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Intrahepatic Cholestasis Of Pregnancy

 Syn. ICP , Obstetric cholestasis , Idiopathic jaundice of pregnancy

Signs & Symptoms

 Prior history of Intrahepatic cholestasis
Note: due to Recurrence
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Epocrates [ Intrahepatic cholestasis of pregnancy]
Pruritus #criteria
Note: Prerequisite for making the diagnosis of ICP/ Precede other sign and symptoms and lab test / Late second and/or third trimester
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Cecil [ 423] Epocrates [ Intrahepatic cholestasis of pregnancy]
Pervious history of Intrahepatic cholestasis of pregnancy
Note: due to Recurrence
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Epocrates [ Intrahepatic cholestasis of pregnancy]
History of ICP in first-degree relatives
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)]

Physical Examination

 Ascites (negative symptom)
Note: due to Liver failure, Liver failure stigma
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)]
Meconium-stained amniotic fluid
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Cecil [ 423] Epocrates [ Intrahepatic cholestasis of pregnancy]
Right upper quadrant abdominal pain
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)]

Lab / Serology

 Elevation in serum bile acid concentrations #criteria
Note: (Chenodeoxycholic acid and deoxycholic acid)
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Cecil [ 423] Epocrates [ Intrahepatic cholestasis of pregnancy]
Elevated serum TBA #criteria
Note: (Chenodeoxycholic acid and deoxycholic acid)
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Cecil [ 423] Epocrates [ Intrahepatic cholestasis of pregnancy]
Centrilobar plugged bile canaliculi with pigment
Note: Predominate in zone 3
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Epocrates [ Intrahepatic cholestasis of pregnancy]

Imagin Study

 Abnormalities on ultrasonography (negative symptom)
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)]
Ascites (negative symptom)
Note: due to Liver failure, Liver failure stigma
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)]

Complication

 Neonatal Respiratory distress syndrome
Note: due to Meconium aspiration syndrome, due to Bile acids entering the lungs, due to premature birth
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Cecil [ 423] Epocrates [ Intrahepatic cholestasis of pregnancy]
Preterm delivery
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Cecil [ 423] Epocrates [ Intrahepatic cholestasis of pregnancy]
Sudden fetal arrhythmia
Note: due to High levels of bile acids
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)]

Risk Factors

 Age > 35
Ref: Epocrates [ Intrahepatic cholestasis of pregnancy]

Cause

 Chronic hepatitis C
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Epocrates [ Intrahepatic cholestasis of pregnancy]
Nonalcoholic liver cirrhosis
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Epocrates [ Intrahepatic cholestasis of pregnancy]
Estrogen
Ref: Uptodate [ Intrahepatic cholestasis of pregnancy (ICP)] Epocrates [ Intrahepatic cholestasis of pregnancy]

Other