Week 4 Mo Parturient with Systemic Diseases Flashcards
Maternal Gestational Diabetes Tx?
Diet control
Insulin
Avoid oral hypoglycemic agent (can cause fetal hypoglycemia)
Gestational Diabetes Complications Maternal?
Preterm labor Polyhydramnion C/S for macrosomia Preeclampsia/eclampsia DM type II
Gestational Diabetes Complications Fetal?
Macrosomia Shoulder dystocia Perinatal mortility 2-5% Congenital defects !!!Hypoglycemia!!!
Dilutional Anemia during Pregnancy is due to what?
Due to 50% increase in plasma volume
If Maternal Hb falls below what level, you should look for another cause (not dilutional anemia due to pregnancy)
below 10.5g/dl
Most common hereditary bleeding disorder?
Von Willebrand’s’s disease
What are signs and symptoms of Von Willebrand’s dz?
Prolonged BT despite normal platelet count (cannot stick to injured area)
A functional deficiency of factor VIII (pseudo-hemophilia) occurs as a result of deficit of vWF, its carrier protein. Deficiency is manifested clinically by prolonged PTT
Mucous membrane bleeding
Easy brusiability
Prolonged bleeding from wounds
Menorrhagia– very heavy period
LABS
Prolonged PTT
Prolonged BT
Treatment of Von Willebrand’s dz?
Desmopressin (dDAVP) increases vWF level
Cryoprecipitate is rich in factor VIII:vWF
Estrogen and OCP
Labs performed on a Mom with gestational Diabetes?
Glycosuria, fasting hyperglycemia
Abnormal GTT
Glucose Tolerance Test?
Hemophilia A is a deficiency in what factor?
VIII
Second most common X-linked Coagulation defect? This mean what sex is rarely affected?
Hemophilia A, and females are rarely affected.
Clinical findings with Hemophillia A?
Soft tissue and joint bleeding
Dangerous CNS bleeding with minor trauma
Spontaneous hematuria leading to ureteral colic
Labs with Hemophilia A?
Prolonged PTT (intrinsic pathway)
Low factor VIII
Normal vWF , therefore normal BT
Treatment for Hemophilia A?
FFP and cryo (low in VIII)
Factor VIII replacement
Hepatitis C and HIV infection very common due to tinted blood transfusion
What factor is deficient in Hemophilia B?
IX
Vitamin C deficiency is a coagulation defect (apparently), what will you lack?
Lack of stable collagen (elderly, alcoholics)
Hepatic failure is a coagulation defect, why is this?
Almost all clotting factors are made in the liver.
What clotting factors ARE NOT made in the LIVER?
Factor VIII:vWF Factor III ( tissue factor thromboplastin) Factor IV ( Ca++)
Vitamin K deficiency is considered a coagulation defect. Tell me why?
Yes, Vit K is fat-soluble vitamin and is required for II (prothrombin), VII, IX, and X formation (also protein C and protein S)
What issues would cause a deficiency in Vitamin K?
Fat malabsorption due to lack /obstruction of bile secretion leads to fatty diarrhea causing deficiency of Vit K
What will you give to all surgical patients with liver dz?
Vit. K
What is Thrombocytopenia?
Platelets of less than 150,000
What does Thromboccytopenia cause?
Bleeding from small capillaries and blood vessels Mucosal, skin bleeding.
What is aplastic anemia?
Low number of platelets, you stop producing new blood cells.
Idiopathic thrombocytopenic purpura (ITP), what is it and what does it cause?
Autoimmune, common.
Due to antiplatelet antibodies.
decreased anti-GPIIb/IIIa antibodies causeing peripheral platelet destruction
Thrombotic thrombocytopenic purpura (TTP), what is it associated with?
Associated with chemo, liver disease, splenomegaly, DIC pre- eclampsia
Tell me about DIC?
Abnormal bleeding and clot formation
Critically ill patients
Coagulation and clot lysis in uncontrolled manner
Due to massive tissue damage
Depletion of clotting factors
Anesthesia considerations with coagulation disorders? (what do you want to know, what are they likely to receive?)
Careful history about bleeding disorders
Operation history
Massive blood transfusion causes
Functional deficiency of platelets
Packed RBCs infusion leading to dilution of V & VIII
FFP contains all clotting factors (except platelets)
What is AIDS? (very basically what does it do)
HIV infect and kill T-helper lymphocytes resulting suppression of cell mediated immunity. Host will develop opportunistic infections (Pneumocystis pneumonia) and various tumors
HIV becomes?
AIDS
HIV 1, what exactly is it?
single strand of RNA enclosed in a protein envelope, belongs to Retrovirus family.
