Anatomy and Physiology

The main involved organ in hyperemesis is the hypothalamus, brainstem, placenta, and ovaries.

Hyperemesis Gravidarum is said to be caused by the growth differentiation factor 15 or more commonly
known as GDF15. GDF15 is a regulator of physiological body weight and appetite via activation of
neurons in the hypothalamus and area postrema (vomiting center) of the brainstem.

(From the study performed by a geneticist, it is said na yung HG or Hyperemesis Gravidarum is caused by
a hormone released during pregnancy which is yung GDF15. Yung gdf15 works with the hypothalamus
and postrema to make the nausea and vomiting happen. And according din from the previous study,
yung level ng human chorionic gonadotrophin or hCG is one of the causes din)

Hypothalamus - the hypothalamus is an integral part of the brain. It is a small cone-shaped structure
that projects downward from the brain. Also, with the activation of neurons in hypothalamus acts with
postrema of the brainstem in making nausea and vomiting happen.

(Sa hypothalamus is yung part kung saan nangyayari yung activation ng mga neurons sa hypothalamus
together with the postrema or yung vomit inducing center.)

Brainstem - is the distal part of the brain that is made up of the midbrain, pons, and medulla oblongata.
In medulla oblongata lies the postrema which acts as the vomit-inducing center of the brain.

(As I have said earlier eto yung vomit-inducing center ng brain and it works together with the
hypothalamus in making hyperemesis happen)
Placenta Placenta is a disc like structure that forms a connection between the embryo and the uterine
wall. It consists of numerous villi that increases the surface area for absorption. It is an organ of
exchange that provides oxygen and nutrients to fetus and removes waste produced by fetus. Human
chorionic gonadotrophin (hCG) is produced in the placenta.

(In placenta kasi, it is where yung hcg or human chorionic gonadotrophin is made. And if sobrang taas ng
ng hcg, sab isa studies before, it may be the cause of severe nausea and vomiting.)

On the other hand the main affected organ is;

Ovaries - are the female pelvic reproductive organs that house the ova and are also responsible for the
production of sex hormones (estrogen and progesterone). They are paired organs located on either side
of the uterus within the broad ligament below the uterine (fallopian) tubes. Also, in the ovaries is where
corpus luteum located, and hCG stimulates this to produce one of the sex hormones, the progesterone.

(this organ naman is the affected organ in secretion din ng hormone sa hcg, ini stiumulate kasi ng hcg
yung corpus luteum na mag secrete ng isa pang hormone which is yung progesterone. This affects na the
pregnancy of the pregnant woman.)

Pathophysiology
Book-based

Although the exact cause of nausea and vomiting is unknown, its effects— decreased placental blood
flow, decreased maternal blood flow, and acidosis— can threaten the health of the mother and fetus.
Dehydration can also lead to preterm labor (Smith et al., 2016). Numerous theories abound, but few
studies have produced scientific evidence to identify the etiology of this condition. It is likely that
multiple factors contribute to it.

Elevated levels of hCG are present in all pregnant women during early pregnancy, usually declining after
12 weeks. This corresponds to the usual duration of morning sickness. In hyperemesis gravidarum, the
hCG levels are often higher and extend beyond the first trimester. Symptoms exacerbate the disease.
Decreased fluid intake and prolonged vomiting cause dehydration; dehydration increases the serum
concentration of hCG, which in turn exacerbates the nausea and vomiting—a vicious cycle (Ricci, 2018).

So the main causes of the hyperemesis are the GDF15, high level of hcg, and hereditary. As from the
case study, the first data that we collected as the factor in hyperemesis is hereditary. We can conclude
na nakuha niya yung sakit with her mother. And hcg as I’ve said earlier, it is a hormone that is produce
naturally in pregnancy but when the level of production is too much, it causes nausea and vomiting. And
lastly is the GDF15 this is another hormone naman and it is also produce during pregnancy, and
hypothalamus and postrema works together with this hormone as said to be one of the causes of
hyperemesis.

And when neither one of these acts it causes excess vomiting and nausea kung saan because of the
severeness na po it causes abnormal potassium and sodium level which then causes ng panghihina or
extreme weakness katulad ng kay Mrs. K. Up to the point the hindi na niya makayanan tumayo and she
needed to use a wheelchair na.

And severe vomiting and nausea causes an appetite disturbance, where the mother cannot eat properly,
katulad kay mrs. K, just after 2 weeks, she already loss 5 pounds na, and kasama din dito yung hindi
pagkain niya ng meal maybe for an entire day or probably several days, which causes naman ng increase
ng ketone in urine aside dito syempre kapag hindi proper yung meals makaka experience po talaga ng
dizziness kasi di na enough yung energy source sa body,

which we can also see sa case ni Mrs. K. and within sa appetite disturbance, it also causes dehydration
and weight loss. Syempre po kapag hindi matino yung meals ni mother mangangayayat talaga siya and
madedehydrate, and from the data collected from Mrs. K, she shows several signs and symptoms of
dehydration, these includes po yung signs of pallor or pamumutla, increase in urine specific gravity
which happens because of not drinking enough fluid, and loss of too much fluid tulad po ng excessive
vomiting and nausea. Next is yung mababa po yung bp niya which shows na hypotensive siya this can
also be the reason ng dizziness niya, and lastly po is yung dry tongue, of course dehydrated si Mrs. K this
is and indication na kulang na kulang po siya ng fluid. And when hyperemesis is not alleviated pwede po
mag cause ng preterm delivery, stillbirth, and Wernicke’s encephalopathy .

