Diseases » Pregnancy » Causes

Causes of Pregnancy

Pregnancy Causes: Book Excerpts

• Differential Diagnosis - Amenorrhea
• Differential Diagnosis - Amenorrhea – Secondary
• Differential Diagnosis - Amenorrhea – Primary
• Medical causes - Abdominal distention
• Medical causes - Amenorrhea
• Medical causes - Low birth weight
• Causes - Abortion
• Causes and incidence - Amenorrhea
• Causes and incidence - Cesarean birth
• Causes and incidence - Adolescent pregnancy
• Causes and incidence - Cardiovascular disease in pregnancy
• Causes and incidence - Pregnancy-induced hypertension
• Causes - Diabetic complications during pregnancy
• Causes and incidence - Ectopic pregnancy
• Medical causes - Abdominal distention
• Medical causes - Amenorrhea
• Medical causes - Low birth weight
• Differential Overview - Secondary Amenorrhea
• Causes - Abortion
• Causes - Cardiovascular disease in pregnancy
• Causes - Hypertension, pregnancy-induced
• Causes - Diabetic complications during pregnancy
• Medical causes - Abdominal distention
• Medical causes - Amenorrhea
• Medical causes - Abdominal distention
• Medical causes - Amenorrhea
• Medical causes - Low birth weight

Medications or substances causing Pregnancy:

The following drugs, medications, substances or toxins are some of the possible causes of Pregnancy as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

• Meningococcal Vaccine
• Mencevax
• ACWY
• Meningitec
• Menjugate
• more drugs...»

See full list of 13 medications causing Pregnancy

Drug interactions causing Pregnancy:

When combined, certain drugs, medications, substances or toxins may react causing Pregnancy as a symptom.

The list below is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

• Griseofulvin and Oral contraceptive interaction
• more interactions...»

Read more about medication causes of Pregnancy

Medical news summaries relating to Pregnancy:

The following medical news items are relevant to causes of Pregnancy:

• Beuty and home products have been found to produce health harming chemicals
• Excess alcohol consumption during pregnancy can result in fetal alcohol spectrum disorder
• Half of $118,000 settlement over baby's death eaten up by costs
• Half of thyroid disease sufferers are undiagnosed
• Heart disease established from embryonic stage
• Hyperemesis symptoms similar to morning sickness
• New risk factors may be associated with cardiovascular disease risk
• Over the counter emergency contraception
• Overweight women more likely to fall pregnant while on the Pill
• Pregnancy diet could increase the risk of cancer in offspring
• Pregnancy syndrome risks maternal and fetal death
• Researchers find that urine protein measurement can determine preeclampsia risk
• Teen sex issues
• Thyroid disease can affect cholesterol levels
• Vitamin C supplementation during pregnancy may increase the risk of wheezing but vitamin E may decrease the risk
• More news »

Related information on causes of Pregnancy:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Pregnancy may be found in:

• Risk factors for Pregnancy
• Medications that may cause Pregnancy
• Hidden causes of Pregnancy

Causes of Pregnancy: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Pregnancy.

Amenorrhea: Differential Diagnosis
(In a Page: Signs and Symptoms)

Secondary amenorrhea

• More common than primary
• Hypothyroidism
• Pregnancy
• Polycystic ovarian syndrome
  –Peripubertal onset of menstrual irregularities with hyperandrogenism (hirsutism) and obesity
• Functional hypothalamic amenorrhea due to stress, eating disorders, weight loss, or excessive exercise
• Hyperprolactinemia
  –Galactorrhea
  –Secondary to medications (e.g., OCP, phenothiazines) or primary due to pituitary adenoma
  Primary amenorrhea
  • Constitutional delay of puberty
    –Family history of late puberty
    –Normal development at later age
  • Outflow tract disorders
    –Transverse vaginal septum
    –Imperforate hymen
    –Pelvic or lower abdominal pain are common presenting symptoms
  • Complete androgen insensitivity syndrome
    –X-linked recessive disorder (46,XY)
    –Resistance to testosterone due to a defect in the androgen receptor
    –Testes may be palpable in labia or inguinal area
  • Müllerian agenesis (Mayer-Rokitansky-Hauser syndrome)
    –Agenesis of fallopian tubes, uterus, vagina
    –Normally functioning ovaries
    Less common etiologies
    • Turner's syndrome
      –45,X gonadal dysgenesis
      –Ovaries replaced with fibrous tissue
    • Ovarian failure (autoimmune oophoritis or secondary to chemotherapy or radiation injury)
    • 5-αreductase deficiency
    • 17-αhydroxylase deficiency
    • Craniopharyngioma
    • Hypopituitarism
    • Congenital GnRH deficiency (Kallman's syndrome if associated with anosmia)
    • Cushing's syndrome

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Amenorrhea – Secondary: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Pregnancy
  –Most common cause
• Anovulatory cycles
  –Common during first few years after menarche
  • Hyperandrogenism
    –Polycystic ovary syndrome: Problems with fertility are common, LH/FSH ratio is greater than 2.5/1
    –Some adrenal tumors
    –Congenital adrenal hyperplasia
    –Exposure to anabolic steroids
  • Major illness or stress
  • Large changes in weight
    –Anorexia nervosa
  • Hypothyroidism
  • Prolactinoma
  • Other causes of hyperprolactinemia
    –Marijuana
    –Opioids
    –Antidepressants
    –Phenothiazines
  • Hypothalamic-pituitary failure
    –Pituitary tumor
    –Sheehan syndrome
    –Cranial irradiation
  • Ovarian failure
    –Autoimmune destruction
    –Infarction due to gonadal torsion
    –Chemotherapy or radiation
    –Idiopathic
  • Oral contraceptives
    –May delay return to regular menses
  • Cushing syndrome
  • Uterine synechiae (Asherman syndrome)
  • Chiari-Frommel syndrome

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Amenorrhea – Primary: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Constitutional delay of puberty
  –Most common cause
• Anatomic causes
  –Uterine aplasia (Mayer-Rokitansky syndrome)
  –Vaginal aplasia
  –Imperforate hymen
• Hypogonadotropic hypogonadism
  –Decreased FSH
  –Congenital and acquired etiologies
• Congenital hypogonadotropic hypogonadism
  –Kallmann syndrome
  –Panhypopituitarism
• Aquired hypogonadotropic hypogonadism
  –Malnutrition
  –Stress
  –Anorexia nervosa
  –Inflammatory bowel disease
  –Celiac disease
  –Excessive exercise
  –Pituitary tumor (e.g., prolactinoma or craniopharyngioma)
• Hypergonadotropic hypogonadism
  –Increased FSH
  –Gonadal dysgenesis (Turner syndrome is the most common)
  –Ovarian failure: Autoimmune oophoritis, galactosemia, effects of chemotherapy or radiation, FSH or LH receptor mutations (rare)
  • Abnormal thyroid function
  • Androgen insensitivity syndrome
  • Congenital adrenal hyperplasia and other causes of hyperandrogenism
  • Medications
  • Pregnancy

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Abdominal distention: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ Abdominal cancer.Generalized abdominal distention may occur when the cancer — most commonly ovarian, hepatic, or pancreatic — produces ascites (usually in a patient with a known tumor). It’s an indication of advanced disease. Shifting dullness and a fluid wave accompany distention. Associated signs and symptoms may include severe abdominal pain, an abdominal mass, anorexia, jaundice, GI hemorrhage (hematemesis or melena), dyspepsia, and weight loss that progresses to muscle weakness and atrophy.

❑ Abdominal trauma.When brisk internal bleeding accompanies trauma, abdominal distention may be acute and dramatic. Associated signs and symptoms of this life-threatening disorder include abdominal rigidity with guarding, decreased or absent bowel sounds, vomiting, tenderness, and abdominal bruising. Pain may occur over the trauma site, or over the scapula if abdominal bleeding irritates the phrenic nerve. Signs of hypovolemic shock (such as hypotension and rapid, thready pulse) appear with significant blood loss.

