GASTROENTEROLOGY ARTICLE OF THE WEE
March 18, 2010
Joshi D, James A, Quaglia A, et al. Liver disease in pregnancy. Lancet 2010:375:594-605.
1. Typical findings consistent with herpes simplex hepatitis include
a. jaundice
b. Leucopenia and thrombocytopenia
c. mucocutaneous lesions consistent with herpes present in >80%
d. coagulopathy
e. improvement with delivery
2. Intrahepatic cholestasis of pregnancy
a. typically develops in the 3rd trimester
b. Is likely associated with a hetrozygote mutation in the MDR 3 gene on chromosome 7q21.1
c. Occurs more often in patients who developed cholestasis while on OCP T
d. Increases maternal mortality
e. Is almost never associated with liver enzyme elevations
f. Classical finding is an elevated serum bilirubin
True or False
3. Intrahepatic cholestasis of pregnancy typically presents in the second trimester
4. Elevated serum transaminases are not typical for hyperemesis gravidarum
5. Jaundice is rare in preeclampsia-related liver disease
6. HELLP can develop in patients with no other sign of preeclampsia
7. Histologically, fatty liver of pregnancy is characterized by macrovesicular steatosis affecting most hepatocytes.
8. After liver transplant, pregnancy should be delayed for at least 1 year.
9. Hyperemesis gravidarum should be treated with steroids to hasten resolution
10. Cholestyramine is the treatment of choice for pruritus in ICP
11. Intrahepatic cholestasis of pregnancy always resolves with delivery, acute fatty liver may evolve into chronic liver disease after delivery
12. The presence of ascites in association with RUQ pain favors Budd-Chiari syndrome over acute fatty liver of pregnancy as the cause of liver dysfunction