scholarly journals Acute Hepatitis in Pregnancy – Diagnostic Challenges

2021 ◽  
Vol 6 (6) ◽  
Keyword(s):  
Family History ◽  
Physical Examination ◽  
Total Bilirubin ◽  
Hyperemesis Gravidarum ◽  
Abdominal Ultrasound ◽  
Blood Analysis ◽  
Pyridoxine Hydrochloride ◽  
Previous Medication ◽  
Obstetric Department ◽  
In Pregnancy

A 35-year-old nulliparous woman, 22 weeks of gestation, with no relevant personal or family history, on Doxylamine Succinate+ Dicyclomine Hydrochloride + Pyridoxine Hydrochloride and Chlorpromazine, was admitted in the Obstetric Department for hyperemesis gravidarum. Physical examination was unremarkable. After stopping her previous medication, she was started on ondansetron. Blood analysis revealed INR 1.0; AST 525U/L; ALT 952U/L, GGT 55U/L, FA 72U/L, total bilirubin (TB) 2.05mg/dL, with direct of 1.37mg/dL. Abdominal ultrasound only revealed vesicular microlithiasis. Choledocholithiasis or hyperemesis gravidarum were the preliminary diagnostic hypotheses.

Clinical case of breast tumor relapse in domestic cat

2020 ◽  
pp. 29-32
Author(s):  
Viktor V. Grechko ◽  
◽  
Lyudmila F. Bodrova ◽  
Dmitriy K. Ovchinnikov ◽  
Keyword(s):  
Histological Examination ◽  
Breast Tumor ◽  
Abdominal Ultrasound ◽  
Liver Parenchyma ◽  
Mammary Glands ◽  
Blood Analysis ◽  
Domestic Cat ◽  
Biological Behavior ◽  
Breast Adenocarcinoma ◽  
Low Grade

Domestic shorthair 10-year-old cat, not sterilized, not vaccinated, feeding from the table. We went to the clinic with breast cancer. General and special research methods were performed: blood analysis, x-ray examination of the lungs and abdominal ultrasound. Based on anamnesis and clinical examination, the diagnosis was made: a malignant breast tumor. The operation was performed. The operating material is sent for histological examination. Chemotherapy was prescribed. After the fi rst chemotherapy and monitoring of the animal's condition, it was necessary to perform a second unilateral mastoectomy of the remaining mammary glands, but the animal's owners refused to perform the operation. Chemotherapy was performed twice. Re-applied, after a year and a half with a sharp deterioration in the General condition and the appearance of a new tumor on the non-removed mammary glands. The owners refused the necessary treatment and decided to euthanize the cat. At the autopsy, breast neoplasms are presented as tubercles of various sizes. There are pronounced signs of inflammation, ulceration and necrosis foci. In the chest cavity, the lungs are enlarged, there were single and multiple formations of white and brown color, round shape of different diameters, dense consistency. There is a large number of metastases in the liver parenchyma. The organ is enlarged in size, dark brown in color, irregularly colored, with an uneven (bumpy) surface. In General, there are many dense nodes of a round-oval shape of white color, of various diameters. Histological examination of the tumor revealed foci of necrosis, atypical glandular complexes with frequently occurring mitosis figures. This structure indicates a low-grade breast adenocarcinoma. In the lungs, there is an expansion of the alveoli and bronchioles, thinning and rupture of the interalveolar partitions. There is a complex of tumor cells. In the liver, there is a lack of structural units of the liver, hepatocytes disperse chaotically, liver triads do not have a clear localization, atrophy and necrosis are expressed. Metastases in the liver, various forms. In a cat, a breast tumor interpreted as an adenocarcinoma had different biological behavior. At the initial diagnosis-adenocarcinoma of medium differentiation, and a year and a half later-low-grade adenocarcinoma.

scholarly journals Profound Hypokalaemia Resulting in Maternal Cardiac Arrest: A Catastrophic Complication of Hyperemesis Gravidarum?