❑ Cirrhosis. In cirrhosis, ascites causes generalized distention and is confirmed by a fluid wave, shifting dullness, and a puddle sign. Umbilical eversion and caput medusae (dilated veins around the umbilicus) are common. The patient may report a feeling of fullness or weight gain. Associated findings include vague abdominal pain, fever, anorexia, nausea, vomiting, constipation or diarrhea, bleeding tendencies, severe pruritus, palmar erythema, spider angiomas, leg edema, and possibly splenomegaly. Hematemesis, encephalopathy, gynecomastia, or testicular atrophy may also be seen. Jaundice is usually a late sign. Hepatomegaly occurs initially, but the liver may not be palpable if the patient has advanced disease.

❑ Heart failure. Generalized abdominal distention due to ascites typically accompanies severe cardiovascular impairment and is confirmed by shifting dullness and a fluid wave. Signs and symptoms of heart failure are numerous and depend on the disease stage and degree of cardiovascular impairment. Hallmarks include peripheral edema, jugular vein distention, dyspnea, and tachycardia. Common associated signs and symptoms include hepatomegaly (which may cause right upper quadrant pain), nausea, vomiting, a productive cough, crackles, cool extremities, cyanotic nail beds, nocturia, exercise intolerance, nocturnal wheezing, diastolic hypertension, and cardiomegaly.

❑ Irritable bowel syndrome. Irritable bowel syndrome may produce intermittent, localized distention — the result of periodic intestinal spasms. Lower abdominal pain or cramping typically accompanies these spasms. The pain is usually relieved by defecation or by passage of intestinal gas and is aggravated by stress. Other possible signs and symptoms include diarrhea that may alternate with constipation or normal bowel function, nausea, dyspepsia, straining and urgency at defecation, a feeling of incomplete evacuation, and small, mucus-streaked stools.

❑ Large-bowel obstruction. Dramatic abdominal distention is characteristic in this life-threatening disorder; in fact, loops of the large bowel may become visible on the abdomen. Constipation precedes distention and may be the only symptom for days. Associated findings include tympany, high-pitched bowel sounds, and the sudden onset of colicky lower abdominal pain that becomes persistent. Fecal vomiting and diminished peristaltic waves and bowel sounds are late signs.

❑ Mesenteric artery occlusion (acute). In this life-threatening disorder, abdominal distention usually occurs several hours after the sudden onset of severe, colicky periumbilical pain accompanied by rapid (even forceful) bowel evacuation. The pain later becomes constant and diffuse. Related signs and symptoms include severe abdominal tenderness with guarding and rigidity, absent bowel sounds and, occasionally, a bruit in the right iliac fossa. The patient may also experience vomiting, anorexia, diarrhea, or constipation. Late signs include fever, tachycardia, tachypnea, hypotension, and cool, clammy skin. Abdominal distention or GI bleeding may be the only clue if pain is absent.

❑ Paralytic ileus. Paralytic ileus, which produces generalized distention with a tympanic percussion note, is accompanied by absent or hypoactive bowel sounds and, occasionally, mild abdominal pain and vomiting. The patient may be severely constipated or may pass flatus and small, liquid stools.

❑ Peritonitis. Peritonitis is a life-threatening disorder in which abdominal distention may be localized or generalized, depending on the extent of the inflammation. Fluid accumulates within the peritoneal cavity and then within the bowel lumen, causing a fluid wave and shifting dullness. Typically, distention is accompanied by sudden and severe abdominal pain that worsens with movement, rebound tenderness, and abdominal rigidity.

The skin over the patient’s abdomen may appear taut. Associated signs and symptoms usually include hypoactive or absent bowel sounds, fever, chills, hyperalgesia, nausea, and vomiting. Signs of shock, such as tachycardia and hypotension, appear with significant fluid loss into the abdomen.

❑ Small-bowel obstruction. Abdominal distention is characteristic in small-bowel obstruction, a life-threatening disorder, and is most pronounced during late obstruction, especially in the distal small bowel. Auscultation reveals hypoactive or hyperactive bowel sounds, whereas percussion produces a tympanic note. Accompanying signs and symptoms include colicky periumbilical pain, constipation, nausea, and vomiting; the higher the obstruction, the earlier and more severe the vomiting. Rebound tenderness reflects intestinal strangulation with ischemia. Associated signs and symptoms include drowsiness, malaise, and signs of dehydration. Signs of hypovolemic shock appear with progressive dehydration and plasma loss.

❑ Toxic megacolon (acute).Toxic megacolon is a life-threatening complication of infectious or ulcerative colitis.  It produces dramatic abdominal distention that usually develops gradually and is accompanied by a tympanic percussion note, diminished or absent bowel sounds, and mild rebound tenderness. The patient also presents with abdominal pain and tenderness, fever, tachycardia, and dehydration.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Amenorrhea: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

❑ Adrenal tumor. Amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic changes. Asymmetrical ovarian enlargement in conjunction with the rapid onset of virilizing signs is usually indicative of an adrenal tumor.

❑ Adrenocortical hyperplasia. Amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism typically appear.

❑ Adrenocortical hypofunction. In addition to amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.

❑ Amenorrhea-lactation disorders. Amenorrhea-lactation disorders, such as Forbes-Albright and Chiari-Frommel syndromes, produce secondary amenorrhea accompanied by lactation in the absence of breast-feeding. Associated features include hot flashes, dyspareunia, vaginal atrophy, and large, engorged breasts.

❑ Anorexia nervosa. Anorexia nervosa is a psychological disorder that can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, a blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.

❑ Congenital absence of the ovaries. Congenital absence of the ovaries results in primary amenorrhea and the absence of secondary sex characteristics.

❑ Congenital absence of the uterus. Primary amenorrhea occurs with congenital absence of the uterus. The patient may develop breasts.

❑ Corpus luteum cysts. Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.

❑ Hypothalamic tumor. In addition to amenorrhea, a hypothalamic tumor can cause endocrine and visual field defects, gonadal underdevelopment or dysfunction, and short stature.

❑ Hypothyroidism. Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.

❑ Mosaicism. Mosaicism results in primary amenorrhea and the absence of secondary sex characteristics.

❑ Ovarian insensitivity to gonadotropins. A hormonal disturbance, ovarian insensitivity to gonadotropins leads to amenorrhea and an absence of secondary sex characteristics.

❑ Pituitary tumor. Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache; visual disturbances, such as bitemporal hemianopsia; and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.

❑ Polycystic ovary syndrome. Typically, menarche occurs at a normal age, followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea. Or, periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany this disorder.

❑ Pseudoamenorrhea. An anatomic anomaly, such as imperforate hymen, obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.

❑ Pseudocyesis. With pseudocyesis, amenorrhea may be accompanied by lordosis, abdominal distention, nausea, and breast enlargement.

❑ Testicular feminization. Primary amenorrhea may signal this form of male pseudohermaphroditism. The patient, outwardly female but genetically male, shows breast and external genital development but scant or absent pubic hair.

❑ Thyrotoxicosis. Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.

❑ Turner’s syndrome. Primary amenorrhea and failure to develop secondary sex characteristics may signal this syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.

❑ Uterine hypoplasia. Primary amenorrhea results from underdevelopment of the uterus, which is detectable on physical examination.

Other causes

❑ Drugs. Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they’re discontinued.

❑ Radiation therapy. Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.

❑ Surgery. Surgical removal of both ovaries or the uterus produces amenorrhea.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Low birth weight: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

This section lists some fetal and placental causes of low birth weight as well as the associated signs and symptoms pres-ent in the neonate at birth.

Chromosomal aberrations

Abnormalities in the number, size, or configuration of chromosomes can cause low birth weight and possibly multiple congenital anomalies in a premature or SGA neonate

For example, a neonate with trisomy 21 (Down syndrome) may be SGA and have prominent epicanthal folds, a flat-bridged nose, a protruding tongue, palmar simian creases, muscular hypotonia, and an umbilical hernia.

