During pregnancy, women experience a lot of changes in the body and usually various discomforts. Changes in the woman’s body during pregnancy include changes in the cardiovascular system, musculoskeletal system, weight, skin, and digestive tract. One of the most common complaints among pregnant women is indigestion.

Commonly known as upset stomach, indigestion or dyspepsia in medical terms occurs as a result of the impaired digestive function of the body. During pregnancy, dyspepsia is not associated with any underlying organic disease, hence called functional dyspepsia or indigestion. Indigestion often occurs together with gastric reflux.

Gastric reflux is the phenomenon when gastric contents regurgitate or move up the esophagus due to the relaxation of the esophageal sphincter. Gastric reflux is also known as heartburn which may cause considerable pain in the chest.

The occurrence of functional dyspepsia during pregnancy is associated with the presence of hormones that are produced during pregnancy. Indigestion is usually felt or experienced during the first, second, and third trimesters.

Indigestion during Pregnancy Symptoms and Signs

Symptoms of indigestion include:

• Chronic pain in the upper abdomen after eating
• Tender abdomen upon palpation
• Early feeling of fullness
• Bloating
• Gassy feeling
• Belching
• Nausea
• Perspiration along with severe pain
• Heartburn

Although indigestion is a normal occurrence during pregnancy due to the hormones, the presence of additional symptoms such as unintentional weight loss, loss of appetite, difficulty in swallowing, abdominal swelling, and persistent vomiting may be signs of a more serious condition such as peptic ulcer disease. During these instances, prompt consultation with a physician is important.

What Causes Indigestion During Pregnancy?

The main cause of dyspepsia during pregnancy is the presence of increased amounts of hormones that affect the digestive system. First, progesterone levels which maintain the pregnancy by protecting the uterine contents until delivery, are high. Progesterone is produced initially by the corpus luteum, the structure that contained the egg cell.

• After the corpus luteum has degraded, the placenta produces progesterone to maintain the pregnancy. It helps maintain the endometrial layer, which supplies oxygen and nutrients to the fetus. Progesterone causes changes in the digestive system such that it slows down the peristaltic movement of the stomach and the intestines, thereby reducing stomach emptying.
• This causes a feeling of fullness even after eating small amounts of food. Aside from progesterone, another hormone responsible for dyspepsia is human placental lactogen (HPL). This is a hormone produced by the placenta to make the mother ready for breast milk production. However, this hormone also causes the slow peristaltic movement of the digestive tract.
• When peristalsis is decreased, there is a tendency for food to not be properly digested and absorbed in the intestines in the appropriate time. As a result, dyspepsia occurs. These hormones also relax the esophageal sphincter, leading to heartburn. In addition, they tend to decrease the contractility of the smooth muscles of the stomach, reducing the digestive mechanism of the organ.
• Indigestion and heartburn become more severe during the second and third trimesters when the growing fetus starts to displace the abdominal organs, including the stomach and the intestines. This makes no room for large amounts of food and considerably decreases the contractility and peristaltic movement.

Certain conditions also contribute to the aggravation or the initiation of dyspepsia. For example:

• Eating fatty foods
• Consuming bulk foods
• Eating too rapidly
• Not maintaining an upright position after meals

Treatment for Indigestion during Pregnancy

Dyspepsia can be treated using the following medications. It is important to consult a physician before taking medications during pregnancy to prevent any adverse effects on the fetus.

• Antacids – Antacids are commonly given for the treatment of dyspepsia and heartburn. Antacids with aluminum and magnesium can be used. Those that contain magnesium trisilicate and sodium bicarbonate should be avoided because these could lead to abnormalities in the fetus. Antacids usually interfere with the absorption of iron so they should be taken at different times. Iron is essential for hemoglobin production for the mother and the fetus; thus, absorption of iron should be optimal. Antacids with calcium should also be avoided because it may lead to fetal toxicity caused by excessive calcium.
• Gastric stimulants – Medications such as domperidone help enhance the peristaltic movement of the stomach and the intestines, hence relieving dyspepsia. It stimulates the smooth muscles of the digestive tract, contracting and enhancing gastric emptying.

It should be mentioned that any intake of medication during pregnancy should be consulted with the obstetrician to protect the fetus from harmful medications. When medication use is not possible, home remedies may be instituted.

