blood lost is 30 ml (range

normally from light spotting – 80 ml)

The amount of blood affected by various factors,

Anovulatory Cycles

Anovulatory cycles are common for the first 12-18 months after menarche and before the onset of menopause

Whe ovulatio does ot o ur → o CL → effe ts of

progesterone on endometrium are absent

Estrogens continue to cause growth, and proliferative endometrium becomes thick enough to break down and begins to slough

The time it takes for bleeding usually < 28 d from the last menstrual period

BIOSINTESIS DAN

MEKANISME KERJA

HORMON REPRODUKSI WANITA

Kuliah 3

Rahmatina B. Herman

Bagian Fisiologi

Ovarian Sex Hormones

Types of ovarian sex hormones:

1. Estrogens

The most important of estrogens is estradiol

2. Progestins

The most important of progestins is progesterone

Production:

> Non-pregnant: by - ovaries

- adrenal cortices

> Pregnancy: by - ovaries

- placenta

Ovarian

Se Hor o es…..

Transport to target organ:

> Loosely bound with plasma albumin

> More tightly bound with a beta globulin: sex binding globulin

- specific estrogen-binding globulin

- specific progesterone-binding globulin

Mechanism of action:

> Location of receptors: - Cell interior

> Signal transduction mechanism:

- Receptors directly alter gene transcription

Types of Estrogens

Beta-estradiol (17β-estradiol):

- major estrogen

- synthesized by ovaries

- strength: 12x estrone and 80x estriol

• Estrone

- by adrenal cortices, ovaries, and some other tissues

• Estriol

Synthesis

Cholesterol

Androstenedione

Testosterone

Estrone

Estradiol

Secreted by Ovaries

Aromatase

Sy thesis…..

The naturally estrogens (17β-estradiol, estrone, and estradiol) are C18 steroids

The biosynthesis of estrogens depends on the enzyme aromatase (CYP19), which converts testosterone to estradiol and androstenedione to estrone

The reaction of converting androstenedione to estrone also occurs in:

Synthesis by Ovaries

Estrogen is synthesized and released into blood

- during follicular phase mainly by granulosa cells

- after ovulation by corpus luteum

- during pregnancy by placenta

Granulosa cells require help to produce estrogen

because they are deficient in the enzymes required to produce androgens that are the precursors of estrogen

They are aided by theca cells

Synthesis by

Ovaries…..

Ovarian follicle

(Diffusion₎

Theca cells

Synthesize androgens

Granulosa cells

Convert androgens to estrogen

Sy thesis y Ovaries…..

Theca interna cells have many LH receptors

LH acts via cAMP to increase conversion of cholesterol to androstenedione

Theca interna cells supply androstenedione to granulosa cells

Estradiol produced by granulosa cells when provided with androgen and secreted into follicular fluid

Granulosa cells have many FSH receptors

FSH facilitates the secretion of estradiol by acting via cAMP to increase aromatase activity

Secretion

Concentration of estradiol in plasma during menstrual cycle is depend on menstrual phase

Almost of this estrogen comes from ovary

Two peaks of secretion occur: one just before ovulation and one during the midluteal phase Estradiol secretion rate is:

- 36 μg/d in the early follicular phase - 380 μg/d just before ovulation

- 250 μg/d during midluteal phase

Transport and Metabolism

Circulating estradiol: 2% is free, 60% is bound to albumin and 38% is bound to sex hormone-binding globulin /gonadal steroid-binding globulin (specific estrogen-binding globulin)

Metabolism by liver:

- conjugated  glucoronide and sulfate - excreted: - most in urine

- in the bile (1/5 → e terohepati circulation

3 Basi e ha is s of estroge ’s effe ts o target

organs/ cells

- Promote proliferation and growth specific cell - Development of primary sex characteristic

- Development of most secondary sex characteristics

Non reproductive effects - Promotes fat deposition - Increases bone density - Closes epiphyseal plates

