Cholestasis of pregnancy: Difference between revisions
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==Background== | <languages/> | ||
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==Background== <!--T:1--> | |||
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*Caused by combination of hormonal, genetic, and environmental factors --> impaired bile flow --> deposition of bile salts in skin and placenta | *Caused by combination of hormonal, genetic, and environmental factors --> impaired bile flow --> deposition of bile salts in skin and placenta | ||
*May predispose mothers to [[vitamin K deficiency]] and increase risk of preterm delivery, [[IUFD]], and neonatal [[respiratory distress syndrome]]<ref>http://bestpractice.bmj.com/topics/en-us/800</ref> | *May predispose mothers to [[Special:MyLanguage/vitamin K deficiency|vitamin K deficiency]] and increase risk of preterm delivery, [[Special:MyLanguage/IUFD|IUFD]], and neonatal [[Special:MyLanguage/respiratory distress syndrome|respiratory distress syndrome]]<ref>http://bestpractice.bmj.com/topics/en-us/800</ref> | ||
==Clinical Features== | </translate> | ||
{{Gallbladder disease types}} | |||
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==Clinical Features== <!--T:3--> | |||
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*Typically develops in late second and/or 3rd trimester | *Typically develops in late second and/or 3rd trimester | ||
*Rapidly resolves after delivery | *Rapidly resolves after delivery | ||
*[[Pruritus]], starts and predominates on palms and soles | *[[Special:MyLanguage/Pruritus|Pruritus]], starts and predominates on palms and soles | ||
*[[RUQ pain]] | *[[Special:MyLanguage/RUQ pain|RUQ pain]] | ||
*[[Nausea]] | *[[Special:MyLanguage/Nausea|Nausea]] | ||
*[[Jaundice]] | *[[Special:MyLanguage/Jaundice|Jaundice]] | ||
==Differential Diagnosis== <!--T:5--> | |||
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{{Jaundice DDX}} | |||
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===Pregnancy-specific pruritus=== <!--T:6--> | |||
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''see also: [[Special:MyLanguage/Rashes of pregnancy|Rashes of pregnancy]]'' | |||
*Pruritus gravidarum | |||
*Atopic eruption of pregnancy | |||
*Polymorphic eruption of pregnancy | |||
*Pemphigoid gestationis | |||
*Prurigo of pregnancy | |||
*Pruritic folliculitis of pregnancy | |||
==Evaluation== | |||
==Evaluation== <!--T:8--> | |||
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*CBC (rule out thrombocytopenia) | *CBC (rule out thrombocytopenia) | ||
*[[LFTs]] | *[[Special:MyLanguage/LFTs|LFTs]] | ||
**Elevated total bile acid concentration | **Elevated total bile acid concentration | ||
**Aminotransferases usually <2x upper limit of normal | **Aminotransferases usually <2x upper limit of normal | ||
**Alk phos and bili may be elevated | **Alk phos and bili may be elevated | ||
**GGT normal or modestly elevated | **GGT normal or modestly elevated | ||
**[[RUQ US]] normal, no biliary duct dilation | **[[Special:MyLanguage/RUQ US|RUQ US]] normal, no biliary duct dilation | ||
==Management== | |||
*Ursodeoxycholic acid ([[ursodiol]]) 300mg TID until delivery | ==Management== <!--T:10--> | ||
<!--T:11--> | |||
*Ursodeoxycholic acid ([[Special:MyLanguage/ursodiol|ursodiol]]) 300mg TID until delivery | |||
*OBGYN follow-up | *OBGYN follow-up | ||
==Disposition== | |||
==Disposition== <!--T:12--> | |||
<!--T:13--> | |||
*Discharge with OBGYN follow-up | *Discharge with OBGYN follow-up | ||
==See Also== <!--T:14--> | |||
==External Links== <!--T:15--> | |||
==References== <!--T:16--> | |||
<!--T:17--> | |||
https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy | https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy | ||
<references/> | <references/> | ||
[[Category:OBGYN]] [[Category:GI]] | [[Category:OBGYN]] [[Category:GI]] | ||
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Latest revision as of 12:30, 7 January 2026
Background
- Caused by combination of hormonal, genetic, and environmental factors --> impaired bile flow --> deposition of bile salts in skin and placenta
- May predispose mothers to vitamin K deficiency and increase risk of preterm delivery, IUFD, and neonatal respiratory distress syndrome[1]
Gallbladder disease types
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Bile duct and pancreas anatomy. 1. Bile ducts: 2. Intrahepatic bile ducts; 3. Left and right hepatic ducts; 4. Common hepatic duct; 5. Cystic duct; 6. Common bile duct; 7. Sphincter of Oddi; 8. Major duodenal papilla; 9. Gallbladder; 10-11. Right and left lobes of liver; 12. Spleen; 13. Esophagus; 14. Stomach; 15. Pancreas: 16. Accessory pancreatic duct; 17. Pancreatic duct; 18. Small intestine; 19. Duodenum; 20. Jejunum; 21-22: Right and left kidneys.
