Endocrine and Automimmune Flashcards

Question

What is obstetric cholestasis?

Answer 1

A pregnancy complication that affects the liver causing abnormal LFTs or raised bile acid levels. Resolves spontaneously after pregnancy. Arises 3rd trimester after 28 weeks, characterised by pruritis of palms with no obvious rash, dark urine, anorexia, malabsorption of fat and elevated bile acid levels.

Answer 2

``` Ethnicity Family Hx of biliary disease Hep C Prior OC multiple gestation AMA >35 ```

Answer 3

Genetic hypersensitivity to oestrogen Unexplained stillbirth? Bile acids cause chronic uteroplacental vasoconstriction, fetal hypoxia and babies at risk of meconium aspiration.

Answer 4

Any woman with itching - refer for LFTs Increased fetal surveillance with growth scan, doppler studies, AFI and CTG. Early planned delivery at 37 weeks as IUFD rate of 7% in one study with 90% occuring after 37 weeks.

Answer 5

Ursodoxycholic acid can be given (a type of bile acid) to address itching and balance biochemistry. Dexamethasone (corticosteriod) Vitamin K - OC can result in fat malabsorption so can be deficient in Vit K as is fat-soluable. Antihistamines Comfort measures - cool baths, loose clothing, skin lotions Postpartum - avoid OCP with oestrogen.

Answer 6

Pruritic Urticarial Papules and Plaques of pregnancy rash - usually third trimester. Comes with severe itch in 80% of cases Associated with weigh gain, primips and marked striae No increase in fetal mortality. Treatment - skin lubrication and topical antipruritics.

Answer 7

Inflammatory disease where immune system attacks it's own tissues (autoantibodies to connective tissue), causing severe fatigue and joint pain. 90% in females 40% of people with SLE ALSO have APS.

Answer 8

1/3 improve, 1/3 stable, 1/3 worsen ``` Increased risk of gestational hypertension Risk of preeclampsia IUGR preterm birth IUFD (8% in 2nd and 3rd tri) Miscarriage (increased risk 40 - 80%) Congenital abnormalities ```

Answer 9

Infection, sunlight or increases in oestrogen.

Answer 10

``` Classic butterfly rash on cheeks Weight loss fatigue and headaches fever with flu-like symptoms arthralgia ```

Answer 11

Depends on severity of disease and if there is a "flare". Note - can have false positive for syphilis Baseline bloods FBC, U&E, LFT, platelets, antibodies Baseline proteinuria Medication review required - change to NSAIDS, or corticosteriods (disease flare)? Aspirin for preeclampsia risk? Fetal monitoring for congenital abnormalities and IUGR Elective delivery if significant flare, preeclampsia, renal deterioration - care as per preterm infant! NVB possible if no flare - continuous monitoring needed.

Answer 12

Avoid oestrogen based OCP Steriods for postpartum 'flare' Continue observations for 10 days to detect flare Monitor for neonatal facial rash Alert to psychiatric symptoms - don't assume baby blues Advise to avoid excess sunlight for baby - risk of neonatal lupus.

Answer 13

Obstetric Lupus or Hughes Syndrome It's an acquired clotting disorder - can be primary or secondary (associated with an infection or other autoimmune disease such as SLE).

Answer 14

There must be one clincial feature, and one laboratory feature for diagnosis. For example: clinical feature = recurrent miscarriage, fetal death, venous or arterial thrombosis, autoimmune thrmobcytopaenia. Lab feature = presense of antibodies on blood test

Answer 15

APA - antiphospholipid antibodies - bind to phospholipids in cell membranes and cause damage. If affects blood vessels - vasculopathy causing clots in narrowed and damaged vessels. Two types included are: ACA - anticardiolipin antibody LAC - lupus anticoagulant Anti-Ro and Anti-La increase incidence of neonatal lupus and heart block on CTG.

Answer 16

Thrombophilias are types of blood clotting disorders. APS is a type of thrombophilia

Answer 17

daily aspirin, LMWH, warfarin (but not in pregnancy as teratogenic)

Answer 18

``` Preeclampsia IUGR recurrent miscarriage preterm birth abruption HELLP ```

Answer 19

Booking in hx Regular scans to detect IUGR Aspirin and LMWH - clotting and preeclampsia Frequent blood monitoring - FBC and platelets Monitor for preeclampsia Emotional support for possible poor outcomes Labour - cease heparin, continuous CTG, anaesthetist consultation early, adequeate hydration - consider IV fluids?, TED stockings in labour, active management of third stage, prompt suturing of perineal trauma.

Answer 20

Be alert for thrombosis. | Thrombopropholaxis should be continued

Answer 21

Autoimmune condition that causes hypothyroidism - immune system attacks the thyroid gland causing inflammation and possibly destruction of the gland, limiting it's ability to produce thyroid hormone.