Pathophysiology 3 Flashcards Preview

Reproductive > Pathophysiology 3 > Flashcards

Flashcards in Pathophysiology 3 Deck (60):
1

Preconception Counseling

-name obesity as a health condition (use classification system)
-counsel on risk: high risk conditions associated with obesity
-Encourage lifestyle changes: point the patient to resources, follow up
-Refer to specialist when needed

2

Identify Obesity

-Screening: ACOG recommends annual weight-BMI calculation
-Definitions: use BMI to identify weight class

3

Obesity and Conception

-obese women have lower rates of fertility
1. anovulation(PCOS)
2. leptin impairs ovarian functioning
3. low fertilization potential of ova
4. risk of spon abortion
5. success rates of ART impacted negatively
6. infrequent intercourse
***reversible if loose weight***

4

Lifetime/Pregnancy risks of obesity

-diabetes, HTN, cancer (endometrial), arthritis, cholesterol, stroke, heart disease

-gestational HTN, preeclamsia, gestational diabetes, macrosomia, cesarean section, birth defects, still birth

5

Counsel of Lifestyle Changes

Motivational Interviewing
1. feedback-identify behaviors and results
2. responsibility-stress who will suffer
3. advice-teach, give ideas
4. menu-identify difficult situations
5. empathy-understand & involved
6. self-efficacy-learn from mistakes

6

Ability for Obesity Counseling

-track calories
-encourage to join support groups (weight watchers)
-exercise (start w/minimal goals, taking stairs)
-track weight loss

7

Candidates for Bariatric Surgery

-well informed, motivated
-BMI >40
-acceptable surgical risk
-failed nonsurgical management
-BMI >35 with complications of obesity (sleep apnea, diabetes, joint disease)

8

Pregnancy & Bariatric Surgery

-not during pregnancy but after
1. Restrictive: gastric banding
2. Combination restrictive/malabsorption

9

Effects of Gastric Bypass of Pregnancy

Lowers risk:
-preeclampsia
-gestational diabetes
-macrosomia
-congential anomalies
-average weight gain in pregnancy
Higher risk:
-cesarean section
-PPROM

10

Obesity & Cesarean Section

-higher rates in obesity & bariatric surgery

11

Obesity & Blood Clots

Give anticoagulation? not if BMI only
-may be necessary if unable to use extremity compression techniques
-compression devices acceptable
-unfractionated/LMWH acceptable (weigh risk of bleeding. dosing)

12

Obesity Risk during Pregnancy

-Screen for nutritional deficiencies: Fe, B12, Vitamin D, Ca
-(bariatric surgeon, met w/nutritionalist)
-surgical complications: anastomotic leaks, bowel obstruction, hernia, band migration, involve bariatric surgeon

13

Obesity: Dumping Syndrome

-rapid transit of high glycemic carbohydrates
-do not use glucola
-screen with fasting & postprandial blood sugars for 1 week
-avoid extended release medicine

14

Pathophys of Thromboembolic Disorders

-physiologic changes of pregnancy contribute to Virchow's triad
-venous stasis in lower extremities from compression of IVC and pelvic veins by enlarging uterus
-increased hormone-mediated deep vein capacitance secondary to increased circulating levels of estrogen & production locally of prostacyclin & nitric oxide
-Progesterone: inc. decidual & hemostatic systems
-doubling of fibrinogen levels
-increases factors: 7,8,9,10,12 1000%
-vWF inc 400%
-40% dec in free protein S conc. = resistance to activated protein C
-returns to baseline 6 weeks postpartum

15

Risk Factors for Thromboembolic Disorders

-age >35
- obseity
-trauma
-immobility
-infection
-smoking
-nephrotic syndrome
-hyperviscosity syndromes
-cancer
-surgery
-history of DVT/PE

16

Risk Factors for Thromboembolic Disorders
Pregnancy Specific

-increased parity
-postpartum endomyometrisis
-operative delivery
-cesarean delivery (9x increased over vaginal)

17

Antiphospholipid Antibody Syndrome

-14% of thromboembolic disease in pregnancy
DIAGNOSIS: 1.presence of prior VTE/characteristic obstetric complications 2. anticardiolipid antibodies or lupus

-associated with venous (DVT/PE) and aterial stroke events

18

Inherited Thrombophilias

-Factor V Leiden homozygous
-Antithrombin III deficency
-Prothrombin Gene G2021A

19

Diagnosis of Deep Venous Thrombosis

-Venous USG
-D-Dimer
-Contrast Venography (allergy)
-MRI

20

Diagnosis of Pulmonary Embolism

-EKG Changes
-Chest X-ray
-Spiral CT Scan****gold standard
-Pulmonary arteriography
-VQ scan
-MRA
-D-Dimer Assays

21

Treatment of Thromboembolic Disorders

1. Unfractionated Heparin: reverse with protamine sulfate
2. Low Molecular Weight Heparin
3. Warfarin/Coumadin: takes 72hrs to start working
4. Fondaparinux: doesn't cross placenta
5. IVC filters: doesn't prevent clot
6. Preoperative prevention

22

Menorrhagia

prolonged (>7days) or excessive (>80mL) uterine bleeding occuring at regular intervals

23

Metrorrhagia

-uterine bleeding occurring at irregular but frequent intervals

24

Menometrorrhagia

-prolonged uterine bleeding occurring at irregular intervals

25

Hypermenorrhea

-synonymous with Menorrhagia

26

Polymenorrhea

-uterine bleeding occurring at regular intervals of less than 21 days

27

Intermenstrual Bleeding

-bleeding of variable amounts occurring between regular menstrual periods

28

Causes of Abnormal Uterine Bleeding: Pregnancy

-Implantation Bleeding
-Abortion
-Molar Trophoblastic
-Ectopic

29

Causes of Abnormal Uterine Bleeding: Neoplasia/Anatomy

-vulva & vagina
-cervix: squamous cell carcinoma
-Uterine Corpus: uterine fibroids, endometrial cancer
-ovary
-endometriosis

30

Causes of Abnormal Uterine Bleeding?

