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Jadella Implant is a form family planning which comes in two silicon rods,implan subdermal Over the years it release progestin to prevent ovulation thus prevent pregnancy
constipation in children , pediatric constipation , management of constipation in children , understanding constipation , causes of constipation in children , functional constipation in children , treatment of constipation ,approach to constipation in children ,constipation in infants
Jadella Implant is a form family planning which comes in two silicon rods,implan subdermal Over the years it release progestin to prevent ovulation thus prevent pregnancy
Nausea-vomiting
By nader al-assadi
Vomiting (emesis) is the oral expulsion of gastrointestinal contents due to gut and thoracoabdominal wall contractions.
Nausea is the subjective feeling of a need to vomit.
regurgitation, the effortless passage of gastric contents into the mouth.
Rumination is the repeated regurgitation of food residue, which may be rechewed and reswallowed. In contrast to emesis, these phenomena exhibit volitional control.
Indigestion is a term encompassing a range of complaints including nausea, vomiting, heartburn, regurgitation, and dyspepsia .
nausea and vomiting in pregnancy is very common. it may be a manifestation of some medical - surgical - gynecological complications. hyperemesis gravidarum is a severe type of vomiting in pregnancy which has got deleterious effects on the health of the mother. it is a very important topic and it is also a topic in obstetrics. we should encourage and help young mothers to identify the symptoms. please read it and get knowledge about nausea and vomiting in pregnancy. stay tuned.
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Mala Arora
Vomiting and nausea are closely related and mediated by the same neural
pathways:
■ vomiting or emesis is forceful expulsion of gastric contents;
■ nausea is the imminent desire to vomit;
retching is the rhythmic contractions of abdominal and chest musculature■
that precedes or accompanies vomiting.
These often occur together and may be accompanied by hypersalivation
(ptyalism)
■ formerly know as pregnancy taxicosis.
■ Central Nervous system changes as confuion, Photo phobia and delirium.
3. Physiological vomiting
Physiological vomiting of pregnancy has been described by the Egyptians as early as 2000 BC.
It is most common in the first trimester and may recur in the third trimester in a milder form.
Historically, Fair weather proposed in the 1960s that nausea and vomiting of pregnancy was
an
allergic reaction to pregnancy, which today would be labeled as an immunological response.
However, there has been no substantiation of his theory. There are several reasons proposed
for physiological vomiting in the first trimester of pregnancy as outlined below.
■ Rising progesterone and beta-human chorionic gonadotrophin (?HCG) levels cause delayed
intestinal motility and gastric stasis. Physiological vomiting is exaggerated in cases of
multiple pregnancy and hydatidiform mole owing to higher ?HCG levels.
■ High levels of estrogen and progesterone, which accompany pregnancy, are potential
mediators of gastric slow-wave dysrhythmias in nausea of pregnancy.
■ Vitamin B6 deficiency, which occurs owing to a change in protein metabolism in
pregnancy, hence vitamin B6 is used for its treatment.
■ Relaxation of the gastro-esophageal sphincter and hyperacidity also contribute.
■ Few studies found a correlation between female fetal sex and hyperemesis gravidarum.
■ During the third trimester of pregnancy, the gravid uterus can mechanically reduce the
distensibility of the stomach as well as change the contour of the cardiac sphincter, leading to
an increased incidence of vomiting.
4. Types of vomiting
The most important clues to diagnosis lie in the history of vomiting and its
accompanying symptoms.
■ Vomiting occurring only in the early morning occurs in pregnancy, hyperacidity
and uraemia.
■ Vomiting occurring after food is more likely to point to peptic ulcer,
gastroparesis, pyloric obstruction and food poisoning.
■ Projectile vomiting without nausea occurs in raised intracranial tension. Silent
regurgitation of food occurs in esophageal diverticuli.
■ Vomiting accompanied by tinnitus and/or giddiness is seen in middle ear
disease
■ Vomiting accompanied with diarrhoea occurs in enteritis and food poisoning.
■ Vomiting with chest pain signifies myocardial infarction and, when
accompanied with abdominal pain, could signify appendicitis.
5. Pathological or hyperemesis gravidarum
If vomiting is excessive, develops or persists after 14 weeks of gestation and
leads to dehydration and/or ketosis, it is called hyperemesis gravidarum. It
affects 1 in 200 pregnant women. If vomiting is sustained over a period of time,
it will lead to maternal weight loss, oliguria, hypokalaemic alkalosis and
constipation. Fetal
intrauterine growth restriction is also reported
In such cases, a pathological cause should be excluded. The causes of
hyperemesis gravidarum In a recent study, occurs in chronic
infection with Helicobacter pylori was present in 61.8 per cent of pregnant
patients with hyperemesis in comparison with 27.6 per cent of
pregnant patients without hyperemesis. Other studies have confirmed this
correlation. A recent study from Turkey has shown higher levels of the hormone
leptin in 18 patients with hyperemesis compared to an equal number of
healthy pregnant women.
