liver disease in pregnancy

Question 1

normal findings in pregnancy

Answer 1

spiders, palmer erythema, decreased gallbladder contractility (increased risk of gall stones), decreased hematocrit, serum urea, urate, albumin and total protein, increased Alk Phos (placenta and bone)

Question 2

hyperemesis gravidarum

Answer 2

first trimester, pretty rare, intractable vomiting: dehydration, electrolyte abnormalities

ALT: 2 to 3 fold elevation, can reach 20 fold
Treatment- symtomatic with rehydration and antiemetics

Question 3

intrahepatic cholestasis of pregnancy

Answer 3

pruritus resolving within 2 days of pregnancy, .1% of all pregnancies, increased risk of prematurity, perinatal deaths, fetal distress, typically 2nd trimester but can occur in any trimester, etiology inclear (increased bile acid secretion)

labs- jaundice, ASTs and ALT s are high, serum bile acids are high, treatment- cholestryamine (binds bile acids), ursodeoxycholic acid- modifies bile acid pool, inhibits absorption of more hydrophobic bile acids

Question 4

Preeclampsia/ Eclampsia

Answer 4

Usually occur after 20 weeks
Preeclampsia- HTN, proteinuria, edema
5-7% of pregnancies, AST and ALTs elevations

Eclampsia= preeclampsia + seizures,
Deliver if near term

HELLP- hemolysis elevated liver test, low platelets (2/3 during third, 1/3 after delivery)

Question 5

Acute fatty liver of pregnancy AFLP

Answer 5

3rd trimester, preecplampsia, etiology - fatty acid oxidation defects in fetus

LCHAD deficiecny in a fetus with a heterozygous mother, leads to fatty liver in mom

Mild- liver test abnormalities
Sever- jaundice, coagulopathy and encephalopathy
Urgent deliver inidicated