PPT (Guide)

ANATOMY AND PHYSIOLOGY

Hyperemesis Gravidarum is said to be caused by the growth differentiation factor 15 or more commonly
known as GDF15. GDF15 is a regulator of physiological body weight and appetite via activation of
neurons in the hypothalamus and area postrema (vomiting center) of the brainstem.

The main organs involved in hyperemesis are the:

• Hypothalamus

• Brainstem

• Placenta and;

• Ovaries
PATHOPHYSIOLOGY

(insert pic from docu)

SCRIPT:

Hyperemesis Gravidarum is said to be caused by the growth differentiation factor 15 or more commonly
known as GDF15. GDF15 is a regulator of physiological body weight and appetite via activation of
neurons in the hypothalamus and area postrema (vomiting center) of the brainstem.

(From the study performed by a geneticist, it is said na yung HG or Hyperemesis Gravidarum is caused by
a hormone released during pregnancy which is yung GDF15. Yung gdf15 works with the hypothalamus
and postrema to make the nausea and vomiting happen. And according din from the previous study,
yung level ng human chorionic gonadotrophin or hCG is one of the causes din.

The main organs involved in hyperemesis are the:

• Hypothalamus

• Brainstem

• Placenta and;

• Ovaries

It is a small cone-shaped structure that projects downward from the brain. Sa hypothalamus is yung part
kung saan nangyayari yung activation ng mga neurons sa hypothalamus together with the postrema or
yung vomit inducing center.

As I have said earlier yung postrema naman is can be found sa may brainstem specifically sa may
medulla oblongata. Eto yung vomit-inducing center ng brain and it works together with the
hypothalamus in making hyperemesis happen.

Next is yung placenta another organ involve sa hyperemesis, although temporary organ lang yung
placenta, it plays a great role during the pregnancy. Placenta is a disc like structure that forms a
connection between the embryo and the uterine wall. In placenta kasi, it is where yung hcg or human
chorionic gonadotrophin is made. And if sobrang taas ng ng hcg, sab isa studies before, it may be the
cause of severe nausea and vomiting.

Lastly is yung ovaries, it is responsible for the production of sex hormones (estrogen and progesterone).
this organ naman is the affected organ in secretion din ng hormone sa hcg, ini stiumulate kasi ng hcg
yung corpus luteum na mag secrete ng isa pang hormone which is yung progesterone. This affects na the
pregnancy of the pregnant woman.

PATHOPHYSIOLOGY

So the main causes of the hyperemesis are the GDF15, high level of hcg, and hereditary. As from the
case study, the first data that we collected as the factor in hyperemesis is hereditary. We can conclude
na nakuha niya yung sakit with her mother. And hcg as I’ve said earlier, it is a hormone that is produce
naturally in pregnancy but when the level of production is too much, it causes nausea and vomiting. And
lastly is the GDF15 this is another hormone naman and it is also produce during pregnancy, and
hypothalamus and postrema works together with this hormone as said to be one of the causes of
hyperemesis. And when neither one of these acts it causes excess vomiting and nausea kung saan
because of the severeness na po it causes a drop of potassium and sodium level which then causes ng
panghihina katulad ng kay Mrs. K. Up to the point the hindi na niya makayanan tumayo and she needed
to use a wheelchair na. And severe vomiting and nausea causes an appetite disturbance, where the
mother cannot eat properly, katulad kay mrs. K, just after 2 weeks, she already loss 5 pounds na, and
kasama din dito yung hindi pagkain niya ng meal maybe for an entire day or probably several days,
which causes naman ng increase ng ketone in urine aside dito syempre kapag hindi proper yung meals
makaka experience po talaga ng dizziness kasi di na enough yung glucose sa blood mo, which we can
also see sa case ni Mrs. K. and within sa appetite disturbance, it also causes dehydration and weight loss.
Syempre po kapag hindi matino yung meals ni mother mangangayayat talaga siya and madedehydrate,
and from the data collected from Mrs. K, she shows several signs and symptoms of dehydration, these
includes po yung signs of pallor or pamumutla, increase in urine specific gravity which happens because
of not drinking enough fluid, and loss of too much fluid tulad po ng excessive vomiting and nausea. Next
is yung mababa po yung bp niya which shows na hypotensive siya this can also be the reason ng
dizziness niya, and lastly po is yung dry tongue, of course dehydrated si Mrs. K this is and indication na
kulang na kulang po siya ng fluid. And when hyperemesis is not alleviated pwede po mag cause ng
preterm delivery, stillbirth, and Wernicke’s encephalopathy .

HYPEREMESIS

 Hereditary
 High Levels of hCG
 GDF15

Excessive Vomiting Low level potassium

and Nausea and sodium
 Increase
Ketones in Urine
 Dizziness Appetite Disturbance Extreme weakness

Weight Loss Dehydration

 Sign Pallor
 Increase Urine
Specific Gravity
 Low Blood
Pressure
 Dry Tongue