Cytomegalovirus infection

Although low birth weight in cytomegalovirus infection is usually associated with premature birth, the neonate may be SGA

Assessment at birth may reveal these classic signs: petechiae and ecchymoses, jaundice, and hepatosplenomegaly, which increases for several days. The neonate may also have a high fever, lymphadenopathy, tachypnea, and dyspnea, along with prolonged bleeding at puncture sites.

Placental dysfunction

Low birth weight and a wasted appearance occur in an SGA neonate

He may be symmetrically short or may appear relatively long for his low weight. Additional findings reflect the underlying cause. For example, if maternal hyperparathyroidism caused placental dysfunction, the neonate may exhibit muscle jerking and twitching, carpopedal spasm, ankle clonus, vomiting, tachycardia, and tachypnea.

Rubella (congenital)

Usually, the low-birth-weight neonate with this congenital rubellais born at term but is SGA

A characteristic “blueberry muffin” rash accompanies cataracts, purpuric lesions, hepatosplenomegaly, and a large anterior fontanel

Abnormal heart sounds, if present, vary with the type of associated congenital heart defect.

Varicella (congenital)

Low birth weight is accompanied by cataracts and skin vesicles.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Abortion: Causes
(Professional Guide to Diseases (Eighth Edition))

Spontaneous abortion may result from fetal, placental, or maternal factors. Fetal factors, which usually cause such abortions at up to 12 weeks’gestation, include the following:

❑ defective embryologic development resulting from abnormal chromosome division (most common cause of fetal death)

❑ faulty implantation of the fertilized ovum

❑ failure of the endometrium to accept the fertilized ovum.

Placental factors usually cause abortion around the 14th week of gestation, when the placenta takes over the hormone production necessary to maintain the pregnancy. These factors include:

❑ premature separation of the normally implanted placenta

❑ abnormal placental implantation.

Maternal factors usually cause abortion between the 11th and 19th week of gestation and include:

❑ maternal infection, abnormalities of the reproductive organs (especially an incompetent cervix, in which the cervix dilates painlessly in the second trimester)

❑ endocrine problems, such as thyroid dysfunction or a luteal phase defect

❑ trauma

❑ phospholipid antibody disorder

❑ blood group incompatibility

❑ drug ingestion (particularly uterotonic agents).

The goal of therapeutic abortion is to preserve the mother’s mental or physical health in cases of rape, unplanned pregnancy, or medical conditions such as moderate or severe cardiac dysfunction.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Amenorrhea: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Amenorrhea is normal before puberty, after menopause, or during pregnancy and lactation; it’s pathologic at any other time. It usually results from anovulation due to hormonal abnormalities, such as decreased secretion of estrogen, gonadotropins, luteinizing hormone, and follicle-stimulating hormone; lack of ovarian response to gonadotropins; or constant presence of progesterone or other endocrine abnormalities.

Amenorrhea may also result from the absence of a uterus, endometrial damage, or from ovarian, adrenal, or pituitary tumors. It’s also linked to emotional disorders and is common in patients with severe disorders, such as depression and anorexia nervosa. Mild emotional disturbances tend merely to distort the ovulatory cycle, while severe psychic trauma may abruptly change the bleeding pattern or may completely suppress one or more full ovulatory cycles. Amenorrhea may also result from malnutrition, intense exercise, and prolonged hormonal contraceptive use. The incidence of primary amenorrhea in the United States is less than 1%. The incidence of secondary amenorrhea (due to some other cause than pregnancy) is about 4%.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Cesarean birth: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

The most common reasons for cesarean birth are malpresentation (such as shoulder or face presentation), fetal intolerance of labor distress, cephalopelvic disproportion ([CPD] the pelvis is too small to accommodate the fetal head), certain cases of toxemia, previous cesarean birth, and inadequate progress in labor (failure of induction).

Conditions causing fetal distress that indicate a need for cesarean birth include prolapsed cord with a live fetus, fetal hypoxia, abnormal fetal heart rate patterns, unfavorable intrauterine environment (from infection), and moderate to severe Rh isoimmunization. Less common maternal conditions that may necessitate cesarean birth include complete placenta previa, abruptio placentae, placenta accreta, malignant tumors, and chronic diseases in which delivery is indicated before term.

Cesarean birth may also be necessary if induction is contraindicated or difficult or if advanced labor increases the risk of morbidity and mortality.

In the case of a previous cesarean delivery, some physicians allow a subsequent vaginal delivery if the cesarean wasn’t classic or if the original reason for the cesarean no longer exists. However, vaginal delivery risks uterine rupture if the uterus is scarred.

The rising incidence of cesarean birth coincides with recent medical and technologic advances in fetal and placental surveillance and care. In the United States, 9% to 16% of all pregnancies terminate in cesarean births, rising to 17% to 25% in perinatal centers that handle high-risk deliveries.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Adolescent pregnancy: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Adolescent pregnancy is prevalent in all socioeconomic levels, and its contributing factors vary. Such factors may include ignorance about sexuality and contraception, increasing sexual activity at a young age, rebellion against parental influence, and a desire to escape an unhappy family situation and to fulfill emotional needs unmet by the family.

In the United States, an estimated 1 million adolescents become pregnant each year.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Cardiovascular disease in pregnancy: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Approximately 1% to 2% of pregnant females have cardiac disease, but the incidence is rising because medical treatment today allows more females with rheumatic heart disease (present in more than 80% of patients who develop cardiovascular complications) and congenital defects (present in 10% to 15% of patients) to reach childbearing age. Coronary artery disease accounts for about 2% of cardiovascular complications.

The diseased heart is sometimes unable to meet the normal demands of pregnancy: 25% increase in cardiac output, 40% to 50% increase in plasma volume, increased oxygen requirements, retention of salt and water, weight gain, and alterations in hemodynamics during delivery. This physiologic stress often leads to the heart’s failure to maintain adequate circulation (decompensation). The degree of decompensation depends on the patient’s age, the duration of cardiac disease, and the heart’s functional capacity at the pregnancy’s outset.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Pregnancy-induced hypertension: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

The cause of pregnancy-induced hypertension is unknown, but geographic, ethnic, racial, nutritional, immunologic, and familial factors and pre-existing vascular disease may contribute to its development. Age is also a factor. Primiparas who are older than age 35 are at higher risk for preeclampsia.

Preeclampsia develops in about 7% of pregnancies. Incidence is significantly higher in low socioeconomic groups. About 5% of females with preeclampsia develop eclampsia; of these, about 15% die from PIH itself or its complications. Fetal mortality is high due to the increased incidence of premature delivery and uteroplacental insufficiency.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Diabetic complications during pregnancy: Causes
(Professional Guide to Diseases (Eighth Edition))

In diabetes mellitus, glucose is inadequately utilized either because insulin isn’t synthesized or because tissues are resistant to the hormonal action of endogenous insulin. During pregnancy, the fetus relies on maternal glucose as a primary fuel source. Pregnancy triggers protective mechanisms that have anti-insulin effects: increased hormone production (placental lactogen, estrogen, and progesterone), which antagonizes insulin’s effects; degradation of insulin by the placenta; and prolonged elevation of stress hormones (cortisol, epinephrine, and glucagon), which raise blood glucose levels.

