GI Disorders In Pregnancy

Question 1

Hyperemesis gravidarum defined as

Answer 1

Weight loss, dehydration, ketosis, alkalosis, from loss of hydrochloride acid, hypokalemia. Acidosis develops from partial starvation.
In some: transient hepatic dysfunction, biliary sludge accumulates
(It’s a Dx of exclusion)

Question 2

Hormones involved in etiopathogensis of hyperemesis gravidarum

Answer 2

hCG- estrogen- progesterone- leptin - placental growth hormone- prolactin- thyroxin- adrenocortical hormones- ghrelins- nesfatin-1 , peptide YY

Question 3

Complications of hyperemesis gravidarum

Answer 3

Renal failure (AKI)
Mallory-weiss tear
Pneumothorax
Pneumomediastinum
Diaphragmatic rupture
Gastroesophageal rupture (Boerhaave syndrome)
Depression
Hypoprothrombinemia (vitamin k deficiency) can led to maternal coagulopathy and fetal ICH as well as vitamin K embryopathy
Rhabdomyolysis
Wernicke encephalopathy and its long term sequelae include blindness, convulsions , and coma
Splenic avlusion

Question 4

Management of severe Hyperemesis gravidarum

Answer 4

IV crystalloid infusion along with Thiamine 100 mg diluted in 1 L of the selected crystalloid

Question 5

several normal pregnancy-induced physiological changes induce appreciable liver-related clinical and laboratory manifestations includes:

Answer 5

Findings such as elevated serum alkaline phosphatase levels, palmar erythema, and spider angiomas, Metabolism is also affected, due to altered expression of the cytochrome P450 system. This alteration is mediated by higher levels of estrogen, progesterone, and other pregnancy hormones. For example, hepatic CYP1A2 expression declines, whereas that of CYP2D6 and CYP3A4 rises. Importantly, cytochrome enzymes are expressed in many organs besides the liver, most notably the placenta.

Question 6

Intra-Hepatic Cholestasis manifestation

Answer 6

pruritus may precede laboratory findings by several weeks. Approximately 10 percent of women have jaundice.

Question 7

ursodeoxycholic acid and Intra-Hepatic Cholestasis

Answer 7

A recent metaanalysis suggests that ursodeoxycholic acid relieves pruritus, lowers bile acid and serum enzyme levels, and may reduce certain neonatal
complications. These include preterm birth, fetal distress, respiratory distress syndrome, and neonatal intensive care unit (NICU) admission (Bacq, 2012).

Question 8

Pregnancy Outcomes in Intra-Hepatic Cholestasis

Answer 8

sudden fetal death not predicted by
nonstress testing.
associations of cholestasis with preeclampsia and gestational diabetes.
increased rate of labor induction,
neonatal complications developed in a third
of the pregnancies, particularly respiratory distress, fetal distress, and meconiumstained amnionic fluid. These problems were noted more frequently in those with higher total bile acid levels.

Question 9

Two associated conditions can be seen in acute fatty liver in postpartum

Answer 9

a fourth of women have evidence
for transient diabetes insipidus. This presumably stems from elevated vasopressinase concentrations caused by diminished hepatic production of its inactivating enzyme. Finally, acute pancreatitis develops in approximately 20
percent.

Question 10

What is the management of abnormal maternal thyroid tests attributable fo gestational transient thyrotoxicosis of hyperemesis gravidarum ?

Answer 10

Supportive. Antihryoid drugs are not recommended.

Question 11

what is the first line pharamacological therapy of hyperemesis gravidarum ? What are the recommended doses for the above medications?

Answer 11

Pyridoxine 25 mg PO , Every 6-8 hours as a single agent or in combination with doxylamaine 10 mg PO 1 or 2 times per day.

Question 12

what are the common laboratory abnormalities found in hyperemesis ?

Answer 12

Increase liver enzymes&raquo_space; usually less than 300 units/L.
Serum bilirubin&raquo_space; less than 4 mg/dL.
Serum amylase or lipase&raquo_space; up to five times greater than normal levels.
Urinanalysis&raquo_space; ketonurea .

Question 13

increased serum bile acid concentrations in Intrahepatic cholestasis of pregnancy is associated with increased rates of

Answer 13

stillbirth, preterm birth, and neonatal unit admission.

PITCHES trial

Question 14

Factors that increase the risk for admission in hyperemesis gravdarum include

Answer 14

hyperthyroidism, previous pregnancy complicated by hyperemesis, diabetes, GI illnesses, some restrictive diets, and asthma.