Liver Disease and Pregnancy

Question 1

What are the main Hepatic Diseases Associated with Pregnancy?

Answer 1

• Preeclampsia and Eclampsia
• Acute Fatty Liver of Pregnancy
• Intrahepatic Cholestasis of Pregnancy

Question 2

Preeclampsia affects 3% to 5% of pregnancies and is characterized by:

Answer 2

• maternal hypertension,
• proteinuria,
• peripheral edema, and
• coagulation abnormalities

Question 3

What is HELLP syndrome?

Answer 3

• h emolysis,
• e levated l iver enzymes, and
• l ow p latelets,

Question 4

What signifies the onset of full-blown eclampsia?

Answer 4

•When hyperreflexia and convulsions occur, the condition is called eclampsia and may be life-threatening.

Question 5

What do these things show?

Answer 5

In preeclampsia,

• (left) Periportal sinusoids contain fibrin deposits associated with hemorrhage into the space of Disse
• (right) Leading to periportal hepatocellular coagulative necrosis

Question 6

What is this showing?

Answer 6

Eclampsia- Blood under pressure may coalesce and expand to form a hepatic hematoma; dissection of blood under Glisson capsule may lead to catastrophic hepatic rupture in eclampsia

Question 7

What causes acute fatty liver of pregnancy?

Answer 7

•Mitochondrial dysfunction (in BABY! Effects mother, woah) thought to play a role

Question 8

How does acute fatty liver of pregnancy present?

Answer 8

•Acute fatty liver of pregnancy presents with a spectrum of disorders ranging from subclinical or modest hepatic dysfunction (evidenced by elevated serum aminotransferase levels) to hepatic failure, coma, and death.

Question 9

When does acute fatty liver of pregnancy most commonly occur?

Answer 9

•Rare, usually in the 3rd trimester, most are mild

Question 10

What is the tx of acute fatty liver of pregnancy?

Answer 10

•Termination of pregnancy is primary treatment

Question 11

What does this show?

Answer 11

Acute fatty liver of pregnancy

• Microvesicular steatosis in zones 2 or 3 (vacuoles may be very small)
• Also marked ballooning of hepatocytes and macrovesicular fat

Question 12

What else can be seen in severe cases of acute fatty liver of pregnancy?

Answer 12

hepatocyte dropout,

reticulin collapse,

portal tract inflammation

Question 13

What is the second leading cause of gestational jaundice (after viral hepatitis)?

Answer 13

Intrahepatic Cholestasis of Pregnancy

Question 14

When does Intrahepatic Cholestasis of Pregnancy most commonly occur?

Answer 14

Usually occurs late in pregnancy

Question 15

What is thought to cause Intrahepatic Cholestasis of Pregnancy?

Answer 15

Estrogenic hormones may inhibit hepatocellular bile secretory activity

Question 16

What are some risks to the fetus with Intrahepatic Cholestasis of Pregnancy?

Answer 16

Associated with higher incidence of fetal distress, stillbirths, prematurity

Question 17

What are some risks to the mother with Intrahepatic Cholestasis of Pregnancy?

Answer 17

Mother at risk for gallstones, malabsorption

Question 18

How does Intrahepatic Cholestasis of Pregnancy present in the mother?

Answer 18

pruritis in third trimester, dark urine, light stools, jaundice

Question 19

How do labs appear in intrahepatic cholestasis of pregnancy?

Answer 19

some may have elevated serum bilirubin, usually conjugated;

mildly elevated alkaline phosphatase

Question 20

What is this showing?

Answer 20

Intrahepatic Cholestasis of Pregnancy

•Microscopic: Mild cholestasis without cirrhosis

Question 21

What is Gaucher Disease?

Answer 21

a genetic disorder in which glucocerebroside (a sphingolipid, also known as glucosylceramide) accumulates in cells and certain organs

•most common of the lysosomal storage diseases

Question 22

How does Gaucher disease present?

Answer 22

•Enlarged liver and spleen. If bone marrow involved trilineage decrease