In a normal pregnancy, an increase in anti-insulin factors is counterbalanced by an increase in insulin production to maintain normal blood glucose levels. However, females who are prediabetic or diabetic are unable to produce sufficient insulin to overcome the insulin antagonist mechanisms of pregnancy, or their tissues are insulin-resistant. As insulin requirements rise toward term, the patient who’s prediabetic may develop gestational diabetes, necessitating dietary management and, possibly, exogenous insulin to achieve glycemic control, whereas the patient who’s insulin-dependent may need increased insulin dosage.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Ectopic pregnancy: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Conditions that prevent or retard the fertilized ovum’s passage through the fallopian tube and into the uterine cavity include:

❑ diverticula, the formation of blind pouches that cause tubal abnormalities

❑ endometriosis, the presence of endometrial tissue outside the lining of the uterine cavity

❑ endosalpingitis, an inflammatory reaction that causes folds of the tubal mucosa to agglutinate, narrowing the tube

❑ pelvic inflammatory disease (PID), an infection of the oviducts and ovaries with adjacent tissue involvement

❑ previous surgery (tubal ligation or resection, or adhesions from previous abdominal or pelvic surgery)

❑ tumors pressing against the tube.

Ectopic pregnancy may result from congenital defects in the reproductive tract or ectopic endometrial implants in the tubal mucosa. The increased prevalence of sexually transmitted tubal infection may also be a factor. In whites, it occurs in 1 in 200 pregnancies; in nonwhites, in 1 in 120.

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Source: Professional Guide to Diseases (Eighth Edition), 2005

Abdominal distention: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Abdominal cancer

Generalized abdominal distention may occur when the cancer—most commonly ovarian, hepatic, or pancreatic cancer—produces ascites (usually in a patient with a known tumor). It’s an indication of advanced disease. Shifting dullness and a fluid wave accompany distention. Associated signs and symptoms may include severe abdominal pain, an abdominal mass, anorexia, jaundice, GI hemorrhage (hematemesis or melena), dyspepsia, and weight loss that progresses to muscle weakness and atrophy.

Abdominal trauma

When brisk internal bleeding accompanies trauma, abdominal distention may be acute and dramatic. Associated signs and symptoms of this life-threatening disorder include abdominal rigidity with guarding, decreased or absent bowel sounds, vomiting, tenderness, and abdominal bruising. The patient may feel pain over the trauma site, or over the scapula if abdominal bleeding irritates the phrenic nerve. Signs of hypovolemic shock (such as hypotension and rapid, thready pulse) appear with significant blood loss.

Bladder distention

Various disorders cause bladder distention, which in turn causes lower abdominal distention. Slight dullness on percussion above the symphysis indicates mild bladder distention. A palpable, smooth, rounded, fluctuant suprapubic mass suggests severe distention; a fluctuant mass extending to the umbilicus indicates extremely severe distention. Urinary dribbling, frequency, or urgency may occur with urinary obstruction. Suprapubic discomfort is also common.

Cirrhosis

In cirrhosis, ascites causes generalized distention and is confirmed by a fluid wave, shifting dullness, and a puddle sign. Umbilical eversion and caput medusae (dilated veins around the umbilicus) are common. The patient may report a feeling of fullness or weight gain. Associated findings include vague abdominal pain, fever, anorexia, nausea, vomiting, constipation or diarrhea, bleeding tendencies, severe pruritus, palmar erythema, spider angiomas, leg edema, and possibly splenomegaly. Hematemesis, encephalopathy, gynecomastia, or testicular atrophy may also occur. Jaundice is usually a late sign. Hepatomegaly occurs initially, but the liver may not be palpable in advanced disease.

Gastric dilation (acute)

Left-upper-quadrant distention is characteristic in acute gastric dilation, but the presentation varies. The patient usually complains of epigastric fullness or pain and nausea with or without vomiting. Physical examination reveals tympany, gastric tenderness, and a succussion splash. Initially, peristalsis may be visible. Later, hypoactive or absent bowel sounds confirm ileus. The patient may be pale and diaphoretic and may exhibit tachycardia or bradycardia.

Heart failure

Generalized abdominal distention due to ascites typically accompanies severe cardiovascular impairment and is confirmed by shifting dullness and a fluid wave. Signs and symptoms of heart failure are numerous and depend on the disease stage and degree of cardiovascular impairment. Hallmarks include peripheral edema, jugular vein distention, dyspnea, and tachycardia. Common associated signs and symptoms include hepatomegaly (which may cause right-upper-quadrant pain), nausea, vomiting, productive cough, crackles, cool extremities, cyanotic nail beds, nocturia, exercise intolerance, nocturnal wheezing, diastolic hypertension, and cardiomegaly.

Irritable bowel syndrome (IBS)

IBS may produce intermittent, localized distention—the result of periodic intestinal spasms. Lower abdominal pain or cramping typically accompanies these spasms. The pain is usually relieved by defecation or by passage of intestinal gas and is aggravated by stress. Other possible signs and symptoms include diarrhea that may alternate with constipation or normal bowel function; nausea; dyspepsia; straining and urgency at defecation; feeling of incomplete evacuation; and small, mucus-streaked stools.

Large-bowel obstruction

Dramatic abdominal distention is characteristic in large-bowel obstruction, a life-threatening disorder; in fact, loops of the large bowel may become visible on the abdomen. Constipation precedes distention and may be the only symptom for days. Associated findings include tympany, high-pitched bowel sounds, and sudden onset of colicky lower abdominal pain that becomes persistent. Fecal vomiting and diminished peristaltic waves and bowel sounds are late signs.

Mesenteric artery occlusion (acute)

In mesenteric artery occlusion—a life-threatening disorder—abdominal distention usually occurs several hours after the sudden onset of severe, colicky periumbilical pain accompanied by rapid (even forceful) bowel evacuation. The pain later becomes constant and diffuse. Related signs and symptoms include severe abdominal tenderness with guarding and rigidity, absent bowel sounds and, occasionally, a bruit in the right iliac fossa. The patient may also experience vomiting, anorexia, diarrhea, or constipation. Late signs include fever, tachycardia, tachypnea, hypotension, and cool, clammy skin. Abdominal distention or GI bleeding may be the only clue if pain is absent.

Nephrotic syndrome

Nephrotic syndrome may produce massive edema, causing generalized abdominal distention with a fluid wave and shifting dullness. It may also produce elevated blood pressure, hematuria or oliguria, fatigue, anorexia, depression, pallor, periorbital edema, scrotal swelling, and skin striae.

Ovarian cysts

Typically, large ovarian cysts produce lower abdominal distention accompanied by umbilical eversion. Because they’re thin walled and fluid filled, these cysts produce a fluid wave and shifting dullness—signs that mimic ascites. Lower abdominal pain and a palpable mass may be present.

Paralytic ileus

Paralytic ileus, which produces generalized distention with a tympanic percussion note, is accompanied by absent or hypoactive bowel sounds and, occasionally, mild abdominal pain and vomiting. The patient may be severely constipated or may pass flatus and small, liquid stools.

Peritonitis

In peritonitis—a life-threatening disorder—abdominal distention may be localized or generalized, depending on the extent of peritonitis. Fluid accumulates first within the peritoneal cavity and then within the bowel lumen, causing a fluid wave and shifting dullness. Typically, distention is accompanied by rebound tenderness, abdominal rigidity, and sudden and severe abdominal pain that worsens with movement.

The skin over the patient’s abdomen may appear taut. Associated signs and symptoms usually include hypoactive or absent bowel sounds, fever, chills, hyperalgesia, nausea, and vomiting. Signs of shock, such as tachycardia and hypotension, appear with significant fluid loss into the abdomen.

Small-bowel obstruction

Abdominal distention, which is characteristic in small-bowel obstruction—a life-threatening disorder—is most pronounced during late obstruction, especially in the distal small bowel. Auscultation reveals hypoactive or hyperactive bowel sounds, whereas percussion produces a tympanic note. Accompanying signs and symptoms include colicky periumbilical pain, constipation, nausea, and vomiting; the higher the obstruction, the earlier and more severe the vomiting. Rebound tenderness reflects intestinal strangulation with ischemia. Associated signs and symptoms include drowsiness, malaise, and signs of dehydration. Signs of hypovolemic shock appear with progressive dehydration and plasma loss.

