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gene or multidrug resistance 3 (MDR3) gene (encoding for a canalicular phospholipid translocator) may be involved in ICP What hormonal factors may be involved in the pathogenesis of ICP What is the cardinal clinical manifestation of ICP that helps distinguish this disease from other liver conditions What do laboratory values reveal in patients with ICP High concentrations of estrogen and excess progesterone may be risk factors for ICP Severe pruritis (especially on the palms and soles of the feet) (Jaundice is present 10% of the time; jaundice without pruritis warrants other causes of liver disease) Increased serum total bile acids (chenodeoxycholic acid, deoxycholic acid, cholic acid) Marked elevation of the cholic/ chenodeoxycholic acid ratio Elevated alkaline phosphatase Elevated total and direct bilirubin Elevated AST and ALT Normal prothrombin time (usually) What are the main liver conditions that must be ruled out Hepatitis (autoimmune and viral) Biliary tract disease Acute fatty liver of pregnancy HELLP syndrome What is the treatment of ICP Treatment is focused on relieving symptoms and preventing maternal and fetal complications Ursodeoxycholic acid (500 mg bid until delivery) has been shown to alleviate pruritis and normalize bile acids and improve liver function test results Early delivery (36 38 weeks) improves symptoms in majority of patients suffering from ICP Can oral contraceptives that contain estrogen be given postpartum Yes Oral contraceptives containing low-dose estrogen can be given after normalization of liver function tests Women should be advised of a potential recurrence of pruritis Fetal death Spontaneous preterm birth Postpartum hemorrhage

Figure 6 - 14

called retained-mode drawing. Conveniently, modern graphics cards know how to draw circles too, so WPF can pass that information to the card to do the work. But screens these days don t know how to draw circles. Everything eventually does get turned into dots, but it s done at the last point of contact, not the first, and that makes a huge difference. Interestingly, monitors used to be able to draw vector-based images (although circles were pushing it). If you ever played some of the old video games like Asteroids or Battle Zone, those games did everything by constantly redrawing vectors to the screen.

Neonatal respiratory syndrome Meconium-stained amniotic fluid What is the rate of recurrence It recurs 60 70% in future pregnancies, but may be milder in severity

Summary

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The operations that have been performed are visible as events that appear on the Event Log tab Once les have been copied, you can view them through Windows Explorer If the disc containing a le is not in the drive when you select it, Simple Trax prompts you to insert the CD containing the le All the les that have been copied appear in the index and Simple Trax records and maintains a list of the le changes over time

In the section about Windows and web UIs, we brought up a number of important points about the ways in which each work. Now that we ve also talked about how WPF works, we d like to revisit those points and compare the old and new worlds:

What is hyperemesis gravidarum It is persistent vomiting typically in the first trimester that is severe enough to cause weight loss, dehydration, acidosis from starvation, alkalosis from vomiting, and hypokalemia It may be related to high or rapidly rising levels of serum estrogen or hCG, or both Elevated levels of hCG or serum thyroxine Elevated levels of serum transaminases (typically <200 IU/L, and ALT > AST) Elevated levels of bilirubin, amylase, lipase, and electrolytes What is the association between hyperthyroidism and hyperemesis gravidarum Although there are biochemical signs of hyperthyroidism (elevated thyroxine levels), this is most likely the effect of hCG on the TSH receptor (seen in 60 70% of patients) Clinical symptoms of hyperthyroidism during hyperemesis gravidarum are not seen First-line pharmacotherapy consists of vitamin B6 or vitamin B6 plus doxylamine Vitamin B1 should also be administered to prevent Wernicke encephalopathy Antiemetics, IV crystalloids, and IV fluids should be given until the vomiting is controlled Mallory-Weiss tears Esophageal rupture Pneumothoraces Pneumomediastinum

Figure 6 - 15

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