Lesson 1: Hyperemesis Gravidarum

Question 1

Hyperemesisgravidarum(HG)isararedisordercharacterizedby _________and __________ nausea and vomiting duringpregnancythatmayrequirehospitalization

• Characterizedby(Triadof):⭐
  
  1. D______⭐
  2. Vitaminandmineraldeficit(E________⭐)
  3. Body________>5%(Prepregnancy_________⭐)

Answer 1

Hyperemesisgravidarum(HG)isararedisordercharacterizedby Severe and persistent nausea and vomiting duringpregnancythatmayrequirehospitalization

• Characterizedby(Triadof):⭐
  
  1. Dehydration⭐
  2. Vitaminandmineraldeficit(Electrolyteimbalance⭐)
  3. Bodyweightloss>5%(Prepregnancyweightloss⭐)

Question 2

Etiology: _________

Answer 2

Etiology: Unknown

Question 3

Etiology: More common in

1. __________
2. __________
3. __________
4. __________
5. __________
6. __________
7. __________
8. ___________
9. __________

Answer 3

1. Trophoblasticdisease
2. Multiplepregnancy
3. Nulliparity
4. Femalefetus
5. Maternalage>30yearsold(firstborn)
6. Maternalobesity
7. Smoking
8. HasHyperemesisgravidarum(HG)inpreviouspregnancy
9. FamilialhistoryofHG

Question 4

Pathogenesis: _____________⭐

Answer 4

Pathogenesis: Unknown ⭐

Question 5

Pathogenesis theories

1. __________
2. __________
3. __________
4. __________
5. __________
6. __________
7. __________
8. ___________
9. __________

Answer 5

1. HighhCG(hormoneimbalances)⭐
2. VitaminBdeficiency(B1,B6)
3. Hyperthyroidism
4. Gastroesophagealreflux
5. HelicobacterPyloriinfections
6. Psychologicalfactors(rejectionofunwantedpregnancyorfearoflabour)
7. Disturbancesincarbohydratemetabolism

Question 6

Hormonal Theory⭐

1. ↑______&________→triggervomitingcenter
2. ↑_________-→relaxationofcardiacsphincter→retentionofgastricfluid

Answer 6

Hormonal Theory⭐

1. ↑hCG&estrogen→triggervomitingcenter
2. ↑Progesterone→relaxationofcardiacsphincter→retentionofgastricfluid

Question 7

Vomiting in pregnancy: > __________⭐

Answer 7

Vomiting in pregnancy: > 50%⭐

Question 8

Hyperemesis gravidarum (HG) occur __________.

Answer 8

Hyperemesis gravidarum (HG) occur 1/1000.

Question 9

Risk factor: ________ or __________ pregnancies⭐ (caused by ↑ hCG)

Answer 9

Risk factor: multiple or molar pregnancies⭐ (caused by ↑ hCG)

Question 10

Diagnosis & Investigation:

1. __________
2. __________
3. __________

Answer 10

1. Clinicalevaluation
2. Detailedpatienthistory
3. Identificationofcharacteristicsymptom

Question 11

Symptoms and signs:

Rapid development within ___________or gradually over _________________.

Answer 11

Symptoms and signs:

Rapid development within a few weeks or gradually over a few months

Question 12

Symptoms and signs:

Occur from ___ to ___ week of pregnancy, peak at _____ weeks.

Answer 12

Symptoms and signs:

Occur from 6th to 20th week of pregnancy, peak at 9th weeks

Question 13

Hyperemesis Gravidarum should only be diagnosed when on set is in ________ trimester of pregnancy (exclude other causes).

Answer 13

Hyperemesis Gravidarum should only be diagnosed when on set is in first trimester of pregnancy (exclude other causes).

