Obstetric cholestasis Flashcards
(13 cards)
What is obstetric cholestasis?
Reduced outflow of bile acids from the liver which resolves after delivery of the baby
Why does obstetric cholestasis occur?
Thought to be due to the result of increased oestrogen & progesterone levels
Who is it more common in?
South Asian women
Explain the pathophysiology of obstetric cholestasis?
Bile acids are produced in the liver from the breakdown of cholesterol. Bile acids flow from the liver → hepatic ducts → past gallbladder → out of bile duct. In obstetric cholestasis, the outflow of bile acids is reduced so they build up in the blood giving the classic symptom of pruritis.
What risk is obstetric cholestasis associated with?
Stillbirth. Reduced by planned, early delivery.
When does it typically present?
Later in pregnancy esp third trimester
What are the symptoms?
Pruritis, particularly of the palms of hands & soles of feet. Fatigue. Dark urine, pale stools. Jaundice.
What do you need to think if there is a rash present?
Polymorphic eruption of pregnancy. Pemphigoid gestationis.
Differentials?
Gallstones. Acute fatty liver. Autoimmune hepatitis. Viral hepatitis.
Investigations?
LFTs - abnormal ALT, AST & GGT will be seen. Raised bile acids.
Management of itching?
Emollients ie. calamine lotion. Antihistamines eg. chlorphenamine to help sleep.
What is considered if prothrombin time is deranged and why?
Water soluble vitamin K as bile acids are important in the absorption of fat soluble vitamins in the intestines so lack of bile acids can lead to vitamin K deficiency and lead to impaired clotting of blood.
why is it normal for ALP to be raised in pregnancy?
- because the placenta produces ALP
- therefore a rise in ALP without other abnormal LFT results is usually due to placental production of ALP rather than liver pathology
