Gastrointestinal & Nutrition

Question 1

Diagnosis:

1. Marked pruritus
2. Elevated total bile acids AND/OR
3. Elevated aminotransferases

with no evidence of other pathology

Answer 1

Intrahepatic cholestasis of pregnancy (ICP)

ICP is a diagnosis of exclusion after other conditions that cause similar findings have been ruled out.

Question 2

What do you do if a patient with suspected intrahepatic cholestasis of pregnancy (ICP) also has jaundice?

Answer 2

Do further work-up! It is uncommon for patients with ICP to have jaundice.

Question 3

What is the first step in the workup of a patient with suspected acute appendicitis during pregnancy?

Answer 3

Obtain a ultrasound with a graded compression technique

Question 4

What are the diagnostic findings of acute appendicitis on ultrasound?

Answer 4

1. Noncompression

2. Dilation of the appendix

Question 5

Why is ultrasound useful in working up acute appendicitis in pregnancy?

Answer 5

1. Ultrasound helps to exclude other potential diagnoses

2. Ultrasound does not expose the fetus to any additional ionizing radiation.