Home remedies for Indigestion During Pregnancy

Home remedies for indigestion include:

• Small, frequent meals – It is better to consume small frequent meals during pregnancy to allow the stomach and the intestines to maximize their functions. In addition, increased nutrient and energy intake are taken from small frequent meals.
• Smoking cessation– Pregnant women who are smokers should avoid smoking not just to prevent or reduce dyspepsia and heartburn, but also to prevent its teratogenic effect on the fetus. Smoking increases production of stomach acids and leads to dyspepsia and indigestion. Read Smoking During Pregnancy Risks, Effects to Mother and Baby
• Avoidance of excessive weight gain – Excessive weight gain during pregnancy may also contribute to dyspepsia because the very large fetus further displaces the abdominal contents.
• Avoidance of certain foods and beverages – Sodas, coffee, and fruit juices that contain too much sugar should be avoided. Moreover, spicy foods and sweet foods such as chocolate should be avoided because these trigger dyspepsia.
• Intake of ginger candies or ginger tea – Ginger, known for its effect of enhancing the peristaltic movement of the digestive tract, prevents indigestion and may relieve current indigestion. Read Top 12 Ginger Health Benefits and Uses
• Exercise and physical activities – Pregnant women should not stay or be confined in bed all the time for they need exercises such as walking and swimming to stimulate smooth muscle contraction in the abdomen, stomach, and intestines, thereby relieving indigestion. Adequate activity and exercise help the overall functions of the digestive tract.
• Position after eating – Lying down immediately after eating causes the stomach acids to regurgitate in the esophagus. Indigestion is caused by a lack of stomach acid in the intestine.

Pregnant women are usually more sensitive than other people when it comes to body changes due to their fear of harming the fetus. It is important to consider that indigestion, one of the physiological changes in pregnancy, should not be feared.

What is Arthrogryposis Multiplex Congenita?

Arthrogryposis is a disorder that has a characteristic of having multiple contractures in the joint area. Some experts would describe it as a neuro musculoskeletal kind of disorder. It is a non-progressive congenital kind of disorder. It is otherwise known as the Arthrogryposis Multiplex Congenita. What happens to these persons is that they have joints which reveal stiffness, contractures, poor mobility and fatigue especially in the muscle area. Other experts would describe it as a heterogeneous kind of condition.

Arthrogryposis Image

What symptoms present in Arthrogryposis?

Patients who are diagnosed with this kind of condition will experience or manifest the following symptoms:

• Rigidity of the joint
• Deformities which are commonly symmetric
• Diminished deep tendon reflex
• Atrophy
• Joint dislocation either in the knees or hips
• Limitation of the motion especially in the jaw
• Craniofacial malformation
• Respiratory problems which includes laryngeal and tracheal stenosis and clefts
• Cardiac problems
• Skin abnormalities such as the limbs in the distal portion may appear bluish in color or cold to touch
• Lethargic
• Sensory deficits
• Abnormal tendon attachments
• Decrease in the muscle mass
• Pterygia or skin webs which can be found across the person’s joints
• Skin may either be doughy, soft, extensible or thick
• Nail defects
• Scalp defects
• There is a presence of indentation in the pretibial linear skin area
• Craniofacial malformation
• Syndactyly
• Digits appears shortened
• Radioulnar synostosis
• Loss of vigor
• Cleft palate
• Feeding problems due to short gut
• Presence of short umbilical cord
• Hypertelorism
• Pulmonary hypoplasia
• Retardation of the growth of the patient
• Fetal akinesia
• Hernia either umbilical or inguinal
• Scoliosis
• Genital deformities such as microphallus or cryptorchidism
• Flat nasal bridge
• Internal rotation of the shoulders
• Hemangioma
• Trismus
• Micrognathia
• Clubfoot
• Extension and pronation of the elbows
• Absent patella
• Dislocated radial heads
• Pterygium
• Taut skin

These are the common symptoms reported by patients who are diagnosed of having Arthrogryposis.

Arthrogryposis Multiplex Congenita Pictures

Hypertelorism as a symptom of Arthrogryposis

Syndactyly as a symptom of Arthrogryposis

Micrognathia as a symptom of Arthrogryposis

What Causes Arthrogryposis?

