EMESIS E
HIPEREMES
IS
VALENTINA MUÑOZ
ARTEAGA
Introducción
Las náuseas y los vómitos en las fases precoces del
embarazo son un fenómeno extremadamente frecuente.
● Náusea: sensación de deseo inminente de vomitar.
● Vómito: la expulsión oral violenta del contenido
gástrico.
● Arcadas: contracciones rítminas forzadas de la
musculatura respiratoria y abdominal que con
frecuencia preceden o acompañan al vómito.
● Regurgitación: expulsión de alimento en ausencia
de náuseas y sin la contracción muscular
respiratoria y abdominal que acompaña a los
vómitos.
EMESIS
Emesis
¿Qué es? Inicio náuseas: 2 – 4 semanas.
Punto máximo: 9 – 16 semanas.
Son formas leves de náusea y vómito que
Se resuelve: 22 semanas.
aparecen en las primeras 16 semanas de
embarazo y no existe un trastorno
nutricional.
75 – 85% de gestantes. Náuseas y Clínica
vómitos esporádicos, generalmente
matutinos. Malestar matutino
Durante el primer trimestre, remisión Pertubaciones del apetito
espontánea antes de las 18 semanas. Vómito ocasional
Pautas de
actuación
●
●
Consejos higiénico-dietéticos
Es muy importante tranquilizar a la paciente
● Para evitar la progresión del cuadro, se aconseja
tratamiento farmacológico (succinato de doxilamina o
diciclomina)
● Es conveniente asociar suplementos vitamínicos
● Suele responder a las medidas higiénico-dietéticas,
apoyo psicológico y tratamiento simple farmacológico
(piridoxina).
Hiperémesis
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gravídica Please keep this slide for attribution
Introducción
Definiciones
1 2 3
Émesis
Hiperémesis Náusea y
gravídica
Náuseas y vómitos
gravídica vómito
Son náuseas y vómitos
esporádicos, generalmente Representa la forma severa persistentes e incoercibles,
matutinos que mejoran a lo de las náuseas y vómitos fuera de toda causa
largo del día y no alteran el durante el primer trimestre orgánica, que impide la
estado general de la del embarazo que afectan correcta alimentación de la
paciente ni impiden su el estado general de la gestante.
correcta alimentación. paciente.
Hiperémesis gravídica Esta asociada a:
Alteraciones en
el equilibrio
Cetonuria
metabólico e
hidroelectrolítico
Pérdida de peso
Deshidratación (>5% del peso
pregestacional)
La incidencia de la hiperémesis gravídica oscila entre el 0.1 – 2% de los
embarazos.
Etiologí Aún es desconocida, siendo probablemente de etiología multifactorial.
a • Mientas más elevadas estén estas hormonas mayor
1. Hormonales serán las náuseas y vómitos.
• hCG presenta una estructura similar a la TSH, por lo
Niveles elevados de Beta-HCG y estrógenos. que el máximo pico del nivel de beta-hCG (suele
verse alrededor de la semana 12 de gestación) puede
dar lugar al hipotiroidismo transitorio y con ellos
síntomas de hiperémesis.
2. Predisposición familiar/personal
• Parece existir una predisposición de presentar HG
en hijas y hermanas de mujeres que la presentaron
en sus embarazos.
3. Otros
• Alteración del pH gástrico
• Infección por H. pylori
• Déficit de piridoxina.
Fisiopatología
Depleción del volumen plasmático, elevación de hematocrito,
Vómitos persistentes. trastornos metabólicos (aumento de urea, nitrógeno, hipotremia,
hipocalemia, hipocloremia y alcalosis metabólica)
Factores de riesgo
Mujeres con un Antecedente de
incremento de la hiperémesis
masa placentaria: gravídica en
embarazo molar, embarazos
embarazo múltiple. anteriores.
Nuliparidad Obesidad
Clínica
● Náuseas y vómitos intensos de predomio matinal.
● Sialorrea y modificaciones del apetito y del gusto.
● Epigastralgias y a veces hematemesis por desgarro de la mucosa gastroesofágica (Síndrome de
Mallory-Weiss).
● Aliento fétido o con olor a frutas.
● Pérdida de peso
● Signos de deshidratación
● En situaciones graves: síntomas neurológicos, encefalopatía (síndrome de Wernicke-
Korsakoff), ictericia, hipertermia, insuficiencia hepatorrenal, confusión, letargo y coma.
Sistema de
puntuación
El índice de puntuación Motherisk-PUQE y el índice de Rhodes son
herramientas que se pueden utilizar para evaluar la gravedad de las náuseas y los
vómitos del embarazo.
1 2 3 4 5
punto puntos puntos puntos puntos
Duración de náuseas en las 2a3 4a6 >6
0 ≤1 hora
últimas 12 horas horas horas horas
3
Número de episodios de vómitos
0 1a2 hasta 5a6 ≥7
en las últimas 12 horas
4
3
Número de episodios de arcadas
0 1a2 hasta 5a6 ≥7
secas en las últimas 12 horas
4
Duración prolongada de los síntomas.