What is reverse transcriptase? (has to do with how HIV replicates)
Viral replication is dependent upon a DNA polymerase known as reverse transcriptase, which is responsible for copying the viral RNA to DNA
How does HIV (AIDS) weaken the cellular immunity?
Additional transcription of DNA results in billions of new viral particles that are extruded from cell membrane by killing the T-helper cells (CD4) weakness of cellular immunity
Where does incorporation of DNA take place (talking about HIV)
Incorporation of DNA then takes place into the host cell genome; the T-helper cells (CD4) cell genome
CD4 count?
<200/mm^3
RISK FACTORS for HIV?
Transmitted by body fluids e.g. semen, blood, vaginal fluids and breast milk
Homosexual and bisexual men
IV drug abusers
Hemophiliacs and recipient of other blood products before 1985
Sexual partners of these groups
Vertical transmission through placenta
HIV - Pathogenesis?
what cells does HIV mess with and what does this cause?
T-helper cells coordinates the immune response of T & B lymphocytes, monocytes and macrophages
Therefore, impaired immunity of both cell-mediated and humoral immunity occur
HIV is also neurotropic and neurological dysfunction is common
Is neurological dysfunction common with HIV?
Yes
HIV- Laboratory diagnosis?
Look for antibodies against viral proteins
Presumptive Dx made with ELISA “RULE OUT test”
Positive results are then confirmed with Western blot assay “ RULE IN test”
HIV PCR / viral load tests
AIDS diagnosis less than or equal to 200 CD4 (N=500-1500)
Stage 1 HIV, tell me about it?
Stage I can include a flu-like illness within a month or two of exposure.
What is seroconversion?
Seroconversion means the immune system is activated against the virus, and antibodies can be detected in the blood.
Stage II of HIV?
Sage II, the individual usually remains free of major disease, even without treatment.
It can last 6-8 years, during which HIV levels in the blood slowly rise.
Stage III of HIV?
Stage III occurs when the immune system loses the fight against HIV.
Symptoms worsen and opportunistic infectious develop
Four stages of infection with HIV?
- Flu-like (acute)
- Feeling fine (latent)
- Falling count
- Final crisis
During latent phase, virus replicates in lymph node.
Physical Examination of a person with HIV? (What signs and symptoms may you see (6 things))
Low grade fever, night sweat, weight loss
Facial seborrhea
Diffuse lymphadenopathy (like Mono)
Splenomegaly
Oral candidiasis “thrush”
Herpes zoster infection
Clinical features of a person with HIV?
Asymptomatic
Persistent fevers and chill
Drenching night sweats
Fatigue, arthralgias, myalgias
Unintentional weight loss “HIV wasting syndrome”
Depression, apathy, as early signs of HIV-related encephalopathy
Special features associated with HIV?
Fever Lymphadenopathy is a common finding Skin lesion Dyspnea Dysphagia Diarrhea Headache and seizures Blindness Hematological abnormalities
What is the most common complaint of a person with HIV, and what labs should be done in relation to this?
Fever!
Blood culture should be drawn for bacteria, fungus, atypical mycobacterium (MAI) and CMV
What kind of skin lesions do you see with HIV?
Pruritus and folliculitis common
Kaposi’s sarcoma
What may be causing the Dyspnea in an HIV patient? (also the leading cause of death)
Pneumocystis carinii pneumonia is leading cause of death
Other causes of pulmonary distress in the HIV patient?
Tuberculosis ( -ve tuberculin test)
Atypical mycobacteria
Dysphagia in an HIV patient may be related to?
Candidal esophagitis “oral thrush”.
Diarrhea in the HIV patient may be due to?
Cryptosporidium , microsporidium , giardia, E.histolytica
Colitis – CMV
HA and seizures in the HIV patient may be due to?
Toxoplasma is the most common finding with patients presenting with headache, confusion and seizures.
Blindness in the HIV patient may be due to?
CMV retinitis – “Cheese and ketchup lesion” MCC
Hematological abnormalities in the HIV patient may be due to?
ITP like thrombocytopenia
Anemia of chronic disease
Lymphocytopenia
Therapy for HIV?
Azidotheymidine (AZT) with CD4 < 500
With CD4 < 200 add pneumocystis prophylaxis
Vaccination for pneumococci, influenza and hepatitis
No live vaccine (polio, rubella) should be administered.
High risk of TB
What HIV medication is a reverse transcriptase inhibitor?
AZT
What is Trimethoprim-sulphamethoxazole given for?
With CD4 < 200 add pneumocystis prophylaxi (HIV patient)