14. Pregnancy and gastrointestinal disorders

Question 1

is cesarean delivery recommended for IBD?

Answer 1

not recommended, unless there are perineal or rectal manifestations of Crohn’s disease.

Question 2

Pregnancy is associated with greater disease activity in patients with?

Answer 2

ulcerative colitis
rather then crohn

Question 3

what preconception counselling should be given to a women with IBD to improve pregnancy outcomes?

Answer 3

1. Adjust nutrition status, administer nutritional supplements (folate, iron, B vitamins).
2. Try to achieve disease control with minimally teratogenic drugs (sulfasalazine, low-dose steroids).
3. targeted biological therapies (monoclonal Ab’s) → shouldn’t be used.

Question 4

when is surgery indicated in IBD?

Answer 4

only for very severe complications (bowel perforation or abscess formation).

Question 5

name the hepatobiliary disorders during pregnancy

Answer 5

1. hyperemesis gravidarum
2. intrahepatic cholestasis of pregnancy (ICP)
3. acute fatty liver of pregnancy
4. HELLP syndrome, severe preeclampsia

Question 6

what does hyperemesis gravidarum cause?

Answer 6

mild elevation of hepatic transaminases during 1st trimester
Usually self-limited and spontaneously resolves

Question 7

what is Intrahepatic cholestasis of pregnancy (ICP)?

Answer 7

Idiopathic cholestasis occurs during the 2nd and 3rd trimesters, resulting in direct hyperbilirubinemia.

Question 8

presentation of Intrahepatic cholestasis of pregnancy (ICP)

Answer 8

Presents with severe pruritus (worse at night) +/- jaundice.

Question 9

treatment for ICP

Answer 9

ursodiol (ursodeoxycholic acid), antihistamine to control symptoms

Question 10

what is acute fatty liver of pregnancy?

Answer 10

Life-threatening disorder, characterized by microvascular fatty infiltration of hepatocytes, leads to severe liver dysfunction.

Usually identified during the 3rd trimester or early after delivery

Question 11

symptoms of acute fatty liver of pregnancy

Answer 11

Initial symptoms may be non-specific; later, patients develop manifestations of acute liver failure (jaundice, encephalopathy, coagulopathy, hypoglycemia).

Question 12

treatment of acute fatty liver of pregnancy

Answer 12

Tx. delivery of the fetus, ICU admission of the mother.

Question 13

what risk is seen in HELLP syndrome?

Answer 13

Risk of subcapsular hematoma +/- rupture and hemorrhagic shock

Question 14

how does HELLP syndrome present

Answer 14

RUQ abdominal pain or epigastric pain.
Increased transaminases > x2 of normal.