Liver disorders Flashcards
Identify the four liver diseases specific to pregnancy and risk factors
HELLP
- hypertension
- PE
- AMA
- multiparty
Acute Fatty Liver (AFLP)
- multigravida
- male sex of fetus
- another liver disease in pregnancy
- previous AFLP
Cholestasis
- history of cholestasis
- muitiple pregnancy - high oestrogen - slows bile production
- other liver diseases
Describe the abnormal liver function and presenting symptoms of HELLP syndrome
Liver damage with hypertension associated with PE
- Haemolysis as pass through endothelial damaged vessels
- Elevated liver enzymes due to damage
- low platelets
S+S
- hypertension
- jaundice
- RUQ pain
- N+V
Describe the complications of HELLP syndrome
- eelcampsia
- DIC
- preterm and stillbirth
- placental abruption
- renal failure
Describe the midwifery assessment and management of HELLP syndrome
- hospitalised ICU
- IV mag sulf to prevent seizures
- inclusion for anaemia and plateleys
antihypertensives for BP
betamethasone for lung maturation
If severe of >34 weeks - IOL
Describe the abnormal liver function and symptoms of acute fatty liver disease
- hypoglycaemia (due to rapid liver failure)
- increased bilirubin and urea
- sudden onset of vomiting
- jaundice
- minimal urine output
- RUQ pain
- vomiting
Describe the complications of acute fatty liver disease
- acute liver failure
- DIC
- acute renal failure
- maternal/fetal mortality
Describe the midwifery management of acute fatty liver disease
- early diagnosis
- delivery (IOL or caesarian if deteriorating)
- aggressive treatment of hypoglycaemia
- ICU admission depending on severity
- supportive treatment in ICU
Describe the abnormal liver function and symptoms of cholestasis
Impaired formation or excretion of bile in the liver through the gall bladder - reduces or stops
- buildup in the liver
- high level of bile acids
- liver damage
- itching at extremities with no visible rash
Describe the complications of cholestasis
- increased risk of stillbirth and preterm birth
Describe the midwifery management of cholestasis
Assessment
- total serum bile acid (above 40 is indication for induction
- LFT - dark urine
- fatty stools
RUQ pain
- bilirubin
If TSBA >40 - induction
If TSBA <40 - repeat every 2 weeks and monitor maternal and fetal wellbeing
Define and describe the development of DIC
DIC arises secondary to conditions which cause coagulation or haemorrhage (placental abruption)
endothelial damage (PE) or platelet injury (HELLP)
The clotting cascade becomes overwhelmed, and becomes disrupted, leading to fibrin to continue being deposited , consuming clotting factors and platelets
this forms micro-emboli throughout blood vessels and removes clotting factors from blood
impaired blood flow to vital organs and predisposing body to bleeding
S+S include
- bleeding, oozing from venipuncture site, bruising, haematuria
- hypotension and shock
- tachycardia
- decreased urine output
Describe the process of multi organ involvement
Describe the medical and midwifery management of DIC
- vital signs
- symptoms assessment
- resus (airways, fluids)
- blood group and hold
- transfer to ICU and given blood
- thrombolytics given and platelets given
- treatment of underlying condition
- education to woman
- assist in postnatal care if separated from baby
- support and education to woman and family
Describe other aetiology which may result in DIC
Define HG and describe the diagnostic features
Severe and ongoing nausea and vomiting , leading to weight loss, volume depletion, and ketonuria and ketonaemia
Diagnostic features
- Ketones in urine
- low magnesium, potassium and liver enzumes
- low blood pressure (postural)
- weight loss of >5%
Describe the management and midwfiery care of women with HG
Assessment - initial and ongoing
Bloods - FBE, U+E and others
Weights
Vitals - postural BP
Abdo palp and CTG and fundal height depending on gestation
Urinalysis
Identify triggers
BGL + Ketones
Nutrition assessment
US to confirm pregnancy and gestation, to exclude other causes/conditions
Ongoing:
Weekly weights
Daily bloods
Vital signs 4hrly
BGL and ketones
Strict FBC
Increased US
Hydration
IV fluids - NaCl most appropriate
Adding electrolytes depending on bloods
Encourage oral intake as tolerated
IV dextrose if no oral intake - aligning with BGL, consider if she is diabetic
Ice chips or fluidy foods
Medication - 1st line, 2nd line, 3rd line - DOSE + ROUTE
1st line and 2nd line (combined)
Pyridoxine (Vit B 6). - reduces severe vomiting
Prochloperazine (Stemitil) - antiemetic
Doxylamine (Restivit) - at night to help sleep
Promethazine (Phenergan)
Maxalon
Ondansetron
Most given as push or through fluid due to oral intolerance
Nutrition
Discontinue multivitamins, prioritising folate if she can still tolerate
Refer to dietician
May consider levels of thiamine, potassium, sodium, magnesium, iron, Vit b12
In really extreme cases can have TPN or NG feeds but not common
Psychosocial
Emotional support
Education
Involvement of family in care
Assess her ability to complete ADLS
Refer to social work - can also help get time off work, if woman has other kids at home
Refer to psych?
Assess social isolation
Midwife supports include taking time to talk, or saying nothing but providing support eg holding hand, sitting with her
Support partner in feelings of helplessness
Describe the potential complications of HG and how to prevent them
- dehydration and electrolyte imbalance
- ketosis
- inability to cope
- altered consciousness
