The CausesHigh-fat dietPsychologicalgeneticOvarianhormones(oestrogens,progesterones)Helicobacter pylori-ReducedLivermotilityandsecretiondysfunctionSerotoninHighlevelsof hCGallergyto corpushormonesDecreased vitaminb6andb1vitaminDecreased adrenocorticosteroid hormoneHyperthyroidism
The Causes
CausesThe pathogenesis of NVP is poorly understood and the etiology is likely to bemultifactorialGenetic component: Sisters and daughters of women with hyperemesis have ahigher incidence.Hormonal: high human chorionic gonadotrophin (hCG) stimulates thechemoreceptor trigger zone in the brain stem including the vomiting center.This is the most accepted theory and proved by the higher frequency in theconditions where thehCG is high, such as in:a)early in pregnancyb)vesicular mole andc) multiple pregnancyAllergy to the corpus luteum or the released hormones, as increased estrogenlevels affects the part of the brain that controls nausea and vomitingDeficiency: of adrenocortical hormone and /or, vitamin B6 and B1.Nervousandpsychological dueto:psychological rejection of an unwanted pregnancy,fear of pregnancy or labor. It is more common in primigravidae.Hyperthyroidismmostprobablybecauseofthethyrotropicactionofhumanchorionic gonadotrophin (HCG)
Causes • The pathogenesis of NVP is poorly understood and the etiology is likely to be multifactorial. • Genetic component: Sisters and daughters of women with hyperemesis have a higher incidence. • Hormonal: high human chorionic gonadotrophin (hCG)stimulates the chemoreceptor trigger zone in the brain stem including the vomiting center. This is the most accepted theory and proved by the higher frequency in the conditions where the hCG is high, such as in: a) early in pregnancy b) vesicular mole and c) multiple pregnancy • Allergy to the corpus luteum or the released hormones, as increased estrogen levels affects the part of the brain that controls nausea and vomiting. • Deficiency: of adrenocortical hormone and /or, vitamin B6 and B1. • Nervous and psychological due to: – psychological rejection of an unwanted pregnancy, – fear of pregnancy or labor. It is more common in primigravidae. • Hyperthyroidism most probably because of the thyrotropic action of human chorionic gonadotrophin (HCG)
Causes continuedHigh-fat diet: Women with a high fat diet are at a much greater risk fordevelopinghyperemesis gravidarum.Theirrisk increasesfivetimes for everyadditional15 grams of saturated fat (such as a quarter-pound cheeseburger) theyeateachdayHelicobacter pylori: 90% of pregnant women with hyperemesis gravidarum arealso infected with this bacterium, which may sometimes cause stomach ulcers.?Gastrointestinal changes : During the entire pregnancy, gastric dysrhythmiashave been associated with morning sickness because the gastrointestinal tract ismore sensitive to the neural/humoral changes, acid reflux and the stomachemptiesmoreslowly.This cancausenauseaandvomitingLiver dysfunction:Liver disease, usually consisting ofmild serum transaminaseelevation, occurs in almost 50% of patients with hyperemesis gravidarum as acauseorresult.Vestibular and olfaction: Hyperacidity of the olfactory system or subclinicalvestibulardisorders.Over activation of sympathetic nerves and enhancedproductionoftumornecrosis factor (TNF)-alpha.21 to induce secretion of hCGIncreased Serotonin: awaiting larger studies to confirm its role in hyperemesisgravidarum
Causes continued •High-fat diet: Women with a high fat diet are at a much greater risk for developing hyperemesis gravidarum. Their risk increases five times for every additional 15 grams of saturated fat (such as a quarter-pound cheeseburger) they eat each day. •Helicobacter pylori: 90% of pregnant women with hyperemesis gravidarum are also infected with this bacterium, which may sometimes cause stomach ulcers. •Gastrointestinal changes : During the entire pregnancy, gastric dysrhythmias have been associated with morning sickness because the gastrointestinal tract is more sensitive to the neural/humoral changes, acid reflux and the stomach empties more slowly. This can cause nausea and vomiting. •Liver dysfunction: Liver disease, usually consisting of mild serum transaminase elevation, occurs in almost 50% of patients with hyperemesis gravidarum as a cause or result. •Vestibular and olfaction: Hyperacidity of the olfactory system or subclinical vestibular disorders. •Over activation of sympathetic nerves and enhanced production of tumor necrosis factor (TNF)-alpha.21 to induce secretion of hCG. •Increased Serotonin: awaiting larger studies to confirm its role in hyperemesis gravidarum
Effect Of Severe VomitingMorning sicknessDehydrationStarvationExcessivevomitingRaised blood ureaEmaciationKetosisHaemo-HepatitisconcentrationPolyneuritisUrineWernicke'sOliguriaKetonuriaencephalopathyProteinuriaConcentratedurineBile saltsLowurinary chlorides
Effect Of Severe Vomiting
Pathological ChangesThese are the same as in prolonged starvation:Liver: small fatty infiltrationKidney: fatty degenerationof the convolutedtubulesHeart:small subendocardialand subpericardialhemorrhagesBrain: congestion and petechial hemorrhages in the brain stem resembling thatof Wernicke's encephalopathyEye: optic neuritis and retinal hemorrhagePeripheral nerves: degenerationBlood:HypovolaemiaandhaemoconcentrationHyponatraemia,hypokalaemia andhypochloraemiaIncreased blood ureaHyperbilirubinaemia (due to liver damage)AcidosisUrine:OliguriaIncreased specific gravityDecreased chlorideAlbuminuriaKetonuria
Pathological Changes These are the same as in prolonged starvation: • Liver: small fatty infiltration • Kidney: fatty degeneration of the convoluted tubules • Heart: small subendocardial and subpericardial hemorrhages • Brain: congestion and petechial hemorrhages in the brain stem resembling that of Wernicke’s encephalopathy • Eye: optic neuritis and retinal hemorrhage • Peripheral nerves: degeneration • Blood: – Hypovolaemia and haemoconcentration – Hyponatraemia, hypokalaemia and hypochloraemia – Increased blood urea – Hyperbilirubinaemia (due to liver damage) – Acidosis • Urine: – Oliguria – Increased specific gravity – Decreased chloride – Albuminuria – Ketonuria