This document discusses various liver diseases that can occur during pregnancy. It covers physiologic liver changes in pregnancy, diseases induced by pregnancy like acute fatty liver of pregnancy (AFLP) and intrahepatic cholestasis of pregnancy (ICP), and preexisting liver diseases. It also discusses liver-related conditions in pregnancy like preeclampsia/eclampsia and HELLP syndrome. Management of various conditions is also summarized.
Liver and kidney diseases can complicate pregnancy. Unique liver diseases include intrahepatic cholestasis of pregnancy (ICP), acute fatty liver of pregnancy (AFLP), and HELLP syndrome. ICP causes pruritus and jaundice. AFLP results in fatty infiltration of hepatocytes. Kidney diseases increase risks of preeclampsia, preterm birth, and infection. Acute pyelonephritis is common. Chronic kidney disease poses high risks. Pregnancy while receiving dialysis or after transplant requires monitoring due to hypertension and infection risks.
Acute fatty liver of pregnancy (AFLP) is a rare but potentially fatal liver condition that can occur late in pregnancy. It is caused by an abnormal breakdown of fatty acids in the liver due to genetic mutations. AFLP presents with nausea, abdominal pain, and liver dysfunction. The condition is diagnosed based on clinical criteria and liver biopsy, and is treated by delivering the baby to reverse liver damage, followed by supportive care which may include intensive care, coagulation treatment, and glucose management. While still risky, early diagnosis and treatment have improved outcomes for both mother and baby.
Obs cholestasis also called IHCP/ICP
and etiology of IHCP ,pathogenesis in IHCP,bile acids as a investigation to detect and confirm it ,it's monitoring in pregnancy
It's adverse effects in pregnancy
Management of IHCP in pregnancy. Various drugs in management of IHCP. GUIDELINES on when to deliver and mode of delivery.Necessary information on obstetric cholestasis
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
The physiological changes in the liver during pregnancy
The possibilities of liver diseases
LFT in pregnancy
Intercurrent and pre-existing liver disease: viral hepatitis, autoimmune hepatitis, gall stones
Pregnancy associated liver disease: Hyperemesis Gravidarum, Acute cholestasis of pregnancy, Acute fatty liver of pregnancy, HELLP syndrome
- Acute liver failure (ALF) is a life-threatening condition caused by severe hepatic injury from various causes. The management of ALF requires a multidisciplinary approach to address complications affecting the brain, lungs, kidneys, and other organs. Liver transplantation may be considered for patients who do not recover spontaneously based on criteria such as coagulopathy and encephalopathy severity.
This document discusses the management of acute liver failure in critical care. It covers the following key points:
- Acute liver failure results from severe hepatic injury and can have various causes. It is a life-threatening condition with high mortality if left untreated.
- Patients present with coagulopathy, encephalopathy, and multi-organ dysfunction. Management involves addressing neurological, respiratory, cardiovascular, renal, infectious and nutritional issues.
- Specific treatments include sedation and ventilation for cerebral edema, fluid resuscitation for hypotension, renal replacement therapy for kidney injury, and antibiotics to prevent infection in immunosuppressed patients. The only cure for severe cases is emergency liver transplantation.
Liver and kidney diseases can complicate pregnancy. Unique liver diseases include intrahepatic cholestasis of pregnancy (ICP), acute fatty liver of pregnancy (AFLP), and HELLP syndrome. ICP causes pruritus and jaundice. AFLP results in fatty infiltration of hepatocytes. Kidney diseases increase risks of preeclampsia, preterm birth, and infection. Acute pyelonephritis is common. Chronic kidney disease poses high risks. Pregnancy while receiving dialysis or after transplant requires monitoring due to hypertension and infection risks.
Acute fatty liver of pregnancy (AFLP) is a rare but potentially fatal liver condition that can occur late in pregnancy. It is caused by an abnormal breakdown of fatty acids in the liver due to genetic mutations. AFLP presents with nausea, abdominal pain, and liver dysfunction. The condition is diagnosed based on clinical criteria and liver biopsy, and is treated by delivering the baby to reverse liver damage, followed by supportive care which may include intensive care, coagulation treatment, and glucose management. While still risky, early diagnosis and treatment have improved outcomes for both mother and baby.
