Obstetric Cholestasis Flashcards
Obstetric cholestasis =
intrahepatic cholestasis of pregnancy
what is the pathophysiology of obstetric cholestasis?
reduction of bile outflow from the liver due to progesterone relaxing the smooth muscle
(a bit like your bile ducts are constipated)
bile acids build up in the blood
when does obstetric cholestasis usually present?
in late pregnancy (after 28 weeks)
which ethnicity has a predisposition to obstetric cholestasis?
SE Asian
most serious complication of obstetric cholestasis
stillbirth (there is an increased risk)
what is the classic, giveaway symptom of obstructive cholestasis?
pruritis on the soles and on the palms
other than pruritis, 4 symptoms of obstructive cholestasis
dark urine
pale, fatty stools
fatigue
jaundice
what does the skin look like in obstetric cholestasis
excoriations only (there is no rash)
2 blood tests for obstetric cholestasis
LFTs
serum bile acids
LFT results in obstetric cholestasis
raised GGT, ALT and AST
NB raised ALP is normal
drug which will address the underlying issue in obstetric cholestasis
Ursodeoxycholic acid
2 options for the management of itching (symptom control) in obstetric cholestasis
emollients
antihistamines (for their sedative quality, not because they stop you itching)
suggest why clotting may be deranged in a patient with obstetric cholestasis, even if their liver is functioning normally
vitamin K is a fat soluble vitamin, and without the production of bile acids there is reduced absorption of vitamin K
which clotting test will be abnormal in vit K deficiency?
prothrombin time
Remember: 1972 WEPT
how can abnormal clotting due to vitamin K deficiency be managed in obstetric cholestasis?
give water soluble vitamin K
they will not absorb fat-soluble vitamin K
