Obstetrics - Liver Disease Unique to Pregnancy

Question 1

Liver Disease Unique to Pregnancy?

Hyperemesis Gravidarum?

What is it?

Answer 1

Complication of pregnancy:

• Starts first trimester, resolves around week 20
• Nausea and vomitting
• Weight loss 5% or more of pre-pregnancy body weight
• Dehydration

Symptoms:

• Nausea and vomitting
• Weight loss 5% or more of pre-pregnancy body weight
• Dehydration: Ketosis and constipation
• Metabolic imbalance - Ketosis and thyrotoxicosis
• Ptyalism (XS salivation)

Question 2

Liver Disease Unique to Pregnancy?

Hyperemesis Gravidarum?

Investigations?

Treatment?

Complications?

Answer 2

Investigations:

• Monitor fetal distress using CTG
• Bloods: FBC,U&E,BUN,TFTs,(TSH low), LFTs AST/ALT <100iu/l
• Vit B levels
• Urinalysis
• USS monitor gestation

Treatment - Medical:

• IV fluid resuscitation
• Anti-emetics - pyridoxine, promethiazine
• Thiamine

Complications:

Mother: weight loss, complications of vomitting (oesophageal rupture, renal damage, vascular depletion, Wernickes Encephalopathy

(An important cause of acute or subacute delirium, Wernicke encephalopathy (WE) is a neurological disorder induced by thiamine, vitamin B1, deficiency. WE is the most important encephalopathy due to a single vitamin deficiency. WE presents with the classic triad of ocular findings, cerebellar dysfunction, and confusion.)

Fetus: Prematurity, low birth weight

Question 3

Liver Disease Unique to Pregnancy?

Intrahepatic Cholestatsis of Pregnancy?

Causes?

Answer 3

What is it:

• Reversible hormonslly influenced cholestasis
• Presents during 2nd trimester
• Condition often recurs in subsequent prgnancies

Question 4

Liver Disease Unique to Pregnancy?

Intrahepatic Cholestatsis of Pregnancy?

Symptoms?

Investigations?

Answer 4

Symptoms:

• Pruritis starting on hands and soles, spreading to face/trunk
• Jaundice
• Steatorrhoea

Investigations:

• Bloods:
  
  • FBC,U&E,BUN, LFTs ALT/AST<1000iu/l,
  • GGT=normal,
  • bile acids high,
  • prothrombin=normal,
  • bilirubin<6mg/dl
• Urinalysis
• USS

Question 5

Liver Disease Unique to Pregnancy?

Intrahepatic Cholestatsis of Pregnancy?

Treatment?

Complications?

Answer 5

Treatment:

• Ursodeoxycholic acid/Anthistimines
• Delivery at 37 weeks or when fetal distress imminent

Complications:

• Severe pruritis
• Deranged clotting (inc vit K levels)
• Fetal distress
• Still birth
• Meconium ingestion/aspiration