Obs cholestasis also called IHCP/ICP
and etiology of IHCP ,pathogenesis in IHCP,bile acids as a investigation to detect and confirm it ,it's monitoring in pregnancy
It's adverse effects in pregnancy
Management of IHCP in pregnancy. Various drugs in management of IHCP. GUIDELINES on when to deliver and mode of delivery.Necessary information on obstetric cholestasis
Dr Abdullah Ansari
MBBS, MD Medicine
Aligarh Muslim University
The physiological changes in the liver during pregnancy
The possibilities of liver diseases
LFT in pregnancy
Intercurrent and pre-existing liver disease: viral hepatitis, autoimmune hepatitis, gall stones
Pregnancy associated liver disease: Hyperemesis Gravidarum, Acute cholestasis of pregnancy, Acute fatty liver of pregnancy, HELLP syndrome
- Acute liver failure (ALF) is a life-threatening condition caused by severe hepatic injury from various causes. The management of ALF requires a multidisciplinary approach to address complications affecting the brain, lungs, kidneys, and other organs. Liver transplantation may be considered for patients who do not recover spontaneously based on criteria such as coagulopathy and encephalopathy severity.
This document discusses the management of acute liver failure in critical care. It covers the following key points:
- Acute liver failure results from severe hepatic injury and can have various causes. It is a life-threatening condition with high mortality if left untreated.
- Patients present with coagulopathy, encephalopathy, and multi-organ dysfunction. Management involves addressing neurological, respiratory, cardiovascular, renal, infectious and nutritional issues.
- Specific treatments include sedation and ventilation for cerebral edema, fluid resuscitation for hypotension, renal replacement therapy for kidney injury, and antibiotics to prevent infection in immunosuppressed patients. The only cure for severe cases is emergency liver transplantation.
Liver diseases can complicate pregnancy in several ways. Some diseases predate pregnancy like cirrhosis, while others are unique to pregnancy such as acute fatty liver of pregnancy (AFLP). AFLP typically presents in the third trimester with nausea, vomiting, and abdominal pain and can progress rapidly to liver failure without treatment. Timely delivery is crucial for managing AFLP and other pregnancy-related liver conditions like preeclampsia. Close monitoring of liver enzymes and symptoms is needed to identify problems and prevent maternal and fetal complications.
This document discusses renal disease and pregnancy. It begins by outlining the normal physiological changes that occur in the kidney during pregnancy, including increased renal plasma flow, GFR, and dilatation of the collecting system. It then covers pregnancy-induced hypertension, including gestational hypertension, chronic hypertension, preeclampsia, and chronic hypertension with superimposed preeclampsia. The document also discusses acute kidney injury in pregnancy and chronic kidney disease and pregnancy. It provides details on diagnosis and management of various conditions.
This document discusses various causes of jaundice that can occur during pregnancy. It begins with definitions of jaundice and normal liver physiology during pregnancy. It then discusses changes in liver function tests during pregnancy and the effects of maternal hyperbilirubinemia on the fetus. The main causes of jaundice unique to pregnancy are identified as intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, HELLP syndrome, and severe hyperemesis gravidarum. Viral hepatitis, gallstones, autoimmune disorders and drugs are identified as causes that can coincide with pregnancy. Details are provided on diagnosis and management of specific conditions like obstetric cholestasis, acute fatty liver of pregnancy, HEL
Acute Fatty Liver of Pregnancy (AFLP) is a rare but serious condition that affects 1 in 7,000-11,000 pregnancies. It is characterized by fatty infiltration and cellular dysfunction in the liver during late pregnancy or early postpartum. Prompt delivery is the recommended treatment as the condition does not typically improve until after delivery, and maternal and fetal mortality rates are high if not treated properly. Diagnosis is based on clinical presentation and lab tests in the absence of a definitive causative agent or diagnostic test. Close monitoring of future pregnancies is advised for women previously affected by AFLP.
acute kidney injury during pregnancy, challenges in diagnosis and treatmentMarwa Elkaref
This document discusses acute kidney injury (AKI) during pregnancy. It begins by explaining the physiological changes in pregnancy that make diagnosing AKI difficult. It then discusses the causes and classifications of AKI during pregnancy. Some key causes mentioned include preeclampsia, HELLP syndrome, and septic abortion. The document outlines supportive management of renal function as well as treating the underlying disease. It notes that dialysis may be needed if other procedures are insufficient.