Toxic megacolon (acute)

Toxic megacolon is a life-threatening complication of infectious or ulcerative colitis that produces dramatic abdominal distention. The distention usually develops gradually and is accompanied by a tympanic percussion note, diminished or absent bowel sounds, and mild rebound tenderness. The patient also experiences abdominal pain and tenderness, fever, tachycardia, and dehydration.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Amenorrhea: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Adrenal tumor

Amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic changes. Asymmetrical ovarian enlargement in conjunction with rapid onset of virilizing signs is usually indicative.

Adrenocortical hyperplasia

Amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism also typically appear.

Adrenocortical hypofunction

Besides amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.

Amenorrhea-lactation disorders

Amenorrhea-lactation disorders, such as Forbes-Albright and Chiari-Frommel syndromes, produce secondary amenorrhea accompanied by lactation in the absence of breast-feeding. Associated features include hot flashes, dyspareunia, vaginal atrophy, and large, engorged breasts.

Anorexia nervosa

Anorexia nervosa is a psychological disorder that can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.

Congenital absence of the ovaries

Congenital absence of the ovaries results in primary amenorrhea and absence of secondary sex characteristics.

Congenital absence of the uterus

Primary amenorrhea occurs with congenital absence of the uterus. The patient also may fail to develop breasts.

Corpus luteum cysts

Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.

Hypothalamic tumor

In addition to amenorrhea, a hypothalamic tumor can cause endocrine and visual field defects, gonadal underdevelopment or dysfunction, and short stature.

Hypothyroidism

Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.

Mosaicism

Mosaicism is a genetic disorder that results in primary amenorrhea and absence of secondary sex characteristics.

Ovarian insensitivity to gonadotropins

Ovarian insensitivity to gonadotropins is a hormonal disturbance that leads to amenorrhea and absence of secondary sex characteristics.

Pituitary infarction

Pituitary infarction usually causes postpartum failure to lactate and to resume menses. Although associated signs and symptoms depend on the infarction’s severity, they include headaches, visual field defects, oculomotor palsies, and an altered level of consciousness. The patient may also lose pubic and axillary hair.

Pituitary tumor

Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache, visual disturbances such as bitemporal hemianopia, and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.

Polycystic ovary syndrome

Typically, menarche occurs at a normal age, followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea. Alternatively, periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany polycystic ovary syndrome.

Pseudoamenorrhea

An anatomic anomaly, such as imperforate hymen, obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.

Pseudocyesis

In pseudocyesis, amenorrhea may be accompanied by lordosis, abdominal distention, nausea, and breast enlargement.

Sertoli-Leydig cell tumor

Sertoli-Leydig cell tumor is an ovarian tumor that may produce amenorrhea along with acne, hirsutism, deepening of the voice, balding, muscle mass development, and clitoral enlargement.

Testicular feminization

Primary amenorrhea may signal this form of male pseudohermaphroditism. The patient, outwardly female but genetically male, exhibits breasts and external genitalia but scant or absent pubic hair.

Thyrotoxicosis

Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.

Turner’s syndrome

Primary amenorrhea and failure to develop secondary sex characteristics may signal this syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.

Uterine hypoplasia

Primary amenorrhea results from underdevelopment of the uterus, which is detectable on physical examination.

Other causes

Drugs

Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they’re discontinued.

Radiation therapy

Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.

Surgery

Surgical removal of both ovaries or the uterus produces amenorrhea.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Low birth weight: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

This section lists some fetal and placental causes of low birth weight as well as the associated signs and symptoms present in the neonate at birth.

Chromosomal aberrations

Abnormalities in the number, size, or configuration of chromosomes can cause low birth weight and possibly multiple congenital anomalies in a premature or SGA neonate. For example, a neonate with trisomy 21 (Down syndrome) may be SGA and have prominent epicanthal folds, a flat-bridged nose, a protruding tongue, palmar simian creases, muscular hypotonia, and an umbilical hernia.

Cytomegalovirus infection

Although low birth weight in this disorder is usually associated with premature birth, some neonates may be SGA. Assessment at birth may reveal these classic signs: petechiae and ecchymoses, jaundice, and hepatosplenomegaly, which increases for several days. The neonate may also have a high fever, lymphadenopathy, tachypnea, and dyspnea, along with prolonged bleeding at puncture sites.

Placental dysfunction

Low birth weight and a wasted appearance occur in an SGA neonate. The neonate may be symmetrically short or may appear relatively long for his low weight. Additional findings reflect the underlying cause. For example, if maternal hyperparathyroidism caused placental dysfunction, the neonate may exhibit muscle jerking and twitching, carpopedal spasm, ankle clonus, vomiting, tachycardia, and tachypnea.

Rubella (congenital)

Usually, the low-birth-weight neonate with this disease is born at term but is SGA. A characteristic “blueberry muffin” rash accompanies cataracts, purpuric lesions, hepatosplenomegaly, and a large anterior fontanel. Abnormal heart sounds, if present, vary with the type of associated congenital heart defect.

Toxoplasmosis (congenital)

The low-birth-weight neonate may be either premature or SGA and may have hydrocephalus or microcephalus. Associated findings include fever, seizures, lymphadenopathy, hepatosplenomegaly, jaundice, and rash. Other defects, which may occur months or years later, include strabismus, blindness, epilepsy, and mental retardation.

Varicella (congenital)

Low birth weight is accompanied by cataracts and skin vesicles.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Secondary Amenorrhea: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Pregnancy

❑ Menopause

❑ Functional hypothalamic amenorrhea

❑ Drugs

❑ Anorexia nervosa

❑ Post-contraceptive

❑ Endometrial scarring

❑ Endocrinopathy

❑ Hyperprolactinemia

❑ Premature ovarian failure

❑ Polycystic ovary syndrome

❑ Chromophobe adenoma

❑ Ovarian tumors

❑ Panhypopituitarism

❑ Müllerian dysgenesis

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Abortion: Causes
(Handbook of Diseases)

Spontaneous abortion may result from fetal, placental, or maternal factors. (See Types of spontaneous abortion.) Fetal factors usually cause abortions before the 12th week of gestation and include:

defective embryologic development resulting from abnormal chromosome division (most common cause of fetal death)

faulty implantation of the fertilized ovum

failure of the endometrium to accept the fertilized ovum.

Placental factors usually cause abortion around the 14th week of gestation, when the placenta takes over the hormone production necessary to maintain the pregnancy. These factors include:

premature separation of the normally implanted placenta

abnormal placental implantation.

Maternal factors usually cause abortion during the second trimester and include:

maternal infection, severe malnutrition, and abnormalities of the reproductive organs (especially an incompetent cervix, in which the cervix dilates painlessly and bloodlessly in the second trimester)

endocrine problems, such as thyroid dysfunction or a luteal phase defect

trauma, including any surgery that requires manipulation of the pelvic organs

phospholipid antibody disorder

blood group incompatibility

drug ingestion.

The goal of therapeutic abortion is to preserve the mother’s mental or physical health in cases of rape, unplanned pregnancy, or medical conditions, such as moderate or severe cardiac dysfunction.

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Source: Handbook of Diseases, 2003

Cardiovascular disease in pregnancy: Causes
(Handbook of Diseases)

Rheumatic heart disease is present in more than 80% of patients who develop cardiovascular complications. In the rest, these complications stem from congenital defects (10% to 15%) and coronary artery disease (2%).

The diseased heart is sometimes unable to meet the normal demands of pregnancy: a 25% increase in cardiac output, a 40% to 50% increase in plasma volume, increased oxygen requirements, retention of salt and water, weight gain, and alterations in hemodynamics during delivery. This physiologic stress commonly leads to the heart’s failure to maintain adequate circulation (decompensation).

The degree of decompensation depends on the patient’s age, the duration of cardiac disease, and the functional capacity of the heart at the outset of pregnancy.

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Source: Handbook of Diseases, 2003

Hypertension, pregnancy-induced: Causes
(Handbook of Diseases)

The cause of PIH is unknown, but it appears to be related to inadequate prenatal care (especially poor nutrition), parity (more prevalent in primigravidas), multiple pregnancies, preexisting diabetes mellitus, and hypertension.

