Pregnancy and GI

Question 1

During pregnancy this micronutrient taken in excess can lead to adverse effects on the pregnancy (spontaneous abortion and birth defects)?

Answer 1

Vitamin A

Question 2

Phentermine/topiramate therapy is used for?

Pregnancy Risk?

Answer 2

obesity

Teratogenic - cleft palate

Question 3

IBD medications safe in pregnancy?

Answer 3

TNF-inhibitors
thiopurines (AZA, 6MP)
5-ASA compounds

Question 4

IBD medications to actively avoid in pregnancy? (risk of)

Answer 4

Methotrexate (teratogenic)
Metronidazole (cleft palate)
Ciprofloxacin (skeletal defects)

Question 5

IBD medication that should be avoid for the first trimester?

Answer 5

Metronidazole

Question 6

These IBD patients should have a c-section

Answer 6

Perianal disease

Question 7

IBD patients would benefit from colectomy - advice for fertility?

Answer 7

• ## IPAA will decrease fertility (adhesions impact fallopian tubes) so keep stoma until after family is complete

Question 8

New mother with IBD on TNFa. What vaccines to avoid for child? For how long?

Answer 8

Live vaccines (ie. rotavirus); 6 months

Question 9

Preferred antibiotic (when needed) for pregnant women and children?

Answer 9

Azithromycin

Question 10

Effect of sulfasalazine on fertility?

Answer 10

sperm dysfunction

Question 11

CD drug to avoid during breastfeeding?

Answer 11

metronidazole

Question 12

5-ASA coated with this should be avoided during pregnancy?

Answer 12

dibutyl phthalate (DBP)

Question 13

Anti-diarrheal to avoid in pregnancy?

Answer 13

Diphenoxylate-atropine (lomotil) class c

Question 14

intrahepatic cholestasis of pregnancy typically presents when? with what symptom?

best test? at what level do pregnancy complications occur?

First line treatment? Second line?

Answer 14

3rd trimester; pruritis;

serum bile acids; >40

Ursodeoxycholic acid; Cholestyramine

Question 15

When should you initiate HCV treatment during pregnancy?

Answer 15

Never

Question 16

OLT immunosupresson drug that has been associated with congenital anomalies

Answer 16

Mycophenolate

Question 17

When to treat HBV in pregnancy? Drug of choice?

Answer 17

HBV viral load >200,000

Tenofovir

Question 18

Liver bx of pregnant patient shows:

1) fibrin deposition, periportal hemorrhage, hepatocyte necrosis/infarction, and microvesicular fat infiltration
2) Microvesicular fat accumulation in the pericentral zone with perioportal sparing
3) Centrilobular cholestasis, little to no inflammation and bile plugs in hepatocytes
4) Hepatocyte necrosis, bile plugs, cholestasis and steatosis
5) Lymphoplasmacytic portal inflammatory infiltrate, interface hepatitis, bridging necrosis

diagnosis?

Answer 18

1) Pre-eclampsia
2) Acute Fatty Liver of Pregnancy
3) Intrahepatic cholestasis of pregnancy
4) Hyperemesis gravidarum
5) Autoimmune Hepatitis

Question 19

Swansea criteria allows for the diagnosis of?

Answer 19

Acute fatty liver of pregnancy

Question 20

most common cause of jaundice in pregnancy?

Answer 20

acute viral hepatitis

Question 21

When to screen for esophageal varices in a cirrhotic pregnant patient?

Answer 21

second trimester

Question 22

intrahepatic cholestasis of pregnancy - when is delivery advised?

Answer 22

37 weeks (the risk of intrauterine death is thought to be more common during the last month of pregnancy)

Question 23

HEV during pregnancy - more severe genotypes?

Answer 23

I and II

Question 24

HEV during pregnancy - mortality rate?

Answer 24

20-50%

Question 25

Ribaviran - use during pregnancy?

Answer 25

Contraindicated - teratogenic