This document discusses various topics related to renal physiology and disease in pregnancy. It begins with an overview of the normal adaptations the kidneys undergo during pregnancy, including increases in kidney size, glomerular filtration rate (GFR), and decreased creatinine and blood urea nitrogen levels. It then covers specific topics like urinary tract infections (UTIs), hypertensive disorders of pregnancy, acute kidney injury, and chronic kidney disease in the context of pregnancy. For each topic, it provides details on pathogenesis, screening, treatment approaches, and management considerations for caring for pregnant patients with renal conditions.
The document summarizes various liver conditions that can cause jaundice in pregnancy. It discusses physiological changes in the liver during pregnancy and various causes of jaundice related and unrelated to pregnancy. These include viral hepatitis, intrahepatic cholestasis of pregnancy (ICP), preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy (AFLP). It provides details on pathogenesis, clinical presentation, management and prognosis for these conditions. Pregnancy-related liver disorders can affect both mother and fetus, so prompt diagnosis and treatment are important.
This document discusses HELLP syndrome, a variant of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets. It provides details on the pathogenesis, diagnosis, classification, clinical presentation, differential diagnosis, and management of HELLP syndrome. Regarding management, the document outlines the three main options - immediate delivery at or after 34 weeks, delivery within 48 hours with stabilization and steroids from 27-34 weeks, and expectant management for less than 48-72 hours before 27 weeks with steroids. The role of steroids in improving maternal and neonatal outcomes is also discussed.
This document discusses various causes of jaundice in pregnancy including intrahepatic cholestasis of pregnancy (ICP), viral hepatitis, acute fatty liver of pregnancy (AFLP), and more. ICP is characterized by pruritus and elevated bile acids and bilirubin. It is caused by hormonal changes that lead to bile stasis. AFLP presents late in pregnancy and can cause liver failure, coagulopathy, and hypoglycemia. Viral hepatitis, most commonly hepatitis B, presents with jaundice, nausea, and elevated transaminases. Management depends on the cause but may include drug therapy, delivery of the fetus, and supportive care.
This document provides guidelines for diagnosing and managing liver disease in pregnant patients. It discusses how the presentation of various liver conditions can differ during pregnancy compared to non-pregnant patients. Key recommendations include:
1) Use the gestational age of the pregnancy to guide diagnosis, as symptoms of different diseases typically occur during specific trimesters.
2) Consider hyperemesis gravidarum in the first trimester when evaluating abnormal liver tests.
3) Include cholestasis of pregnancy in the differential for abnormal liver tests presenting in the second trimester.
4) Consider preeclampsia-related conditions like HELLP syndrome in the second half of pregnancy, usually the third trimester,
1) HELLP syndrome is a serious condition characterized by hemolysis, elevated liver enzymes, and low platelets that can occur in pregnant women with preeclampsia.
2) It is important to monitor pregnant patients closely for signs and symptoms of HELLP syndrome and test for liver enzymes, platelets, and signs of hemolysis.
3) If HELLP syndrome is diagnosed, the goal is stabilization of the mother followed by expedited delivery, usually within 48 hours, as expectant management poses high risks.
This document summarizes renal disorders that can occur in pregnancy. It discusses the normal physiologic changes in pregnancy that affect the kidneys as well as specific disorders like preeclampsia, hypertension, AKI, lupus nephritis, diabetic nephropathy, and nephrotic syndrome. It provides diagnostic criteria and recommendations for management and treatment for many of these conditions to help support healthy pregnancies and outcomes.
