Week 4 Mo Parturient with Systemic Diseases Flashcards Preview

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Flashcards in Week 4 Mo Parturient with Systemic Diseases Deck (149)
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1

Maternal Gestational Diabetes Tx?

Diet control

Insulin

Avoid oral hypoglycemic agent (can cause fetal hypoglycemia)

2

Gestational Diabetes Complications Maternal?

Preterm labor
Polyhydramnion
C/S for macrosomia
Preeclampsia/eclampsia
DM type II

3

Gestational Diabetes Complications Fetal?

Macrosomia
Shoulder dystocia
Perinatal mortility 2-5%
Congenital defects
!!!Hypoglycemia!!!

4

Dilutional Anemia during Pregnancy is due to what?

Due to 50% increase in plasma volume

5

If Maternal Hb falls below what level, you should look for another cause (not dilutional anemia due to pregnancy)

below 10.5g/dl

6

Most common hereditary bleeding disorder?

Von Willebrand's’s disease

7

What are signs and symptoms of Von Willebrand's dz?

Prolonged BT despite normal platelet count (cannot stick to injured area)

A functional deficiency of factor VIII (pseudo-hemophilia) occurs as a result of deficit of vWF, its carrier protein. Deficiency is manifested clinically by prolonged PTT

Mucous membrane bleeding

Easy brusiability

Prolonged bleeding from wounds

Menorrhagia– very heavy period

LABS
Prolonged PTT
Prolonged BT

8

Treatment of Von Willebrand's dz?

Desmopressin (dDAVP) increases vWF level

Cryoprecipitate is rich in factor VIII:vWF

Estrogen and OCP

9

Labs performed on a Mom with gestational Diabetes?

Glycosuria, fasting hyperglycemia

Abnormal GTT

Glucose Tolerance Test?

10

Hemophilia A is a deficiency in what factor?

VIII

11

Second most common X-linked Coagulation defect? This mean what sex is rarely affected?

Hemophilia A, and females are rarely affected.

12

Clinical findings with Hemophillia A?

Soft tissue and joint bleeding
Dangerous CNS bleeding with minor trauma
Spontaneous hematuria leading to ureteral colic

13

Labs with Hemophilia A?

Prolonged PTT (intrinsic pathway)
Low factor VIII
Normal vWF , therefore normal BT

14

Treatment for Hemophilia A?

FFP and cryo (low in VIII)
Factor VIII replacement
Hepatitis C and HIV infection very common due to tinted blood transfusion

15

What factor is deficient in Hemophilia B?

IX

16

Vitamin C deficiency is a coagulation defect (apparently), what will you lack?

Lack of stable collagen (elderly, alcoholics)

17

Hepatic failure is a coagulation defect, why is this?

Almost all clotting factors are made in the liver.

18

What clotting factors ARE NOT made in the LIVER?

Factor VIII:vWF
Factor III ( tissue factor thromboplastin)
Factor IV ( Ca++)

19

Vitamin K deficiency is considered a coagulation defect. Tell me why?

Yes, Vit K is fat-soluble vitamin and is required for II (prothrombin), VII, IX, and X formation (also protein C and protein S)

20

What issues would cause a deficiency in Vitamin K?

Fat malabsorption due to lack /obstruction of bile secretion leads to fatty diarrhea causing deficiency of Vit K

21

What will you give to all surgical patients with liver dz?

Vit. K

22

What is Thrombocytopenia?

Platelets of less than 150,000

23

What does Thromboccytopenia cause?

Bleeding from small capillaries and blood vessels Mucosal, skin bleeding.

24

What is aplastic anemia?

Low number of platelets, you stop producing new blood cells.

25

Idiopathic thrombocytopenic purpura (ITP), what is it and what does it cause?

Autoimmune, common.
Due to antiplatelet antibodies.

decreased anti-GPIIb/IIIa antibodies causeing peripheral platelet destruction

26

Thrombotic thrombocytopenic purpura (TTP), what is it associated with?

Associated with chemo, liver disease, splenomegaly, DIC pre- eclampsia

27

Tell me about DIC?

Abnormal bleeding and clot formation

Critically ill patients

Coagulation and clot lysis in uncontrolled manner

Due to massive tissue damage

Depletion of clotting factors

28

Anesthesia considerations with coagulation disorders? (what do you want to know, what are they likely to receive?)

Careful history about bleeding disorders

Operation history

Massive blood transfusion causes
Functional deficiency of platelets
Packed RBCs infusion leading to dilution of V & VIII

FFP contains all clotting factors (except platelets)

29

What is AIDS? (very basically what does it do)

HIV infect and kill T-helper lymphocytes resulting suppression of cell mediated immunity. Host will develop opportunistic infections (Pneumocystis pneumonia) and various tumors

30

HIV becomes?

AIDS