Liver things

Question 1

AFLP what does it look like?

Answer 1

SICK
urate 502-60s rather than 302-40s of PE
Fast rising LFTs
Hypodense liver from macroliposomes
Hypoglycaemia-->dextrose infusion
Coags go offf

Question 2

Woman gets really itchy- what could it be:

Answer 2

obstetric cholestasis- PALMS AND SOLES
NO rash, unlike PUPP- itchy stretch marks
If bile acids over 40 can cause sudden death inutero

If cholestasis of preg, could get cholestasis with OCP!

Question 3

ALP in preg?

Answer 3

Goes up

Question 4

How do you differentiate between some different liver pictures?

Answer 4

Bile acids only go up in intrahepatic cholestasis
Bili up in HELP and fatty liver but not plain PE, cholestasis or hyperemesis
ALT up 2-5 x in hyperemesis and plain PE but not way up like in fatty liver (up to 30 x), HELP.

Question 5

Hyper emesis for fetus?

Answer 5

Hip dysplasia
IUGR
undescended testes

Question 6

What can be the underlying defect in HELP?

Answer 6

Fatty acid oxidation disorder, most commonly LCHAD-

Question 7

WHICH bile acid level is particuarly bad for fetus?

Answer 7

Over 40

Can try Ursodeoxycholic acid if not too high (inhibits hepatic synthesis and secretion of cholesteroland absorption)

Question 8

Cholestyramine MOA for itch?

Answer 8

Increase bile acid synthesis and secretion so less in plasma to be deposited in tissues

Question 9

can you do a colonoscopy in preg?

Answer 9

no

but sigmoid ok