- Symptomatic cholelithiasis (biliary colic)
- Choledocholithiasis
- Acute calculous cholecystitis
- Ascending cholangitis
- Acalculous cholecystitis
- Biliary atresia
- Cholestasis of pregnancy
Clinical Features
- Typically develops in late second and/or 3rd trimester
- Rapidly resolves after delivery
- Pruritus, starts and predominates on palms and soles
- RUQ pain
- Nausea
- Jaundice
Differential Diagnosis
Jaundice
Indirect Hyperbilirubinemia
- Hemolytic
- G6PD
- Drug related
- Autoimmune hemolytic anemia
- Hematoma resorption
- Ineffective erythropoiesis
- Gilbert's
Direct (Conjugated) Hyperbilirubinemia
- Choledocholithiasis
- Cholecystitis
- Ascending cholangitis
- AIDS cholangiopathy
- Stricture
- Neoplasm
- Pancreatic head
- Gallbladder
- Primary liver (e.g. hepatocellular carcinoma)
- Metastatic
- Obstructing AAA
Hepatocellular damage
Patient will have severely elevated AST/ALT with often normal Alkaline Phosphatase
- Viral hepatitis
- Fulminant hepatic failure
- alcoholic hepatitis
- Ischemic hepatitis
- Toxins
- Isoniazid
- Phenytoin
- acetaminophen
- Ritonavir
- Halothane
- Sulfonamide
- Autoimmune hepatitis
- Primary biliary cirrhosis
- HELLP Syndrome
- Congestive Hepatopathy
Pregnancy Related
Transplant Related
Pediatric Related
- Inborn error of metabolism
- Neonatal jaundice (physiologic)
Additional Differential Diagnosis
- Reye syndrome
- TPN
- Heatstroke
- Budd-Chiari (with acute ascites)
- Wilson's disease
- Sarcoidosis
- Amyloidosis
Masqueraders
Only bilirubin stains the sclera
- Carotenemia
- Quinacrine ingestion
- Dinitrophenol, teryl (explosive chemicals)
Pregnancy-specific pruritus
see also: Rashes of pregnancy
- Pruritus gravidarum
- Atopic eruption of pregnancy
- Polymorphic eruption of pregnancy
- Pemphigoid gestationis
- Prurigo of pregnancy
- Pruritic folliculitis of pregnancy
Evaluation
- CBC (rule out thrombocytopenia)
- LFTs
- Elevated total bile acid concentration
- Aminotransferases usually <2x upper limit of normal
- Alk phos and bili may be elevated
- GGT normal or modestly elevated
- RUQ US normal, no biliary duct dilation
Management
- Ursodeoxycholic acid (ursodiol) 300mg TID until delivery
- OBGYN follow-up
Disposition
- Discharge with OBGYN follow-up
See Also
External Links
References
https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy