IBCLC Exam Anatomy, Physiology, and Endocrinology

Polythelia

Having one or more extra nipples

Poland Syndrome

Unilateral hypoplasia of the breast combined with hypoplasia of the thorax and pectoral muscles

Hypoplasia Type 1

Underdevelopment of lower medial quadrant of breast

Hypoplasia Type 2

Underdevelopment of lower medial and lateral quadrant of breast

Hypoplasia Type 3

Underdevelopment of lower medial and lateral quadrant of breast with skin deficiency in subareolor region

Hypoplasia Type 4

Severe breast constriction with minimal breast base

Polymastia

The presence of more than two breasts, usually due to accessory (supernumerary) breast tissue along the embryologic milk line

Symmastia

A condition in which the two breasts are joined by tissue across the midline, resulting in loss of the normal cleavage

Hyperplasia

Excessive growth of breast tissue due to an increased number of cells, often hormonally driven; may be physiologic or pathologic

Hypermastia

Excessive enlargement of the breasts due to overgrowth of glandular and/or fatty tissue (also called macromastia or gigantomastia in severe cases).

Sheehan’s Syndrome

Postpartum syndrome caused by ischemic necrosis of the pituitary gland following severe postpartum hemorrhage, leading to deficiencies in pituitary hormones

Lactogenesis I

Also known as secretory differentiation, begins in pregnancy (around 16-20) weeks, breasts produce colostrum

Lactogenesis II

Also known as secretory activation, the onset of copious milk production due to the drop in progesterone after delivery of placenta

Lactogenesis III

Also known as galactopoeisis, The ongoing production of mature milk, typically controlled by an autocrine system

Human placental lactogen

placental hormone that prepares the breasts for lactation and alters maternal metabolism to support fetal growth.

Insulin

A hormone that supports lactation by enabling mammary cells to take up glucose and synthesize milk components, especially lactose, working alongside prolactin and cortisol to maintain milk production. Could also inhibit lactogenesis II

Cortisol

Hormone that promotes maturation of the neonate’s intestine when found in BM, and that in high volumes can delay lactogenesis II and inhibit prolactin and oxytocin release in mom

Estrogen

A hormone that stimulates growth of the mammary ducts during pregnancy but inhibits milk secretion, with its postpartum decline allowing lactation to begin

TSH

A pituitary hormone that indirectly supports lactation by stimulating the thyroid to produce T3 and T4, which are essential for energy metabolism and normal milk production

Feedback inhibitor of lactation

A protein in breast milk that regulates milk production locally: when milk accumulates in the alveoli, ___ slows further milk synthesis, helping the breast maintain an appropriate supply based on how much milk is removed.

Paget’s disease

A rare type of breast cancer that affects the nipple and areola, unilaterally, often presenting with redness, scaling, itching, or ulceration, and usually associated with an underlying ductal carcinoma in the breast tissue

Fibroadenoma

A benign (non-cancerous) breast tumor composed of fibrous and glandular tissue, typically round, firm, mobile, and painless, most common in young women

Olfactory nerve

I. Nerve for smell — helps infant recognize mother’s scent and locate the nipple

Optic nerve

II. Nerve for vision, assists in visual tracking of breast/nipple

Oculomotor nerve

III. Nerve that affects eye movement and pupil constriction

Trochlear nerve

IV. Nerve that affects eye movement via the superior oblique muscle

Trigeminal nerve

V. Nerve for sensory: face, lips, gums; Motor: muscles of mastication. Critical for latch and sucking

Abducens

VI. Nerve that affects eye movement via the lateral rectus

Facial nerve

VII. Nerve that helps with lip seal, cheeks, sucking, and facial expression

Vestibulocochlear nerve

VIII. Nerve that helps with hearing and balance

Glossopharyngeal nerve

IX. Nerve that affects pharyngeal muscles, posterior tongue, taste; Affects swallowing and gag reflex in baby

Vagus nerve

X. Nerve that affects pharynx and larynx. Swallowing, coordinating suck swallow breathe, heart rate regulation

Spinal accessory nerve

XI. Nerve that affects sternocleidomastoid and trapezius

Hypoglossal nerve

XII. Nerve that affects tongue muscles and movement for sucking and latching

Phagocyte

White blood cell that engulfs and absorbs pathogens and releases IgA

Lymphocytes

T cells and B cells that are essential for cell mediated immunity, antiviral activity

Prostaglandins

Compounds that are cytoprotective (maintain gut lining integrity)

Cytokines

Immunodulating agents that bind to specific cellular receptors, activate the immune system, promote mammary growth, and move lymphocytes into breastmilk and across the neonatal bowel wall

