HYPEREMESIS GRAVIDARUM
| A | Electrocardiographic evidence of hypokalemia | |
| B | Metabolic acidosis | |
| C | Jaundice | |
| D | Ketonuria |
| A | Electrocardiographic evidence of hypokalemia | |
| B | Metabolic acidosis | |
| C | Jaundice | |
| D | Ketonuria |
Hyperemesis gravi- darum is intractable vomiting of pregnancy and is associated with dis- turbed nutrition. Early signs of the disorder include weight loss (up to 5% of body weight) and ketonuria. Because vomiting causes potassium loss, electrocardiographic evidence of potassium depletion, such as inverted T waves and prolonged QT and PR intervals, is usually a later finding. Jaun- dice also is a later finding and is probably due to fatty infiltration of the liver; occasionally, acute hepatic necrosis occurs. Metabolic acidosis is rare. Hypokalemic nephropathy with isosthenuria may occur late. Hypopro- teinemia also may result, caused by poor diet as well as by albuminuria. Patients who have hyperemesis gravidarum are best treated (if the disease is early in its course) with parenteral fluids and electrolytes, sedation, rest, vitamins, and antiemetics if necessary. In some cases, isolation of the patient is necessary. Very slow reinstitution of oral feeding is permitted after dehydration and electrolyte disturbances are corrected. Therapeutic abortion may be necessary in rare instances; however, the disease usually improves spontaneously as pregnancy progresses.
Wernicke’s encephalopathy is seen in all conditions, EXCEPT:
| A |
Chronic alcoholic |
|
| B |
Hyperemesis gravidarum |
|
| C |
Peritoneal dialysis patients |
|
| D |
Hypothyroidism |
Wernicke’s encephalopathy is seen in all conditions, EXCEPT:
| A |
Chronic alcoholic |
|
| B |
Hyperemesis gravidarum |
|
| C |
Peritoneal dialysis patients |
|
| D |
Hypothyroidism |
Wernicke’s encephalopathy
- Chronic alcoholism
- It is also seen in nonalcoholic patients with
- Protracted starvation
- Hyperemesis gravidarum
- Gastrointestinal operations for morbid obesity
- Infusion of glucose solutions for parenteral nutrition without proper thiamine supplementation.
- Hemo- and peritoneal dialysis
- Patients with various cancers,
- Bone marrow transplantation
- AIDS.
The following conditions are associated with molar pregnancy except :
| A |
Pregnancy induced hypertension |
|
| B |
Thyrotoxicosis |
|
| C |
Gestational diabetes |
|
| D |
Hyperemesis gravidarum |
The following conditions are associated with molar pregnancy except :
| A |
Pregnancy induced hypertension |
|
| B |
Thyrotoxicosis |
|
| C |
Gestational diabetes |
|
| D |
Hyperemesis gravidarum |
Gestational diabetes
Differential diagnosis of Hyperemesis gravidarum:
| A |
Gastritis |
|
| B |
U.T.I |
|
| C |
Reflux oesophagitis |
|
| D |
All |
Differential diagnosis of Hyperemesis gravidarum:
| A |
Gastritis |
|
| B |
U.T.I |
|
| C |
Reflux oesophagitis |
|
| D |
All |
Ans. is a, b and c
- Nausea and vomiting of pregnancy commonly termed morning sickness’ is a normal phenomenon in pregnancy, occurring in about 70% of all pregnancies.
- in most women, it is limited to the first trimester. but a few may continue to have symptoms throughout pregnancy.
- Hyperernesis gravidarum is the other end of the spectrum characterised by severe nausea and intractable vomiting sufficient to interfere with nutrition.
- Risk Factors : – Maternal age > 35 years High body weight.
Nulliparity H. mole
– Cigarette smoking Twin pregnancy
– Fetal loss Positive family history
– Unplanned pregnancy
- Clinical features are due to : — Dehydration Stareation Ketoacidosis
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Vomiting associated with Pregnancy (unr-lated to pregnancy) |
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Medical W · intestinal infestation · Urinary tract infection · Hepatitis/Pancreatitis · Keto-acidosis of diabetes · Uraemia · CNS disorder |
Surgical · Appendicitis ·Peptic ulcer reflux ·Intestinal obstruction · Cholecystitis/Cholelithiasis |
Gynaecological |
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· Twisted ovarian tumour · Red degeneration of fibroid |
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Management : Mild to moderate Nausea and Vomiting of Pregnancy – usually needs no treatment except reassurance and frequent small meals. Vitamin B5 alone or with doxylamine is safe and can be considered.
|
Vomiting associated with Pregnancy (unr-lated to pregnancy) |
|
|
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Medical W · intestinal infestation · Urinary tract infection · Hepatitis/Pancreatitis · Keto-acidosis of diabetes · Uraemia · CNS disorder |
Surgical · Appendicitis · Peptic ulcer reflux · Intestinal obstruction · Cholecystitis/Cholelithiasis |
Gynaecological |
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· Twisted ovarian tumour · Red degeneration of fibroid |
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When is pregnancy is terminated in hyperemesis Gravidarum :
| A |
Increased acetone in urine |
|
| B |
Decrease in renal output |
|
| C |
Vomiting is more than 3 months |
|
| D |
All |
When is pregnancy is terminated in hyperemesis Gravidarum :
| A |
Increased acetone in urine |
|
| B |
Decrease in renal output |
|
| C |
Vomiting is more than 3 months |
|
| D |
All |
Ans. is b i.e. Decrease in renal output
|
Indications for Therapeutic termination in Hyperemesis
|
gravidarum |
|
Extra Edge
– Thiamine deficiency leading to Wernicke encephalopathy. – Vitamin K deficiency.
– Plasma zinc levels increased. – Plasma copper levels decreased. – Plasma magnesium levels unchanged. |
Indications for termination of pregnancy in hyperemesis gravidarum include all except :
| A |
Jaundice |
|
| B |
Oliguria |
|
| C |
Neurological complications |
|
| D |
None |
Indications for termination of pregnancy in hyperemesis gravidarum include all except :
| A |
Jaundice |
|
| B |
Oliguria |
|
| C |
Neurological complications |
|
| D |
None |
None
Which is more common in primigravida than multigravida :
| A |
PPH |
|
| B |
Placenta previa |
|
| C |
Malpresentation |
|
| D |
Hyperemesis |
Which is more common in primigravida than multigravida :
| A |
PPH |
|
| B |
Placenta previa |
|
| C |
Malpresentation |
|
| D |
Hyperemesis |
Hyperemesis