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Anna Walch ◽  
Madeline Duke ◽  
Travis Auty ◽  
Audris Wong
Keyword(s):  
Cardiac Arrest ◽  
Hyperemesis Gravidarum ◽  
Extracellular Fluid ◽  
Nutritional Deficiencies ◽  
Normal Limits ◽  
Life Threatening ◽  
Total Body ◽  
Anuric Renal Failure ◽  
Hospital Cardiac Arrest ◽  
In Pregnancy

We present a case of a 39-year-old G8P6 Pacific Islander woman who at 15+5 weeks’ gestation had an out-of-hospital cardiac arrest secondary to profound hypokalaemia which was associated with severe hyperemesis gravidarum (HG). Her clinical course after arrest was complicated by a second 5-minute cardiac arrest in the Intensive Care Unit (ICU) (pre-arrest potassium 1.8), anuric renal failure requiring dialysis, ischaemic hepatitis, and encephalopathy and unfortunately fetal demise and a spontaneous miscarriage on day 2 of admission. Despite these complications, she was discharged home 4 weeks later with a full recovery. Following a plethora of inpatient and outpatient investigations, the cause of her cardiac arrest was determined to be profound hypokalaemia. The hypokalaemia was presumed second to a perfect storm of HG with subsequent nutritional deficiencies causing electrolyte wasting, extracellular fluid (ECF) volume reduction, and activation of the renin-angiotensin-aldosterone axis (RAAS). This combined with the physiological changes that promote potassium wasting in pregnancy including volume expansion, increased renal blood flow, increased glomerular filtration rate, and increase in cortisol contributed to the patient having a profoundly low total body potassium level. This diagnosis is further strengthened by the fact that her pre- and post-pregnancy potassium levels were within normal limits in the absence of supplementary potassium. This case highlights the potentially life-threatening electrolyte imbalances that can occur with HG and the importance of recognising the disease, comprehensive electrolyte monitoring, and aggressive management in pregnancy.

Thyroid Disease I: Hyperthyroidism in Pregnancy

2020 ◽  
Author(s):  
Robert B. Martin ◽  
Brian Casey
Keyword(s):  
Hyperemesis Gravidarum ◽  
Beta Blockers ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Storm ◽  
Care Level ◽  
Hypermetabolic State ◽  
Life Threatening ◽  
Overt Hyperthyroidism ◽  
In Pregnancy ◽  
Stimulating Hormone

Thyroid physiologic adaptations in pregnancy may be confused with pathologic changes. Human chorionic gonadotropin rises early in pregnancy, stimulating thyrotropin secretion and suppressing thyroid stimulating hormone. These chemical changes are often seen in hyperemesis gravidarum and gestational transient thyrotoxicosis. Therefore, mild thyrotoxicosis may be difficult to differentiate from early pregnancy thyroxine stimulation.  However, overt hyperthyroidism usually includes classic symptoms seen outside of pregnancy in addition to suppressed TSH and T4 levels. Treatment includes thionamides propylthiouracil and methimazole.  Thyroid ablation is contraindicated in pregnancy. Often, in affected women, the fetus is euthyroid, but neonates can develop hyper or hypothyroidism with or without a goiter. Lastly, thyroid storm, though rare, is life threatening. Often presenting as a hypermetabolic state with cardiomyopathy and pulmonary hypertension, it generally results from decompensation from preeclampsia, anemia, sepsis, or surgery.  Treatment requires intensive care level management, with initiation of thionamides, iodine, and beta blockers.   This review contains 2 figures, 4 tables and 38 references. Keywords: Thyroid-releasing hormong, thyroid-stimulating hormone, thyromegaly, thyroid-stimulating immunoglobulins, thryotoxicosis, thionamides, thyroid storm

scholarly journals Gambaran Kadar Hemoglobin pada Ibu Hamil Trimester III di Rumah Sakit Robert Wolter Mongisidi Manado

