GASTROINTESTINAL DISORDERS IN PREGNANCY (AB) Flashcards
What are the diagnostic procedures for pregnant women with GI disorder symptoms?
Endoscopy,
non-invasive imaging techniques (ultrasound, MRI, limited use of CT),
laparoscopy.
Why is endoscopy used in pregnant women?
It is useful for diagnosing and managing upper GI issues; can visualize the esophagus, stomach, duodenum, and colon.
What is a risk associated with endoscopy during pregnancy?
A slightly increased risk of preterm birth, though this is likely due to the disease itself rather than the procedure.
What imaging technique is ideal for evaluating the GI tract in pregnancy?
Abdominal sonography (ultrasound).
Why is CT scan use limited during pregnancy?
Due to radiation exposure.
What are the benefits of laparoscopy during pregnancy?
Minimally invasive, replaces traditional surgery for many abdominal disorders, and allows diagnosis and treatment.
Why is enteral feeding preferred over parenteral nutrition?
It uses the entire GI tract and has fewer serious complications.
What are some conditions treated with enteral or parenteral nutrition during pregnancy?
Achalasia, anorexia nervosa, appendiceal rupture, bowel obstructions, burns, cholecystitis, Crohn’s disease, diabetic gastropathy, esophageal injury, hyperemesis gravidarum, jejunoileal bypass, malignancies.
What is hyperemesis gravidarum?
Severe, unrelenting nausea and vomiting in pregnancy, leading to weight loss, dehydration, ketosis, alkalosis, and hypokalemia.
What is a severe complication of hyperemesis gravidarum?
Acute kidney injury, esophageal rupture (Boerhaave’s syndrome), Wernicke encephalopathy (thiamine deficiency), Mallory-Weiss tears, vitamin K deficiency, diaphragmatic rupture.
What are the risk factors for hyperemesis gravidarum?
Increased hCG (multiple pregnancy, molar gestation), increased estrogen and progesterone, carrying a female fetus (1.5-fold increased risk).
What vitamin deficiency is associated with Wernicke encephalopathy in hyperemesis gravidarum?
Thiamine deficiency.
How is hyperemesis gravidarum managed?
Vitamin replacement, antiemetics (Diclegis, ondansetron, promethazine, metoclopramide), IV hydration, hospitalization if necessary, enteral or parenteral nutrition for intractable cases.
What are the first-line antiemetics for nausea and vomiting in pregnancy?
Diclegis (doxylamine + pyridoxine), promethazine, prochlorperazine, ondansetron, metoclopramide.
Why is total parenteral nutrition (TPN) given through a central venous catheter?
TPN is hyperosmolar and requires rapid dilution in a high-flow vascular system.
What are the common complications of parenteral feeding?
Catheter sepsis, hyperalimentation complications, electrolyte imbalances.
What are common medications for GERD in pregnancy?
Proton pump inhibitors (pantoprazole, lansoprazole, omeprazole), H2-receptor antagonists (famotidine, cimetidine, nizatidine).
What dietary modification can help mild cases of hyperemesis gravidarum?
Ginger-flavored candies and small frequent meals.
When should a pregnant patient with hyperemesis gravidarum be hospitalized?
If vomiting persists after outpatient treatment, leading to dehydration, electrolyte imbalance, or weight loss.
What is the main symptom of gastroesophageal reflux disease (GERD)?
Heartburn (pyrosis), a burning sensation from the epigastric area towards the throat.
What causes the retrosternal burning sensation in GERD?
Esophagitis caused by gastroesophageal reflux related to relaxation of the lower esophageal sphincter.
What lifestyle modifications can help manage GERD?
Tobacco and alcohol abstinence, small meals, head-of-bed elevation, and avoidance of postprandial recumbency.
What is the first-line therapy for GERD?
Oral antacids.
What medications are used for severe GERD symptoms?
Sucralfate (Carafate) + proton-pump inhibitor or H2-receptor antagonist.
What is the recommended dosage for sucralfate in GERD?
1-g sucralfate tablet taken orally 1 hour before meals and at bedtime for up to 8 weeks.
Why should antacids not be taken within 30 minutes before or after sucralfate doses?
