Cholestasis Of Pregnancy

Question 0

Pruritic urticarial papules and plaques of pregnancy - etiology? Sx? Findings?

Answer 0

Skin condition of unknown etiology

Intensive pruritus and erythematous papules on abdomen and extremities

Question 1

Cholestasis in pregnancy? Symptoms? Symptoms usually occur when? Confirm Diagnosis with?

Answer 1

Intrahepatic cholestasis (unknown etiology)

pruritus +/- jaundice, with NO skin rash

Night

Increased circulating bile acid levels

Question 2

Herpes gestationis?

Answer 2

Skin condition only seen pregnancy – intense itching and vesicles/tense bullae on abdomen and extremities

Question 3

Intrahepatic cholestasis of pregnancy – can recur with?

Answer 3

Subsequent pregnancies and ingestion of OCP

Question 4

Intrahepatic cholestasis pregnancy – LFTs? Tx?

Answer 4

Not necessarily elevated but may be over 1000

Ursodeoxycholic acid (less effective: hydroxyzine, cholestyramine)

Question 5

Intrahepatic cholestasis – Effects on the mother? fetus?

Answer 5

No hepatic sequelae, but increased incidence of

1. Gallstones
2. recurrence in subsequent pregnancies
3. prematurity
4. fetal distress/Meconium aspiration
5. fetal loss

Question 6

Intrahepatic cholestasis of pregnancy – treatment? Previously used?

Answer 6

Antihistamines and cornstarch baths, ursodeoxycholic acid

Bile salt binder, cholestyramine has been associated with vitamin K deficiency

Question 7

Herpes gestationis – Relationship to HSV? Begins when? Etiology?

Answer 7

None; second trimester

Possibly autoimmune – IgG antibodies directed at basement membrane

Question 8

Herpes gestationis – areas most affected? Definitive diagnosis by? Tx?

Answer 8

Arms;

Immunofluorescent examination biopsy specimens

Oral corticosteroids

Question 9

Herpes gestationis – effects on fetus? On neonates?

Answer 9

IUGR, stillbirth

Transient neonatal herpes gestationis

Question 10

Progression of PUPPP? Description of lesions?

Answer 10

Begins on abdomen, spreads to thighs, butt, arms

Erythematous urticarial plaques surrounded by narrow pale halo

Question 11

PUPPP – immunofluroescent studies show? Immunologic findings? Effects on fetus? Treatment?

Answer 11

Negative for IgG and complement

Normal epidermis with superficial perivascular infiltrate of lymphocytes and histiocytes of papillary dermis

No adverse effect on fetal/maternal outcome

Steroids and antihistamines

Question 12

Cause of intrafollicular bleeding?

Answer 12

Thin-walled capillaries invade granulosa cells from theca interna

Question 13

Status and Drug therapy that predisposes to cyst rupture? Prevent by?

Answer 13

Pregnancy and Anticoagulation; more drugs to prevent ovulation

Question 14

Symptoms of hemorrhagic corpus lutea? Prior to rupture?

Answer 14

Severe onset of severe lower abdominal pain (especially with hemoperitoneum)

Unilateral cramping and lower abdominal pain for 1 to 2 weeks before rupture

Question 15

Most common times for corpus luteum cyst rupture?

Answer 15

The 20-26 of menstrual cycle

Question 16

Differential diagnosis for suspected hemorrhagic corpus luteum?

Answer 16

Ectopic pregnancy, ruptured endometrioma, adnexal torsion, appendicitis, splenic injury/rupture

Question 17

Ultrasound findings of hemorrhagic corpus luteum? Confirm diagnosis by?

Answer 17

Free intraperitoneal fluid and fluid around ovary

Laparoscopy

Question 18

Treatment of ruptured luteal cyst?

Answer 18

Secure homeostasis

If bleeding stops, no further therapy
If bleeding continues, cystectomy

Question 19

Corpus luteum produces? Until? Corpus luteum maintained by? What takes over?

Answer 19

It progesterone, 10 weeks,

Beta hCG; placental steroidogenesis

Question 20

If corpus luteum removed prior to 12 weeks gestation, patient needs?

Answer 20

Exogenous progesterone to sustain pregnancy

Question 21

Patient with localized tenderness over fibroid in pregnancy? Mechanism?

Answer 21

Degenerating leiomyoma;

Estrogen causes rapid growth of fibroid, fibroid out-grows blood supply leading to ischemia and pain

Question 22

Pain in ovarian torsion?

Answer 22

Colicky abdominal pain

Question 23

Movement of appendix in pregnancy? Movement of gallbladder?

Answer 23

Superiorly and laterally; does not move

Question 24

Earliest sign of hypovolemia?

Answer 24

Decreased urine output > positive tilt test > tachycardia > hypotension