On Sex-specific tissues

Essential for egg maturation and release

Stimulates growth and maintenance of entire female reproductive tract

Stimulates granulosa cell proliferation which lead to follicle maturation

Thins cervical mucus to permit sperm penetration Enhances transport of sperm by stimulating upward contractions of uterus and oviduct

Stimulates growth of endometrium and myometrium

Induces synthesis of endometrial progesterone receptors

Triggers onset of parturition by increasing uterine responsiveness to oxytocin during late gestation through a twofold effect by

- inducing synthesis of myometrial oxytocin receptors

- increasing myometrial gap junctions so that uterus can contract as a coordinated unit in response to oxytocin

Other reproductive effects

• Promotes development of secondary sexual characteristics

• Controls GnRH and gonadotropin secretion: - Low levels: inhibit secretion

- High levels responsible for triggering LH surge

• Stimulates duct development in breasts during gestation

• Inhibits milk secreting action of prolactin during gestation

On uterus & external sex organ

:

- Increase the size

- External genitalia enlarge with deposition of fat

- Change vaginal epithelium from cuboidal  stratified - Endometrium changes:

> proliferation of the stroma

> greatly increased development of endometrial glands

On Fallopian tube

:

- Proliferation of glandular tissue

- Increase the number of ciliated epithelial cell - Enhance the activity of the cilia

On breast:

- Development of the stromal tissue

- Growth of an extensive ductile system - Deposition of fat

- Develop lobules and alveoli (initiate growth)

- Characteristic growth and external appearance of the mature female breast

On metabolism:

- Increase metabolic rate (1/3 of testosterone)

On electrolyte balance: Na retention

- Slight and rarely significance, except in pregnancy

On protein deposition:

- Slight increase in total body protein

On fat deposition:

- Increase quantities of fat in subcutaneous tissue  decreased specific gravity  flotation in water

On skin:

- Develop texture which is soft and smooth - Thicker than children and more vascular

- Increase secretion of axillary sweat gland  acne (by adrenal androgen)

On hair distribution:

- No greatly effect (opposite to testosterone)

On skeleton:

- Increase osteoblastic activity  growth

- Early uniting of the epiphyses with the shafts of long bone (stronger than testosterone)

Osteoporosis caused by estrogen deficiency:

- Diminished osteoblastic activity - Decreased bone matrix

- Decreased deposition of Ca & Phosphate

On central nervous system

- Increase libido in humans and estrous behavior in

animals by direct effect on neurons in hypothalamus - Increase proliferation of dendrites on neurons in rats

Intracellular function:

- circulate in blood only a few minutes  target cells - combine with receptor protein in cytoplasm



- activate specific portions of chromosomal DNA



- initiate transcription process  DNA – RNA 

> division of cell

> protein formation  in a few specific target organs

Synthesis

Cholesterol

Pregnenolone

17-Hydroxy progesterone

Dehydroepi androsterone

Synthesis

The most important type of progestin is

progesterone

Progesterone is C21 steroid

Progesterone is synthesized and released into

blood

> by ovaries:

- major source is CL (after ovulation)

- In very small amounts by granulosa and theca cells just before ovulation

- placenta

Secretion

Concentration of progesterone in plasma during menstrual cycle is depend on menstrual phase

Progesterone secretion rate is 0.9 ng/ml during the follicular phase, and late in follicular phase,

progesterone secretion begins to increase

During luteal phase, corpus luteum produces large

ua tities → plas a o e tratio arkedly

increased to a peak value of approximately 18 ng/ml Stimulating effect of LH is due to activation of adenylyl cyclase and involves subsequent step that is

Transport and Metabolism

Circulating progesterone: 2% is free, 80% is bound

to albumin and 18% is bound to sex

hormone-binding globulin /corticosteroid-hormone-binding globulin

(specific progesterone-binding globulin)

