Ch 58 Cholestasis of Pregnancy

Question 1

intrahepatic cholestasis of pregnancy is a disease that is induced by pregnancy and resolves following delivery. characterized by

Answer 1

pruritis, icterus (jaundice), or both

Question 2

most women with cholestasis develop puritus in late pregnancy . generalized puritus is usually the presenting symptom. there are no accompanying skin changes unless there are excoriations from scratching. a minority of woemn 10% develop jaundice within several days following puritus.

Answer 2

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Question 3

bile acids are cleared incompletely by the liver and accumulate in plasma of women with cholestasis. serum concentration of total bile acids may be elevated 10-100folid. hyperbilirubinemia results from retention of conjugated pigment, but total plasma concentrations rarely exceed 4-5mg/dl

alkaline phosphatase level is usually elevated more so than for normal pregnancy

changes disappear after delivery but often recur in subsequent pregnancies or when an oral estrogen containing contraceptive is taken

Answer 3

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Question 4

ultrasound examination can serve to exclude cholethiasis or biliary obstruction. acute viral hepatitis is ruled out based on only modest elevations in serum transaminase levels. however, women with chronic hepatits C infection have approximately 20fold increased risk to develop cholestasis of pregnancy

Answer 4

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Question 5

puritus asscoated with cholestasis is caused by elevated serum bile salts and may be troublesome. orally adminsitered antihistamines and topical emollients may provide some relief. Cholestyramine, which binds to bile salts, may be effective at relieving pruritus; however, effect is modest. may result in impairment of fat soluble vitamins, ex vtamin K deficiency. –> fetal coagulopathy with resultant intracranial hemorrhage

Answer 5

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Question 6

URSODEOXYCHOLIC ACID has been reported to quickly relieve puritus and lower serum hepatic enzyme levels in women with obstetric cholestasis.

Answer 6

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Question 7

ursodeoxycholic acid therapy provides superior relief of puritus when compared to cholestyramine.

Answer 7

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Question 8

effect of cholestasis on pregnancy outcome

Answer 8

early reports suggested perinatal mortality was increased in women with cholestasis, but more recent publications have failed to confirm the risk