Good morning and welcome to your Thursday dose of Your Daily Meds.
Bonus Review: Why are newborn infants susceptible to Vitamin K deficiency?
Answer: Firstly, Vitamin K deficiency in the newborn can result in haemorrhagic disease of the newborn, resulting in neonates bleeding to death…
Not good.
Neonates are Vitamin K deficient as -
* Vitamin K does not cross the placenta in sufficient amounts = neonatal hepatic stores are low as are their stores of clotting factors 2, 7, 9 and 10
* The neonatal bowel is initially sterile, so they don’t even get that little bit of bacterial production of Vitamin K
* Breast milk is low in Vitamin K
Happily, bacteria colonise the neonatal colon in the first week and start to produce some Vitamin K.
Case:
A 16-year-old female presents to the Emergency Department complaining of diffuse abdominal pain, anorexia and vomiting. On examination, she was febrile to 38°C and the abdomen was tender, especially over the right iliac fossa. The which of the following would not be considered a sign of peritonism in this patient?
* Rigidity
* Involuntary guarding
* Murphy’s sign
* Rebound tenderness
* Percussion tenderness
Have a think.
Scroll for the chat.
Something Obstetric:
A 32-year-old female presents to the Emergency Department complaining of vaginal bleeding. She is in the third trimester of her second pregnancy. She reports no pain with the bleeding and no other discharge. She reports a large volume of bright red blood in an episode of bleeding prior to presentation to the ED. On examination, she is afebrile, hypotensive and tachycardic. In which of the following differential diagnoses for this complaint would a digital examination be contraindicated?
* Vasa praevia
* Abruptio placentae
* Spontaneous abortion
* Atrophic vaginitis
* Placenta previa
Have a think.
Remember some Latin (or Greek…I dunno).
More scroll for more chat.
McMurphy:
Key to answering this question is recognising the likelihood diagnosis of appendicitis and the risk of peritonitis with inflammation and rupture.
The classical history of diffuse abdominal pain that eventually localises to the right iliac fossa describes the process of inflammation spreading from visceral peritoneum to parietal peritoneum. The sensory input from the visceral peritoneum is vague, while the sensation associated with parietal peritoneum inflammation is well-localised and distinct.
Peritonism describes the painful sensation resulting from when inflamed peritoneal surfaces are moved relative to each other. Rigidity, a tendency for the patient to remain very still, and involuntary guarding, an inability to relax the abdominal wall even with distraction, are associated with peritonitis. Rebound tenderness, tenderness felt on the quick release after firm palpation, and percussion tenderness also suggest peritonism.
Murphy’s sign describes the cessation of inhalation during palpation of the right upper quadrant and is sensitive for acute cholecystitis.
The Preview:
Placenta praevia is an obstetric complication of placental implantation into the uterine wall such that it is near or covering the internal cervical os. Complete praevia is a complete covering of the os by the placenta. A marginal praevia is when the placenta is less than 2cm from the internal os, but not covering it. Placenta praevia has an inherent risk for haemorrhage.
Because of the risk of uncontrolled bleeding, digital examination of the vagina is contraindicated until placenta praevia is excluded. Any pregnant woman beyond the first trimester presenting with vaginal bleeding should have a speculum examination and diagnostic ultrasonography. If ultrasonography is unavailable and a digital examination is necessary, it should be performed in a theatre prepared for emergent caesarean delivery if at a suitable gestation.
Vasa praevia is a condition in which the blood vessels supplying the foetus run adjacent or over the internal cervical os. Vasa previa may be associated with a low-lying placenta. There is a risk of foetal exsanguination due to vessel damage when the membranes rupture. The vessels can also be compressed by the foetus during labour.
Abruptio placentae is the premature separation of the placenta from the uterus. Patients present with bleeding, uterine contractions and foetal distress.
Spontaneous abortion, a process of early pregnancy loss, is associated with a history of vaginal bleeding, abdominal pain and passage of tissue. The vaginal bleeding and abdominal pain tends to subside when the tissue has passed.
Atrophic vaginitis is characterised by vaginal soreness, postcoital burning, dyspareunia, burning leukorrhoea and occasional spotting.
Bonus: What is erythropoietin? Where is it produced?
Answer in tomorrow’s dose.
Closing:
Thank you for taking your Meds and we will see you tomorrow for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!
Luke.
Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks.
Just credit us where credit is due.