Age is also a factor. Adolescents and primiparas over age 35 are at higher risk for preeclampsia. Other theories postulate a long list of potential toxic sources, such as autolysis of placental infarcts, autointoxication, uremia, maternal sensitization to total proteins, and pyelonephritis.

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Source: Handbook of Diseases, 2003

Diabetic complications during pregnancy: Causes
(Handbook of Diseases)

In diabetes mellitus, glucose is inadequately used either because insulin isn’t synthesized (as in type 1, insulin-dependent diabetes) or because tissues are resistant to the hormonal action of endogenous insulin (as in type 2, non–insulin-dependent diabetes).

Protective mechanisms

During pregnancy, the fetus relies on maternal glucose as a primary fuel source. Pregnancy triggers protective mechanisms that have anti-insulin effects: increased hormone production (placental lactogen, estrogen, and progesterone), which antagonizes the effects of insulin; degradation of insulin by the placenta; and prolonged elevation of stress hormones (cortisol, epinephrine, and glucagon), which raise blood glucose levels.

In a normal pregnancy, an increase in anti-insulin factors is counterbalanced by an increase in insulin production to maintain normal blood glucose levels. However, women who are prediabetic or diabetic can’t produce sufficient insulin to overcome the insulin antagonist mechanisms of pregnancy, or their tissues are insulin-resistant.

As insulin requirements rise toward term, the patient who is prediabetic may develop gestational diabetes, necessitating dietary management and, possibly, exogenous insulin to achieve glycemic control. The insulin-dependent patient may need increased insulin dosage.

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Source: Handbook of Diseases, 2003

Abdominal distention: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Abdominal cancer

Generalized abdominal distention may occur when the cancer — most commonly ovarian, hepatic, or pancreatic — produces ascites (usually in a patient with a known tumor). It’s an indication of advanced disease. Shifting dullness and a fluid wave accompany distention. Associated signs and symptoms may include severe abdominal pain, an abdominal mass, anorexia, jaundice, GI hemorrhage (hematemesis or melena), dyspepsia, and weight loss that progresses to muscle weakness and atrophy.

Abdominal trauma

When brisk internal bleeding accompanies trauma, abdominal distention may be acute and dramatic. Associated signs and symptoms of this life-threatening disorder include abdominal rigidity with guarding, decreased or absent bowel sounds, vomiting, tenderness, and abdominal bruising. Pain may occur over the trauma site or over the scapula if abdominal bleeding irritates the phrenic nerve. Signs of hypovolemic shock (such as hypotension and rapid, thready pulse) appear with significant blood loss.

Bladder distention

Various disorders cause bladder distention which, in turn, causes lower abdominal distention. Slight dullness on percussion above the symphysis pubis indicates mild bladder distention. A palpable, smooth, rounded, fluctuant suprapubic mass suggests severe bladder distention; a fluctuant mass extending to the umbilicus indicates extremely severe bladder distention. Urinary dribbling, frequency, or urgency may occur with urinary obstruction. Suprapubic discomfort is also common.

Cirrhosis

With cirrhosis, ascites causes generalized distention and is confirmed by a fluid wave and shifting dullness. Umbilical eversion and caput medusae (dilated veins around the umbilicus) are common. The patient may report a feeling of fullness or weight gain. Associated findings include vague abdominal pain, fever, anorexia, nausea, vomiting, constipation or diarrhea, bleeding tendencies, severe pruritus, palmar erythema, spider angiomas, leg edema and, possibly, splenomegaly. Hematemesis, encephalopathy, gynecomastia, or testicular atrophy may also be seen. Jaundice is usually a late sign. Hepatomegaly occurs initially; however, the liver may not be palpable if the patient has advanced disease.

Gastric dilation (acute)

Left-upper-quadrant distention is characteristic of acute gastric dilation, but the presentation varies. The patient usually complains of epigastric fullness or pain and nausea (with or without vomiting). Physical examination reveals tympany, gastric tenderness, and a succussion splash. Initially, visible peristalsis may occur. Later, hypoactive or absent bowel sounds confirm ileus. The patient may be pale and diaphoretic and may exhibit tachycardia or bradycardia.

Heart failure

Generalized abdominal distention due to ascites typically accompanies severe cardiovascular impairment and is confirmed by shifting dullness and a fluid wave. Signs and symptoms of heart failure are numerous and depend on the disease stage and degree of cardiovascular impairment. Hallmarks include peripheral edema, jugular vein distention, dyspnea, and tachycardia. Common associated signs and symptoms include hepatomegaly (which may cause right-upper-quadrant pain), nausea, vomiting, productive cough, crackles, cool extremities, cyanotic nail beds, nocturia, exercise intolerance, nocturnal wheezing, diastolic hypertension, and cardiomegaly.

Irritable bowel syndrome

Irritable bowel syndrome may produce intermittent, localized distention — the result of periodic intestinal spasms. Lower abdominal pain or cramping typically accompanies these spasms. The pain is usually relieved by defecation or by passage of intestinal gas and is aggravated by stress. Other possible signs and symptoms include diarrhea that may alternate with constipation or normal bowel function; nausea; dyspepsia; straining and urgency at defecation; feeling of incomplete evacuation; and small, mucus-streaked stools.

Large-bowel obstruction

Dramatic abdominal distention is characteristic of large-bowel obstruction, a life-threatening disorder; in fact, loops of the large bowel may become visible on the abdomen. Constipation precedes distention and may be the only symptom for days. Associated findings include tympany, high-pitched bowel sounds, and the sudden onset of colicky lower abdominal pain that becomes persistent. Fecal vomiting and diminished peristaltic waves and bowel sounds are late signs.

Mesenteric artery occlusion (acute)

In acute mesenteric artery occlusion, a life-threatening disorder, abdominal distention usually occurs several hours after the sudden onset of severe, colicky periumbilical pain accompanied by rapid (even forceful) bowel evacuation. The pain later becomes constant and diffuse. Related signs and symptoms include severe abdominal tenderness with guarding and rigidity, absent bowel sounds and, occasionally, a bruit in the right iliac fossa. The patient may also experience vomiting, anorexia, diarrhea, or constipation. Late signs include fever, tachycardia, tachypnea, hypotension, and cool, clammy skin. Abdominal distention or GI bleeding may be the only clue if pain is absent.

Nephrotic syndrome

Nephrotic syndrome may produce massive edema, causing generalized abdominal distention with a fluid wave and shifting dullness. It may also produce elevated blood pressure, hematuria or oliguria, fatigue, anorexia, depression, pallor, periorbital edema, scrotal swelling, and skin striae.

Ovarian cysts

Typically, large ovarian cysts produce lower abdominal distention accompanied by umbilical eversion. Because they’re thin walled and fluid filled, these cysts produce a fluid wave and shifting dullness — signs that mimic ascites. Lower abdominal pain and a palpable mass may be present.

Paralytic ileus

Paralytic ileus, which produces generalized distention with a tympanic percussion note, is accompanied by absent or hypoactive bowel sounds and, occasionally, extreme distress and vomiting. The patient may be severely constipated or may pass flatus and small, liquid stools.

Peritonitis

In peritonitis, a life-threatening disorder, abdominal distention may be localized or generalized, depending on the extent of peritonitis. Fluid accumulates first within the peritoneal cavity and then within the bowel lumen, causing a fluid wave and shifting dullness. Typically, distention is accompanied by sudden and severe abdominal pain that worsens with movement. Rebound tenderness and abdominal rigidity may be present.

Associated signs and symptoms usually include hypoactive or absent bowel sounds, fever, chills, hyperalgesia, nausea, and vomiting. Also, the skin over the patient’s abdomen may appear taut. Signs of shock, such as tachycardia and hypotension, appear with significant fluid loss into the abdomen.

