Swaraj Hospital & Research Institute, Bolangir

 

HELP SCORE:  https://www.hyperemesis.org/wp-content/uploads/2020/03/HELP-SCORE_2024.pdf POSSIBLE DIFFERENTIAL DIAGNOSIS GASTROINTESTINAL    Gastroparesis Intestinal obstruction Peptic Ulcer Disease Helicobacter Pylori Pancreatitis Appendicitis GENITOURINARY Pyelonephritis Uremia Ovarian torsion Kidney stones Uterine leiomyoma PREGNANCY COMPLICATIONS Acute fatty liver Preeclampsia Molar pregnancy MISCELLANEOUS Drug toxicity Infection NEUROLOGIC Pseudotumor cerebri Migraines CNS tumor METABOLIC & ENDOCRINE Diabetic ketoacidosis Porphyria Addison’s disease Thyroid disease Primary Hyperparat...

 

  🩸 Flowchart: Bleeding in Early Pregnancy Step 1: Triage      •     Assess haemodynamic stability      •     Unstable → Resuscitate (ABC, IV fluids, blood products) → Urgent surgical             referral      •     Stable → Proceed to history & examination Step 2: History & Examination      •     Gestational age, bleeding details, pain, risk factors      •     Abdominal exam → tenderness, guarding      •     Speculum exam → source of bleeding, products of conception      •     Avoid bimanual exam if ectopic suspected Step 3: Investigations     •     Urine/serum pregnancy test     •     Quantitative β-hCG (repeat in 48–72 hrs)     •     Transvaginal ultrasoun...

 

STEP 1: PATIENT PRESENTS Symptoms:   Regular contractions / Abdominal pain / Leaking per vaginum / Backache. Gestational Age:   20w – 36w 6d STEP 2: INITIAL ASSESSMENT ·          Sterile Speculum Exam  (Always BEFORE Digital Exam) o     Check for pooling of liquor →  ?  PPROM o     Swab for HVS/GBS if indicated. ·          Digital Exam  (if no ROM) o     Cervical dilation ≥2 cm or effacement ≥80%? ·          Ultrasound o     Confirm gestational age, presentation, AFV. STEP 3: DIAGNOSIS CONFIRMED YES, to BOTH: 1.     Regular contractions (4 in 20 min or 8 in 60 min) 2.     Progressive cervical change   STEP 4: INTERVENTIONS (By Gestational Age) 22w – 23w 6d ·          Counsel...

 

 

    To make a diagnosis of acute pancreatitis (from any cause), one needs 2 out of 3 of the following criteria:   Clinical symptoms: Persistent, severe, epigastric pain with tenderness on palpation Laboratory studies: Serum amylase or lipase greater than 3 times the upper limit of normal;   Lipase remains elevated for a longer period of time and has a higher specificity as compared with amylase Imaging: Computed Tomography, Magnetic Resonance (MR), Ultrasonography) Showing Focal or Diffuse Enlargement of Pancreas   In a patient with a characteristic clinical presentation, the demonstration of an elevated serum amylase or lipase level will confirm the diagnosis of acute pancreatitis. However, serum amylase may be spuriously normal in patients with hypertriglyceridemia and spuriously elevated in patients with acidemia (arterial pH ≤ 7.32), serum lipase is the preferred laboratory test for diagnosing acute pancreatitis. It is important to no...