2020 ◽  
Vol 1 (2) ◽  
Author(s):  
Selfesina Sikoway ◽  
Yanti Mewo ◽  
Youla Assa
Keyword(s):  
Pregnant Women ◽  
Descriptive Study ◽  
Hemoglobin Level ◽  
Inclusion Criteria ◽  
Third Trimester ◽  
Cross Sectional ◽  
Abnormal Phenomenon ◽  
Cross Sectional Design ◽  
Obstetric Department ◽  
In Pregnancy

Abstract: Hemoglobin (Hb) is a parameter used to determine anemia prevalence. The average level of normal Hb at the end of pregnancy is around 12.5 g/dL, meanwhile, aproximately 5% of pregnant women have Hb level less than 11.0 g/dL. To date, Hb level below 11.0 g/dL especially at the end of pregnancy should be considered as an abnormal phenomenon and is usually caused by iron deficiency and not by hypervolemia which is commonly found in pregnancy. This study was aimed to determine the hemoglobin level of third semester pregnant women in Robert Wolter Mongisidi Hospital Manado. This was a descriptive study with a cross sectional design. Subjects were 39 third semester pregnant women who visited the Obstetric Department of Robert Wolter Mongisidi Hospital and fulfilled the inclusion criteria. The results showed that 25 subjects (64.1%) had low hemoglobin levels and 14 subjects (35.9%) had normal level of hemoglobin. In conclusion, most third semester pregnant women had low hemoglobin levels.Keywords: hemoglobin rate, third trimester pregnant women, anemia Abstrak: Hemoglobin (Hb) darah merupakan parameter yang digunakan untuk menetapkan prevalensi anemia. Nilai normal Hb pada akhir kehamilan rata-rata 12,5 g/dL, dan sekitar 5% wanita hamil konsentrasinya kurang dari 11,0 g/dL. Nilai Hb dibawah 11,0 g/dL terutama pada akhir kehamilan perlu dianggap abnormal dan biasanya disebabkan oleh defisiensi besi dan bukan karena hipervolemia yang umumnya ditemukan pada kehamilan. Penelitian ini bertujuan untuk mengetahui kadar hemoglobin pada ibu hamil trimester III di Rumah Sakit Robert Wolter Mongisidi Manado. Jenis penelitian ialah deskriptif dengan menggunakan desain potong lintang. Subyek penelitian ialah 39 ibu hamil trimester III yang berkunjung di Poliklinik Kebidanan di Rumah Sakit Robert Wolter Mongisidi Manado yang memenuhi kriteria inklusi. Hasil penelitian menunjukkan 25 subyek (64,1%) memiliki kadar hemoglobin rendah dan 14 subyek (35,9%) memiliki kadar hemoglobin normal. Simpulan penelitian ini ialah sebagian besar ibu hamil trimester III memiliki kadar hemoglobin rendah.Kata kunci: kadar hemoglobin, ibu hamil trimester III, anemia

scholarly journals Prevalence of Diabetes Mellitus in Pregnancy amongst Antenatal Clinic Attendees at Booking at the Rivers State University Teaching Hospital

2020 ◽  
pp. 7-8
Author(s):  
S. Eli ◽  
D. G. B. Kalio ◽  
K. E. Okagua ◽  
A. A. Aloku ◽  
B. O. A. Atraide ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Family History ◽  
Teaching Hospital ◽  
Antenatal Clinic ◽  
University Teaching ◽  
State University ◽  
History Of ◽  
Rivers State ◽  
Prevalence Of Diabetes Mellitus ◽  
In Pregnancy

