Acute Abdomen in Pregnancy 2 4.18.58 PM

Acute Abdomen in Pregnancy 2 4.18.58 PM - Acute Abdomen in...

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Acute Abdomen in Pregnancy Kate Pettit, MS III June 18, 2007
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The Most Important Equation + + =
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10-14 yrs 15-19 yrs 20-24 yrs 25-29 yrs 30-34 yrs 35-39 yrs 40-44 yrs 45-54 yrs 0 20 40 60 80 100 120 140 c How old are your prospective pregnant patients? CDC 2004 Live Births per 1,000 Women Avg Age at First Birth in US: 25.1 yrs
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DDx of Abdominal Pain in Pregnancy Divided into three categories: 1) Conditions incidental to pregnancy 2) Conditions associated with pregnancy 3) Conditions due to pregnancy
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Conditions Incidental to Pregnancy Acute appendicitis Acute pancreatitis Peptic ulcer Gastroenteritis Hepatitis Bowel obstruction Bowel Perforation Herniation Meckel’s Diverticulitis Toxic megacolon Pancreatic pseudocyst Ovarian cyst rupture Adnexal torsion Ureteral calculus Rupture of renal pelvis Ureteral obstruction SMA syndrome Thrombosis/infarction Ruptured visceral artery aneurysm Pneumonia Pulmonary embolus Intraperitoneal hemorrhage Splenic rupture Abdominal trauma Acute intermittent porphyria Diabetic ketoacidosis Sickle Cell Disease
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Conditions Associated with Pregnancy Acute pyelonephritis Acute cystitis Acute cholecystitis Acute fatty liver of pregnancy Rupture of rectus abdominus muscle Torsion of pregnant uterus
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Conditions Due to Pregnancy Ectopic pregnancy Septic abortion with peritonitis Acute urinary retention due to retroverted uterus Round ligament pain Torsion of pedunculated myoma Placental abruption Placenta percreta HELLP Syndrome Acute Fatty Liver of Pregnancy Uterine rupture Chorioamionitis
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Ectopic Pregnancy Classic Symptoms Abdominal pain Amennorrhea Vaginal Bleeding Diagnosis Transvaginal U/S (TVS) Presence of a true gestational sac at 4.5 to 5 wks is the 1 st sign of IUP. Cardiac activity is first detected at 5.5 to 6 weeks. Serum quantitative HCG Absence of an intrauterine gestational sac at hCG concentrations >1500-2000 IU/L suggests an ectopic or nonviable intrauterine pregnancy Management Option of medical vs surgical management if pt is hemodynamically stable and no rupture has occurred. Emergent surgical management if rupture has occurred and/or patient is hemodynamically unstable Prognosis Ruptured ectopic pregnancies account for 4- 10 percent of all pregnancy related deaths.
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HELLP Syndrome Hemolysis – Elevated Liver Enzymes – Low Platelets Incidence: 1 in 1K pregnancies Timing: Majority diagnosed at 28-36 wks Labs : Plts, AST/ALT, indirect bili, haptoglobin, schistocytes on peripheral Smear Management: Emergent delivery for pregnancies > 34 weeks, nonreassuring fetal status, severe maternal disease (multiorgan dysfunction, DIC, liver infarction or hemorrhage, ARF, or abruptio placenta) Delayed delivery in stable pregnancies <34 wks after administration of
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Acute Abdomen in Pregnancy 2 4.18.58 PM - Acute Abdomen in...

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