The exact cause of why Arthrogryposis occurs to some patients, are still unidentified. Although, some experts or researchers have provided mechanisms that may be the causative factor of this kind of disorder or disease condition such as:

• There is a malfunctioning or malformation in the central nervous system, which is the most common etiological reason. Such malformation includes brain malformations, spinal muscular atrophy, spina bifida and the like.
• There was exposure of the pregnant mother to harmful substances like alcohol, drugs such as phenytoin or Dilantin.
• During pregnancy, there was a presence of chronic leakage of amniotic fluid or perhaps there was lower amount of amniotic fluid which leads to reduction of movement space for the fetus.
• There was an inherited kind of neuromuscular disorder like myasthenia gravis, multiple sclerosis or perhaps myotonic dystrophy
• There was a presence of infection during the pregnancy period such infections like rubeola or rubella which is otherwise known as German Measles
• The mother, during her pregnancy period, experience fever of about 39 degree Celsius or 102.2 degree Fahrenheit for a longer period or perhaps she had an increase in her body temperature which was brought about by prolonged hot tub soaking which will then result to fetal hyperthermia or overheating which will eventually lead to the fetus to acquiring this kind of disease condition.
• There is a presence of compromise with regards to the vascular areas of the fetus. Perhaps there is an impingement and such other factors which lead to this kind of vascular compromise.
• There is a presence of decrease mobility or akinesia of the fetus which will lead to developing this kind of disease condition.

How to Treat Arthrogryposis Multiplex Congenita?

With regards to treatment that is done with patients who have Arthrogryposis, they are told that there is no reversal treatment once they are afflicted with this kind of disease condition. However, there can be improvement of the individual’s quality of life. You must take note that each person varies in the respond to the treatment provided or given. Hence, a combination of therapies would prove to be beneficial for anyone. Such therapies or treatment method which will lead to the improvement of this kind of disease condition includes:

Physical Therapy

This kind of therapy is vital in joint motion improvement as well as being able to avoid atrophy of the muscle. Patients who are diagnosed with either distal Arthrogryposis or amyoplasia are known to greatly respond to this kind of therapy. This kind of therapy includes mobility training, strengthening and stretching exercises which will be good in improving the range of motion and flexion which will lead to an increase in mobility.

Physical Therapy for a child with Arthrogryposis

Occupational Therapy

This kind of therapy includes splinting and casting of the joints which are affected. It includes training of the ADL as well as the skills that targets the fine motor areas. In addition to that, it also addresses the emotional and psychosocial implications of persons that have to live with the disability all through their lives.

Casting of the affected joints

Surgical Procedure or Therapy

There is a need for surgical procedure such as orthopedic surgery or surgical procedure which includes external or llizarov fixator or osteotomy and the like. The kind of surgical procedure done to each patient differs and will greatly depend on the condition as well as the assessment made by the physician or surgeon who is in charged.

Arthrogryposis Multiplex Congenita Prognosis

Patients who are diagnose with Arthrogryposis multiplex congenital should be advised to follow or consult their trusted family pediatrician or physician as soon as possible. Aside from that, it is advised that patients with Arthrogryposis multiplex congenital are encourage to allow their child to join activities that will be able to promote movement.

Despite the fact that this kind of condition is a severe kind, those who are diagnosed with Arthrogryposis multiplex congenital are taught to be independent in performing activities of daily living such as regular persons would often do.

The persons with Arthrogryposis multiplex congenital are engaged with therapies and sometimes surgical procedures so as they can be able to go about their day to day life. These persons with this kind of condition have normal speech and cognition and hence, there is a high degree of potential for reward, productivity as well as being independent in the real world. In addition to that, their life span is normal.

What is Idiopathic Intracranial Hypertension?

Idiopathic intracranial hypertension or IIH is a neurologic disorder characterized by elevation of the intracranial pressure (ICP). The cranium is a closed system, and any increase in pressure beyond normal limits inside the cranium will lead to compression and damage of brain tissue.

The intracranial pressure is maintained by efficient blood flow and the production and reabsorption of cerebrospinal fluid (CSF).

The disorder was originally termed as pseudotumor cerebri (PTC) because it mimics a brain tumor although no tumor is present. Due to the absence of malignancy, it was then changed to benign intracranial hypertension (BIH). However, because the condition can be neither a benign case nor a false tumour and because the condition may result in blindness, the term was changed to idiopathic intracranial hypertension.

IIH occurs is one in every 100,000 people, and it is more apparent in women than in men. There is no difference in the rate of IIH by gender in children.

Signs and Symptoms

IIH produces signs and symptoms that result from the elevation of the ICP. These arise within hours to weeks of intracranial elevation. The most common symptom is the headache.