-trauma
-systemic disease: coagulopathies, blood dyscrasias, endocrinopathy
-drug effects

31

Pregnancy on Asthma

-Dyspnea 60-70% all pregnant women
-pregnancy has unpredictable effect on underlying asthma

32

Asthma Effects on Infant

-increased risk IUGR
-increased neonatal hypoxia
-increased low birth rate
-increased neonatal mortality

33

Best Measure of Pulmonary Function

-FEV1

34

Choice for Rescue inhaler in Pregnancy?

SABA- albuterol

35

Choice for Controller in Pregnancy?

ICS - Budesonide

36

Choice for ADD On in Pregnancy?

LABA - Salmeterol

37

What may cause bronchospasms and should be avoided in pregnancy?

Hemabate (PGF2)

38

Birth Control Pill Benefits

-dec. risk of ovarian & endometrial cancer
-decreased dysfunctional uterine bleeding
-menstrual regularity (inc. hemoglobin)
-inc. SHBG so dec. androgens: less hirsuitism & acne
-can be used "off label" for poly cystic ovary syndrome

39

Side effects of Oral Contraceptives

Estrogen: nausea, breast tenderness/enlargement
-low does, increased breakthrough bleeding
-unexpected bleeding common with low dose
-older formulations with >50mcg of ethinyl estradiol caused more MI and stroke
-venous thromboembolism: with combination pills especially in smokers

40

Progesterone-Only

"mini pill"
-daily & continuously, no placebo
-take at same time each day
-best for women breast-feeding
-women > 35 years old who smoke

41

Transdermal Patch

-mixe
-new patch 3 weeks off for 1 week
-less effective in women >90kg adipose tissue
-breakthrough for 2 cycles
-skin irritation

42

Prevalence of Urinary Incontinent

10-35% of adults
-women>men
-patients under-reporting

43

Classifying Urinary Incontinence

-stress
-urge
-mixed
-overflow
-functional
-unconscious or reflex
-fistula

44

Management Urinary Incontinence

-assess
-understand risk factors & reversible causes
-treat reversible conditions
-educate
-treat to improve quality of life
-agree on management plan

45

Risk Factors of Urinary Incontinence

F>M
menopause, childbirth, immobility, environmental barriers, altered cognition, meds, smoking, collagen disorders,

46

Increased risk of Urinary Incontinence with past medical history?

-parity
-any repairs or other birth trauma (forceps/vacuum)

47

Drugs to prevent voiding?

-anti-cholinergic
-alpha-adrenergic

48

Drugs to promote voiding?

-cholinergic-bladder irritability
-alpha-blocking-decrease sphincter tone

49

Diet and Urinary Incontinence?

caffeine
spicy foods
alcohol
citrus food & drinks

50

Q-Tip Test

-assesses bladder neck mobility
-sterile technique
-anesthetic gel
+30> hypermobility
-stress urinary incontinence (SUI) often has hypermobility, but if have it not necessarily SUI

51

Laboratory Testing Urinary Incontinence

Urinalysis & Culture
-bacterial mucosal irritation
-endotoxin inhibition of alpha-adrenergic receptors in urethra

52

To hold the urine??

-urethral pressure must be greater than bladder, abdominal, volume pressure

53

Treatment of Urinary Incontinence

-treat reversible conditions first
-behavioral therapy
-medications
-devices
-surgery

54

Reversible Causes of Urinary Incontinence

-UTI
-atrophic urethritis/vaginitis
-dietary
-meds
-excess fluid intake/caffeine
-delirium
-phychological
-restricted mobility

55

Nonsurgical Treatment of Stress incontinence

-Kegel exercises (stop peeing mid stream, then start again)
-Pessaries: requires regular care, managed by patient
-Fem-Soft (helps prevent leaking)

56

Surgical Treatment of Stress Incontinence

-Burch Retropubic Urethropexy
-Sling (mesh: have erosion/problems)
-Urethral Bulking: inject substance to close urethra up some (if to much can't pee)

57

Symptoms of Prolapse

-pressure
-bulge "down there"
-vaginal irritation/Ulvers

***pain is not presenting symptom***

58

Symptoms of Anterior Prolapse

-stress urinary incontinence
-incomplete bladder emptying
-possible increased frequency of UTIs

59

Symptoms of Posterior Prolapse

-incomplete stool evacuation
-splinting to assist defecation

60

Risk Factors of Prolapse

-childbirth
-increased intra-abdominal pressure (chronic cough/lifting/obesity/constipation/straining)
-Neurologic Injury
-Genetic Predisposition (connective tissue abnormalities)
-Estrogen Deficiency