Question 14

Symptoms and signs:

Increase of ______ body (Ketosis)

Answer 14

Symptoms and signs:

Increase of ketone body (Ketosis)

Question 15

Types of ketone body:

1. A______
2. B_______
3. A________

Answer 15

Types of ketone body:

1. Acetoacetate
2. Beta-hydroxybutyrate
3. Acetone

Question 16

Differential Diagnosis:

1. __________
2. __________
3. __________
4. __________
5. __________
6. __________
7. __________
8. ___________
9. __________

Answer 16

Differential Diagnosis:

1. Morning sickness typically continues from 4th week to 16th week (ឆាប់ចេញឆាប់បាត់)
2. Cholecystitis
3. Appendicitis
4. Pyelonephritis
5. Gastroenteritis
6. Gall bladder disease
7. Pancreatitis
8. Migraine
9. Complicated ovarian tumors

Question 17

Pregnancy Unique-Quantification of Emesis (PUQE) Score:
__to ___: mild nausea and vomiting of pregnancy.
___to ___: moderate nausea and vomiting of pregnancy.
>= __: severe nausea and vomiting

Answer 17

Pregnancy Unique-Quantification of Emesis (PUQE) Score:
4 to 6: mild nausea and vomiting of pregnancy.
7 to 12: moderate nausea and vomiting of pregnancy.
>= 13: severe nausea and vomiting

Question 18

Dry heaving, sometimes called retching, refers tovomit-like feelings without __________.

Answer 18

Dry heaving, sometimes called retching, refers tovomit-like feelings without any substance.

Question 19

Investigations:
Urinalysis: ____________

Answer 19

Investigations:
Urinalysis: to detect ketones in urine

Question 20

Investigations:

Midstream urine culture (MSU): ____________

Answer 20

Investigations:

Midstream urine culture (MSU): to exclude UTI

Question 21

Investigations:

Fullbloodcount(FBC):_______________

Answer 21

Investigations:

Fullbloodcount(FBC):↑hematocrit(Ht)

Question 22

Investigations:

Urea & electrolytes: _____________

Answer 22

Investigations:

Urea & electrolytes: ↓ K+, ↓ Na+

Question 23

Investigations:

Liver function test: ___________, _______

Answer 23

Investigations:

Liver function test: ↑ transaminases, ↓ albumin

Question 24

Investigations:

Ultrasound for reassurance & to exclude ______ and _______ pregnancies.

Answer 24

Investigations:

Ultrasound for reassurance & to exclude multiple and molar pregnancies.

Question 25

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, _____&________. 2. Hyponatremia and rapid reversal of hyponatremia → central pontine myelinosis⭐ 3. Thiamine deficiency → Wernicke's encephalopathy⭐ 4. Vitamin K deficiency → Maternal coagulopathy⭐ 5. Mallory Weiss tears & Boerhaave syndrome⭐

Answer 25

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, liver & renal failure 2. Hyponatremia and rapid reversal of hyponatremia → central pontine myelinosis⭐ 3. Thiamine deficiency → Wernicke's encephalopathy⭐ 4. Vitamin K deficiency → Maternal coagulopathy⭐ 5. Mallory Weiss tears & Boerhaave syndrome⭐

Question 26

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, liver & renal failure 2. Hyponatremia and rapid reversal of hyponatremia → _________________⭐ 3. Thiamine deficiency → Wernicke's encephalopathy⭐ 4. Vitamin K deficiency → Maternal coagulopathy⭐ 5. Mallory Weiss tears & Boerhaave syndrome⭐

Answer 26

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, liver & renal failure 2. Hyponatremia and rapid reversal of hyponatremia → central pontine myelinosis⭐ 3. Thiamine deficiency → Wernicke's encephalopathy⭐ 4. Vitamin K deficiency → Maternal coagulopathy⭐ 5. Mallory Weiss tears & Boerhaave syndrome⭐

Question 27

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, liver & renal failure 2. Hyponatremia and rapid reversal of hyponatremia → central pontine myelinosis⭐ 3. Thiamine deficiency → ___________________⭐ 4. Vitamin K deficiency → Maternal coagulopathy⭐ 5. Mallory Weiss tears & Boerhaave syndrome⭐