This document discusses pregnancy in patients with systemic lupus erythematosus (SLE). It notes that SLE affects women disproportionately and can lead to pregnancy complications. Careful evaluation of disease activity and organ function is important before and during pregnancy. Medications like hydroxychloroquine can help control SLE without harming the fetus. Flares of SLE are common in pregnancy and can impact maternal and fetal outcomes. Differentiating preeclampsia from lupus nephritis is important for management. Close monitoring and treatment of flares is necessary to support a healthy pregnancy in SLE patients.
This document discusses acute liver failure (ALF), defining it as the rapid development of severe liver injury and encephalopathy in someone who previously had a normal liver or well-compensated liver disease. It describes the development of encephalopathy within different time periods to classify ALF as hyper-acute, acute, or subacute. Common causes, clinical presentation, investigations, complications including cerebral edema, and treatment approaches are summarized.
The document discusses various types of hepatobiliary diseases that can occur during pregnancy including viral hepatitis, drug-induced hepatitis, autoimmune hepatitis, ischemic hepatitis, and viral hepatitis A-E. It notes physiological changes in liver enzymes and function during pregnancy. It provides details on symptoms, transmission, management, and risks for mother and baby associated with each condition.
Jaundice in pregnancy can be caused by hemolytic, hepatocellular, or obstructive factors. Hemolytic jaundice may be due to blood transfusion incompatibility or infection, hepatocellular jaundice can result from viral hepatitis, preeclampsia, acute fatty liver of pregnancy, or drugs/alcohol, and obstructive jaundice may be from cholestasis of pregnancy, gallstones, or other conditions. Cholestasis of pregnancy is caused by estrogen sensitivity and shows a familial tendency, with symptoms of itching and mild jaundice. It can lead to complications like postpartum hemorrhage, premature labor, and stillbirth, so induction of labor is
1) The document discusses pregnancy induced hypertension, its classification, diagnosis, and management. It defines four types of hypertensive disorders in pregnancy: gestational hypertension, preeclampsia-eclampsia (mild and severe), superimposed preeclampsia-eclampsia, and chronic (preexisting) hypertension.
2) For diagnosis of hypertension in pregnancy, blood pressure must exceed 140/90 mmHg. Diagnosis of mild or severe preeclampsia depends on blood pressure levels and presence of proteinuria.
3) Management of mild preeclampsia can involve outpatient monitoring with regular visits or inpatient monitoring with maternal and fetal monitoring and treatment if signs worsen.
The document discusses HELLP syndrome, a variant of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets. It defines HELLP syndrome and describes its signs, symptoms, diagnostic criteria, potential complications, differential diagnoses, and management. HELLP syndrome occurs in 0.2-0.6% of pregnancies and is more severe than preeclampsia alone. Diagnosis is based on thrombocytopenia (<100,000 platelets/uL), elevated liver enzymes (>70 IU/L AST), and signs of hemolysis on blood smear. Immediate delivery is usually indicated if HELLP syndrome is diagnosed at or after 34 weeks, while expectant management may be attempted between
1) Pregnancy induced hypertension complicates 5-10% of pregnancies and is a leading cause of maternal mortality. It includes gestational hypertension, preeclampsia, and chronic hypertension.
2) Preeclampsia is diagnosed when a woman develops high blood pressure and protein in the urine after 20 weeks of pregnancy. Symptoms can include headaches, abdominal pain, and vision changes.
3) Management of mild preeclampsia involves outpatient monitoring while management of severe preeclampsia requires hospitalization, magnesium sulfate treatment, and sometimes antihypertensive drugs. Delivery is the definitive treatment when the condition becomes severe or the pregnancy reaches term.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Liver diseases can complicate pregnancy in several ways. Some diseases predate pregnancy like cirrhosis, while others are unique to pregnancy such as acute fatty liver of pregnancy (AFLP). AFLP typically presents in the third trimester with nausea, vomiting, and abdominal pain and can progress rapidly to liver failure without treatment. Timely delivery is crucial for managing AFLP and other pregnancy-related liver conditions like preeclampsia. Close monitoring of liver enzymes and symptoms is needed to identify problems and prevent maternal and fetal complications.