Small-bowel obstruction

Abdominal distention, which is characteristic of small-bowel obstruction, is most pronounced during late obstruction, especially in the distal small bowel. Auscultation reveals hypoactive or hyperactive bowel sounds, whereas percussion produces a tympanic note. Accompanying signs and symptoms of this life-threatening disorder include colicky periumbilical pain, constipation, nausea, and vomiting; the higher the obstruction, the earlier and more severe the vomiting. Rebound tenderness reflects intestinal strangulation with ischemia. Associated signs and symptoms include drowsiness, malaise, and signs of dehydration. Signs of hypovolemic shock appear with progressive dehydration and plasma loss.

Toxic megacolon (acute)

Acute toxic megacolon is a life-threatening complication of infectious or ulcerative colitis. It produces dramatic abdominal distention that usually develops gradually and is accompanied by a tympanic percussion note, diminished or absent bowel sounds, and mild rebound tenderness. The patient also presents with abdominal pain and tenderness, fever, tachycardia, and dehydration.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Amenorrhea: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Adrenal tumor

In a patient with an adrenal tumor, amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic changes. Asymmetrical ovarian enlargement in conjunction with rapid onset of virilizing signs is usually indicative.

Adrenocortical hyperplasia

In a patient with adrenocortical hyperplasia, amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism typically appear.

Adrenocortical hypofunction

Besides amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.

Anorexia nervosa

Anorexia nervosa, a psychological disorder, can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.

Congenital absence of the ovaries and uterus

Congenital absence of the ovaries and uterus results in primary amenorrhea and absence of secondary sex characteristics. Primary amenorrhea occurs with congenital absence of the uterus. The patient may not develop breasts.

Corpus luteum cysts

Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.

Hypothyroidism

Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.

Pituitary infarction

Pituitary infarction usually causes postpartum failure to lactate and failure to resume menses. Although associated signs and symptoms depend on the infarction’s severity, they include headaches, visual field defects, oculomotor palsies, and an altered level of consciousness. The patient may also lose pubic and axillary hair.

Pituitary tumor

Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache, vision disturbances such as bitemporal hemianopia, and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.

Polycystic ovary syndrome

In polycystic ovary syndrome, menarche typically occurs at a normal age and is followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea or periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany this disorder.

Pseudoamenorrhea

With pseudoamenorrhea, an anatomic anomaly such as imperforate hymen obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.

Testicular feminization

Primary amenorrhea may signal testicular feminization, a form of male pseudohermaphroditism. The patient, outwardly female but genetically male, shows breast and external genital development but scant or absent pubic hair.

Thyrotoxicosis

Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.

Turner’s syndrome

Primary amenorrhea and failure to develop secondary sex characteristics may signal Turner’s syndrome, a syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.

Other causes

Drugs

Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they’re discontinued.

Radiation therapy

Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.

Surgery

Surgical removal of both ovaries or the uterus produces amenorrhea.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Abdominal distention: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Abdominal cancer.Generalized abdominal distention may occur when the cancer—most commonly ovarian, hepatic, or pancreatic—produces ascites (usually in a patient with a known tumor). It's an indication of advanced disease. Shifting dullness and a fluid wave accompany distention. Associated signs and symptoms may include severe abdominal pain, an abdominal mass, anorexia, jaundice, GI hemorrhage (hematemesis or melena), dyspepsia, and weight loss that progresses to muscle weakness and atrophy.

Abdominal trauma.When brisk internal bleeding accompanies trauma, abdominal distention may be acute and dramatic. Associated signs and symptoms of this life-threatening disorder include abdominal rigidity with guarding, decreased or absent bowel sounds, vomiting, tenderness, and abdominal bruising. Pain may occur over the trauma site, or over the scapula if abdominal bleeding irritates the phrenic nerve. Signs of hypovolemic shock (such as hypotension and rapid, thready pulse) appear with significant blood loss.

Cirrhosis.In cirrhosis, ascites causes generalized distention and is confirmed by a fluid wave, shifting dullness, and a puddle sign. Umbilical eversion and caput medusae (dilated veins around the umbilicus) are common. The pa-tient may report a feeling of fullness or weight gain. Associated findings include vague abdominal pain, fever, anorexia, nausea, vomiting, constipation or diarrhea, bleeding tendencies, severe pruritus, palmar erythema, spider angiomas, leg edema, and possibly splenomegaly. Hematemesis, encephalopathy, gynecomastia, or testicular atrophy may also be seen. Jaundice is usually a late sign. Hepatomegaly occurs initially, but the liver may not be palpable if the patient has advanced disease.

Heart failure.Generalized abdominal distention due to ascites typically accompanies severe cardiovascular impairment and is confirmed by shifting dullness and a fluid wave. Signs and symptoms of heart failure are numerous and depend on the disease stage and degree of cardiovascular impairment. Hallmarks include peripheral edema, jugular vein distention, dyspnea, and tachycardia. Common associated signs and symptoms include hepatomegaly (which may cause right upper quadrant pain), nausea, vomiting, a productive cough, crackles, cool extremities, cyanotic nail beds, nocturia, exercise intolerance, nocturnal wheezing, diastolic hypertension, weight gain, and cardiomegaly.

Irritable bowel syndrome.Irritable bowel syndrome may produce intermittent, localized distention—the result of periodic intestinal spasms. Lower abdominal pain or cramping typically accompanies these spasms. The pain is usually relieved by defecation or by passage of intestinal gas and is aggravated by stress. Other possible signs and symptoms include diarrhea that may alternate with constipation or normal bowel function, nausea, dyspepsia, straining and urgency at defecation, a feeling of incomplete evacuation, and small, mucus-streaked stools.

Large-bowel obstruction.Dramatic abdominal distention is characteristic in this life-threatening disorder; in fact, loops of the large bowel may become visible on the abdomen. Constipation precedes distention and may be the only symptom for days. Associated findings include tympany, high-pitched bowel sounds, and the sudden onset of colicky lower abdominal pain that becomes persistent. Nausea, fecal vomiting, and diminished peristaltic waves and bowel sounds are late signs.

Mesenteric artery occlusion (acute). In this life-threatening disorder, abdominal distention usually occurs several hours after the sudden onset of severe, colicky periumbilical pain accompanied by rapid (even forceful) bowel evacuation. The pain later becomes constant and diffuse. Related signs and symptoms include severe abdominal tenderness with guarding and rigidity, absent bowel sounds and, occasionally, a bruit in the right iliac fossa. The patient may also experience vomiting, anorexia, diarrhea, or constipation. Late signs include fever, tachycardia, tachypnea, hypotension, and cool, clammy skin. Abdominal distention or GI bleeding may be the only clue if pain is absent.

Paralytic ileus.Paralytic ileus, which produces generalized distention with a tympanic percussion note, is accompanied by absent or hypoactive bowel sounds and, occasionally, mild abdominal pain and vomiting. The patient may be severely constipated or may pass flatus and small, liquid stools.

Peritonitis.Peritonitis is a life-threatening disorder in which abdominal distention may be localized or generalized, depending on the extent of the inflammation. Fluid accumulates within the peritoneal cavity and then within the bowel lumen, causing a fluid wave and shifting dullness. Typically, distention is accompanied by sudden and severe abdominal pain that worsens with movement, rebound tenderness, and abdominal rigidity.

The skin over the patient's abdomen may appear taut. Associated signs and symptoms usually include hypoactive or absent bowel sounds, fever, chills, hyperalgesia, nausea, and vomiting. Signs of shock, such as tachycardia and hypotension, appear with significant fluid loss into the abdomen.

Small-bowel obstruction.Abdominal distention is characteristic in small-bowel obstruction, a life-threatening disorder, and is most pronounced during late obstruction, especially in the distal small bowel. Auscultation reveals hypoactive or hyperactive bowel sounds, whereas percussion produces a tympanic note. Accompanying signs and symptoms include colicky periumbilical pain, constipation, nausea, and vomiting; the higher the obstruction, the earlier and more severe the vomiting. Rebound tenderness reflects intestinal strangulation with ischemia. Associated signs and symptoms include drowsiness, malaise, and signs of dehydration. Signs of hypovolemic shock appear with progressive dehydration and plasma loss.

