L12: Hyperemesis Gravidarum Flashcards by Ahmed Farag

Q

Def of Emesis gravidarum

A

Vomiting that occurs mostly during early morning, usually appears at 6 weeks & disappears after 14 weeks & doesn’t affect the general condition of woman.

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Q

Def of Hyperemesis graviderum

A

Severe vomiting during first 14 weeks affecting the general condition of woman

OR

persistent vomiting after 14 weeks & before 20 weeks.

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Q

Incidence of Hyperemesis graviderum

A

1/500

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Q

Compare between Morning Sickness & Hyperemesis Gravidarum

A

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Q

Causes of Hyperemesis graviderum

A

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Q

Theories of Hyperemesis graviderum

HCG Theory

A

High HCG level stimulates CRTZ (this may explain high incidence in vesicular mole & multifetal pregnancy).

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Q

Theories of Hyperemesis graviderum

Psychological & Emotional Theory

A

May play role through stimulation of CRTZ (this may be evidenced by improvement of condition after hospitalization & isolation from stressful home environment).

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Q

Theories of Hyperemesis graviderum

Allergic Theory

A

Allergic reaction to pregnancy hormones (HCG, estrogen & progesterone

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Q

Theories of Hyperemesis graviderum

Infection Theory

A

Infection è Helicobacter Pylori bacteria (gastritis) may play role.

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Q

Theories of Hyperemesis graviderum

Nutritional Theory

A

Vitamins B1 & B6 deficiency.

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Q

Theories of Hyperemesis graviderum

Thyroid Gland Activation Theory

A

May Play Role

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Q

Pathology of Hyperemesis graviderum

A

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Q

Hyperemesis graviderum

Biochemical Disorders

A

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Q

Hyperemesis graviderum

Biochemical Disorders (Electrolyte Changes)

A

↓↓ Na+ & Clˉ & ↑↑ blood urea.

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Q

Hyperemesis graviderum

Biochemical Disorders (Metabolic Changes)

A

Hypoglycemia & ketoacidosis (ketone bodies).

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Q

Hyperemesis graviderum

Biochemical Disorders (Circulatory Changes)

A

Hypovolemia & hemoconcentration

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Q

Hyperemesis graviderum

Biochemical Disorders (Urinary Changes)

A

Oliguria, Ketonuria, proteinuria & ↑↑ urinary urea

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Q

Hyperemesis graviderum

Organic Disorders

A

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Q

Hyperemesis graviderum

Organic Disorders (Liver)

A

fatty degeneration

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Q

Hyperemesis graviderum

Organic Disorders (Kidney)

A

Tubular & Gomerular degeneration

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Q

Hyperemesis graviderum

Organic Disorders (Heart)

A

Subendocardial He, degeneration, brown atrophy of the heart

Q

Hyperemesis graviderum

Organic Disorders (CNS)

A

Peripheral neuritis, Wernicke’s encephalopathy & Korsakoff’s syndrome

Q

Hyperemesis graviderum

Organic Disorders (Eye)

A

Optic neuritis, retinal hge without exudates, visual field defects

Q

Dx of Hyperemesis Gravidarum

A

…

Dx of **Hyperemesis Gravidarum** - Clinically

DHD Symptoms in **Hyperemesis Gravidarum**

- Hypotension. - Decreased temperature. - Oliguria. - Dry tongue. - Sunken eyes. - Dry wrinkled skin.

Starvation Symptoms in **Hyperemesis Gravidarum**

- Emaciation. - Loss of weight.

General Manifestations in **Hyperemesis Gravidarum**

- Vital signs: Tachycardia, hypotension & subnormal temperature. - Jaundice: In severe cases - Oliguria: In late cases.

Nervous Manifestations in **Hyperemesis Gravidarum**

- Peripheral neuritis: Pain & tingling sensation. - Wernicke's encephalopathy: Nystagmus, optic neuritis & diplopia - Korsakoff's syndrome: Confusion & memory loss for recent events.

Manifestations of severe **Hyperemesis Gravidarum**

Investigations for **Hyperemesis Gravidarum** - Blood

Investigations for **Hyperemesis Gravidarum**

Investigations for **Hyperemesis Gravidarum** - Urine

Investigations for **Hyperemesis Gravidarum** - US

Investigations for **Hyperemesis Gravidarum** - Fundoscope

DDx of **Hyperemesis Gravidarum**

DDx of **Hyperemesis Gravidarum** - Obstetric Causes

DDx of **Hyperemesis Gravidarum** - Gynecological Causes

DDx of **Hyperemesis Gravidarum** - Other Causes

TTT of Mild Cases of **Hyperemesis Gravidarum**

TTT of Mild Cases of **Hyperemesis Gravidarum** - Fluids

Ample amounts must be taken to avoid dehydration.

TTT of Mild Cases of **Hyperemesis Gravidarum** - Isolation

Form stressful home environment (hospitalization may be needed).

TTT of Mild Cases of **Hyperemesis Gravidarum** - Diet

Small, frequent, semisolid, rich in CHO & poor in fat & proteins.

TTT of Mild Cases of **Hyperemesis Gravidarum** - Drugs

TTT of Severe Cases of **Hyperemesis Gravidarum**

TTT of Severe Cases of **Hyperemesis Gravidarum** - Isolation

single room & no visitors are allowed

TTT of Severe Cases of **Hyperemesis Gravidarum** - NPO

For 48 Hours

TTT of Severe Cases of **Hyperemesis Gravidarum** - IV Fluids

Glucose 5% & normal saline 0.9

TTT of Severe Cases of **Hyperemesis Gravidarum** - Drugs

As above + sedatives

TTT of Severe Cases of **Hyperemesis Gravidarum** - Observation

In Hyperemesis Gravidarum, Termination of pregnancy is indicated in ......

In Hyperemesis Gravidarum, Indication of hospitalization .......