Fibromyalgia

Fibromyalgia
Presentation by:Anna Mae Smith, MPAS, PA-C
Lock Haven University

Myofascial pain

* Minor tear in muscle that causes a localized irritation - trigger point
* Fibromyalgia - widespread myofascial (soft tissue) pain

Diffuse aching, stiffness & fatigue
Fibromyalgia Syndrome

* Most common rheumatic cause of chronic diffuse pain
* Generalized pain & symptom pain amplification syndrome
* Extremely common pain phenomenon occurring in a defined pattern & reproduced by pressure on "trigger points"

EPIDEMIOLOGY

* Incidence/Prevalence in USA: 3 in 100
* Predominant age: 18-70
* Predominant sex: Female > Male

DIfferential
* Hypothyroidism
* Psychogenic rheumatism
* Muscle strain/sprain
* Muscle disease
* Polymyalgia rheumatica
* Temporal arteritis

SIGNS & SYMPTOMS

* Typically insidious in onset
* Diffuse soft tissue pain
* Pain is increased in the morning, with weather changes, anxiety, stress
* Pain improved by mild physical activity or vacations (stress-relieving situations)
* Non-restorative sleep, with early morning awakening in an unrefreshed state.
* Abnormal non-rapid eye movement (non-REM) stage IV sleep
* Generalized fatigue or tiredness
* Anxiety
* Chronic headache
* Irritable bowel syndrome
* Tension headaches
* Subjective, non-confirmable complaints of swelling or numbness, not associated with objective neurologic findings
* Depression
* Reduced physical endurance
* Decreased social interaction
* Paresthesias – normal nerve studies
* Sensation of swollen hands!

Trigger Points

* Temporalis - above the ear
* Anterior to tragus of ear
* Scalenus capitis
* Sternocleidomastoid
* Low anterior neck
* Pectoralis minor
* Manubriosternal
* Anterior and posterior axillary folds
* Trapezius ridge
* Upper rhomboids
* Lower rhomboids
* Iliac crest
* Mid-buttocks
* Mid-rectus femoris
* Mid-vastus lateralis
* Quadriceps insertion - at the patella
* Humeral epicondyles


LABS

* ESR
* CBC
* TFT

TREATMENT

Prognosis

* With resolution of sleep disturbance, may resolve totally
* Aggressive physical therapy is critical in those who do not respond
* Approximately 5% do not respond to any form of therapeutic intervention.
Hypnosis may be attempted in that group.

FIBROMYALGIA .ppt

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Gestational Diabetes Mellitus

Gestational Diabetes Mellitus
Presentation by: Anna Mae Smith, MPAS,

PA-C
Defined
* Complicates 3-5% of all pregnancies!
* Glucose intolerance identified during pregnancy
* Accounts for more gestational complications than any other adverse factors!
ETIOLOGY

* Most women revert back to euglycemia post-partum
* HPL- human placental lactogen stimulates insulin release
* HPL also decreases glucose uptake & gluconeogenesis
* Estrogen & progesterone also increase during pregnancy and in turn increase maternal insulin levels!!
* As the placenta grows it releases more & more hormones(HPL) included.
* As the pregnancy progresses into the 3rd trimester hyperinsulinemia & hyperglycemia!!!
* The pathologic defect in GDM is a diminished compensatory response to the increased insulin resistance commonly associated with pregnancy!!

RISK FACTORS - Environ/Maternal

* Obesity (60-80%)
* Age >30
* Previous delivery of infant> 4000gms
* Previous unexplained stillbirth
* Multiple spontaneous abortions
* Persistent gylcosuria

RISK FACTORS - Hereditary
Gold standard

* Screen everyone at 28 wks gestation!
* 50 gm oral glucose load on a fasting stomach.
* Glucose level 1 hour later


Fetal Complications

* Macrosomia - weight > 90th percentile for a given gestational age.
o Shoulder dystocia
o Dystocia

Congenital malformations
Neonatal Hypoglycemia
Newborns also at greater risk for...
Maternal Risks

TREATMENT
Oral hypoglycemic agents

* Not successfully studied!
* Have same effect on fetal pancreas as moms!
* Infants experience prolonged hypoglycemia (4-10 days) to moms who took sulfonylureas

Gestational Diaberes Mellitus.ppt

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The Placenta

The Placenta
Presentation by: Anna Mae Smith, MPAS, PA-C

Placenta

* FETAL SIDE
* MATERNAL SIDE
* They provide…
o protection
o nutrition
o respiration
o excretion
o hormone production
* FETAL SIDE
* MATERNAL SIDE
DECIDUA - formed from the endometrium

PLACENTAL ATTACHMENT

* Posterior wall
* Anterior wall
* Fundus
* With consecutive pregnancies the blastocyst attaches lower in the uterus

Placental Transfer
Hormones that cross the placenta
Antibodies
Infections

* CMV
* Rubella
* Coxsackie
* Varicella
* Polio
* Syphilis
* Spirochetes

Congenital Cataracts in rubella
Placental Transfer
DRUGS
Placental Production
Amniotic Fluid
FETAL CIRCULATION
After Birth
FIRST BREATH

Placenta.ppt

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