Progesterone has a short half-life

Converted in liver to pregnanediol, which is

conjugated to glucuronic acid

Final preparation of the uterus for pregnancy

- Prepares a suitable environment of a developing embryo/ fetus

- Promotes formation of a thick mucus plug in cervical canal

- Inhibits uterine contractions during gestation

Final preparation of the breast for lactation

- Stimulates alveolar development in breasts during gestation

- Inhibits milk-secreting action of prolactin during gestation

Inhibits hypothalamic GnRH and gonadotropin secretion

On uterus:

- promote secretory change during the latter half of

y le → prepari g for i pla tatio

- decrease frequency and intensity of uterine

o tra tio → preve t e pulsio of i pla ted

ovum

On Fallopian tube:

- pro ote se retory ha ge → utritio for fertilized ovum

On breast:

- Development of lobules and alveoli

- Proliferate, enlarge, to become secretory of alveolar cells

- Cause breast swell

development in lobules and alveoli

Increase fluid in subcutaneous tissue

On electrolyte balance:

- In large quantity: Na retention (less than aldosterone)

- More often: increased Na and water excretion

Competition with aldosterone for binding

with receptor so that effect of aldosterone on Na retention is blocked

with net results increased Na excretion

The effects of progesterone, like those of other

steroids are brought about by an action on DNA to initiate synthesis of RNA

Progesterone receptor is bound to a heat shock protein

The synthetic steroid mifepristone binds to the

receptor but does not release the heat shock protein, and it blocks the binding of progesterone

Mifepristone combined with prostaglandin can be used to produce elective abortions

Tugas

Anatomy-Physiology of Ovaries:

- Immature follicle

- Mature follicle

- Theca cells

- Granulosa cells

Definisi



Makanan



Zat gizi

Ilmu Gizi



Dasar



Masyarakat

Sejarah Ilmu Gizi



Hipocrates



Lavoisier



Eijkman



Burkitt

Makanan dan zat gizi



Mayor



Minor

 Vitamin

 Mineral

Makanan



Mengandung zat gizi



Interaksi zat gizi dalam makanan



Variasi makanan

Malnutrisi di Rumah Sakit

 Hanya 46% kasus yang diukur Tinggi badan

 23% kasus yang tidak diukur Berat badannya

 61% yang ditimbang kehilangan BB >6kg

Malnutrisi di Rumah Sakit

Prevalensi



Di AS: bervariasi antara 30% hingga 50%

Malnutrisi di Rumah Sakit

Prevalensi



69%: Adequate nutritional status



21%: moderately malnourished



10%: severely malnourished

Malnutrisi di Rumah Sakit

Prevalensi Di RSUP M Jamil



56,67% gizi kurang



40% gizi normal



3,33% gizi lebih



2 minggu, IMT menurun dari 19,07±3,84

menjadi 18,75±3,64 (P=0,013)



73,33% tidak mendapatkan kalori sesuai

kebutuhan

Akibat malnutrisi



Perubahan intestinal barier



Penurunan filtrasi glomerulus



Gangguan fungsi jantung

Akibat malnutrisi



Kehilangan berat badan



Penyembuhan luka melambat



Gangguan imunitas



Penambahan masa inap rumah sakit



Meninggikan treatment cost

Malnutrisi dan komplikasinya



Studi dan penelitian:

- komplikasi terjadi 2 – 20 kali lebih banyak

Malnutrisi dan penyembuhan luka



Amputasi kaki



86% pasien gizi baik sembuh tanpa ada

masalah



Hanya 20% pasien dengan gizi buruk yang

sembuh baik

Malnutrisi dan peningkatan

komplikasi



42% pasien gizi buruk mengalami

komplikasi besar



9% pasien gizi sedang mengalami

komplikasi besar



Pasien gizi buruk 4 kali lipat alami

komplikasi post operasi diabnding gizi baik

Malnutrisi dan peningkatan

komplikasi



Pasien at “risk for malnutrition”:



