Cholestasis Of Pregnancy Flashcards Preview

Ob/Gyn > Cholestasis Of Pregnancy > Flashcards

Flashcards in Cholestasis Of Pregnancy Deck (25):
0

Cholestasis in pregnancy? Symptoms? Symptoms usually occur when? Confirm Diagnosis with?

Intrahepatic cholestasis (unknown etiology)

pruritus +/- jaundice, with NO skin rash

Night

Increased circulating bile acid levels

1

Pruritic urticarial papules and plaques of pregnancy - etiology? Sx? Findings?

Skin condition of unknown etiology

Intensive pruritus and erythematous papules on abdomen and extremities

2

Herpes gestationis?

Skin condition only seen pregnancy – intense itching and vesicles/tense bullae on abdomen and extremities

3

Intrahepatic cholestasis of pregnancy – can recur with?

Subsequent pregnancies and ingestion of OCP

4

Intrahepatic cholestasis pregnancy – LFTs? Tx?

Not necessarily elevated but may be over 1000

Ursodeoxycholic acid (less effective: hydroxyzine, cholestyramine)

5

Intrahepatic cholestasis – Effects on the mother? fetus?

No hepatic sequelae, but increased incidence of
1. Gallstones
2. recurrence in subsequent pregnancies


1. prematurity
2. fetal distress/Meconium aspiration
3. fetal loss

6

Intrahepatic cholestasis of pregnancy – treatment? Previously used?

Antihistamines and cornstarch baths, ursodeoxycholic acid

Bile salt binder, cholestyramine has been associated with vitamin K deficiency

7

Herpes gestationis – Relationship to HSV? Begins when? Etiology?

None; second trimester

Possibly autoimmune – IgG antibodies directed at basement membrane

8

Herpes gestationis – areas most affected? Definitive diagnosis by? Tx?

Arms;

Immunofluorescent examination biopsy specimens

Oral corticosteroids

9

Herpes gestationis – effects on fetus? On neonates?

IUGR, stillbirth

Transient neonatal herpes gestationis

10

Progression of PUPPP? Description of lesions?

Begins on abdomen, spreads to thighs, butt, arms

Erythematous urticarial plaques surrounded by narrow pale halo

11

PUPPP – immunofluroescent studies show? Immunologic findings? Effects on fetus? Treatment?

Negative for IgG and complement

Normal epidermis with superficial perivascular infiltrate of lymphocytes and histiocytes of papillary dermis

No adverse effect on fetal/maternal outcome

Steroids and antihistamines

12

Cause of intrafollicular bleeding?

Thin-walled capillaries invade granulosa cells from theca interna

13

Status and Drug therapy that predisposes to cyst rupture? Prevent by?

Pregnancy and Anticoagulation; more drugs to prevent ovulation

14

Symptoms of hemorrhagic corpus lutea? Prior to rupture?

Severe onset of severe lower abdominal pain (especially with hemoperitoneum)

Unilateral cramping and lower abdominal pain for 1 to 2 weeks before rupture

15

Most common times for corpus luteum cyst rupture?

The 20-26 of menstrual cycle

16

Differential diagnosis for suspected hemorrhagic corpus luteum?

Ectopic pregnancy, ruptured endometrioma, adnexal torsion, appendicitis, splenic injury/rupture

17

Ultrasound findings of hemorrhagic corpus luteum? Confirm diagnosis by?

Free intraperitoneal fluid and fluid around ovary

Laparoscopy

18

Treatment of ruptured luteal cyst?

Secure homeostasis

If bleeding stops, no further therapy
If bleeding continues, cystectomy

19

Corpus luteum produces? Until? Corpus luteum maintained by? What takes over?

It progesterone, 10 weeks,

Beta hCG; placental steroidogenesis

20

If corpus luteum removed prior to 12 weeks gestation, patient needs?

Exogenous progesterone to sustain pregnancy

21

Patient with localized tenderness over fibroid in pregnancy? Mechanism?

Degenerating leiomyoma;

Estrogen causes rapid growth of fibroid, fibroid out-grows blood supply leading to ischemia and pain

22

Pain in ovarian torsion?

Colicky abdominal pain

23

Movement of appendix in pregnancy? Movement of gallbladder?

Superiorly and laterally; does not move

24

Earliest sign of hypovolemia?

Decreased urine output > positive tilt test > tachycardia > hypotension