Hyperemesis-gravidarum.ppt HYPER EMESIS

DESCRIBES HYPER EMESIS GRAVIDARUM

1. HYPEREMESIS
GRAVIDARUM
MRS. U. SREEVIDYA
PROFESSOR

4.  Less than 1 in 1000 pregnancies
 Marked reduction in the incidence

7. THEORIES
1. HORMONAL
 Increased HCG
 High serum level of estrogen
 Excess progesterone
 Thyroxin,prolactin and Adrenocortical hormone
2. PSYCHOGENIC
3. DIETETIC DEFICIENCY
 Vitamin B6,B1
4. ALLERGIC
5. IMMUNOLOGICAL BASIS
6. DECREASED GASTRIC MOTILITY

8. EFFECTS OF SEVERE VOMITING
 Dehydration
 Metabolic acidosis (from starvation)
 Alkalosis (from loss of hydrochloric acid)
 Electrolyte imbalance
 Weight loss

9. PATHOLOGY
 LIVER – Centrilobular fatty infiltration
without necrosis
 KIDNEY – Fatty changes in the cells of
convoluted tubule
 HEART – Subendocardial hemorrhage
 Brain – Wernicke’s encephalopathy

10. METABOLIC CHANGES
 Inadequate intake of food
 Glycogen depletion
 Fat reserve is broken down
 Inadequate oxidation of fat
 Accumulation of ketone bodies
 Acetone excreted through breath and kidney

11. METABOLIC CHANGES….CONTD
 Increase in endogenous tissue protein
metabolism
 Excessive excretion of non – protein nitrogen in
the urine

12. CIRCULATORY CHANGES
 Fall in plasma sodium,pottasium and chlorides
 Acidosis and ketosis
 Rise in blood urea and uric acid
 Hypoglycemia
 Hypoproteinemia
 Hypovitaminosis
 Hyperbilirubinemia

13. BIOCHEMICAL CHANGES
Haemoconcentration
Rise in hemoglobin percentage
Rise in RBC count
Rice in haematocrit value

14. CLINICAL MANIFESTATION
For the purpose of management the cases are
grouped into:
 EARLY
 LATE

15. CLINICAL MANIFESTATION….CONTD
EARLY
 Vomiting occurs throughout the day
 Normal day to day activities are curtailed
 No evidence of dehydration and starvation

16. CLINICAL MANIFESTATION….CONTD
LATE
SYMPTOMS
 Vomiting increase in frequency
 Retching
 Urine quantity diminished to the extend of oliguria
 Epigastric pain
 Constipation

17. CLINICAL MANIFESTATION….CONTD
LATE
SIGNS
Features of dehydration and ketosis
 Dry coated tongue
 Sunken eye
 Acetone smell in breath
 Tachycardia
 Hypotension
 Rise in temperature
 Jaundice is a late sign

20. INVESTIGATIONS
 URINALYSIS
 Quantity – Small
 Dark colour
 High specific gravity
 Presence of acetone and rarely protein
 Dimnished or absence of
 BIOCHEMICAL AND CIRCULATORY CHANGES
 OPHTHALMIC EXAMINATION
 Retinal haemorrhage and detachment of retina
 ECG

21. COMPLICATIONS
1. Neurologic complications
2.Esophageal tear
2. Jaundice
3. Convulsions and coma
4. Renal failure
5.Stress ulcers in the stomach

23. MANAGEMENT
PRINCIPLES
 To control vomiting
 To correct fluid and electrolyte imbalance
 To correct metabolic disturbances
 To prevent serious complications

25. Fluids

27. NURSING CARE
HYPEREMESIS PROGRESS CHART
 Pulse
 Temperature
 Blood pressure
 Intake-output
 Urine for acetone,protein,bile
 Blood biochemistry
 ECG

32. THANK YOU