Lecture: liver disease in pregnancy

This lecture was a nice overview of liver disease in pregnancy.  Fortunately it is not common.  Recall that alkaline phosphatase and alpha fetoprotein (AFP) can be elevated in pregnancy and extend beyond partum.  Most disease occurs in the third trimester.

Acute fatty liver of pregnancy is one example.  It may present with vague, constitutional symptoms, nausea, or perhaps right upper quadrant abdominal pain.  LFT should be elevated but non-specific.  Delivery is the appropriate treatment.

In the second to third trimester is intrahepatic cholestasis of pregnancy.  Pruritus begins on palms and soles before becoming generalized.  Diagnosis is made with serum bile acids > 10; if > 40 fetal health is also at risk.  It generally resolves post-partum without clinical sequelae, and may return in subsequent gestations.  Ursodiol is indicated (10-15 mg/kg).  Delivery may be indicated.

HELLP syndrome (hemolytic enemia, elevated LFT, low platelets) is part of a disease continuum that includes pre-eclampsia (hypertension, proteinuria, edema).  LFT may be markedly elevated.  Mortality is near 100% without delivery, and approaches 40-50% with delivery.  Supportive care is indicated.

Other diagnoses in pregnancy include Budd-Chiari Syndrome, cholelithiasis, new viral hepatitis.  Pregnancy after liver transplantation is possible, and it is preferable to wait at least 12 months post-op.

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