• Headache – Headaches, characterized as throbbing and generalized, occur in almost all the patients with IIH. The pain or discomfort can radiate to the shoulders and neck. It is more severe in the morning and may worsen during coughing and sneezing because of further increase in the ICP.
• Pulsatile Tinnitus –  Tinnitus (ringing in the ears) may also be experienced as a result of increased pressure in the otic nerve.
• Projectile Vomiting – An increase in the ICP can lead to projectile vomiting. When the ICP put pressure on the vomiting center in the brain, the severe compression causes vomiting.
• Lack of coordination and unstable balance – An increased ICP may also cause compression of the cerebellum, which is responsible for balance and coordination.
• Double vision – The abducens nerve may also be affected, leading to abducens nerve palsy.
• Facial muscle weakness and transient loss of senses – Other cranial nerves may also be affected with the increased ICP, leading to problems in facial expressions and the interpretation of senses.
• Visual obscurations – Visual obscurations involve the presence of blind spots in the vision as a result of papilledema (swelling of the optic disc).

Causes

The exact cause of the condition is unknown because the usual findings in diagnostic tests do not indicate any underlying conditions. However, obesity may contribute to the development of IIH. If other underlying conditions which cause an increased ICP are present, then the diagnosis of secondary intracranial hypertension is made.

Pathophysiology

Any increase in the ICP is associated with the increased volume of brain tissue, cerebrospinal fluid (CSF), and blood, the three most common components of the cranium.

Any increase in brain tissue (ex., presence of tumor) may lead to an increased ICP. Cerebral edema (swelling of the brain) may also occur as a result of infection and other conditions. However, with IIH, there is an absence of these conditions.

The blood may also be a cause of the increased ICP. Any obstruction in the venous blood flow leads to blood congestion in the cranium. In addition, the CSF may also be a factor in the elevation of the ICP. Poor reabsorption of CSF by the ventricles leads to an increased amount of CSF circulating through the Central Nervous System (CNS).

Diagnosis

Diagnostic tests of IIH include:

Brain scan

Imaging tests involving the brain is essential in identifying any underlying conditions. Imaging tests may include MRI or CT scan. Normal brain scan results indicate that there are no underlying conditions involving the brain that may cause the increased ICP. Venogram of the intracranial veins may also be undertaken to identify the presence of cerebral venous sinus thrombosis (CVST).

Lumbar puncture

Lumbar puncture is employed to determine any abnormalities and cytologic changes in the CNS that may cause an ICP increase. Infections of the CNS and presence of tumors may be detected using analysis of the CSF. Lumbar puncture also measures the opening pressure in the CSF, thereby identifying the increased ICP.

The diagnosis of IIH is made based on the modified Dandy criteria, described as the following:

• Elevated ICP symptoms
• Normal findings on brain scan
• Absence of localizing signs
• No alteration in level of consciousness (i.e., patient is alert and awake)
• Normal cytologic findings in lumbar puncture with an increased ICP of more than 25 cm H20.
• Absence of any other reasons for the increased ICP.

Treatment

Treatment of IIH is primarily geared towards the normalization of the ICP since no other conditions can be treated to eradicate IIH. Treatments are also done to reduce pressure in the optic disc and to prevent permanent vision loss. Treatments include:

Diuretics

Diuretic medications are administered to reduce the ICP by inhibiting further production of CSF. This also allows the kidneys to excrete excess fluid from the body. Diuretics which are used are in the form of carbonic anhydrase inhibitors such as acetazolamide (Diamox) or loop diuretics such as furosemide.

Analgesics

Analgesics such as ibuprofen and acetaminophen can be used to relieve headaches.

Corticosteroids

Corticosteroids such as methylprednisolone are also given to reduce cerebral edema. This significantly causes reduction in ICP. However, the dose of corticosteroids should be tapered accordingly to prevent rebound edema once the medication is discontinued.

Lumbar Puncture

Lumbar puncture is employed to directly reduce the ICP by removing some CSF. The lumbar puncture is done by inserting a thin needle on the spine and then aspirating the CSF. Lumbar puncture is also an emergency procedure to prevent vision loss when visual obscurations are already apparent.

Surgery

Surgery ,which involves the creation of shunts from the ventricles to effectively drain the CSF, is done when patients do not respond to lumbar puncture and other treatments. Ventriculoperitoneal shunt is employed to create a shunt from the ventricles into the peritoneum so that the CSF can be absorbed in the circulation and eliminated through the urine. Optic nerve sheath decompression may also be done to prevent permanent loss of vision.

The treatment for the increased ICP should be immediately employed to prevent complications. Patients usually respond to treatment, but some may experience chronic IIH and eventually some of its complications.

Complications

The primary complication of IIH is the presence of papilledema. Papilledema can result in vision loss when untreated.