Intrahepatic Cholestasis Of Pregnancy+ Other Liver Pathology Flashcards

1
Q

What is Gestational pruritis

A

Itching with peak bile acid <19umol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Mild ICP bile acid level

A

19-39umol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Moderated ICP- bile acid level

A

40-99umol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Severe- bile acid level

A

> /= 100umol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Incidence of ICP

A

0.7%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clinical issues (6) ICP

A
  • symptom control
  • fetal monitoring
  • preterm birth
  • stillbirth risk
  • difficulty sleeping
  • timing of delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is intrahepatic cholestasis of pregnancy diagnosed

A

Resolution of
- symptoms,
- Lft and bile salts

4 weeks postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Who to request viral screen and liver ultrasound for (5)

A
  • unsure diagnosis
  • early onset severe disease
  • markedly elevated transaminases
  • liver failure
  • no resolution postpartum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ICP increases the risk of ……… in pregnancy(2)

A

Pre eclampsia
Gestational diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Frequent symptoms of ICP (3)

A
  • generalized itching
  • itching to palms and soles
  • itching worse at Night
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Infrequent symptoms of ICP (4)

A
  • dark urine
  • pale stools
  • steatorrhoea
  • jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Risk of developing hepatobiliary disease

A

15%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Prevalence of stillbirth with severe ICP

A

3.44%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fetal complications moderate to severe ICP (4)

A
  • stillbirth
  • meconium stained liquor
  • neonatal care
  • preterm birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Frequency of biochemical monitoring for cholestasis if pregnancy

A

1 week post diagnosis then based on clinical picture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MOA of ursodeoxycholic acid

A
  • decreases pruritus (not statistically significant
  • increases hepatobilliary transport
  • decreases hepatotoxic effects of bile salts in mother and fetus

NB: does not improve overall outcome so do not offer routinely

17
Q

Timing of birth : Mild disease

A

<40 weeks

18
Q

Timing of birth: moderate disease

A

38-39weeks

19
Q

Timing of birth: severe disease

A

35-36 weeks

20
Q

Mode of delivery in ICP

A

Induction of labour

21
Q

Estrogen containing contraception
UKMEC

A

Class 2
(If no history if ocp induced cholestasis)

22
Q

Non estrogen contraception
UKMEC

A

CLASS 1

23
Q

Treatment options of ICP

A

Antihistamines for itching
- loratidine
- chlorphenamine

24
Q

Recurrence rate of ICP

A

45-90%

25
Q

What benign liver pathology is associated with combined hormonal contraception

A

HEPATIC ADENOMA

26
Q

What is the lifetime risk.of haemorrhage within a hepatic adenoma

A

27%

27
Q

Lifetime risk of rupture and intraperitoneal bleed in hepatic adenoma

A

17%