Liver Disease in Pregnancy

Question 1

What findings are there in both liver disease and pregnancy?

Answer 1

Spiders/Palmar erythema
Decreased gallbladder contractility
Decreased: Hematocrit, serum urea, albumin, total protein
Increased alkaline phosphatase

Question 2

In what trimester does Hyperemesis Gravidarum most commonly occur?

Answer 2

First trimester

Question 3

What are the characteristics of Hyperemesis Gravidarum?

What is the treatment?

Answer 3

Intractable vomiting: dehydration, electrolyte abnormalities
ALT: 2 to 3 fold elevation (can reach 20 fold)
Treatment: treat symptoms - rehydration and antiemetics

Question 4

In what trimester is Intrahepatic Cholestasis of Pregnancy (IHCP) most likely to occur?

Answer 4

Typically third trimester but can occur in any trimester

Question 5

What are the characteristics of IHCP?

Answer 5

Pruritis resolving within 2 days of pregnancy

Increased risk of prematurity, perinatal deaths, fetal distress

Question 6

What are the lab findings associated with IHCP?

What is the treatment? (Besides delivery)

Answer 6

Labs: jaundice (25%), 4 fold AST/ALT increase, serum bile acids increased 30-100 fold
Tx: Cholestyramine (binds bile acids)
Ursodeoxycholic acid (modifies bile acid pool and inhibits absorption of more hydrophobic bile acids)

Question 7

Preeclampsia and Eclampsia usually occur after ____ weeks

Answer 7

20 (Usually late second or third trimester)

Question 8

What are the differences between Preeclampsia and Eclampsia?

Answer 8

Preeclampsia: Hypertension, proteinuria, edema (5-7% of pregnancies) - AST/ALT increase in 25-50%
Eclampsia: Preeclampsia + seizures (0.1-0.2% of pregnancies) - AST/ALT increase in 80-90%

Question 9

In what trimester is Acute Fatty Liver of Pregnancy (AFLP) most likely to occur?

Answer 9

Third trimester

Question 10

What other pregnancy/liver disorder often occurs with AFLP?

Answer 10

Preeclampsia (20-40%)

Question 11

What is the etiology of AFLP?

Answer 11

Fatty acid oxidation defects in fetus - LCHAD: long-chain 3-hydroxyacyl coenzyme dehydrogenase deficiency (in a fetus with a heterozygous mother)
Leads to fatty liver in mother

Question 12

What are the Mild and Severe forms of AFLP?

Answer 12

Mild: liver test abnormalities
Severe: Jaundice, coagulopathy and encephalopathy (urgent delivery indicated)

Question 13

In what semester is HELLP syndrome most common?

Answer 13

Third trimester

Question 14

What are the findings in HELLP syndrome?

Answer 14

Hemolytic anemia
Elevated Liver tests
Low Platelets
* Urgent delivery indicated