Mehlm+UW hyperemesis gravidarum 12-13 (1)

Question 1

Mehl. definition?

Answer 1

Vomiting in pregnancy that is so severe that ketones are present in the urine.

Question 2

Mehl. what is responsible for nausea?

Answer 2

incr. hCG

Question 3

Mehl. when nausea peaks?

Answer 3

It peaks at 8-10 weeks, which is when the placenta takes
over production of progesterone, obviating the need for the presence of hCG to maintain a corpus luteum.

Question 4

Mehl. vignette? next best step?

Answer 4

Vignette will give you a woman with severe vomiting at 8-10 weeks and then ask for next best step in diagnosis –> answer = “urinary ketones.”

Question 5

Mehl. Sometimes they will already mention ketonuria, and then they want the management, which is
“intravenous hydration and anti-emetic therapy.”

Answer 5

.

Question 6

Mehl. why I/v fluids?

Answer 6

Women with HG clearly can’t keep anything down, so oral
rehydration and anti-emetics are not sufficient.

Question 7

Mehl. what antiemetics?

Answer 7

Both metoclopramide and ondansetron are used for Tx.

Question 8

Mehl. vomiting in pregnancy arrows? K, Cl, HCO3, pH

Answer 8

decr. K; decr. Cl; incr. HCO3; incr. pH

Question 9

UW. notes. pathopghysiology?

Answer 9

incr. ß-hCG and progesterone in pregnancy

Question 10

UW. notes. what causes nausea?

Answer 10

incr. ß-hCG symptom: NAUSEA

Question 11

UW. notes. what causes vomiting?

Answer 11

Incr. progesterone symptom: VOMITING. (because of relaxation of LES (ie GERD) and stomach (ie delayed gastric emptying)

Question 12

UW. table/notes. risk factors? 5

Answer 12

a. Prior history of hyperemesis gravidarum
b. Multiple gestations
c. Hydatiform mole
d. History of GERD
e. History of migraines or motion sickness

Question 13

UW. Self-note: it seems that hyperemesis gravidarum is linked with incr. b-hCG levels and its risk factors are the same which are accompanied by incr. b-hCG

Answer 13

.

Question 14

UW. notes. when resolves?

Answer 14

Resolves by 16-20 weeks gestation but can persist until delivery

Question 15

UW. table/notes. clinical features?

Answer 15

Severe, persistent vomiting
a. Dehydration: Dry mucous membranes; Delayed capillary refill; Tachycardia
b. Hypoglycemia: Ketonuria
c. Orthostatic hypotension
d. Electrolyte abnormalities
e. >5% loss of prepregnancy weight

Question 16

UW. table/notes. labs?

Answer 16

Hypochloremic metabolic alkalosis;
Hypokalemia;
KETONURIA (basis for differentiating it from normal vomiting);
Hemoconcentration
incr. serum aminotransferases (sitas pries notes buvo, bet bbz)

Question 17

UW. notes. Can be assoc. with what other condition?

Answer 17

It can also be associated with transient hyperthyroidism (eg, thyrotoxicosis of hyperemesis) due to stimulation of thyroid by elevated b-hCG

Question 18

UW table Tx?

Answer 18

Admission to hospital
Antiemetics and i/v drugs

Question 19

UW notes. Tabacco?

Answer 19

Tobacco use protects against hyperemesis gravidarum because it incr. metabolism of estrogen –> decr. serum estrogen