GI/Liver ABC Flashcards
Differential for rash/ itching
cholestasis pupp pemphigoid gestationis poriasis (pusular poriasis of pregnancy- impetigo herpetiformis) atopic eruption (excema) impetigo herpetic lesions varicella scabes folliculitis drug reaction
Labs for itching
liver function tests fasting bile acids cbc coagulation studies bilirubin
monitoring of cholestasis
twice weekly antenatal testing kick counts growth scans consider repeat labs delivery 36-37 weeks ursodiol 300 TID hydroxyzine benadryl prn (lotion/cool showers)
pusular poriasis of pregnancy- impetigo herpetiformis
plaques with rings of pus
nails get oncholytic
oftern intertriginous (no hands/feet)
Nausea/vomiting/diarrhea/fever
antenatal monitoring/growth ultrasounds- due to placental insufficiency, SAB, FGR, IUFD,
High dose IV steroids, check electrolytes including calcium, consider antibiotics
can reoccur with OCP’s or pregnancy
herpes gestationis (phemphigoid getationis)
not herpes herpetiform bilsters autoimmune puritis than lesions starts on trunk (around umbilicus) 75% flair postpartum 25% flair with OCP or menses
Biopsy- eosinophilic infiltrate, basal cell necrosis, edema of dermal papillae, C3 on immunofloresnce
Tx: topical steroids, antihistamine (oral), often need IV steroids
Pregnancy risk factors: FGR, prematurity, 5% of neonates with eruptions
mother at risk for graves
PUPPS
Risk factor : nullip, multiples
Sx: papules in striae, periumbilical sparing *, palms/soles spared, white “halo”
Tx: topical steroids, po antihistamines, may need IV steroids
No fetal/maternal morbidity - uncommon reoccurance
Atopic eruption of pregnancy:
Prurigo of pregnancy
Puritic folliculitis of pregancy
Eczema
NO Increased risk for pregnancy
Prurigo of pregnancy- exstensors of limbs and trunk, crusted, lesions group
Puritic folliculitis
- need to rule out bacterial/ candida cuases
Eczema -1-2 trimester - skin hydration
RUQ pain ddx
cholecystitis cholelithiasis choledocolithasis cholangitis GERD pancreatitis ( gullstone) gastritis ulcer pyelo renal abcess Pregnancy: AFL, PreE, PTL, abruption, uterine rupture
Treatment for cholecystitis
NPO
symptom management
general surgery
unasyn
if concern for gullstone pancreatitis MRCP ( ERCP if they are going to treat in this manner)
Recurrent cholecystitis treatment options
ERCP with sphincterotomy
biliary stent placement
cholecystectomy
Chrons diease
lesion pathology
skip lesions/ full thickness bloody diarrhea sometimes granoloma/abscesses/perianal disease Minimal risk for cancer no surgical cure often involves the colon rectum can be involved 50% of the time
Pregnancy risk factors of chron’s disease
miscarriage
PTB
FGR
? congenital anomalies
- risk of flair similar to outside of pregnancy
First line treatment: sulfasalazine, mesalamine
- don’t use MTX or thalidomide!
- c section with perianal disease
No operative delivery/episitomy
Symptomatic colitis work-up and differential
r/o c diff
? colonoscopy
infectious colitis diverticulitis ischemic colitis rectal ulcer NSAID colitis
ulcerative colitis
mucosal layer lesions continuous lesions blood diarrhea almost always generally no abcesses risk for cancer surgical cure
Bariatic surgery - risk/benefits in pregnancy
Benefits: lower htn/dm
risk: intestinal obstruction, gi hemorrhage
wait 12-24 months
Growth ultrasounds
nutritional support- check iron/protein/b12/folate/vit d/ calcium/iron.