Background: The prevalence of diabetes mellitus (DM) have tripled from 1980 till date as a result of many factors of which obesity/excessive weight gain is a closely related factor of DM. There are many adverse challenges of DM in pregnancy with its associated fetal and maternal consequences. Aim: To determine the prevalence of DM in pregnancy amongst antenatal clinic (ANC) at booking at the Rivers State University Teaching Hospital (RSUTH). Methods: It was a cross sectional study of ANC attendees at booking at the RSUTH. Simple random sampling method was used. The Information was coded and analyzed using SPSS version 25. Results: A total of 99 pregnant women were recruited at booking in the ANC of the RSUTH. The mean age was 32.2 years and the modal parity was 1.0.The number of ANC attendees with weight equal to or greater than 90 Kg were 21 (21.2%), number with weight greater than equal to 90 Kg with glucose in urine were 10 (10.1%) Three (3.0%) of the subjects were known diabetic whereas 12 (12.1%) had family history of DM. Conclusion: The study revealed the prevalence of DM amongst ANC attendees at the RSUTH as 3.0%. There was corresponding glycosuria in 10.1% of the ANC attendees. ANC attendees had family history of DM were 12.1%. Advocacy is needed to educate the populace on the predisposing factors of DM and its adverse effect on maternal and child health.

Obstetrics

2020 ◽  
pp. 1-103
Author(s):  
Charlotte Goumalatsou
Keyword(s):  
Diabetes Mellitus ◽  
Human Immunodeficiency Virus ◽  
Venous Thromboembolism ◽  
Connective Tissue ◽  
Cardiac Disease ◽  
Postnatal Care ◽  
Hyperemesis Gravidarum ◽  
Immunodeficiency Virus ◽  
Obstetric Emergencies ◽  
In Pregnancy

This chapter in the Oxford Handbook of Clinical Specialties describes the obstetrics specialty, including antenatal care and screening. Medical conditions in pregnancy are investigated, including hyperemesis gravidarum, sickle-cell disease, cardiac disease, psychiatry, epilepsy, anaemia, HIV (human immunodeficiency virus), diabetes mellitus, thyroid disease, jaundice, malaria, renal disease, respiratory disease, connective tissue disease, hypertension, thromboprophylaxis, thrombophilia, and venous thromboembolism. Antenatal problems are explored, leading on to a discussion of labour and delivery, postnatal care, and obstetric emergencies.

The liver in pregnancy

2013 ◽  
pp. 309-318
Author(s):  
Daniel Marks ◽  
Marcus Harbord
Keyword(s):  
Liver Disease ◽  
Hyperemesis Gravidarum ◽  
Gallstone Disease ◽  
Liver Function Tests ◽  
The Other ◽  
Liver Disorders ◽  
Hepatic Rupture ◽  
Chiari Syndrome ◽  
Acute Fatty Liver ◽  
In Pregnancy

Liver disease in pregnancy Liver function tests in pregnancy Hyperemesis gravidarum Obstetric cholestasis Acute fatty liver of pregnancy Pre-eclampsia HELLP syndrome Spontaneous hepatic rupture Gallstone disease Pancreatitis Budd–Chiari syndrome Viral hepatitis Pre-existing cirrhotic liver disease A number of liver disorders are unique to, or more likely to occur in, pregnancy. These should be considered alongside the other causes of liver disease that occur in non-pregnant patients. Transient mild derangements of LFT are common and rarely require further assessment beyond repeat monitoring to ensure normalization. However, liver disorders in pregnancy often present non-specifically and, therefore. all patients merit formal clinical assessment....

Endocrine disorders in pregnancy

2018 ◽  
pp. 283-296
Author(s):  
Helen E. Turner ◽  
Richard Eastell ◽  
Ashley Grossman
Keyword(s):  
Thyroid Hormone ◽  
Hyperemesis Gravidarum ◽  
Post Partum ◽  
Management Strategies ◽  
Normal Pregnancy ◽  
Endocrine Disorders ◽  
Pituitary Diseases ◽  
Pregnant State ◽  
Pituitary Adrenal Axis ◽  
In Pregnancy

This chapter discusses thyroid, adrenal, and pituitary diseases that occur during pregnancy. A series of changes in thyroid hormone economy take place in normal pregnancy. As a result of these changes, thyroid hormone levels in pregnancy differ from those in the non-pregnant state. This chapter includes a description of normal thyroid physiology and thyroid pathophysiology, including hyperemesis gravidarum, post-partum thyroiditis, hypothyroidism, and hyperthyroidism. Changes in the hypothalamo-pituitary–adrenal axis during normal and abnormal pregnancies are also described, with syndromes such as Cushing’s syndrome and Addison’s disease listed. Finally, pituitary adenomas in pregnancy, and their respective features and management strategies, are listed, including acromegaly, hypopituitarism, TSH-secreting adenomas, and prolactinoma.