2,6 kali kemungkinan alami komplikasi



3,4 kali kemungkinan alami komplikasi

besar dibanding gizi baik

Peran Gizi Klinik



Asuhan Nutrisi Rumah Sakit



Tim: Dokter Ahli, Dokter Ahli Gizi, Dietitian,

Perawat, Farmasi

NUTRISI BAYI DAN ANAK

untuk TUMBUH KEMBANG

MAKANAN BAYI & ANAK SEHAT & SAKIT

 NUTRIEN : zat penyusun bahan makanan

air, karbohidrat, protein, lemak, vitamin , mineral

KH, PROT dan LEMAKmakronutrien Vit, Mineral dan Air ---mikronutrien

 Bahan makanan :

ASAH

ASUH

ASIH

NUTRISI

MP-ASI

MP-ASI



Nutrisi penting utk T-K serta

kehidupan dan kesehatan masa

depan



Kebutuhan nutrisi : paling tinggi

Tujuan pemberian makanan

pada bayi dan anak

 Memberikan nutrien yg cukup untuk kebutuhan memelihara kesehatan

memulihkan bila sakit melaksanakan aktivitas

pertumbuhan , perkembangan jasmani dan psikomotor

 Mendidik kebiasaan yang baik tentang makanan.

KEBUTUHAN NUTRIEN

PADA BAYI DAN ANAK

 AIR : Medium pelarut dan pengangkut nutrient ( KH, Protein, lemak, Vitamin, mineral )

Kebutuhan :seimbang dgn intake kalori pd masing-masing umur Triwulan I 175 – 200 ml / kgBB / hr

Triwulan II 150 -- 175 ml / kgBB / hr Triwulan III 130 – 140 ml / kgBB /hr Triwulan IV 120 -- 140 ml / kgBB / hr

Rata-rata 100 -160 ml / kgBB/hr

KARBOHIDRAT

 Kegunaan :

- Sumber energi utama / sumber serat - Antiketogenik

- Penyimpanan kalori sebagai glikogen - Komponen antibodi dan struktur sel - Konversi = fat = as amino

 Kebutuhan : 25 – 55 % total kalori

PROTEIN

 SUMBER : Hewani dan Nabati

Kadar asam amino prot hewani > prot nabati

Kegunaan; Sumber energi / asam amino Pembentukan sel baru

Pengganti sel rusak

Keseimbangan osmotik & asam basa

Komponen enzim & anti bodi

 FAO / WHO = the save level of protein intake jumlah protein perlu utk menjaga kesehatan

1 – 12 bulan 3,5 – 2,0 gr / kgBB / hr 1 – 3 tahun 3,0 – 2,8 gr / kgBB/hr 3 – 9 tahun 2,0 – 1,5 gr / kgBB/hr

Nilai protein makanan = 60% nilai gizi protein



LEMAK :

Nabati & Hewani mengandung as lemak esensial Linoleat & arakhidonat -- Precusor DHA & AA Kegunaan :- Sumber kalori yg efisien

- Sumber trigliserida, kolesterol

- Memberikan rasa sedap makanan - Pelarut vit A, D, E, K---- .absorbsi

- Bantalan kulit/isolator perubahan suhu - Pertumbuhan rambut

VIT GUNANYA DEFISIEN SI HIPER VITAMIN SUMBER A PENGLIHAT AN, EPITEL BUTA SENJA KAROTENE MIA SAYUR BERWARNA B1 METABO LISME OEDEM NEURITIS HATI,DA-GING,SUSU, NIA CIN

KO-ENZIM PELAGRA KULIT ME-RAH GATAL

DAGING

VIT GUNANYA DEFISIEN SI HIPER VITAMIN SUMBER FO-LAT METABO-LISME ANEMIA MEGALO-BLASTIK HATI,KEJU SAYUR, KA-CANG B6 META-BOLISME IRITABEL, KEJANG, NEURITIS SENSORI NEUROPATI DAGING, HATI, KACANG B12 MTB