Amylase

Enzyme that facilitates infant digestion of polysaccharides

Lipase

Enzyme that hydrolizes fat in infant intestine

Human growth factors

Polypeptides that stimulate proliferation of intestinal mucosa and epithelium; strengthens mucosal barrier to antigens

Cholecystokinin

Hormone in BM that enhances digestion and makes infant feel sleepy

Thyroxin

Hormone found in BM that protects against hypothyroidism

Prolactin

Hormone in breastmilk that enhances development of B and T lymphocytes

DHA and ARA

Long chain polyunsaturated fatty acids that are associated with a higher visual acuity and cognitive ability. Content of this is dependent on maternal diet

Free fatty acids

Lipids that have anti-infective effects

Triglycerides

Fats that are the largest source of calories in BM. Broken down by lipase into free fatty acids and glycerol

Lactose

Carbohydrate, major energy source; breaks down into galactose and glucose. Enhances absorption of Ca, Mg, and Mn

Oligosaccharides and glyconjugates

Carbohydrates in BM with microbial and viral ligands

Minerals

In BM, regulate normal body functions

Whey

Component of BM that contains lactoferrin, lysozyme, and immunoglobins, alpha-lactalbumin

Immunoglobulins

SIgA, IgM, IgG; immunity response to specific antigens in the environment

Lactoferrin

A protein that binds to iron and is antibacterial especially against E. coli. Preserved in lower qualities in pasteurization

Lysozyme

A protein that kills bacteria and is anti-inflammatory; activity increases starting at 6 months after delivery

Taurine

Amino acid in abundance in BM that is associated with early brain maturation and retinal development

Water

Component that comprises 87.5% of human milk volume

Casein

Protein that inhibits microbial adhesion to mucosal membranes

Lactobacilius bifus

is a component in human milk that promotes the growth of beneficial gut bacteria, particularly Bifidobacteria, which aids in the development of a healthy digestive system in infants

Hypothalamus

Links the nervous system to the endocrine system via the pituitary gland

90-160 bpm

Normal newborn heart rate

Orbicularis oris

Muscle that puckers and closes the lips. Made up of 4 muscles that encircle the mouth

Masseter

Muscle that moves the jaw up and down. Used in suckling and chewing

Depressor anguli oris

Muscle that assists with frowning and facial expression

Depressor labii inferioris

Muscle that assists in downward motion of the lower lip

Buccinator

Muscle that assists w/ tightening of cheeks, sucking, adjusts lips corners

Temporalis

Muscle for jaw stabilization, graded jaw movements

Choanal atresia

Rare congenital anamoly blocking posterior nostrils on one or both sides

HELLP syndrome

A rare result of pre-eclampsia. H=intravascular hemolysis EL= elevated liver enzymes LP=low platelets

Hyperadenia

Mammary tissue without a nipple present

Laryngomalacia

respiratory disorder in which the epiglottis lacks normal stiffness or muscle tone causing stridor

Eminences of pars villosa

Tiny swellings on inner surfaces of the infant’s lips. Help maintain a seal

Phasic bite

A reflex characterized by a rhythmic opening and closing of the jaw when the gums are stimulated

Cephalohematoma

Collection of blood beneath periosteum due to birth trauma. Does not cross suture lines

Caput succedaneum

Edema over the periosteum that crosses suture lines

Normal newborn respiratory rate

30-60 breaths per minute

Pierre Robin Syndrome

Syndrome of oral facial abnormalities, micrognathia, glossoptosis (tongue blocks airway) Cleft palates common. Difficulty maintaining the airway

Prolactin inhibiting factor

Hormone from the hypothalamus that stimulates dopamine release and thus inhibits prolactin

Apgar score

Index used to evaluate a newborn’s condition based on heart rate, color, reflex, tone, and respiration

VBL (very low birth weight)

Birth weight less than 1500 grams

Late preterm infant

An infant between 34 0/7 and 36 6/7 weeks gestation

Mammary bud

A cluster of embryonic epithelial cells that mark the beginning of milk ducts. Forms aprox 49 days after conception

Nevus Flammeus

AKA Port Wine Stain. Reddish or flat pink lesion that does not blanch with pressure caused by dilated capillaries below the epidermal skin

H in HELLP syndrome

intravascular hemolysis

EL in HELLP syndrome

Elevated liver enzymes

LP in HELLP syndrome

Low platelets

Nerve supply of the breast

2nd-6th intercostal nerves

Internal mammary and lateral thoracic arteries

The 2 main arteries that supply blood to the breast