Lesson 1: Hyperemesis Gravidarum Flashcards
Hyperemesisgravidarum(HG)isararedisordercharacterizedby _________and __________ nausea and vomiting duringpregnancythatmayrequirehospitalization
- Characterizedby(Triadof):⭐
- D______⭐
- Vitaminandmineraldeficit(E________⭐)
- Body________>5%(Prepregnancy_________⭐)
Hyperemesisgravidarum(HG)isararedisordercharacterizedby Severe and persistent nausea and vomiting duringpregnancythatmayrequirehospitalization
- Characterizedby(Triadof):⭐
- Dehydration⭐
- Vitaminandmineraldeficit(Electrolyteimbalance⭐)
- Bodyweightloss>5%(Prepregnancyweightloss⭐)
Etiology: _________
Etiology: Unknown
Etiology: More common in
- __________
- __________
- __________
- __________
- __________
- __________
- __________
- ___________
- __________
- Trophoblasticdisease
- Multiplepregnancy
- Nulliparity
- Femalefetus
- Maternalage>30yearsold(firstborn)
- Maternalobesity
- Smoking
- HasHyperemesisgravidarum(HG)inpreviouspregnancy
- FamilialhistoryofHG
Pathogenesis: _____________⭐
Pathogenesis: Unknown ⭐
Pathogenesis theories
- __________
- __________
- __________
- __________
- __________
- __________
- __________
- ___________
- __________
- HighhCG(hormoneimbalances)⭐
- VitaminBdeficiency(B1,B6)
- Hyperthyroidism
- Gastroesophagealreflux
- HelicobacterPyloriinfections
- Psychologicalfactors(rejectionofunwantedpregnancyorfearoflabour)
- Disturbancesincarbohydratemetabolism
Hormonal Theory⭐
- ↑______&________→triggervomitingcenter
- ↑_________-→relaxationofcardiacsphincter→retentionofgastricfluid
Hormonal Theory⭐
- ↑hCG&estrogen→triggervomitingcenter
- ↑Progesterone→relaxationofcardiacsphincter→retentionofgastricfluid
Vomiting in pregnancy: > __________⭐
Vomiting in pregnancy: > 50%⭐
Hyperemesis gravidarum (HG) occur __________.
Hyperemesis gravidarum (HG) occur 1/1000.
Risk factor: ________ or __________ pregnancies⭐ (caused by ↑ hCG)
Risk factor: multiple or molar pregnancies⭐ (caused by ↑ hCG)
Diagnosis & Investigation:
- __________
- __________
- __________
- Clinicalevaluation
- Detailedpatienthistory
- Identificationofcharacteristicsymptom
Symptoms and signs:
Rapid development within ___________or gradually over _________________.
Symptoms and signs:
Rapid development within a few weeks or gradually over a few months
Symptoms and signs:
Occur from ___ to ___ week of pregnancy, peak at _____ weeks.
Symptoms and signs:
Occur from 6th to 20th week of pregnancy, peak at 9th weeks
Hyperemesis Gravidarum should only be diagnosed when on set is in ________ trimester of pregnancy (exclude other causes).
Hyperemesis Gravidarum should only be diagnosed when on set is in first trimester of pregnancy (exclude other causes).
Symptoms and signs:
Increase of ______ body (Ketosis)
Symptoms and signs:
Increase of ketone body (Ketosis)
Types of ketone body:
- A______
- B_______
- A________
Types of ketone body:
- Acetoacetate
- Beta-hydroxybutyrate
- Acetone
Differential Diagnosis:
- __________
- __________
- __________
- __________
- __________
- __________
- __________
- ___________
- __________
Differential Diagnosis:
- Morning sickness typically continues from 4th week to 16th week (ឆាប់ចេញឆាប់បាត់)
- Cholecystitis
- Appendicitis
- Pyelonephritis
- Gastroenteritis
- Gall bladder disease
- Pancreatitis
- Migraine
- Complicated ovarian tumors
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
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
Dry heaving, sometimes called retching, refers tovomit-like feelings without __________.
Dry heaving, sometimes called retching, refers tovomit-like feelings without any substance.
Investigations:
Urinalysis: ____________
Investigations:
Urinalysis: to detect ketones in urine
Investigations:
Midstream urine culture (MSU): ____________
Investigations:
Midstream urine culture (MSU): to exclude UTI
Investigations:
Fullbloodcount(FBC):_______________
Investigations:
Fullbloodcount(FBC):↑hematocrit(Ht)
Investigations:
Urea & electrolytes: _____________
Investigations:
Urea & electrolytes: ↓ K+, ↓ Na+
Investigations:
Liver function test: ___________, _______
Investigations:
Liver function test: ↑ transaminases, ↓ albumin
Investigations:
Ultrasound for reassurance & to exclude ______ and _______ pregnancies.
Investigations:
Ultrasound for reassurance & to exclude multiple and molar pregnancies.
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⭐
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⭐
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⭐
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⭐
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⭐
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⭐
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⭐
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⭐
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⭐
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⭐
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⭐
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⭐
Complications
Fetal risks
1. _____________ (IUGR)
2. Fetal death ← fetal intracranial bleeding , Wernicke’s encephalopathy⭐
Complications
Fetal risks
1. Growth restriction (IUGR)
2. Fetal death ← fetal intracranial bleeding , Wernicke’s encephalopathy⭐
Complications
Fetal risks
1. Growth restriction (IUGR)
2. Fetal death ← fetal intracranial bleeding , Wernicke’s encephalopathy⭐
Complications
Fetal risks
1. Growth restriction (IUGR)
2. ______________ ← fetal intracranial bleeding , Wernicke’s encephalopathy⭐
Complications
Fetal risks
1. Growth restriction (IUGR)
2. Fetal death ← __________________ , Wernicke’s encephalopathy⭐
Complications
Fetal risks
1. Growth restriction (IUGR)
2. Fetal death ← fetal intracranial bleeding , Wernicke’s encephalopathy⭐
Complications
Fetal risks
1. Growth restriction (IUGR)
2. Fetal death ← fetal intracranial bleeding , ___________________⭐
Complications
Fetal risks
1. Growth restriction (IUGR)
2. Fetal death ← fetal intracranial bleeding , Wernicke’s encephalopathy⭐