9) Maternal Medicine - Gastro/Abdo pain Flashcards
Percentage of patients with IBD diagnosed<35 years
50%
Where is the inflammation in UC?
Mucosal layer of colon
Where is the inflammation in CD?
Transmural anywhere from mouth –> perianal area.
Proportion of women with IBD conceiving after diagnosis made
25%
Which IBD does smoking increase risk of relapse in?
Crohn’s
Risk of relapse of IBD in pregnancy
30% relapse rate if stable.
2/3 if active disease at conception.
When do most IBD relapses occur?
Early pregnancy
Effect of pregnancy on overall relapses?
Lowers risk
Effect of IBD on pregnancy
- Similar fertility (unless active disease or extensive surgery)
- Stable disease no increase in adverse outcomes
- Miscarriage, PTB, Low birthweight in patients with active disease
What can be used to diagnose IBD flare?
- Clinical features
- CRP
- Faecal calprotectin
- Imaging
Mycophenolate/methotrexate in IBD
Stop 3/12 before conception
Aminosalicylates (sulfasalazine/mesalazine) in IBD
- Safe and should be continued (up to 3g/day)
- Higher doses associated with fetal nephrotoxicity
- Bloody diarrhoea in mesalazine
- Sulfasalazine needs high dose folic acid (DHFR inhibitor)
Thiopurines (azathioprine/mercaptopurine) in IBD
Safe.
Azathioprine preferred.
Calcineurin inhibitors (tacrolimus/ciclosporin) in IBD
If steroids refractory.
Link to PTB and low birthweight.
Indications for surgery in IBD
Obstruction Perforation Haemorrhage Abscess Toxic megacolon
Indications for CS in IBD
- Active perianal or rectal disease
- After ileo-anal pouch formation
Perineum in IBD
Avoid episiotomy
Analgesia in IBD
- NSAIDs can exacerbate for some
- Opiates lead to constipation and exacerbate perianal disease
Incidence of acute abdomen in pregnancy
1 in 500
Increase in childhood cancer risk from abdominal CT
0.1% and fatal adult cancers 0.3%
Incidence of biliary colic/cholecystitis
1-6 in 1000
Treatment for biliary colic/cholecystitis
If obstructive stone - ERCP.
Definitive surgery during index admission preferred.
Incidence of bowel obstruction
1 in 1500
Incidence of pancreatitis
3 in 10,000
Blood tests in pancreatitis
Serum amyase 3 x uLN diagnostic.
Serum lipase more sensitive and specific.
Normal renal tract dilatation
5mm left, 15mm right, 2cm ureters.
Risk of visceral artery aneurysm rupture in pregnancy
4 x higher
Which visceral artery aneurysm rupture most common?
Splenic artery rupture (95% cases during pregnancy)
Most common surgical abdomen in pregnancy
Appendicitis
Gallstone disease next
Incidence of appendicitis in pregnancy
1/800-1/1500
Appendicitis in pregnancy more or less common?
Less common
Most common time for appendicitis in pregnancy
2nd trimester.
Perforation most common in 3rd trimester.
Which symptoms significantly different between pregnant appendicitis and non-pregnant?
More likely RUQ pain, dysuria.
Less likely rebound/guarding and low grade fever.
Number of negative laparotomies for appendicitis
35%
Incision for appendicitis
Transverse incision over point of maximal tenderness unless diagnosis uncertain then do lower midline
Which routine of operation associated with higher risk of fetal loss?
Laparoscopic (RR 1.9)
Incidence of failed intubation in pregnant
3.3%
Intra-abdominal pressure during laparoscopy in pregnancy
<12 mmHg
Fetal loss associated with appendicitis
1.5% Simple
6% Peritonitis
36% Perforated
Risk of PTB with appendicitis?
1% second trimester, 9% 3rd trimester
Percentage of patients operated on in first trimester who miscarry
10%