MINERAL FUNGSI DEFISIENSI

CALSIUM = Ca TULANG, GIGI, OTOT, PEMBE-KUAN, AKSI JANTUNG GGN-TULANG, RAKHITIS, OS-TEO MALASIA, OSTEO PORESIS FLOUR = F EMAIL TL GIGI CARIES GIGI

IODIUM = I HORMON

TIROKSIN

GONDOK & KRETINISME FERUM = Fe HEMOGLOBIN &

ENZIM

ANEMIA MIK-ROSITIK HPKR

MINERAL FUNGSI DEFISIENSI

PHOSPOR ( P )

TULANG,GIGI METABOLISME

RIKETSIA

KALIUM ( K )

KONTRAKSI OTOT IMPULS SYARAF IRAMA JANTUNG TEK OSMOTIK

OTOT LEMAH , METEORISMUS / KEMBUNG

NATRIUM ( Na )

KESB ASAM-BASA TEK OSMOTIK

IMPULS SYARAF

KRAMP OTOT, KEJANG

ZINC ( Zn )

PEMBTK ENZIM

AKRODERMATI-TIS.HIPERPIGMENTASI, HIPOGONADISME,

VIT GUNANYA DEFISIEN SI HIPER VITAMIN SUMBER C INTEGRITAS SEL &

AB-SORBSI Fe SCURVY SBH LUKA LAMBAT CITRUS BUAH SAYUR D ABSORBSI

Ca dan P

ENERGI = KALORI



Makronutrien yg dikonsumsi



Kalori



Kebutuhan : Kalori / Kg BB /hari

Bayi

: 110 ( 100

–

120 )

Usia 1

–

9 th :

100 ( 110

–

80 )

KEGUNAAN KALORI

 Metabolisme basal

Bayi 55 kal / kgBB/hr,+ 10% kenaikan suhu 1 C Dewasa 25 – 30 kal/kgBB/hr

 Spesific dynamic action

Bayi 7 – 8% x total kalori Anak 5% x total kalori

 Pembuangan Ekskreta < 10% x kalori/kgBB/hr

 Aktivitas jasmani 15- 25 kal / kgBB/hr

 Pertumbuhan & perkembangan ( Fsikomotorik ) = kalori yg disimpan Bayi  20 – 40 kal

KEGUNAAN KALORI

 Metabolisme basal

Bayi 55 kal / kgBB/hr,+ 10% kenaikan suhu 1 C Dewasa 25 – 30 kal/kgBB/hr

 Spesific dynamic action

Bayi 7 – 8% x total kalori Anak 5% x total kalori

 Pembuangan Ekskreta < 10% x kalori/kgBB/hr

 Aktivitas jasmani 15- 25 kal / kgBB/hr

 Pertumbuhan & perkembangan ( Fsikomotorik ) = kalori yg disimpan Bayi  20 – 40 kal

KENAIKAN KEBUTUHAN ENERGI BERDASARKAN AKTIVITAS

AKTIVITAS KENAIKAN Tirah baring + 10%

Aktivitas ringan + 30% ( duduk, main ) Aktivitas sedang + 50% ( berdiri, main )

BALANCED DIET

( GIZI SEIMBANG )



PROTEIN

15%



LEMAK

35%



KHO

50%

1 GRAM PROTEIN ~ 4 KALORI

1 GRAM LEMAK

~ 9 KALORI

PENGATURAN MAKAN

 Umur

 Berat badan

 Dignosis penyakit

 Mulut sebagai penerima

 Kebiasaan makan, kesukaan dan toleransi

 Pengaturan makan bayi

ASI / Susu formula

CARA MENGHITUNG

KEBUTUHAN KALORI

 Kebutuhan nutrient = data kebutuhan nutrient

 Jumlah makanan = dalam kilokalori

 Jenis mkn yg diolah = menu (hidangan)

