Surgical complications in pregnacny Flashcards
what trimester is the safest to have a surgery like appendectomy
second trimester (so like 13 to 27wks)
If surgery must be done. what should they be premedicated with
bicitrate and H2 blockers
-all pregnant women need to be treated like they have a full stomach
approach the pregnant patient w/ a surgical emergency as you would a non-pregnant patient
she stressed this
what is the most common surgical emergency in pregnancy
appendicitis
-note that appendicitis signs can be confusing with regular pregnant symptoms
where is McBurney’s point in pregnant women
the growing uterus progressively displaces the appendix in a counterclockwise rotation out of the pelvis into the RUQ
-so RUQ pain
Radiation greater then 5 rads is serious shit. What will happen if exposed before second to third wk after conception
severe abnormalities will not exist if pregnancy continues
Exposure of radiation greater then 5 rads btw the fourth and eleventh weeks after conception
severe abnormalities of many organs
Exposure of radiation greater then 5 rads btw eleventh and sixteenth weeks after conception
stunted growth, microcephaly, or mental retardation
Exposure of radiation greater then 5 rads btw sixteenth and twentieth weeks after conception
mild degrees of mental retardation and stunted growth
Exposure of radiation greater then 5 rads after twentieth week of conception
abnormalities not likely to be produced
what is the tetragonic period according to wooton
btw fourth and twentieth. most severe in the beginning
how many rads is a CT scan to the abdomen
- 5 rads
- if you suspect appenditis, and she is after the twentieth week since conception the baby will be fine
Laparoscope or Laparotomy for acute appendicitis. which poses concern that CO2 used for insufflation will be absorbed through peritoneum into maternal bloodstream and across the placenta resulting in fetal respiratory acidosis
Laparoscope
why do women have such high cholesterol levels
estrogen increase the saturation of cholesterol in bile
almost all gall stones in pregnant women are almost always made of what
cholesterol
increase WBC count, elevated bilirubin levels, jaundice, increased thickness of gallbladder wall on U/S
acute cholecystitis and cholelithiasis
how do you manage acute cholecystitis and cholelithiasis in a prego woman
IV fluids, gastric decompression, and diet
-note if patient has cholangitis or pancreatitis caused by common bile duct stone than you can do endoscopic retrograde cholangiopancreatography
If patient has acute cholecystitis and cholelithiasis and develops signs of peritonitis then how would you manage
Laprascopic cholecystectomy
Symptoms: severe, non-colicy epigastric pain radiating to the back. Nausea and vomiting. Elevated serum amylase (>200 U/dL)
Acute pancreatitis
-usually as a result of cholecystitis, cholelithiasis or alcoholism
what diagnosis has tx plans such as 1 to 10 days bed rest, IV fluids, pain management, and nasogastric suction
acute pancreatitis
upright x-ray reveals dilated loops of bowel and air fluid levels
bowel obstruction
sudden onset of severe intermittent abdominal pain. Pain after sex also. what can cause this
adnexal torsion
-may radiate to flank or down anterior thigh
what is confirmed by presence of mass on U/S and LACK of flow by doppler study
adnexal torsion
-tx is surgical removal
what types of ovarian tumors have a risk of ~5% of malignancy
germ cell tumors and epithelial tumors
