HRP- nausea and vomiting and thyroid Flashcards
what is the most likely pathogenesis associated with NVP ?
HCG is most likely associated with nausea and vomiting with pregnancy
what are the complications of HEG ?
SGA neonates
fetal demise
wernicke’s encephalopathy
electrolyte imbalance
what is the first line management regarding nausea and vomiting in pregnant woman ?
dietary changes and to avoid triggers
anti-emetic / anti-histamines
vitamin B pyroxidine
what is the triad of hyperemesis gravidarum ?
- weight loss of more than 5%
- dehydration
- ketonuria
given that improvement is seen after administration of vitamin B what is the next best step in management ?
maintenance
gradual withdrawal
what is the best management foe pregnant women with persistent HEG ?
rectal or parenteral route of antiemetics
what is the protocol associated with metoclopramide use ?
used as a second line treatment due to its extrapyramidal effects
what is the protocol associated with the use of ondansetron ?
safe and effective however used as second line treatment due to limited data
what is the protocol associated with corticosteroid use in NVP ?
cannot be used for pregnancy below 10 weeks due to teratogenic effects
what is the most appropriate intravenous hydration therapy for NVP ?
each bag should contain normal saline with additional potassium chloride
what is the protocol regarding dextrose infusion in NVP ?
dextrose is not appropriate unless the serum sodium levels are normal and thiamine has been administered
what is CPM associated with ?
central pontine myelosis associated with rapid ( too rapid) sodium correction
what is thiamine used to prevent the happening of in HEG ?
wernicke’s encephalopathy
if a woman is admitted for HEG what should be offered in terms of prophylaxis ?
thromboprophylaxis LMWH
when does NVP peak ?
weak 9
when can NVP be diagnosed ?
only in the first half of pregnancy
which initial investigation should be done for a preg woman coming in with prolonged vomiting ?
serum electrolytes and urea
what are the levels at which anemia is diagnosed at each trimester ?
first trimester - 110 mg/dl
second trimester - 105 mg/dl
postpartum - less than 100 mg/dl
what are the 2 most common causes of anemia in pregnancy ?
physiological anemia
iron deficiency anemia
what is the daily recommendation of supplemental iron that should be taken for all pregnant women ?
30 mg a day through pregnancy and 3 months postpartum
when should screening for anemia be performed ?
at booking and at 28 weeks
what is the first step management for normocytic and microcytic anemia in pregnant women ?
a trial of oral iron should be considered
how should the side effects of oral iron be lessened ?
use iron syrup mix with orange juice take on an empty stomach increase dose gradually double dose every other day take a larger dose at bedtime
when is parenteral iron indicated ?
when oral iron is not tolerated or absorbed
contraindicated in the first trimester
when can blood transfusion be given in cases of anemia ?
severe anemia below 70 mg/dl in the postnatal period
what is the role of rHUEPO ?
expensive
serious side effects
lazma
what are the different diseases associated with hyperthyroidism ?
graves
active thyroid adenoma
toxic nodular goitre
transient gestational thyrotoxicosis
what are the different diseases associated with hypothyroidism ?
hashimotos disease
iodine deficiency
post-thyroidectomy
post radioactive iodine ablation
what is the management of hyperthyroidism in pregnant women ?
PTU in the first trimester
carbimazole or methimazole in the 2nd and 3rd trimester
what can be added in severe cases of hyperthyroidism ?
propranolol
if there is no response to propranolol and hyperthyroid drugs what is the next best step in management ?
thyroidectomy
what is the management for thyrotoxicosis storm ?
dexamethasone
PTU
iodine
propranolol
what is the management of hypothyroidism ?
levothyroxine
may increase dose by 20% in first trimester
what is the presence of TPO antibodies associated with ?
autoimmiune diseases :
hashimotos
grave’s
what are the lab findings associated with :
subclinical hypothyroidism
subclinical hyperthyroidism
sub hypothyroidism : TSH is elevated FT4 is normal sub hyperthyroidism : TSH is decreased FT4 is is normal
