ACUTE ABDOMEN IN PREGNANCY

Question 1

acute abdomen in pregnancy

Answer 1

refers to any serious acute intra-abdominal condition accompanied by
-pain
-tenderness
-muscular rigidity

Question 2

etiology of acute abdomen

Answer 2

1.obstetric (placental abruption, HELLP)
2.non obstetric (appendicitis, cholecystitis)
3.extra abdominal causes (cardiac pain, psychological abuse of drugs
4.exacerbated by pregnancy (gallbladder disease, acute pyelonephritis)

Question 3

placental abruption

Answer 3

-premature separation of a normally situated placenta
-pain with or without vaginal bleeding

Question 4

placental abruption clinical exam

Answer 4

-uterus larger than dates
-tense and tender
-fetal heart shows signs of distress

Question 5

placental abruption US dx

Answer 5

-difficult to assess
-acute isoechoic clot to placenta with no flow on color doppler
-clot may be marginal, preplacental or retroplacental

Question 6

appendicitis

Answer 6

-acute appendicitis can present in any trimester
-pain in the RLQ, most common presentation

Question 7

appendicitis US

Answer 7

-often displaced by enlarging gravida uterus
-blind ending, noncompressible tube
-diameter >6mm
-look for appendicolith
use TV
-inflamed peri appendiceal fat is echogenic
-if raptured, focal fluid collection

Question 8

appendicitis complications

Answer 8

-perforation
-peritonitis
-septicemia (blood poisoning by bacteria)
-miscarriage
-preterm labor
-intrauterine death

Question 9

renal stone disease

Answer 9

ureteric dilatation, particularly suspicious for stone if dilatation stops abruptly

Question 10

renal stone disease US

Answer 10

-use tv for distal ureter for ureterovesical junction stones
-stones = echogenic, posterior shadowing, twinkle artefact with color doppler
-uretic jets with color doppler
-measure intrarenal indices (RI)
-physiologic Calie stasis does not cause elevated RI

Question 11

pyelonephritis

Answer 11

-enlarged kidney +/-parenchymal edema
-perinephric edema
-abscess or pyonephritis (collection) which may require drainage

Question 12

gallbladder disease

Answer 12

second most common
-acute cholecystitis >40years

Question 13

cholecystitis

Answer 13

-gallstones
-gallbladder wall thickening
-pericholecystic fluid
+ murphy sign
*REMEMBER RUQ PAIN AND ABNORMAL LFT MAY INDICATE PREECLAMPSIA

Question 14

ovarian torsion

Answer 14

-maximum risk at 12-14 weeks and immediately after postpartum
-adnexal mass can undergo torsion in pregnancy

Question 15

ovarian torsion US

Answer 15

-ovarian or paraovarian mass as lead point
-echogenic stroma
-ovarian enlargement
-peripheral follicles from edema
-hemorrhage/ necrosis/ infarct
-doppler to assess flow (flow does exclude clinical findings)
-lack of venous flow

Question 16

fibroid degeneration

Answer 16

-larger fibroids at greater risk for acute hemorrhage degeneration
-require narcotic analgesia for control
-low grade fever in hemorrhagic degeneration
-cystic often with thick irregular septations

Question 17

trauma

Answer 17

-leading non obstetric cause of maternal death
-fetal death due to abruption
-wait 10-14days post injury and consider performance of fetal MRI to look for intracranial hemorrhage
-ischemic encephalopathy

Question 18

ischemic encephalopathy

Answer 18

a type of brain damage. It’s caused by a lack of oxygen to the brain before or shortly after birth. It affects the central nervous system