Gastrointestinal Disorders and Pregnancy

Question 1

Common discomforts:

Answer 1

Nausea
Heartburn
constipation

Question 2

Nausea and vomiting are intense. Fever, ketones in urine, leukocytosis

Answer 2

Appendicitis

Question 3

Appendicitis pain continues to grow more intense, localized at _______________, can shift higher in pregnant woman. _____ confirms inflamed appendix

Answer 3

McBurney point

MRI

Question 4

S/S of Appendicitis

Answer 4

sharp, peristaltic lower quadrant pain

Question 5

Dx of GERD or Hiatal Hernia

Answer 5

UTZ or direct endoscopy

Question 6

Tx of GERD or Hiatal Hernia

Answer 6

a. antacids or PPI
- esomeprazole magnesium
b. clothing that is loose around waist
c. sleep w/ head elevated

Question 7

Management of Appendicitis

Answer 7

Advise woman not to eat or drink or take laxatives as it may cause peristalsis and cause rupture of appendix

Question 8

If ____________, CS may be done along with removal of appendix

If rupture occurs, fecal material may be spread to the fetus via _______

_____________ after ruptured appendix may cause ________ due to changes in the placement of FT

Answer 8

near term

fallopian tubes

Peritoneal adhesions, infertility

Question 9

Risks of Appendicitis in Pregnancy

Answer 9

a. peritonitis
b. preterm labor

Question 10

reflux of acid stomach secretions into esophagus

Answer 10

Gastroesophageal Reflux Disease

Question 11

a portion of the stomach extends and protrudes up through the diaphragm into the esophagus, trapping stomach acid and causing it to reflux into the esophagus

Answer 11

Hiatal Hernia

Question 12

S/S of A Woman with Gastroesophageal Reflux Disease or Hiatal Hernia

Answer 12

a. heartburn
b. gastric regurgitation
c. dysphagia
d. possible weight loss because of stomach pain
e. hematemesis

Question 13

Assoc. with women 40 years and older, who are obese and have high-fat diet

Answer 13

Cholecystitis and Cholelithiasis

Question 14

pain from blockage of ducts by gallstones

Answer 14

Biliary colic

Question 15

gallstones

Answer 15

cholelithiasis

Question 16

Gallstones from cholesterol

Answer 16

hypercholesterolemia

Question 17

S/S of Cholecystitis and
Cholelithiasis

Answer 17

a. constant aching and pressure in the right epigastrium
b. jaundice

Question 18

Management of Cholecystitis and Cholelithiasis

If symptoms cannot be controlled, surgery may be done during pregnancy

Answer 18

a. lower fat intake
b. UTZ to diagnose
c. IV fluids for fluid and nutrients
d. analgesics

Question 19

is important for fetal brain growth – do not eliminate fats

Answer 19

Linoleic acid

Question 20

A Woman with Pancreatitis
* Tends to occur in late adolescent
* S/S: (4)
* Dx:

Answer 20

severe epigastric pain, N&V, anorexia, fever

elevated serum amylase (after two tests)

Question 21

Pancreatitis
* Tx: (4)
* Pregnancy loss may occur from acidosis, hypovolemia, and fetal hypoxia

Answer 21

a. nasogastric suction
b. bowel rest
c. analgesia
d. IV hydration through parenteral nutritional supplementation

Question 22

Hepatitis

• fecal-oral contact

Answer 22

Hep A

Question 23

to prevent disease after exposure of Hep A

Answer 23

y-globulin

Question 24

contaminated blood and blood products or contaminated semen and vaginal secretions

Answer 24

Hep B & C

Question 25

Hep B&C can be transferred to the fetus via ____

Answer 25

placenta

Question 26

same method as Hep B & C but rarely seen in pregnant women

Answer 26

Hep. D & E

Question 27

few symptoms and may not be present for 12 mos. After exposure

Answer 27

Hep. C

Question 28

Most common cause of chronic liver disease and liver transplantation in US

Answer 28

Hep. C

Question 29

leads to liver cell necrosis with scarring and inability to convert indirect to direct bilirubin to excrete direct bilirubin

Answer 29

Hep. B

Question 30

Vaccine can be administered to high risk women

Answer 30

Hep B

Question 31

Mgmt of Hepatitis

Answer 31

a. high-calorie diet b. CS to reduce blood exchange between mother and fetus

Question 32

Risks of Hepatitis in pregnancy

Answer 32

a. miscarriage b. preterm labor

Question 33

If mother contracts hep B in later pregnancy, infant may develop ________________ or ____________ later in life

Answer 33

liver cirrhosis carcinoma

Question 34

T or F BF is not CI as virus is not transmitted by breastmilk

Answer 34

True

Question 35

Mgmt of Hepatitis

Answer 35

* Use precautions during birth to avoid exposure to maternal body fluids * Wash infant well * First dose Hep B vaccine should be administered * Observe infant for symptoms of infection

Question 36

inflammation of the terminal ileus

Answer 36

Crohn Disease

Question 37

inflammation of the distal colon

Answer 37

Ulcerative Colitis

Question 38

Both known to be an autoimmune process * Associated with passive and active smoking

Answer 38

Inflammatory Bowel Disease 1. Crohn Disease 2. Ulcerative Colitis

Question 39

In Inflammatory Bowel Disease, ________ develop

Answer 39

shallow ulcers

Question 40

S/S of Inflammatory Bowel Disease

Answer 40

a. chronic diarrhea b. weight loss c. occult blood in stool d. N & V

Question 41

If IBD is extreme, obstruction and _________ with peritonitis occurs

Answer 41

fistula formation

Question 42

malabsorption particularly of Vit. B can occur along with Fetal growth restriction

Answer 42

Crohn Disease

Question 43

Tx of IBD

Answer 43

a. rest GIT by total parenteral nutrition b. sulfasalazine (mainstay tx) c. infliximab d. adalimumab

Question 44

This Tx of IBD may cause neonatal jaundice so dosage is decreased in term

Answer 44

sulfasalazine