011315 liver dis in pregnancy Flashcards
liver disease and pregancy share what symptoms
spider angiomata, palmar erythema
decreased gallbaldder contractility (stones)
increased alkaline phosphatase
etc
hyperemesis gravidarum occurs in what trimester
first
hyperemesis gravidarum
vomiting repeatedly throughout day–dehydration, electrolyte abnormalities
ALT raised 2-3 fold, can reach 20 fold
intrahepatic cholestasis of pregnancy–consequences
pruritis resolving within 2 days of pregnancy
increased risk of prematurity, perinatal deaths, fetal distress
what trimester does IHCP typically occur
3rd trimester
what labs do you see in IHCP
serum bile acids increased 30-100 fold (deposits in skin to cause severe pruritis)
up to 4 fold AST/ALT elevation
tx for IHCP
supportive:
cholestyramine (binds bile acids)
ursodeoxycholic acid (modifies bile acid pool and inhibitis absorption of more hydrophobic bile acids)
preeclampsia
HTN, proteinuria, edema
AST and ALT elevation in 25-50%
when does precclampsia and eclampsia occur
after 20 wks usually
eclampsia
preeclampsia and seizures
AST and ALT elevations in 80-90%
acute fatty liver of preganancy occurs when
3rd trimester
acute fatty liver of pregnancy-its etiology?
fatty acid oxidation defects in fetus (long chain 3 hydroxyacyl coenzyme dehydrogenase deficiency in a fetus with heterozygous mother)
in acute fatty liver pregnancy–20-40% of its pts have?
preeclampsia
symptoms of AFLP
mild liver test abnormalities
severe jaundice, coagulopathy and encepathlopathy (so fulminant liver failure)
HELLP syndrome
hemolytic anemia
elevated liver tests (blirubin, ALT, AST)
low platelets (not the same mechanism as cirrhosis)
