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Hyperemesis gravidarum


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Hyperemesis gravidarum

  1. 1. HyperemesisGravidarum<br /><br />
  2. 2. Definitions<br />>Morning sickness: is the nausea felt by about 50% of pregnant <br />women on getting up in the morning.<br />> Emesis gravidarum: Actual vomiting in the morning.<br />> These two conditions usually start between the 4th and 6th weeks of pregnancy and improves or disappears about the 12 th week.<br />>Hyperemesisgravidarum: The vomiting is not confined to the morning but it is repeated throughout the day until it affects the general condition of the patient.<br /><br />
  3. 3. Aetiology<br /> 1. Hormonal: high human chorionic gonadotrophin (hCG) stimulates the chemoreceptor trigger zone in the brain stem including the vomiting center. This is the most accepted theory and proved by the higher frequency in the conditions where the hCG is high as in:-<br /> a. early in pregnancy,<br /> b. vesicular mole and<br /> c. multiple pregnancy.<br /><br />
  4. 4. Aetiology<br />2.Allergy: to the corpus luteum or the released hormones.<br />3. Deficiency of:<br /> a. adrenocortical hormone and /or,<br /> b. vitamin B6 and B1<br />4.Nervous and psychological: <br />a.due to psychological rejection of an unwanted pregnancy,<br /> b. fear of pregnancy or labour so it is more common in primigravidae.<br /><br />
  5. 5. Pathological Changes:<br />These are the same as in prolonged<br />* Liver: small fatty infiltration.<br />* Kidney: fatty degeneration of the convoluted tubules.<br />* Heart: small subendocardial and subpericardialhaemorrhages.<br />* Brain: congestion and petechialhaemorrhages in the brain stem resembling that of Wernicke’s encephalopathy.<br /><ul><li>Eye: optic neuritis and retinal haemorrhage.</li></ul>* Peripheral nerves: degeneration. starvation:<br /><br />
  6. 6. Pathological Changes:<br /> Blood:<br />Hypovolaemia and haemoconcentration.<br />Hyponatraemia, hypokalaemia and hypochloraemia.<br /> Increased blood urea.<br />Hyperbilirubinaemia (due to liver damage).<br /> Acidosis.<br /> Urine:<br />Oliguria.<br /> Increased specific gravity.<br /> Decreased chloride.<br />Albuminuria.<br />Ketonuria.<br /><br />
  7. 7. Diagnosis<br />Symptoms:<br /> >The patient cannot retain anything in her stomach, <br /> vomiting occurs through the day and night even without eating.<br /> >Thirst, constipation and oliguria.<br /> >In severe cases, vomitus is bile and/ or blood stained.<br /> > Finally, there is manifestations of Werniche’s encephalopathy as drowsiness, nystagmus and loss of vision then coma.<br /><br />
  8. 8. Diagnosis<br />Signs:<br />Manifestations of starvation and dehydration: * *Loss of weight.<br /> * Sunken eyes.<br /> * Dry tongue and inelastic skin.<br /> * Pulse: rapid and weak.<br /> * Blood pressure: low.<br /> * Temperature: slight rise.<br /><br />
  9. 9. Differential diagnosis<br />Other causes of vomiting as:<br /> * cholecystitis,<br /> * appendicitis,<br /> * pyelonephritis,<br /> * gastroenteritis,<br /> * gall bladder diseases,<br /> * complicated ovarian tumours.<br /><br />
  10. 10. Management<br />Hospitalisation<br />For observation, fluid therapy and competition of neurosis.<br /><br />
  11. 11. Management<br />Intravenous fluids<br /> * Oral feeding is prevented for 24-48 hours.<br /> * Three litres of glucose 5% is given by rapid infusion over 2-3 hours.<br /> * Maintain intravenous glucose 5% and saline therapy.<br /> * When vomiting is controlled frequent gradual smallcarbohydrate diets are started.<br /><br />
  12. 12. Management<br />Drugs<br />* Adrenocortical preparations.<br />* Vit. B6 and Vit. B1.<br />* Antihistaminics that have antiemetic effect as meclozinehydrochloride 25-50 mg twice daily. A preparation contains both meclozine hydrochloride + pyridoxine hydrochloride (vit. B6) is of good benefit.<br />* Phenothiazine (chlorpromazine=largactil) 5-10 mg three times daily has a tranquilliser and antiemetic effect.<br /><br />
  13. 13. Observation for:<br />* Vomiting: frequency, amount, colour and contents.<br />* Vital signs: pulse, temperature and blood pressure.<br />* Fluid: intake and output.<br />* Urine analysis: specific gravity, albumin, ketonebodies,chloride and bile pigments.<br />* Blood: urea, electrolyte and liver function tests.<br />* Eye: examination of the fundus.<br /><br />