6. Acute systemic infections
■ For example, chorioamnionitis, and viral infections, such as influenza,
encephalitis, meningitis,
hepatitis, pancreatitis or generalized peritonitis
7. Central nervous system
■ Raised intracranial tension, as in benign intracranial hypertension,
neoplasms, meningitis and
encephalitis
■ Raised intracranial pressure can sometimes occur with pre-eclampsia and
eclampsia owing to cerebral oedema, which can cause vomiting in the third
trimester
10. Surgical
■ Ovarian torsion, degenerating fibroids
■ Inflammations, such as appendicitis, diverticulitis, cholecystitis
■ Renal and biliary colic
■ Intestinal obstruction (refer to section on intestinal causes)
■ Gallstones
11. Intestinal
■ Enteritis
■ Intestinal inflammation as in ulcerative colitis or Crohn’s disease
■ Intestinal obstruction due to adhesions, hernia, mesenteric lymphadenitis,
adenomatous polyps,stricture, volvulus, Hirchsprung’s disease
■ Food poisoning
● bacterial due to Shigella , Salmonella , Staphylococcus , Clostridium
● viral due to rotavirus
● toxins, such as Clostridium botulinum
● allergy to foods, such as eggs, nuts or mushrooms
■ Intestinal ischaemia, as in mesenteric vein thrombosis, Henoch–Schönlein
purpura
■ Hepatitis viral hepatitis A, B, C, D and E, Epstein–Barr virus,
cytomegalovirus, leptospirosis
■ Pancreatitis due to a calculus in the common bile duct, viral or alcohol
induced
12. Gastrointestinal
Oesophageal
■ Gastro-oesophageal reflux disease
■ Hiatus hernia
■ Achalasia cardia
Gastric
■ Gastritis
■ Peptic ulcers due to Helicobacter pylori
■ Disordered gastrointestinal motility seen in diabetes or idiopathic gastroparesis
■ Pyloric stenosis – partial or complete
■ Fundoplication for obesity
■ Aerophagia syndrome
■ Gastric carcinoma
13. ■ Investigations
These should include the following.
■ Urine analysis : urine should be checked for specific gravity and the presence of
glucose and ketones. It may occasionally show the presence of bile pigments.
■ Complete blood count : this will show a rise in haematocrit and haemoglobin
percentage. There may be slight leucocytosis.
■ Serum electrolytes , such as sodium and potassium: this will show
hyponatraemia, hypokalaemia and, in severe cases, hypokalaemic metabolic
acidosis.
■ Blood sugar : hyperglycaemia may be present in diabetes, while hypoglycaemia
may be present in persistent vomiting, which requires correction with intra-
venous fluids.
■ Liver function tests : 20–30 per cent of women show mild elevation of liver
enzymes in hyperemesis. In cases of hepatitis, the enzymes are markedly raised
and it may be of value to check the hepatitis markers. Serum amylase and/or lipase
will be raised in pancreatitis. Liver function tests also provide an opportunity to
look at serum protein levels, an indication of the nutritional status of the mother.
■ Renal function tests , as renal failure is a complication of severe dehydration.
■ Thyroid function tests : 50–70 per cent of women have transient
hyperthyroidism. This is usually a self-limiting condition and does not require
antithyroid therapy.
14. ■ Parathyroid hormone , if clinically indicated: hyperparathyroidism is a rare
cause of hyperemesis, which may be intractable. High serum calcium levels
will point to the diagnosis. Both maternal and fetal morbidity is high and surgery
is the definitive cure.
■ An electrocardiogram will show widened QRS complexes and U waves in
hypokalaemia.
■ An ultrasound scan to confirm intrauterine pregnancy, to exclude multiple
pregnancy or hydatidiform mole. It will also show the presence of gallstones,
mesenteric adenitis, dilated loops of bowel in intestinal obstruction, the presence
of an appendicular lump and small contracted kidneys in uraemia.
15. Complication of vomiting
The most obvious complications are dehydration and malnutrition.
Loss of gastric fluid leads to dehydration, metabolic alkalosis and
hypokalaemia.
The patient will need fluid replacement to treat the dehydration. A general
examination will give some idea of the severity of dehydration.
The presence of ketones in the urine and a raised haematocrit will confirm the
severity of dehydration. The patient then needs to be admitted to hospital.
16. Treatment of NVP varies with the severity of the disease and can begin
with nonpharmacological choices including dietary/lifestyle modifica-
tion and vitamin/herbal supplementation, followed by pharmacological
antiemetic therapy. Nonpharmacological therapy includes increased rest
and avoidance of foods and odors that trigger symptoms (perfumes,
smoke, petroleum products). Adjustment in eating habits may include
small, frequent snacks with a focus on bland and dry foods or foods
high in protein. Spicy, fatty, and acidic foods may need to be eliminated.
High-protein meals have been shown to alleviate nausea and vomiting
better than carbohydrate or fatty meals.
Acupressure has been used to alleviate symptoms of nausea and vomit-
ing by applying pressure at the Neguian P6 acupoint. This point is located
approximately 2in. proximal to the wrist crease between the flexor carpi
radialis and palmaris longus tendons (Niebyl 2010). See band
Ginger root, a common spice and flavorer, has also been used for treat
ment.Ozgolietal. randomized women to ginger 2 50 mg four times a day for
4 days versus placebo with an improvement in nausea (85% versus 56%;
P=0.01) and a decrease in vomiting (50% versus 9%; P=0.05). Ginger
extracts at doses up to 1g/day have been shown to be more efficacious
at reducing nausea than vitamin B 6 (pyridoxine). ACOG recommends the
use of vitamin B 6 (10–25mg orally every 8hours) alone or in combination
with doxylamine succinate as first-line therapy (ACOG Practice Bulletin
52, 2004).