Toxic megacolon (acute).Toxic megacolon is a life-threatening complication of infectious or ulcerative colitis. It produces dramatic abdominal distention that usually develops gradually and is accompanied by a tympanic percussion note, diminished or absent bowel sounds, and mild rebound tenderness. The patient also presents with abdominal pain and tenderness, fever, tachycardia, and dehydration.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

Amenorrhea: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Adrenal tumor.Amenorrhea may be accompanied by acne, thinning scalp hair, hirsutism, increased blood pressure, truncal obesity, and psychotic personality changes. Asymmetrical ovarian enlargement in conjunction with the rapid onset of virilizing signs is usually indicative of an adrenal tumor.

Adrenocortical hyperplasia.Amenorrhea precedes characteristic cushingoid signs, such as truncal obesity, moon face, buffalo hump, bruises, purple striae, hypertension, renal calculi, psychiatric disturbances, and widened pulse pressure. Acne, thinning scalp hair, and hirsutism typically appear.

Adrenocortical hypofunction.In addition to amenorrhea, adrenocortical hypofunction may cause fatigue, irritability, weight loss, increased pigmentation (including bluish black discoloration of the areolas and mucous membranes of the lips, mouth, rectum, and vagina), nausea, vomiting, and orthostatic hypotension.

Amenorrhea-lactation disorders.Amenorrhea-lactationdisorders, such as Forbes-Albright and Chiari-Frommel syndromes, produce secondary amenorrhea accompanied by lactation in the absence of breast-feeding. Associated features include hot flashes, dyspareunia, vaginal atrophy, and large, engorged breasts.

Anorexia nervosa.Anorexia nervosa can cause either primary or secondary amenorrhea. Related findings include significant weight loss, a thin or emaciated appearance, compulsive behavior patterns, a blotchy or sallow complexion, constipation, reduced libido, decreased pleasure in once-enjoyable activities, dry skin, loss of scalp hair, lanugo on the face and arms, skeletal muscle atrophy, and sleep disturbances.

Congenital absence of the ovaries.Congenital absence of the ovaries results in primary amenorrhea and the absence of secondary sex characteristics.

Congenital absence of the uterus.Primary amenorrhea occurs with congenital absence of the uterus. The patient may develop breasts.

Corpus luteum cysts.Corpus luteum cysts may cause sudden amenorrhea as well as acute abdominal pain and breast swelling. Examination may reveal a tender adnexal mass and vaginal and cervical hyperemia.

Hypothalamic tumor.In addition to amenorrhea, a hypothalamic tumor can cause endocrine and visual field defects, gonadal underdevelopment or dysfunction, and short stature.

Hypothyroidism.Deficient thyroid hormone levels can cause primary or secondary amenorrhea. Typically vague, early findings include fatigue, forgetfulness, cold intolerance, unexplained weight gain, and constipation. Subsequent signs include bradycardia; decreased mental acuity; dry, flaky, inelastic skin; puffy face, hands, and feet; hoarseness; periorbital edema; ptosis; dry, sparse hair; and thick, brittle nails. Other common findings include anorexia, abdominal distention, decreased libido, ataxia, intention tremor, nystagmus, and delayed reflex relaxation time, especially in the Achilles tendon.

Mosaicism.Mosaicism results in primary amenorrhea and the absence of secondary sex characteristics.

Ovarian insensitivity to gonadotropins.A hormonal disturbance, ovarian insensitivity to gonadotropins leads to amenorrhea and an absence of secondary sex characteristics.

Pituitary tumor.Amenorrhea may be the first sign of a pituitary tumor. Associated findings include headache; visual disturbances, such as bitemporal hemianopsia; and acromegaly. Cushingoid signs include moon face, buffalo hump, hirsutism, hypertension, truncal obesity, bruises, purple striae, widened pulse pressure, and psychiatric disturbances.

Polycystic ovary syndrome.Typically, menarche occurs at a normal age, followed by irregular menstrual cycles, oligomenorrhea, and secondary amenorrhea. Periods of profuse bleeding may alternate with periods of amenorrhea. Obesity, hirsutism, slight deepening of the voice, and enlarged, “oysterlike” ovaries may also accompany this disorder.

Pseudoamenorrhea.An anatomic anomaly, such as imperforate hymen, obstructs menstrual flow, causing primary amenorrhea and, possibly, cyclic episodes of abdominal pain. Examination may reveal a pink or blue bulging hymen.

Pseudocyesis.With pseudocyesis, amenorrhea may be accompanied by lordosis, abdominal distention, nausea, and breast enlargement.

Testicular feminization.Primary amenorrhea may signal this form of male pseudohermaphroditism. The patient, outwardly female but genetically male, shows breast and external genital development but scant or absent pubic hair.

Thyrotoxicosis.Thyroid hormone overproduction may result in amenorrhea. Classic signs and symptoms include an enlarged thyroid (goiter), nervousness, heat intolerance, diaphoresis, tremors, palpitations, tachycardia, dyspnea, weakness, and weight loss despite increased appetite.

Turner's syndrome.Primary amenorrhea and failure to develop secondary sex characteristics may signal this syndrome of genetic ovarian dysgenesis. Typical features include short stature, webbing of the neck, low nuchal hairline, a broad chest with widely spaced nipples and poor breast development, underdeveloped genitalia, and edema of the legs and feet.

Uterine hypoplasia.Primary amenorrhea results from underdevelopment of the uterus, which is detectable on physical examination.

Other causes

Drugs.Busulfan, chlorambucil, injectable or implanted contraceptives, cyclophosphamide, and phenothiazines may cause amenorrhea. Hormonal contraceptives may cause anovulation and amenorrhea after they're discontinued.

Radiation therapy.Irradiation of the abdomen may destroy the endometrium or ovaries, causing amenorrhea.

Surgery.Surgical removal of both ovaries or the uterus produces amenorrhea.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

Low birth weight: Medical causes
(Nursing: Interpreting Signs and Symptoms)

This section lists some fetal and placental causes of low birth weight as well as the associated signs and symptoms present in the neonate at birth.

Chromosomal aberrations.Abnormalities in the number, size, or configuration of chromosomes can cause low birth weight and possibly multiple congenital anomalies in a premature or SGA neonate. For example, a neonate with trisomy 21 (Down syndrome) may be SGA and have prominent epicanthal folds, a flat-bridged nose, a protruding tongue, palmar simian creases, muscular hypotonia, and an umbilical hernia.

Cytomegalovirus infection.Although low birth weight in cytomegalovirus infection is usually associated with premature birth, the neonate may be SGA. Assessment at birth may reveal these classic signs: petechiae and ecchymoses, jaundice, and hepatosplenomegaly, which increases for several days. The neonate may also have a high fever, lymphadenopathy, tachypnea, and dyspnea, along with prolonged bleeding at puncture sites.

Placental dysfunction.With placental dysfunction, low birth weight and a wasted appearance occur in an SGA neonate. He may be symmetrically short or may appear relatively long for his low weight. Additional findings reflect the underlying cause. For example, if maternal hyperparathyroidism caused placental dysfunction, the neonate may exhibit muscle jerking and twitching, carpopedal spasm, ankle clonus, vomiting, tachycardia, and tachypnea.

Rubella (congenital).Usually, the low-birth-weight neonate with congenital rubella is born at term but is SGA. A characteristic “blueberry muffin” rash accompanies cataracts, purpuric lesions, hepatosplenomegaly, and a large anterior fontanel. Abnormal heart sounds, if present, vary with the type of associated congenital heart defect.

Varicella (congenital).With congenital varicella, low birth weight is accompanied by cataracts and skin vesicles.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

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