Prevalence of Hip Ultrasound Abnormalities in Newborns With a Hip Click

2020 ◽  
Vol 59 (8) ◽  
pp. 773-777
Author(s):  
John T. Gaffney ◽  
John Spellman
Keyword(s):  
Family History ◽  
Confidence Interval ◽  
Physical Examination ◽  
Prospective Studies ◽  
Hip Dysplasia ◽  
Developmental Dysplasia ◽  
Inclusion Criteria ◽  
History Of ◽  
Hip Ultrasound ◽  
Dysplasia Of The Hip

A hip click on examination of the newborn hip is believed to be the result of a ligament or myofascial structure and thought to be benign. Some studies suggest a link between hip clicks and developmental dysplasia of the hip. The purpose of our study is to estimate the prevalence of ultrasound hip abnormalities in newborns with a hip click and an otherwise normal physical examination. Results. Ninety patients meeting inclusion criteria of a hip click with an otherwise normal physical examination underwent diagnostic ultrasound with a 17.8% prevalence of hip abnormalities found (95% confidence interval ±7.9% [range of 9.9% to 25.7%]). Our study had 64 (71%) females and 26 (29%) males. The prevalence of hip pathology for females was 18.8% (12 of 64 patients) and for males was 15.4% (4 of 26 patients). Thirty-three patients were found to have bilateral hip clicks on presentation, with 21.2% (7 of 33) of those patients found to have hip pathology on ultrasound (3 of the 7 had pathology of both hips). Six patients had a family history of hip dysplasia and 1 of these patients (16.7%) had pathology on ultrasound. The average age to hip sonography was 6.6 weeks. Conclusions. In all, 17.8% of newborns with a hip click were found to have hip abnormalities on ultrasound. The prevalence of hip pathology, on ultrasound, suggests that additional larger, prospective studies are needed to clarify the association between a hip click and abnormal ultrasound found at 6 weeks of age or greater.

scholarly journals Hyperthyroidism During Pregnancy: Etiology, Diagnosis and Management

2005 ◽  
Vol 1 (1) ◽  
pp. 97-104
Author(s):  
John H Lazarus
Keyword(s):  
Radioiodine Therapy ◽  
Hyperemesis Gravidarum ◽  
Thyroid Stimulating Hormone ◽  
Postpartum Women ◽  
Reference Ranges ◽  
Second Trimester ◽  
Autoimmune Thyroid ◽  
Mother And Child ◽  
Neonatal Hyperthyroidism ◽  
In Pregnancy

Pregnancy has marked effects on thyroid physiology and autoimmune thyroid disease tends to ameliorate through gestation due to the general immunosuppression seen in pregnancy. There is a need for trimester-specific thyroid hormone reference ranges. Hyperthyroidism in pregnancy – usually due to Graves' disease – is not common but, if the patient is compliant, a good outcome can be expected for both mother and child if treatment with anti-thyroid drugs (propylthiouracil is preferred) is instituted. Thyroid-stimulating hormone receptor antibody should be measured at 36 weeks in such patients in order to predict the possibility of neonatal hyperthyroidism. Transient gestational hyperthyroidism is often associated with hyperemesis gravidarum and thyroid function should be checked in patients severely affected by this condition. Radioiodine therapy is contraindicated in pregnancy but thyroid surgery may be performed safely in the second trimester. Autoimmune thyroiditis and Graves’ hyperthyroidism occur quite commonly in postpartum women.

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