This document discusses renal disease and pregnancy. It begins by outlining the normal physiological changes that occur in the kidney during pregnancy, including increased renal plasma flow, GFR, and dilatation of the collecting system. It then covers pregnancy-induced hypertension, including gestational hypertension, chronic hypertension, preeclampsia, and chronic hypertension with superimposed preeclampsia. The document also discusses acute kidney injury in pregnancy and chronic kidney disease and pregnancy. It provides details on diagnosis and management of various conditions.
This document discusses various causes of jaundice that can occur during pregnancy. It begins with definitions of jaundice and normal liver physiology during pregnancy. It then discusses changes in liver function tests during pregnancy and the effects of maternal hyperbilirubinemia on the fetus. The main causes of jaundice unique to pregnancy are identified as intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, HELLP syndrome, and severe hyperemesis gravidarum. Viral hepatitis, gallstones, autoimmune disorders and drugs are identified as causes that can coincide with pregnancy. Details are provided on diagnosis and management of specific conditions like obstetric cholestasis, acute fatty liver of pregnancy, HEL
Acute Fatty Liver of Pregnancy (AFLP) is a rare but serious condition that affects 1 in 7,000-11,000 pregnancies. It is characterized by fatty infiltration and cellular dysfunction in the liver during late pregnancy or early postpartum. Prompt delivery is the recommended treatment as the condition does not typically improve until after delivery, and maternal and fetal mortality rates are high if not treated properly. Diagnosis is based on clinical presentation and lab tests in the absence of a definitive causative agent or diagnostic test. Close monitoring of future pregnancies is advised for women previously affected by AFLP.
acute kidney injury during pregnancy, challenges in diagnosis and treatmentMarwa Elkaref
This document discusses acute kidney injury (AKI) during pregnancy. It begins by explaining the physiological changes in pregnancy that make diagnosing AKI difficult. It then discusses the causes and classifications of AKI during pregnancy. Some key causes mentioned include preeclampsia, HELLP syndrome, and septic abortion. The document outlines supportive management of renal function as well as treating the underlying disease. It notes that dialysis may be needed if other procedures are insufficient.
This document discusses various topics related to renal physiology and disease in pregnancy. It begins with an overview of the normal adaptations the kidneys undergo during pregnancy, including increases in kidney size, glomerular filtration rate (GFR), and decreased creatinine and blood urea nitrogen levels. It then covers specific topics like urinary tract infections (UTIs), hypertensive disorders of pregnancy, acute kidney injury, and chronic kidney disease in the context of pregnancy. For each topic, it provides details on pathogenesis, screening, treatment approaches, and management considerations for caring for pregnant patients with renal conditions.
The document summarizes various liver conditions that can cause jaundice in pregnancy. It discusses physiological changes in the liver during pregnancy and various causes of jaundice related and unrelated to pregnancy. These include viral hepatitis, intrahepatic cholestasis of pregnancy (ICP), preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy (AFLP). It provides details on pathogenesis, clinical presentation, management and prognosis for these conditions. Pregnancy-related liver disorders can affect both mother and fetus, so prompt diagnosis and treatment are important.
This document discusses HELLP syndrome, a variant of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets. It provides details on the pathogenesis, diagnosis, classification, clinical presentation, differential diagnosis, and management of HELLP syndrome. Regarding management, the document outlines the three main options - immediate delivery at or after 34 weeks, delivery within 48 hours with stabilization and steroids from 27-34 weeks, and expectant management for less than 48-72 hours before 27 weeks with steroids. The role of steroids in improving maternal and neonatal outcomes is also discussed.
This document discusses various causes of jaundice in pregnancy including intrahepatic cholestasis of pregnancy (ICP), viral hepatitis, acute fatty liver of pregnancy (AFLP), and more. ICP is characterized by pruritus and elevated bile acids and bilirubin. It is caused by hormonal changes that lead to bile stasis. AFLP presents late in pregnancy and can cause liver failure, coagulopathy, and hypoglycemia. Viral hepatitis, most commonly hepatitis B, presents with jaundice, nausea, and elevated transaminases. Management depends on the cause but may include drug therapy, delivery of the fetus, and supportive care.
