Cholestasis of pregnancy: Difference between revisions

(Created page with "==Background== *characterized by pruritus and elevation in serum bile acid concentrations, typically developing in late second and/or third trimester and rapidly resolving aft...")
 
 
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==Background==
==Background==
*characterized by pruritus and elevation in serum bile acid concentrations, typically developing in late second and/or third trimester and rapidly resolving after delivery
*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>
 
{{Gallbladder disease types}}


==Clinical Features==
==Clinical Features==
*pruritus, starts and predominates on palms and soles
*Typically develops in late second and/or 3rd trimester
*RUQ abd pain
*Rapidly resolves after delivery
*Nausea
*[[Pruritus]], starts and predominates on palms and soles
*Jaundice
*[[RUQ pain]]
*[[Nausea]]
*[[Jaundice]]


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


==Evaluation==
==Evaluation==
*increase in serum total bile acid concentration
*CBC (rule out thrombocytopenia)
*increase in serum aminotransferases usually less than two times upper limit of normal
*[[LFTs]]
*alk phos and bili can be elevated as well
**Elevated total bile acid concentration
*GGT is normal or modestly elevated
**Aminotransferases usually <2x upper limit of normal
*US is normal, biliary ducts not dilated
**Alk phos and bili may be elevated
**GGT normal or modestly elevated
**[[RUQ US]] normal, no biliary duct dilation


==Management==
==Management==
*Ursodeoxycholic acid 300mg TID until delivery
*Ursodeoxycholic acid ([[ursodiol]]) 300mg TID until delivery
*OBGYN follow-up
*OBGYN follow-up


==Disposition==
==Disposition==
*home with OBGYN follow-up
*Discharge with OBGYN follow-up


==See Also==
==See Also==
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https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy
https://www.uptodate.com/contents/intrahepatic-cholestasis-of-pregnancy
<references/>
<references/>
[[Category:OBGYN]] [[Category:GI]]

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
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.

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

  1. ↑ http://bestpractice.bmj.com/topics/en-us/800
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