EPIGASTRIC PAIN

peptic ulcer disease
(5-15%)
■ gastro-oesophageal reflux
disease (5-15%)
■ gastric or oesophageal
cancer (<2%)
■ gallstones/biliary pain
■ chronic pancreatitis/
pancreatic cancer
■ coeliac disease
■ lactose intolerance
■ medications – digoxin,
theophylline, erythromycin,
potassium supplements,
corticosteroids and NSAIDs
■ infiltrative diseases of
the stomach – eosinophillic
gastritis, Crohn’s disease,
sarcoidosis
■ metabolic causes –
hypothyroidism,
hypercalcaemia,
hyperkaelemia, heavy
metals
■ hepatoma and
steatohepatitis
■ intestinal angina
■ abdominal wall pain
■ Zollinger-Ellison syndrome
■ diabetic radiculopathy
Functional dyspepsia
(up to 60%)
■ caffeine, alcohol and
smoking can exacerbate
symptoms

PERINATAL DEPRESIION

■ Women often don’t recognise
themselves as being depressed
– they hide their symptoms or
present as the baby having the
problem.
■ When symptoms (anxiety,
lowered mood, tearfulness,
fears of not being able to cope
or being a bad mother) are
recurrent, severe or continue for
more than two weeks, the diagnosis
of depression or anxiety
disorder must be considered.
■ In PND many anxieties arise
from the lack a balanced
perspective. Cognitive behavioural
therapy is well suited to
address these issues.
■ Maternal depression is associated
with poor developmental
outcomes for children with
implications for the child’s
education and the potential for
mental illness as adults.
■ Mothers’ groups can be
beneficial if they are specifically
for women with PND but general
mothers groups can alienate
women if they feel different to
the other “coping” mothers.
■ Early detection and treatment
of PND may lead to remission
of symptoms and improvement
for mother, child and family
members, but it does not
guarantee a good outcome.
For some women, mother-infant
or long-term therapy is needed

Dermatology

Skin care advice for patients with lymphoedema


■ Keep the skin supple using a non-perfumed moisturising cream such as sorbolene.
■ Avoid drying out your skin and consider using a soap-free alternative.
■ Clean any scratches, grazes or cuts immediately using an antiseptic solution,
use an antibacterial cream and cover the area with a clean, dry plaster.
■ Use an electric razor for shaving instead of a wet razor.
■ Avoid tattoos and body piercing.
■ Consider ways to protect the skin, such as wearing gloves while washing dishes,
gardening or handling pets.

Administration of Anti -D

At the first pregnancy consultation the mother's blood
group should be determined and blood taken for detection/
measurement of blood group antibodies. For
complete and incomplete miscarriages all Rh(D) negative
women who have not actively formed their own
anti-D should be given 250IU of anti-D.
There is insufficient evidence to suggest that a threatened
miscarriage before 12 weeks gestation necessitates
use of anti-D, but meta-analyses indicate that antenatal
administration of anti-D (for all indications
including miscarriage) can result in a 78% reduction
in allo-immunisation.

CLINICAL DEFINITION OF MISCARRIAGE-Australia

Complete miscarriage • No intrauterine gestational sac
• No ovarian/fallopian mass
• Products of conception passed
• No evidence of POC in uterus
• Endometrial thickness <15mm in longitudinal section Incomplete
• No intrauterine gestational sac
miscarriage • No ovarian/fallopian mass
• POC passed
• More POC seen in uterus

Missed miscarriage

• Intact intrauterine gestational sac
• Fetal pole seen
• No fetal heartbeat
• CRL >6mm
OR
• Intact intrauterine gestational sac
measuring >20mm
• Fetal pole not seen