Answer 27

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, liver & renal failure 2. Hyponatremia and rapid reversal of hyponatremia → central pontine myelinosis⭐ 3. Thiamine deficiency → Wernicke's encephalopathy⭐ 4. Vitamin K deficiency → Maternal coagulopathy⭐ 5. Mallory Weiss tears & Boerhaave syndrome⭐

Question 28

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, liver & renal failure 2. Hyponatremia and rapid reversal of hyponatremia → central pontine myelinosis⭐ 3. Thiamine deficiency → Wernicke's encephalopathy⭐ 4. Vitamin K deficiency → _________________⭐ 5. Mallory Weiss tears & Boerhaave syndrome⭐

Answer 28

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, liver & renal failure 2. Hyponatremia and rapid reversal of hyponatremia → central pontine myelinosis⭐ 3. Thiamine deficiency → Wernicke's encephalopathy⭐ 4. Vitamin K deficiency → Maternal coagulopathy⭐ 5. Mallory Weiss tears & Boerhaave syndrome⭐

Question 29

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, liver & renal failure 2. Hyponatremia and rapid reversal of hyponatremia → central pontine myelinosis⭐ 3. Thiamine deficiency → Wernicke's encephalopathy⭐ 4. Vitamin K deficiency → Maternal coagulopathy⭐ 5. ______________ tears & Boerhaave syndrome⭐

Answer 29

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, liver & renal failure 2. Hyponatremia and rapid reversal of hyponatremia → central pontine myelinosis⭐ 3. Thiamine deficiency → Wernicke's encephalopathy⭐ 4. Vitamin K deficiency → Maternal coagulopathy⭐ 5. Mallory Weiss tears & Boerhaave syndrome⭐

Question 30

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, liver & renal failure 2. Hyponatremia and rapid reversal of hyponatremia → central pontine myelinosis⭐ 3. Thiamine deficiency → Wernicke's encephalopathy⭐ 4. Vitamin K deficiency → Maternal coagulopathy⭐ 5. Mallory Weiss tears & ____________syndrome⭐

Answer 30

Complications: Maternal risks 1. Dehydration⭐→ electrolyte imbalance, liver & renal failure 2. Hyponatremia and rapid reversal of hyponatremia → central pontine myelinosis⭐ 3. Thiamine deficiency → Wernicke's encephalopathy⭐ 4. Vitamin K deficiency → Maternal coagulopathy⭐ 5. Mallory Weiss tears & Boerhaave syndrome⭐

Question 31

Complications Fetal risks 1. _____________ (IUGR) 2. Fetal death ← fetal intracranial bleeding , Wernicke's encephalopathy⭐

Answer 31

Complications Fetal risks 1. Growth restriction (IUGR) 2. Fetal death ← fetal intracranial bleeding , Wernicke's encephalopathy⭐

Question 32

Complications Fetal risks 1. Growth restriction (IUGR) 2. Fetal death ← fetal intracranial bleeding , Wernicke's encephalopathy⭐

Answer 32

Complications Fetal risks 1. Growth restriction (IUGR) 2. ______________ ← fetal intracranial bleeding , Wernicke's encephalopathy⭐

Question 33

Complications Fetal risks 1. Growth restriction (IUGR) 2. Fetal death ← __________________ , Wernicke's encephalopathy⭐

Answer 33

Complications Fetal risks 1. Growth restriction (IUGR) 2. Fetal death ← fetal intracranial bleeding , Wernicke's encephalopathy⭐

Question 34

Complications Fetal risks 1. Growth restriction (IUGR) 2. Fetal death ← fetal intracranial bleeding , ___________________⭐

Answer 34

Complications Fetal risks 1. Growth restriction (IUGR) 2. Fetal death ← fetal intracranial bleeding , Wernicke's encephalopathy⭐