Liver Disease and Pregnancy Flashcards
What are the main Hepatic Diseases Associated with Pregnancy?
- Preeclampsia and Eclampsia
- Acute Fatty Liver of Pregnancy
- Intrahepatic Cholestasis of Pregnancy
Preeclampsia affects 3% to 5% of pregnancies and is characterized by:
- maternal hypertension,
- proteinuria,
- peripheral edema, and
- coagulation abnormalities
What is HELLP syndrome?
- h emolysis,
- e levated l iver enzymes, and
- l ow p latelets,
What signifies the onset of full-blown eclampsia?
•When hyperreflexia and convulsions occur, the condition is called eclampsia and may be life-threatening.
What do these things show?
In preeclampsia,
- (left) Periportal sinusoids contain fibrin deposits associated with hemorrhage into the space of Disse
- (right) Leading to periportal hepatocellular coagulative necrosis
What is this showing?
Eclampsia- Blood under pressure may coalesce and expand to form a hepatic hematoma; dissection of blood under Glisson capsule may lead to catastrophic hepatic rupture in eclampsia
What causes acute fatty liver of pregnancy?
•Mitochondrial dysfunction (in BABY! Effects mother, woah) thought to play a role
How does acute fatty liver of pregnancy present?
•Acute fatty liver of pregnancy presents with a spectrum of disorders ranging from subclinical or modest hepatic dysfunction (evidenced by elevated serum aminotransferase levels) to hepatic failure, coma, and death.
When does acute fatty liver of pregnancy most commonly occur?
•Rare, usually in the 3rd trimester, most are mild
What is the tx of acute fatty liver of pregnancy?
•Termination of pregnancy is primary treatment
What does this show?
Acute fatty liver of pregnancy
- Microvesicular steatosis in zones 2 or 3 (vacuoles may be very small)
- Also marked ballooning of hepatocytes and macrovesicular fat
What else can be seen in severe cases of acute fatty liver of pregnancy?
hepatocyte dropout,
reticulin collapse,
portal tract inflammation
What is the second leading cause of gestational jaundice (after viral hepatitis)?
Intrahepatic Cholestasis of Pregnancy
When does Intrahepatic Cholestasis of Pregnancy most commonly occur?
Usually occurs late in pregnancy
What is thought to cause Intrahepatic Cholestasis of Pregnancy?
Estrogenic hormones may inhibit hepatocellular bile secretory activity
What are some risks to the fetus with Intrahepatic Cholestasis of Pregnancy?
Associated with higher incidence of fetal distress, stillbirths, prematurity
What are some risks to the mother with Intrahepatic Cholestasis of Pregnancy?
Mother at risk for gallstones, malabsorption
How does Intrahepatic Cholestasis of Pregnancy present in the mother?
pruritis in third trimester, dark urine, light stools, jaundice
How do labs appear in intrahepatic cholestasis of pregnancy?
some may have elevated serum bilirubin, usually conjugated;
mildly elevated alkaline phosphatase
What is this showing?
Intrahepatic Cholestasis of Pregnancy
•Microscopic: Mild cholestasis without cirrhosis
What is Gaucher Disease?
a genetic disorder in which glucocerebroside (a sphingolipid, also known as glucosylceramide) accumulates in cells and certain organs
•most common of the lysosomal storage diseases
How does Gaucher disease present?
•Enlarged liver and spleen. If bone marrow involved trilineage decrease
