Liver and Gallbladder in Pregnancy

Question 1

Gallstones in pregnancy

Answer 1

C: first line (esp. T1+3)
M: IV fluids, electrolyte correction, bowel rest, pn management, broad spec ABx
Relapse rates high and may require surgery ideally 2nd trimester

Question 2

Obstetric cholestasis Ix

Answer 2

Bile acids (raised)
LFTs (bili)
CTG
Coag screen (vit K def.)
Fasting cholesterol (likely high)
HCV serology (higher risk OC)

Question 3

Obstetric cholestasis risks

Answer 3

Premature birth
stillbirth
meconium passage

Question 4

Symptomatic Obstetric cholestasis Mx

Answer 4

Ursodeoxycholic acid (red. itch + improves LFTs)
?Vit K supplementation

Question 5

Indication for Vit K supplementation in Obstetric cholestasis

Answer 5

If PT prolonged or severe biochemical abnormalities

Given as 5-10mg OD PO tablet

Question 6

Antenatal monitoring in Obstetric cholestasis

Answer 6

Advise monitoring foetal movements
LFTs: weekly until delivery and 10d postnatal
doppler and CTG: 2/wk until delivery

Question 7

Advice for Obstetric cholestasis

Answer 7

Loose cotton clothes reduce itching
Book into consultant team based care
Arrange FU to ensure LFTs return to normal

Question 8

PACES counselling Obstetric cholestasis

Answer 8

RF: (F)Hx OC, Hx liver dx, multiple preg.
Dx: gallbladder function ceased, risks liver damage
Risks: stillbirth/PTD
Early deliv. 37wk
2/wk monitoring of CTG/UAD
weekly LFTs
Close attention to RFM
Sx Mx (anti-itch and emollients, ?vit K)
HIGH recurrence

Question 9

Acute fatty liver of pregnancy

Answer 9

Sx: Abdo pn, N+V, headache, jaundice
Ix: LFTs (ALT v elevated), glucose (low), urate (high)
Mx: supportive
Delivery is definitive Mx when stabilised