Embarazo + Pancreatitis Severa + Hipertensión Arterial Gestacional

Abstract

Acute pancreatitis (AP) during pregnancy is a rare cause of abdominal pain and, although rarely progresses to necrotizing form, it is a serious complication whose diagnosis often is difficult. There are many causal factors of AP during pregnancy; the most frequent is the gallstone disease of the bile duct, even though metabolic disorders such as hyperlipidemia may trigger it as well.

Hypertension in pregnancy remains a major perinatal health problem worldwide. It is one of the biggest causes of premature birth, perinatal mortality and also figures among the leading causes of maternal death in both industrialized and developing countries. Statistical incidence ranges from 0.1 to 35%. The terminology used to refer to this disease has gone through altering. Currently the most widely accepted terms are pregnancy-induced hypertension, if it is not accompanied by proteinuria, and the term preeclampsia is used when proteinuria is present. Preeclampsia (PEE) is a multisystem disease of unknown causes that can manifest itself in the second half of pregnancy, childbirth or in the immediate postpartum period. It is characterized by an immunological- vascular maternal response, abnormal to the conceptus implantation. It is also manifested by an altered endothelial function which is represented by the activation of the coagulation cascade as well as an increase in the peripheral vascular resistance and platelet aggregation. The following case is of a female patient of 33 years of age, with a personal medical history of cholelithiasis diagnosed 7 months ago. The pacient´s gynecological and obstetric history does: G: 1 P: 0 C: 0 A: 0 HV. 0, LMP. 01/18/2015 and a gestational age of 35 weeks. The patient reports epigastric pain OF 9/10 VAS, around 24 hours ago. The pain was colicky, the same which radiated from the hemi-belt to the right dorsal region, with the apparent cause being the intake of a heavy meal. Patient reports presenting the same picture for 8 days which yielded with the intake of unspecified analgesics, the picture is accompanied by nausea that fails vomiting, anorexia, and generalized asthenia. For this reason, the patient is assisted in the emergency room of the IESS Hospital of Ambato, and after being assessed by medical specialists in surgery and gynecology, admission is decided, subsequently valuation to laboratory tests is required. Paraclinical tests showed elevated amylase and lipase amylase. AMYLASE 3322; LIPASE: 7823.1. In the physical examination; TA: 140/95 mm hg FC : 104 bpm FR: 17rpm T: 36.8 ° C Saturation O2: 94 %. Patient is conscious, oriented with time and space, dehydrated, conjunctives: slightly jaundiced, preserved cardiopulmonary. Abdomen: pregnant, epigastric pain, AFU: 32cm, negative uterine activity, single fetus, alive, head left oblique, FHR 140-150 bpm, fetal movements present. Inguinogenital region; external female genitalia: presence of urinary catheter with dark diuresis. Upper and lower extremities: symmetric. Presence of edema ++ / +++, proximal and distal pulses present. Tone strength and mobility preserved, no DTR.

Because of the patient's clinical condition, admission to intensive care unit is decided. During the patient’s hospital stay, the patient presented thrombocytopenia, in addition to increased pancreatic enzymes making it a possible incomplete HELLP SYNDROME.