Editing Liver disease in pregnancy (section)

== '''Liver disease in pregnancy''' ==

*
* Abormalities in FBE, blood film and coags mark severe lift-threatening disease

=== Acute fatty liver of pregnancy ===

** Usually third trimester after 32 weeks. Higher risk in twin, male and primipara pregnancies.
** Possible relationship to pre-eclampsia - mild HTN, oedema and proteinuria
** Presentation
*** Vomiting, polydipsia, epigastric or RUQ pain, malaise, fatigue, pruritis, rapidly progressive jaundice to liver failure
** Investigation
*** Transaminases generally 300-500, with raised bilirubin and ALP
*** USS has poor sensitivity in identifying acute fatty liver but is necessary to exclude differentials
*** FNA could confirm diagnosis, but not normally done because it wastes time
** Cured by delivery - that reduces mortality to about 20%, but mum's condition can worsen post-delivery
** Liver transplant may be required
** No chronic disease following recovery
** Recurrent disease with future pregnancies is not expected, but has been reported

=== Cholestasis of pregnancy ===

** Strong genetic predisposition
** Itch is predominant feature, along with jaundice
** Cholestatic LFTs but mother is otherwise well. Can sometimes see a significant rise in transaminases.
** May be a history of similar problems in previous pregnancies or with oral contraception
** Associated with increased rate of fetal loss
** Ursodeoxycholic acid helps with maternal symptoms and appears to reduce fetal mortality
** Recurrence in future pregnancies is likely

=== Pre-eclampsia/HELLP ===

** HTN, proteinuria and hyper-reflexia
** Liver disease occurs in about 10% of pre-eclampsia
** Transaminases can go above 500. jaundice is often mild.
** Most maternal deaths are cerebral, but liver can contribute through infarction, haemorrhage or haematoma
** Cured by delivery
** HELLP = haemolysis, elevated LFTs, low platelets (microangiopathic haemolytic anaemia) - needs urgent delivery

[[Category:Gastroenterology]]