The transport mechanism of monosaccharides across the intestinal mucosal cells.

o   Monosaccharides are formed by single saccharide molecules.

o   We normally talk about glucose, fructose & galactose as monosaccharides. There are so many except these three.

o   When we talk about starches, they are digested to various types of monosaccharides, disaccharides by gut enzymes secreted from various organs like pancreas.

o   There are same enzymes which digest disaccharides to monosaccharides. They are placed on brush border of the mucosal cells. Isomoltase, Moltase, Sucrose.

o   After the digestion final product is monosaccharides & they are transported across the intestinal mucosal cells to the portal system by various transport mechanisms.

How G protein help in signal transmission in to the cell from an incoming ligand & outline the steps.

• Ligand bind G protein coupled receptor which has α ,β & γ subunits.
• After binding, GTP in α dissociates from β & γ( all 3 subunits can produce physiological effects)
• Causes production of a 2^nd messenger eg:-cAMP via activation of adenylyl cyclase.
• cAMP produce activated protein kinase A( pK_A)  à  pK_A phosphorylate certain molecules & activate /inhibit  à brings about the physiological action
• When work is done , intrinsic GTPase activity of GTP-α converts GTP to GDP   à α ,β & γ subunits reassociates  à action terminates.

Management of Postpartum Collapse

COLLAPSE

Before delivery	After delivery	After 3rd stage
Rupture uterus	PPH – During 3rd stage	Ruptured uterus
Amniotic fluid embolism		Uterine inversion

 

RUPTURED UTERUS

History

• Past caesarean section
• Grand multigravida
• Multigravida given oxytocin during labour
• Almost never in primigravida - except following manipulations or previous uterine scar e.g. myomectomy

Management of Postpartum Collapse - AMNIOTIC FLUID EMBOLISM



Presentation

• Extremely sudden severe shock with severe dyspnoea, cyanosis Pulmonary oedema
• Blood stained frothy sputum
• Convulsions may occur  

Onset

• Usually immediately after membranes rupture however it can occur even with intact membranes occurs during strong uterine contractions
• Usually fatal 

Management of Postpartum Collapse - CONVULSIONS

Convulsions may be due to eclampsia, epilepsy, malaria, head injury, cerebral abscess, meningitis, encephalitis, etc.

Whatever the cause, initial steps are the same.

• Stop the fits
• Maintain airway
• Prevent aspiration
• Prevent injuries

Immediate care :

• Position the patient - head low, turn to a side
• airway - plastic or metal
• Suck the mouth and pharynx
• Place cushions around the patient or tie the limbs loosely with soft cloth