11 Liver Disorders Flashcards
Acute Fatty Liver of Pregnancy - pathophys
Idiopathic condition generally arising in the third trimester. It is believed to be caused by a metabolic abnormality (increased fatty acid metabolised) in the foetus resulting in maternal liver damage and potential maternal/fetal mortality. Very rare
Risk factors: multigravid, male foetus, coexisting diagnosis of other liver disease of pregnancy, previous episode of AFL
HELLP Syndrome - pathophys
- A variant of preeclampsia that results in high mortality and morbidity for the woman and foetus. Can occur without a diagnosis of PE in some conditions.
- Platelets used up due to inappropriate production of microemboli
- 10-20% of women with preeclampsia are complicated by HELLP
- Potential complications: anaemia, placental abruption, ICU admission following delivery,
Hyperemesis Gravidarum (HG) - pathophys
- Intractable vomiting during pregnancy leading to weight loss and volume depletion, resulting in ketonuria and/or ketonemia
- Believed to be caused by a rapidly rising blood level of human chorionic gonadotropin (HCG)
Disseminated intravascular coagulation (DIC) - pathophys
- A disease secondary to those that cause hypercoagulation and haemorrhage
- The body’s ability to regulate coagulation is disrupted, causing platelet aggregation and consumption of clotting factors. Aka endothelial cell damage and platelet injury. Fibrin levels increase causing ischaemic damage
AFL - signs & symptoms, medical management
- Nausea and vomiting
- Encephalopathy
- Abdominal pain
- Jaundice
- Polydipsia and polyuria
- Hypoglycaemia
- Prompt delivery
- Review of coagulopathy and laboratory results
- Potential ICU admission
HELLP - signs & symptoms, medical management
- Preeclampsia (10-20%)
- Severe epigastric pain
- Vomiting
- Hypertension
- Proteinuria
- Peripheral oedema
- Bleeding
- Hypotension and shock
- Tachycardia
- Decreased urinary output
- Prompt delivery
- Bloods to diagnose & LFTs
- Midwifery care in the antenatal period regarding education on escalation of PE to HELLP
- Magnesium sulphate to prevent seizures
- Antihypertensives & anticonvulsants
DIC - signs & symptoms, medical management
- Bleeding
- Hypotension and shock
- Tachycardia
- Decreased urinary output
- Monitor for signs of shock, haemorrhage, thrombosis, and sepsis
- Red blood cell administration, fresh plasma, platelets, other clotting factors such as Vitamin K may be administered. Heparin
HG - signs and symptoms, medical management
- Severe nausea and vomiting
- Loss of weight (>5%)
- Urine ketones
- Electrolyte imbalance (hypokalaemia, hypomagnesemia, metabolic acidosis)
- Abnormal renal function tests
- ?GDF 15 gene
- IV fluids to replace lost intravascular volume
- Referral to psychosocial supports
- Encourage oral hydration
- Antiemetics
- MCS
- Bloods for electrolytes
- BGL and ketones
- Regular weights (weekly)
- Nutritional assessment & FBC
- US
- Small manageable meals
- 4 hourly vital signs
- MEDS: Pyridoxine (Vit B 12), Prochlorperazine, Doxylamine, Promethazine, Maxalone, Ondansetron (know dose and routes)
Polymorphic eruption of pregnancy
An immune response to collagen damage which occurs as the abdomen stretches during pregnancy, resulting in visible lesions on the skin. Can be itchy, appears at the lower abdomen, proximal thighs, buttocks, area under breasts
No risk to mother or baby. Self care such as sensitive soaps and short nails. Moderate topical corticosteroids may be used. Antihistamine medication. Potential dermatologist referral for oral corticosteroids if worsening
Atopic eruption of pregnancy
Women with a hx of atopic dermatitis are prone. Thought to be caused by immunological changes in pregnancy. Can look similar to eczema - lesions on face, neck, chest, upper limbs. Presence of small, erythematous papules on trunk and limbs, pruritic nodules on limbs
No harm to mother or baby however is likely to reoccur in subsequent pregnancies. Risk of fetal atopic diseases in future. Emollients, topical corticosteroids, oral corticosteroids, phototherapy
Pemphigoid gestationist
Rare autoimmune condition. Intense pruritus following the appearance of a rash. Begins at the umbilical region and can progress to the body. Erythematous papules and plaques can be seen, forming to blisters
Risk of preterm delivery, low infant birth weight, newborn rash, and flare ups. Corticosteroids, antihistamines, antenatal monitoring
ICP/Obstetric cholestasis
Itch without a rash. Severe pruritus, can cause severe fetal complications if untreated. Pruritus, particularly of the hands and feet in the absence of a rash. Jaundice (25%). Dark urine
LFTs, hospital admission, GP