It can interfere with sucralfate’s protective action.
When should endoscopy be considered in GERD?
If symptoms persist despite medical therapy.
What are the possible complications of GERD?
Esophagitis, stricture, Barrett esophagus, and adenocarcinoma.
What is a diaphragmatic hernia?
Herniation of abdominal contents through the foramen of Bochdalek or Morgagni.
Which structure is involved in a diaphragmatic hernia?
The esophageal hiatus in the diaphragm.
What is the maternal mortality rate of diaphragmatic hernia in pregnancy?
Approximately 45%, making it a surgical emergency.
What is a rare cause of spontaneous diaphragmatic rupture in pregnancy?
Increased intra-abdominal pressure during vaginal delivery.
What is achalasia?
A rare motility disorder in which the lower esophageal sphincter does not relax properly with swallowing.
What causes achalasia?
Inflammatory destruction of the myenteric (Auerbach) plexus within the smooth muscle of the lower esophagus.
What are the symptoms of achalasia?
Dysphagia, chest pain, and regurgitation.
What radiographic finding is seen in achalasia?
Bird-beak or ace of spades narrowing at the distal esophagus on barium swallow.
What test is confirmatory for achalasia?
Manometry.
What is the surgical treatment for achalasia?
Myotomy (excision of smooth muscle of the lower esophagus).
What medical treatments are used for achalasia?
Soft diet, anticholinergics, nitrates, calcium-channel antagonists, botulinum toxin A.
What is peptic ulcer disease (PUD)?
Erosive ulcer disease involving the stomach and duodenum.
What are the main causes of peptic ulcer disease?
H. pylori infection and NSAID use.
Why is peptic ulcer disease uncommon in pregnancy?
Physiological changes in pregnancy include reduced gastric acid secretion, decreased motility, and increased mucus secretion.
What is the first-line therapy for peptic ulcer disease?
H2-receptor blockers or proton-pump inhibitors.
What is the role of sucralfate in peptic ulcer disease?
Provides a protective coating at the ulcer base and inhibits pepsin.
What is the diagnostic approach for H. pylori in pregnancy?
Urea breath test, serological testing, or endoscopic biopsy.
What is the treatment for H. pylori-positive ulcers?
Multidrug therapy with amoxicillin, clarithromycin, metronidazole, and a proton-pump inhibitor.
What is the most common cause of upper GI bleeding in pregnancy?
Mallory-Weiss tears (small linear mucosal tears near the gastroesophageal junction).
What is the initial management of upper GI bleeding?
Iced-saline irrigations, topical antacids, and IV H2-blockers or proton pump inhibitors.
When is endoscopy indicated for upper GI bleeding?
If bleeding persists despite conservative management.
What is Boerhaave syndrome?
Esophageal rupture due to greatly increased esophageal pressure, often secondary to forceful belching.
How is diarrhea classified based on duration?
Acute (<2 weeks), Persistent (2-4 weeks), Chronic (>4 weeks).
What is the most common cause of acute diarrhea?
Infectious agents, often foodborne pathogens.
What are indications for evaluating acute diarrhea?
Profuse watery diarrhea with dehydration, grossly bloody stools, fever >38°C, duration >48 hours without improvement, recent antibiotic use, or immunocompromised status.
What is the first-line treatment for mild acute diarrhea?
Oral rehydration therapy.
When should a patient with diarrhea be hospitalized?
If moderate dehydration is present or if symptoms do not improve after 3-4 hours of observation.
What is the most important risk factor for Clostridium difficile infection?
Antibiotic use, especially aminopenicillins, clindamycin, cephalosporins, and fluoroquinolones.
What are other risk factors for Clostridium difficile infection?
Inflammatory bowel disease, immunosuppression, advanced age, and gastrointestinal surgery.
What is the diagnostic test for Clostridium difficile?
Enzyme immunoassay for toxins in stool or DNA-based tests for toxin genes.
What is the first-line treatment for Clostridium difficile infection?
Oral vancomycin or metronidazole.
What is the mainstay of treatment for diarrhea in pregnancy?
IV hydration with normal saline or lactated Ringer’s with potassium supplementation.
When is empirical antibiotic treatment recommended for diarrhea?
