Hepatic disease assoc. w/ pregnancy: Gupta

Question 1

Describe preeclampsia’s effect on the liver, on histo.

Complications?

Answer 1

Periportal sinusoids contain fibrin deposits associated w/ hemorrhage into the space of Disse—> periportal hepatocellular coagulative necrosis.
Complication: can lead to subcapsular hematoma that can rupture

Question 2

What causes acute fatty liver of pregnancy?

Describe it histologically.

Answer 2

Fetal mitochondrial dysfunction —> problems in mom.
Primary tx is to terminate pregnancy/deliver fetus.

Microvesicular steatosis in zones 2-3
Also, marked ballooning of hepatocytes and macrovesicular fat.
Severe cases: hepatocyte dropout, reticulin collapse, portal tract inflammation.

Question 3

What is the leading cause of gestational jaundice?

Second leading cause?

Answer 3

1st- Viral hepatitis

2nd- intrahepatic cholestasis

Question 4

What causes intrahepatic cholestasis of pregnancy?
What is the mother now at elevated risk for?
Symptoms of intrahepatic cholestasis of pregnancy?
Labs?

Answer 4

:: Elevated estrogen levels inhibit hepatocellular bile secretory activity. (elevated conjugated bilirubin)
:: Elevated risk of gallstones, malabsorption
:: Symptoms: pruritis in 3rd trimester, dark urine (body trying to get rid of bilirubin), light stools (can’t get it out in feces), jaundice (excess bilirubin deposited in tissue).
:: Labs: mildly elevated ALP (gallstones), some may have elevated serum bilirubin (conjugated)

Question 5

Hepatocytes have a “crinkled paper appearance”. What is going on?

Answer 5

Gaucher Disease.
Metabolic disease where glucocerebrosides accumulate in hepatocytes and give them the crinkled paper appearance.
This is the MOST COMMON of the lysosomal storage diseases!
—> hepatosplenomegaly