Week 4- beginning of minor complaints through pytalsim

Question 1

Fatigue usu resolves by what wks? When does it reappear? What are the two causes for fatigue with PG?

Answer 1

resolves by 12-14 wks gestation- due to increased basal metabolic rate
reappears in 3rd trimester dt increased fetal wt

Question 2

ddx of fatigue?

Answer 2

anemia

Question 3

5 types of anemia we are concerned with?

Answer 3

B-12 deficiency
hemolysis
thalassemia
physiologic
malabsorption (nutritional deficiency)

Question 4

name 5 ssxs of anemia

Answer 4

fatigue
dizziness
h/as
weakness
SOB on exertion and w/rest
pica (ice)
sore tongue
n/v
depression
palpitations
jaundice
pallor of skin and/or mucous membranes and nail beds
nail spooning

Question 5

risks assoc w/anemia during PG? (5)

Answer 5

pre-term birth 
IUGR
preeclampsia in primips
high ratio of placenta wt:infant wt (predicts adult HTN)
post-partum hemorrhage

Question 6

name 3 etiologies of nutritional deficiency anemia (NDA)

Answer 6

inadequate intake or absorption of iron
genetic d/os
BM damage
renal dz
hyperactive spleen
chronic infxn
iron loss

Question 7

what iron-rich food(s) could you recommend for NDA? what supplement to increase absorption of iron? name 3 things to avoid with iron supplements

Answer 7

dark green leafy veggies, dried fruit, legumes, nuts, dark molasses, egg yolks, meat (liver, poultry), shrimp, oysters
add ascorbic acid
avoid: fiber, oxalates, phytates, phosphates, excessive zine and vit E, polyphenols, calcium

Question 8

if a PG woman is anemia what is the tx while she is PG? after the anemia has been corrected?

Answer 8

cont tx during PG and 3 mo after anemia has been corrected

Question 9

how many weeks of folic acid deficiency will result in anemia for how many weeks?

Answer 9

20 weeks deficient= 20 weeks of anemia

Question 10

name 5 predisposing factors for folate deficiency and possible pernicious anemia

Answer 10

enzyme deficiencies
EtOH abuse
low income
adolescence
folate antagonists 
malabsorption syndromes
anticonvulsant meds
renal dialysis
d/o of erythropoiesis
malignancy
mult PG
multiparity
hyperemesis gravidarum
assoc anemia
smoking cigs

Question 11

name 5 predisposing factors for B12 deficiency and possible pernicious anemia

Answer 11

vegan diet
acid-pepsin in stomach
pancreatic proteases
gastric fxnal intrinsic factor
functioning cobalamin
EtOH intake
abx 
H2 blockers and other acid reducing meds
metformin 
nicotine

Question 12

folate deficiency can result in what two defects?

Answer 12

NTD and cleft palate defects

Question 13

name 3 sequelae of B12 deficiency in PG

Answer 13

anxiety, depression
neuropathy
insomnia
memory issues/foggy thinking
muscle weakness
dizziness
heart palpitations
bleeding gums
mouth sores
nausea
poor appetite
diarrhea

Question 14

to correct for folate deficiency, prescribe what dose of supplemental folate a PG woman could take along with 3 foods high in folate

Answer 14

800-1000 ug/d
dark leafy greens
asparagus
okra
brussel sprouts
artichokes
broccoli
chili peppers
orange juice
yeast
organs meats
lean beef
fish 
legumes
fresh fruit and veggies
eggs
cheese and milk

Question 15

to correct for B12 deficiency, prescribe what dose of supplements a PG woman could take along with 3 foods high in B12

Answer 15

2.6 mcg of B12 (including dietary intake)
take sublingually if concerned about absorption or B12 injections
red meat
fish and shellfish (caution)
dairy
breakfast cereals w/B12 fortification

Question 16

name 5 treatments for PG mom with blood sugar imbalance

Answer 16

small frequent meals (q3h)
200 mcg GTF chromium w/meals
decrease refined sugar and refined CHOs
increase protein: 60-90 g/d min
botanicals: devil's club, gymnema sylvestris, syzygium, taraxacum, fenugreek, blood sugar stabilizing formula

Question 17

3 generals causes for insomnia in PG? when is it usually worst and why?

Answer 17

discomfort
nocturia
worry and anxiety
bad in 1st tri dt anxiety, nausea, hormona changes, nocturia
bad in 3rd tri dt difficulty finding comfortable position dt size of baby, anxiety about labor, nocturia

Question 18

name 4 possible txs for insomnia in PG

Answer 18

counseling
warm baths
pillows 
wet sock
botanicals: chamomile, scutallaria, valerian
increase exercise
decrease caffeine
protein snack before bed
homeopathy

Question 19

increase in what hormone causes drowsiness? suggestion to deal with drowsiness?

Answer 19

progesterone
TAKE NAPS! esp in 1st & 3rd tri
rest for 1/2 an hour, don’t fight it

Question 20

name 3 causes of n/v in pregnancy. when does n/v usu start? when is it most severe? av amount of days it will continue for?

Answer 20

Beta Hcg- slows peristalsis
prog- slows peristalsis and decreases HCl in stomach
low E intake stimulates placental growth (aka n/v may contribute to fetal growth)
dietary habits
emotions
fatigue
nutritional factors
usu starts at 8.2 weeks, can cont for 34 d, most severe at week 11
can be all day long…

Question 21

n/v can be worse in what scenarios?

