Liver Disease in Pregnancy

Question 1

What are some liver disease findings in pregnancy?

Answer 1

Spider angiomas
Palmar erythema
Decreased gallbladder contractility (increased risk of gallstones)
Increase alk phase
Decreased hematocrit, serum urea, uric acid, albumin, total protein

Question 2

When does hyperemesis gravidarum occur?

Answer 2

First trimester

Question 3

What happens to liver enzymes with hyperemesis gravidarum?

Answer 3

ALT 2-3 fold elevation, can reach 20-fold

Treatment: symptomatic with rehydration and antiemetics

Question 4

Intrahepatic cholestatsis of pregnancy

Answer 4

Pruritus resolves within 2 days of pregnancy
Increased risk of prematurity, perinatal deaths, fetal stress
Typically occurs in 3rd trimester, but can be at anytime
Jaundice in 25%
Up to 4-fold AST/ALT increase
Serum bile acids increased 30-100 fold

Question 5

What do you use to treat Intrahepatic cholestasis of pregnancy?

Answer 5

Cholestyramine-binds bile acids

Ursodesoxycholic acid- modifies bile acid pool, inhibits absorption of more hydrophobic bile acids

Question 6

What is preeclampsia?

Answer 6

Hypertension, proteinuria, edema

Typically occurring after 20 weeks

Question 7

What is eclampsia?

Answer 7

Preeclampsia + seizures

AST and ALT elevations in 80-90%

Question 8

What causes acute fatty liver of pregnancy (AFLP)?

Answer 8

Fatty acid oxidation defect in fetus –> long-chain 3-hydroxyacyl coenzyme dehydrogenase deficiency in fetus with a heterozygote mother

Ranges from mild to severe
Presents in third trimester
Urgent delivery indicated

Question 9

HELLP Syndrome

Answer 9

Hemolytic anemia
Elevated Liver tests
Low Platelets

Occurs in 3rd trimester
Urgent delivery indicated
Complication of preeclampsia/eclampsia