Miscellaneous Flashcards
Hypertension with raised LFTs
Labetalol, as methyldopa not advised with deranged LFTS
Phaechromacytoma
Alpha block, LCSC, then remove tumour
PseuohyperPTH
caused by a maternally inherited G-protein abnormality. There is a characteristic phenotype with short stature, dysmorphic features (including short 4th or 5th metacarpals), and intellectual impairment. In addition there is resistance to a variety of hormones that act via cAMP (including PTH, TSH, and gonadotrophins).
Spontaneous or paternally inherited mutations cause dysmorphic features alone. Biochemically, there is hypocalcaemia with raised PTH concentrations, raised TSH with low T4 and raised gonadotrophins. Hypocalcaemia causes paraesthesia, cramps, tetany, and carpopedal spasm; hypothyroidism causes fatigue. The mainstay of treatment is calcium and vitamin D.
Cholestasis of pregnancy
Only occurs 2-3rd trimester
ALP 10x (ALP rises mildly normally, due to placenta). GGT normal, bili <60
Treatment options include ursodeoxychloric acid, cholestyramine, phenobarbital and vitamin K to treat the coagulopathy.
Gestational diabetes
Aim for HbA1c <6.0
Disease should be quiescent for 6/12 in SLE prior to pregnancy
SSA/RO CHB
Stop MMF, methotrexate, warfarin
VTE risk is equal across all trimesters
UFH and clexane okay to use in pregnancy and breastfeeding. Warfarin safe in 1st 6 weeks and breastfeeding
Ileofemoral DVT more common
L>R
Prophylaxis recommended if - (this includes 6/52 post partum)
Single unprovoked
Single prior, with COCP
Positive family hx
Anticoagulation recommended
Recurrent unprovoked
Antithrombin deficiency
Not recommended
FVL heterozygous
Provoked VTE unrelated to OCP or pregnancy
ALP (placenta) , cholesterol, lipids rise
AST, ALT, Bili, GGT also fall
acute fatty liver of pregnancy
Third trimester. 50% have associated pre-eclampsia. Plt <100, AST/ALT >300, bili low, DIC risk
Rx: deliver the baby, transplantation
HELLP
> 22 weeks. 2/3 antepartum 1/3 postpartum
Rx: delivery. Steroid play no role
Hyperemesis gravidarum
1st trimester, better >20 weeks, can screw with LFTs
Rx: promethazine, thiamine
