Liver Disease in Pregnancy Flashcards Preview

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Flashcards in Liver Disease in Pregnancy Deck (14)
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1
Q

What findings are there in both liver disease and pregnancy?

A

Spiders/Palmar erythema
Decreased gallbladder contractility
Decreased: Hematocrit, serum urea, albumin, total protein
Increased alkaline phosphatase

2
Q

In what trimester does Hyperemesis Gravidarum most commonly occur?

A

First trimester

3
Q

What are the characteristics of Hyperemesis Gravidarum?

What is the treatment?

A

Intractable vomiting: dehydration, electrolyte abnormalities
ALT: 2 to 3 fold elevation (can reach 20 fold)
Treatment: treat symptoms - rehydration and antiemetics

4
Q

In what trimester is Intrahepatic Cholestasis of Pregnancy (IHCP) most likely to occur?

A

Typically third trimester but can occur in any trimester

5
Q

What are the characteristics of IHCP?

A

Pruritis resolving within 2 days of pregnancy

Increased risk of prematurity, perinatal deaths, fetal distress

6
Q

What are the lab findings associated with IHCP?

What is the treatment? (Besides delivery)

A

Labs: jaundice (25%), 4 fold AST/ALT increase, serum bile acids increased 30-100 fold
Tx: Cholestyramine (binds bile acids)
Ursodeoxycholic acid (modifies bile acid pool and inhibits absorption of more hydrophobic bile acids)

7
Q

Preeclampsia and Eclampsia usually occur after ____ weeks

A

20 (Usually late second or third trimester)

8
Q

What are the differences between Preeclampsia and Eclampsia?

A

Preeclampsia: Hypertension, proteinuria, edema (5-7% of pregnancies) - AST/ALT increase in 25-50%
Eclampsia: Preeclampsia + seizures (0.1-0.2% of pregnancies) - AST/ALT increase in 80-90%

9
Q

In what trimester is Acute Fatty Liver of Pregnancy (AFLP) most likely to occur?

A

Third trimester

10
Q

What other pregnancy/liver disorder often occurs with AFLP?

A

Preeclampsia (20-40%)

11
Q

What is the etiology of AFLP?

A

Fatty acid oxidation defects in fetus - LCHAD: long-chain 3-hydroxyacyl coenzyme dehydrogenase deficiency (in a fetus with a heterozygous mother)
Leads to fatty liver in mother

12
Q

What are the Mild and Severe forms of AFLP?

A

Mild: liver test abnormalities
Severe: Jaundice, coagulopathy and encephalopathy (urgent delivery indicated)

13
Q

In what semester is HELLP syndrome most common?

A

Third trimester

14
Q

What are the findings in HELLP syndrome?

A

Hemolytic anemia
Elevated Liver tests
Low Platelets
* Urgent delivery indicated