For moderately severe diarrhea with fecal leukocytes or gross blood.
What antibiotics are used for Salmonella spp.?
Ciprofloxacin or trimethoprim-sulfamethoxazole.
What antibiotic is used for Campylobacter spp.?
Azithromycin.
What antibiotics are used for Clostridium difficile?
Oral metronidazole or vancomycin.
What antibiotics are used for Giardia spp. and Entamoeba histolytica?
Metronidazole.
When can loperamide be used for diarrhea?
For non-febrile, non-bloody diarrhea.
What is the role of Bismuth subsalicylate (Pepto-Bismol) in diarrhea?
It may alleviate symptoms.
What are the two main forms of Inflammatory Bowel Disease (IBD)?
Ulcerative colitis and Crohn’s disease.
What is the presumed cause of inflammation in IBD?
Dysregulated mucosal immune function in response to commensal microbiota, with or without an autoimmune component.
What layer of the colon does ulcerative colitis affect?
The mucosal (superficial) layer.
In what percentage of ulcerative colitis cases is the disease confined to the rectum and rectosigmoid?
0.4
What are the major symptoms of ulcerative colitis?
Diarrhea, rectal bleeding, tenesmus, and abdominal cramps.
What are two dangerous complications of ulcerative colitis?
Toxic megacolon and catastrophic hemorrhage.
What extraintestinal manifestations are associated with ulcerative colitis?
Arthritis, uveitis, and erythema nodosum.
What is the annual risk of colon cancer in ulcerative colitis?
1% per year.
What is another name for Crohn’s disease?
Regional enteritis, Crohn ileitis, or granulomatous colitis.
How does Crohn’s disease differ from ulcerative colitis in terms of bowel involvement?
Crohn’s disease affects the entire GI tract (mouth to anus) and involves deeper layers, often transmural.
What are common symptoms of Crohn’s disease?
Right lower quadrant cramping abdominal pain, diarrhea, weight loss, low-grade fever, and obstructive symptoms.
What are two common complications of Crohn’s disease?
Perianal fistulas and abscesses.
Which form of IBD has a greater risk of gastrointestinal cancer?
Ulcerative colitis.
What is the first-line drug for the treatment of ulcerative colitis?
5-Aminosalicylic acid (5-ASA) or mesalamine.
Which drug inhibits prostaglandin synthesis in the colonic mucosa?
Sulfasalazine (Azulfidine).
What class of drugs is used for moderate to severe ulcerative colitis unresponsive to 5-ASA?
Glucocorticoids (orally, parenterally, or by enema).
What immunomodulating drugs are used for ulcerative colitis?
Azathioprine, 6-mercaptopurine, and cyclosporine.
What are examples of TNF-alpha inhibitors used in IBD?
Infliximab (Remicade), Adalimumab (Humira), and Golimumab (Simponi).
Why is folic acid supplementation recommended in ulcerative colitis treatment?
To counteract the antifolate effects of sulfasalazine and prevent neural tube defects.
Does ulcerative colitis significantly alter pregnancy outcomes?
No, but disease activity at conception influences the course during pregnancy.
How is intestinal obstruction diagnosed during pregnancy?
It is difficult to diagnose, but suspicion arises with a history of prior surgery, abdominal pain, and imaging.
What is the most common cause of intestinal obstruction in pregnancy?
Compression of adhesions by the growing uterus.
What is Ogilvie syndrome?
Acute colonic pseudo-obstruction causing massive abdominal distension.
When does Ogilvie syndrome most commonly develop?
Postpartum, especially after cesarean delivery.
What is the first-line treatment for Ogilvie syndrome?
Intravenous neostigmine (2 mg) for colonic decompression.
What imaging modality is preferred for appendicitis diagnosis in pregnancy?
MRI (if available) due to high diagnostic accuracy and ability to rule out other conditions.
What is the first-line surgical approach for appendicitis in early pregnancy?
Laparoscopy (in the first two trimesters).
What antibiotic prophylaxis is given before appendectomy in pregnancy?
Second-generation cephalosporin or third-generation penicillin.
How does appendicitis impact pregnancy outcomes?
Increases the risk of abortion or preterm labor, especially if peritonitis develops.
