Review Note
Last Update: 09/30/2024 05:34 PM
Current Deck: Geneeskunde::3e bachelor::long & hart::ZSO 4 hemodynamiek
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Front
1.
What is
the significance of the appearance of right-side pain in this patient in terms
of that being a possible reflection of organ dysfunction? What organ would be
affected, how could you test for dysfunction of that organ, and would such
dysfunction have any potential hemodynamic consequences in the patient if the
preeclampsia were not resolved?
First Pregnancy and
Preeclampsia
A 28-year-old woman has an unremarkable first pregnancy with
no serious complications through her first 28 weeks of gestation. She has been
seen regularly by her obstetrician and has exhibited normal weight gain
associated with pregnancy. She has no previous history of diabetes,
hypertension, or other systemic disease before or during her current pregnancy.
During her 30-week checkup, her blood pressure was 128/85, and she complains
about feeling slightly more “bloated” than usual with swelling in her legs that
seems to get more uncomfortable as the day goes on. Her obstetrician recommends
she try to get more bed rest, stay off her feet as much as possible, and return
for evaluation in 1 week.
At the patient’s follow-up
visit 1 week later, her blood pressure is 145/95. Her face is noticeably “puffy,”
and she has evidence of edema in her upper extremities. She has gained over 10
lb in 1 week. She complains of epigastric discomfort and being bothered by
bright lights. A basic urinalysis is performed, and a simple dipstick measure
reveals a 3+ reading for protein in the patient’s urine. Upon these findings,
the patient is admitted by her obstetrician to a local tertiary care hospital.
In the hospital, the
patient’s urine is rechecked for the presence of protein and again registers a
3+ value by simple urine dipstick determination. The patient is then
catheterized for urine collection. Over the next 24 hours, the patient’s urine
output is recorded at 500 mL, with protein present of 6.8 g. At this time, the
patient complains of headaches and tenderness in her upper right quadrant, and
she shows signs of definitive peripheral edema. Her blood pressure at this
point is 190/100, and it is decided to try to deliver the fetus. Upon delivery,
the newborn is placed in neonatal intensive care. The expelled placenta is
small and shows signs of widespread ischemic damage. Within a week of delivery,
the mother’s blood pressure returns to normal, and her edema subsides. One
month later, the mother shows no ill effects of this later term syndrome.
Back
1. The appearance of right-sided pain can be taken to indicate
evolving liver or biliary problems. The former could be caused by distention
(edema) in the liver and/or the development of microthrombi in the liver
circulation, which then causes hepatic ischemia, cell dysfunction, and cell
death. Liver distention, with resultant dissection of the Glisson capsule, can
lead to sudden rupture of the liver and internal hemorrhagic shock. Detection
of elevated liver enzymes in plasma could signify progression of liver
complications in preeclampsia. Another sequela of liver dysfunction in
preeclampsia is the development of the HELLP syndrome (Hemolysis, Elevated
Liver enzymes, and Low Platelets), which is now viewed as
a distinct clinical condition in preeclampsia. HELLP is a serious complication
in preeclampsia and an indicator of a significantly deteriorating condition in
the pregnant patient.
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