Cholestasis of pregnancy: Difference between revisions

 
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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 [[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>
{{Gallbladder disease types}}


==Clinical Features==
==Clinical Features==
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==Differential Diagnosis==
==Differential Diagnosis==
*Liver disease in pregnancy:
{{Jaundice DDX}}
**[[Acute fatty liver of pregnancy]]
 
**[[HELLP]] (hemolysis, elevated liver enzymes, and low platelets) syndrome
===Pregnancy-specific pruritus===
**[[Hyperemesis gravidarum]]
''see also: [[Rashes of pregnancy]]''
*Pregnancy-specific pruritus (see also: [[Rashes of pregnancy]])
*Pruritus gravidarum
**Pruritus gravidarum
*Atopic eruption of pregnancy
**Atopic eruption of pregnancy
*Polymorphic eruption of pregnancy
**Polymorphic eruption of pregnancy
*Pemphigoid gestationis
**Pemphigoid gestationis
*Prurigo of pregnancy
**Prurigo of pregnancy
*Pruritic folliculitis of pregnancy
**Pruritic folliculitis of pregnancy


==Evaluation==
==Evaluation==

Latest revision as of 23:38, 28 February 2024

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

Gallbladder anatomy (overview).
Gallbladder anatomy

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

Differential diagnosis of hyperbilirubinemia.

Indirect Hyperbilirubinemia

Direct (Conjugated) Hyperbilirubinemia

Hepatocellular damage

Patient will have severely elevated AST/ALT with often normal Alkaline Phosphatase

Pregnancy Related

Transplant Related

Pediatric Related

Additional Differential Diagnosis

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