Pérdida de peso objetiva (>5% del peso
Criterios de internamiento
pregestacional)
Deshidratación clínica
Alteraciones hidroelectrolíticas
Deterioro nutricional o metabólico progresivo.
LEVE - MODERADO GRAVE
TODOS los siguientes criterios Si presenta ALGUNO de los siguientes criterios
PUQUE ≥ 13
Intolerancia incluso a líquidos
Signos de deshidratación
PUQUE 3 – 12
Tolerancia oral a líquidos
Sin signos de deshidratación Alteración perfil renal o iones
Menos 5% pérdida de peso
Perfil renal e iones normales.
>5% pérdida peso
Fracaso tratamiento conservador en dosis plenas
TRATAMIENTO AMBULATORIO INGRESO HOSPITALARIO
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Table of contents
01 02 03
Abstract Introduction Case presentation
04 05 06
Discussion Conclusion Roadmap
Introduction
Background
Provide a brief overview of the condition or disease being discussed in the case. Include
pertinent information about its prevalence, clinical manifestations and any relevant
previous studies or literature
Importance
Highlight the significance and educational value of the case. Emphasize the uniqueness,
rarity, or complexity of the presented case, and explain how it contributes to the existing
knowledge or clinical practice
Case presentation
Patient profile Clinical findings Diagnostic workup
Include essential demographic Present an overview of the Outline the diagnostic process,
information such as age, gender, patient's physical examination including the reasoning behind the
and medical history. Describe the findings, laboratory test results and chosen investigations and tests.
patient's chief complaint and the any imaging or diagnostic Discuss the results, their
timeline of symptoms leading to procedures. Highlight key interpretation and their
discover the diagnosis abnormalities that aid in the final contribution to reaching the final
diagnosis diagnosis
Discussion
Differential diagnosis Treatment
Explore potential diagnoses based on the Present the confirmed diagnosis and
patient's presentation and relevant findings. explain diagnostic criteria. Outline the
Discuss distinguishing features for each and chosen treatment approach and
reasons for inclusion/exclusion rationale behind it
Clinical course Lessons learned
Describe the patient's progression, Discuss the case's educational value,
treatment response and any significant highlighting unique aspects. Share insights
events or complications. Summarize the gained, including diagnostic challenges,
final outcome treatment considerations or disease
mechanisms
Conclusion
Challenge Significance
Address any diagnostic challenges, emphasizing Emphasize the case's educational value, impact on
the importance of thorough investigation and medical knowledge, professional development,
clinical reasoning and learning
Success Research
Highlight successful outcomes achieved through Identify areas for future investigation that have
the chosen treatment approach, showcasing emerged from the case, stimulating advancements
effectiveness
Lessons Summary
Summarize valuable lessons learned, providing End with a concise concluding statement,
insights to guide future clinical decision-making summarizing the overall significance of the case
and enhance care
50,000
Patients on the study
20,000
Received placebo treatment
5,000
Had secondary effects
95%
Use percentages in your case report
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allows for the clear visualization and
concise representation of data trends,
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This is a table
Age Gender M. history Symptoms Diagnosis
Patient 1 45 Male Hypertension Symptom Diagnosis 1
Patient 2 32 Female Asthma Symptom Diagnosis 2
Patient 3 60 Male Diabetes Symptom Diagnosis 3
Patient 4 50 Female None Symptom Diagnosis 4
Patient 5 28 Male None Symptom Diagnosis 5
Patient 6 70 Female Osteoarthritis Symptom Diagnosis 6
Milestones reached
Initial presentation with Diagnostic evaluation Accurate confirmation Initiation of appropriate
chief complaint and investigations of treatment
the diagnosis
Monitoring response to Resolution of presenting Follow-up assessment Case discussion and
treatment symptoms for outcomes lessons learned
Case presentation: medical history
About the patient Key findings
Patient’s age 35 years old
● Summarize the most important or relevant aspects of
the patient's medical history
Gender Female
● Use bullet points to present the key findings in a clear
Medical Chest pain, shortness of and organized manner
conditions breath
Previous
None reported
Conclusions
treatments
In this section, summarize the key findings from the
1 medical history
She has been experiencing these
symptoms for the past 2 days, with the
Introduction pain increasing in intensity and Provide an overview of the implications for the current
frequency 2 diagnosis and treatment plan
Discussion
Introduction:
● Briefly summarize the main findings and results of the case report
● Mention the purpose of the discussion and what will be covered
Main discussion:
● Present different perspectives and opinions on the findings, based on the literature and other
relevant sources
● Use bullet points to highlight key arguments and counterarguments
● Address any limitations or weaknesses of the study and suggest potential solutions or areas for
further research
Conclusions:
● Summarize the key points of the discussion and their implications for clinical practice or future
research
● Offer any final recommendations or take-home messages for the audience
Outcomes and recommendations
Start
1 2 3
Outcome Outcome Outcome
A. Write your A. Write your A. Write your
recommendation recommendation recommendation
B. Write your B. Write your B. Write your
recommendation recommendation recommendation
C. Write your C. Write your C. Write your
recommendation recommendation recommendation
D. Write your D. Write your D. Write your
recommendation recommendation recommendation
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