Answer 21

mult gestation
hydatidiform mole (r/o w/persistent sxs after 1st tri)
did not take multi-vit before or w/in 6 weeks of conception
if they have pre-existing heartburn and acid reflux

Question 22

n/v can be a ‘positive’ thing for what reasons? (what can it decrease risk of?)

Answer 22

decreased risk of SAB, preterm birth, IUGR, perinatal death

Question 23

list 5 txs to combat n/v in PG

Answer 23

dry crackers before getting out of bed or even before opening their eyes
foods high in B vitamins
light protein snack at bedtime
small meals every 1-2 h, avoid full stomach
easily digested foods
cold, clear or carbonated fluids or sour b/w meals
avoid food sensitivities
almonds
yogurt or kefir w/cinnamon
barley or oat broth
fresh air
hard candies
1 tsp apple cider vinegar per 8 oz warm water in morn and w/meals
ginger
discorea
raspberry leaf tea
homeopathy
botanicals: zingiber off, dioscorea villosa, raspberry leaf tea, peppermint tea, catnip tea, meadowsweet, peach leaf, spearmint, lemon balm, basil, cardamom, umeboshi paste

Question 24

specifically, name 3 homeopathics good for treating n/v in PG

Answer 24

ipecac, keosotum, tabacum, coffea, sepia, symphoricarpus, asarum, lactic acid, nat mur, phosphorous

Question 25

what 3 supplements could one take to combat n/v in PG (and dose)?

Answer 25

B6: 50 mg TID x 3-4d then 50 mg qd
vit K- 3 gtt K quinone orally
vit C- 500 mg QID

Question 26

what is hyperemesis gravidarum? what does it mean? name 3 possible etiologies

Answer 26

severe intractable n/v, worst b/w 8-12 wks, normally over by 16 wks
means it’s a viable PG!
can be dt hormonal changes, psychological and social stresses, thyroid issues possibly

Question 27

name 3 ddx of hyperemesis gravidarum

Answer 27

pancreatitis
hepatitis
cholecystitis
pyelonephritis
gastroenteritis
peptic ulcer 
acute fatty liver of PG
appendicitis
diabetic ketoacidosis
pseudotumor cerebri

Question 28

labs to hyperemesis gravidarum? pts w/this are at increased risk for what possible complication of PG?

Answer 28

electrolytes
hct
LFTs
urine osmolality, urine analysis, ketonuria
serum bicarb
TSH
serum amylase/creatinine 
at increased risk of preeclampsia!!

Question 29

first line rx tx for hyperemesis gravidarum? second line? third line? adjunctive meds?

Answer 29

first line: antihistamines (unisom)
second line: dopamine antagonists
third line: serotonin antagonists
adjunctive meds: acid reducing agents

Question 30

name 5 naturopathic txs of hyperemesis gravidum

Answer 30

homeopathy (esp tabacum, ipecac, nux vom, sepia)
liver support (silybum and protomorphogens)
counseling
drainage
acupuncture

Question 31

etiology of hearburn? (5)

Answer 31

relaxation of cardiac sphincter (prog caused)
decreased gastric motility
decreased eso peristalsis
displacement of stomach up and to the R
increased intragastric P and decreased intraesophageal P

Question 32

name 3 management (food related) techniques for heartburn in PG

Answer 32

slow relaxed meals
avoid trigger foods (coffee, EtOH, chocolate, fats)
avoid cold foods and drink
pat of butter at start of meal
more raw foods
1 tbsp apple cider vinegar in water
no lying down for 3 hrs after eating
avoid carbonated bevs, processed foods, sugar, cigs
good posture
wear loose fitting clothing
raw almonds, yogurt, dry popcorn, papaya
digestive enzymes
liquid cal-mag

Question 33

name 3 medical interventions for heartburn in PG

Answer 33

antacids
antisecretory antihistamines
complementary txs: osteopathy, chinese medicine, reflexology, botanicals (papaya, peppermint tea, marshmallow, catnip, ginger, slippery elm)

Question 34

ddx of dyspepsia, flatulence, eructations

Answer 34

preterm labor
UTI
round lig pain

Question 35

5 ways to prevent dyspepsia, flatulence and eructations naturally. name 1 medical intervention. name 5 complementary medicines

Answer 35

consume 4 or more fruits and veggies/d (steamed)
avoid gas forming foods
avoid CHO and prots in same meal
exercise
abd massage
medical intervention: simethicone
complementary: homeopathy (carbo veg, nux vom), yogurt, kefir, probiotics, digestive enzymes, botanicals (dill, papaya, ginger, fennel), fennel, chamomile and mint celestial times tea

Question 36

what causes constipation? name 3 ways to manage constipation. name 2 medical interventions. name two complementary measures.

Answer 36

increase in prog slows peristalsis

management: increase fruit, veggies and fiber, exercise, decrease stress, increase rest, 8 glass of decaf fluid/d (H2O), regular bowel habits, avoid laxatives
medical: natural bulk laxatives, digestive enzymes
complementary: homeopathy (sepia, nux vom, calcarea carb, sulphur, pulsatilla, kali-c, merc) and botanicals (yellow doc, dandelion tea, psyllium seeds)

Question 37

what is ptyalsim? etiology? 3 management techniques?

Answer 37

drooling, increased saliva

etiology: excess acidity in mouth, starchy foods, cycles w/nausea
management: decrease starch intake, avoid diary, increase fruit, homeopathy (ipecac, merc, keosotum, coffea, helonias, kali-iodum)