 Jadual makan

 Cara pemberian mkn (oral, sonde, intra-gastric)

Age

(yrs)

Energy

(kcal/kgBW)

0-1

110-120

1-3

100

4-6

90

7-9

80

10-

70-60

RDA

Category Age Wt Ht Energy Prot Vit Min yr kg cm kcal g

Infants 0.0-0.5 6 60 kgx115 kgx2.2 0.5-1.0 9 71 kgx105 kgx2.0

Children 1-3 13 90 1300 23 4-6 20 112 1700 30 7-10 28 132 2400 34

Males 11-14 45 157 2700 45 15-18 66 176 2800 56 19-22 70 177 2900 56 23-50 70 178 2700 56 51+ 70 178 2400 56

Males (P’tiles) Females (P’tiles)

Age (yrs) 10 50 90 10 50 90 1 10.3 14.1 18.8 10.6 13.6 17.6 2-3 11.6 15.0 20.2 10.5 13.5 17.9 4-6 12.3 15.2 20.4 10.7 13.8 18.6 7-10 12.8 16.7 22.3 10.4 14.1 18.4 11-14 12.4 16.8 22.2 9.0 13.0 18.2 15-16 11.4 15.9 21.1 7.4 11.8 17.3

Praktek pemberian makan pd bayi



Terdapat 3 periode :

1. ASI eksklusif

2. ASI + MP-ASI

BAGAN PEMBERIAN MAKAN BAYI

UMUR (BLN)

ASI BUAH / BISKUIT

BBS NASI

TIM 0 - 6 ASI

ekslf

OD

6 – 7 OD 2 x 1x

7- 8 OD 2x 2x 1x saring

8 – 10 OD 2x 1x 2x tanpa

saring

10 -12 OD 2x - 3x

Tahapan penyapihan :

R.hisap R.telan

R.ekstrusi

</-Mengunyah Menggigit

Gerak memutar Rahang stabil Koordinasi tangan baik

“

Bagaimana mengetahui bayi sudah

cukup mendapat ASI? “



Tanda bayi sdh cukup mendapat cairan dan

energi :

- miksi banyak minimal 6-8 x/h - b.a.b teratur

- menyusu 8 - 12 x/h

- tampak puas setelah menyusu

Penilaian pertumbuhan

- Monitor kenaikan BB :

trimester 1 : 25-30 g/h = 200 g/mg = 750-900 g/bln trimester 2 : 20 g/h = 150 g/mg = 600 g/bln trimester 3 : 15 g/h = 100 g/mg = 400 g/bln trimester 4 : 10 g/h = 50-75 g/mg = 200-300 g/bln

Apakah ibu dalam keadaan sehat/sakit ?

Apakah cara menyusui sudah benar ?

- posisi ibu & bayi berhadapan - kepala dan punggung bayi lurus

- mulut bayi mencakup seluruh putting dan areola

Apakah anak dalam keadaan sehat/sakit ?

- demam,batuk, pilek

- gangguan sal.cerna

Bila cara menyusui sudah benar dan anak

tidak sakit,maka sangat mungkin ASI tidak

mencukupi

Perlu makanan tambahan :

- usia < 4 bulan : FORMULA (PASI)

Pada bayi dgn ASI eksklusif



Tidak boleh diberi MP-ASI sebelum

usia 4 bulan

MP-ASI (periode 2)

Proses penyapihan (‘weaning”)

Proses dimulainya pemberian

makanan ksusus selain ASI secara

bertahap jenis maupun

konsistensinya sampai seluruh

Makanan khusus

:

-

bentuk : cair,lunak,padat

- jenis : jus, biskuit, bubur susu,

nasi tim

MP-ASI yang baik



Kaya akan energi dan nutrien



Bersih/higienis dan aman



Lembut dan mudah

dikonsumsi



Mudah didapat