This document provides guidelines for diagnosing and managing liver disease in pregnant patients. It discusses how the presentation of various liver conditions can differ during pregnancy compared to non-pregnant patients. Key recommendations include:
1) Use the gestational age of the pregnancy to guide diagnosis, as symptoms of different diseases typically occur during specific trimesters.
2) Consider hyperemesis gravidarum in the first trimester when evaluating abnormal liver tests.
3) Include cholestasis of pregnancy in the differential for abnormal liver tests presenting in the second trimester.
4) Consider preeclampsia-related conditions like HELLP syndrome in the second half of pregnancy, usually the third trimester,
1) HELLP syndrome is a serious condition characterized by hemolysis, elevated liver enzymes, and low platelets that can occur in pregnant women with preeclampsia.
2) It is important to monitor pregnant patients closely for signs and symptoms of HELLP syndrome and test for liver enzymes, platelets, and signs of hemolysis.
3) If HELLP syndrome is diagnosed, the goal is stabilization of the mother followed by expedited delivery, usually within 48 hours, as expectant management poses high risks.
This document summarizes renal disorders that can occur in pregnancy. It discusses the normal physiologic changes in pregnancy that affect the kidneys as well as specific disorders like preeclampsia, hypertension, AKI, lupus nephritis, diabetic nephropathy, and nephrotic syndrome. It provides diagnostic criteria and recommendations for management and treatment for many of these conditions to help support healthy pregnancies and outcomes.
This document discusses pregnancy in patients with systemic lupus erythematosus (SLE). It notes that SLE affects women disproportionately and can lead to pregnancy complications. Careful evaluation of disease activity and organ function is important before and during pregnancy. Medications like hydroxychloroquine can help control SLE without harming the fetus. Flares of SLE are common in pregnancy and can impact maternal and fetal outcomes. Differentiating preeclampsia from lupus nephritis is important for management. Close monitoring and treatment of flares is necessary to support a healthy pregnancy in SLE patients.
This document discusses acute liver failure (ALF), defining it as the rapid development of severe liver injury and encephalopathy in someone who previously had a normal liver or well-compensated liver disease. It describes the development of encephalopathy within different time periods to classify ALF as hyper-acute, acute, or subacute. Common causes, clinical presentation, investigations, complications including cerebral edema, and treatment approaches are summarized.
The document discusses various types of hepatobiliary diseases that can occur during pregnancy including viral hepatitis, drug-induced hepatitis, autoimmune hepatitis, ischemic hepatitis, and viral hepatitis A-E. It notes physiological changes in liver enzymes and function during pregnancy. It provides details on symptoms, transmission, management, and risks for mother and baby associated with each condition.
Jaundice in pregnancy can be caused by hemolytic, hepatocellular, or obstructive factors. Hemolytic jaundice may be due to blood transfusion incompatibility or infection, hepatocellular jaundice can result from viral hepatitis, preeclampsia, acute fatty liver of pregnancy, or drugs/alcohol, and obstructive jaundice may be from cholestasis of pregnancy, gallstones, or other conditions. Cholestasis of pregnancy is caused by estrogen sensitivity and shows a familial tendency, with symptoms of itching and mild jaundice. It can lead to complications like postpartum hemorrhage, premature labor, and stillbirth, so induction of labor is
1) The document discusses pregnancy induced hypertension, its classification, diagnosis, and management. It defines four types of hypertensive disorders in pregnancy: gestational hypertension, preeclampsia-eclampsia (mild and severe), superimposed preeclampsia-eclampsia, and chronic (preexisting) hypertension.
2) For diagnosis of hypertension in pregnancy, blood pressure must exceed 140/90 mmHg. Diagnosis of mild or severe preeclampsia depends on blood pressure levels and presence of proteinuria.
3) Management of mild preeclampsia can involve outpatient monitoring with regular visits or inpatient monitoring with maternal and fetal monitoring and treatment if signs worsen.
The document discusses HELLP syndrome, a variant of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets. It defines HELLP syndrome and describes its signs, symptoms, diagnostic criteria, potential complications, differential diagnoses, and management. HELLP syndrome occurs in 0.2-0.6% of pregnancies and is more severe than preeclampsia alone. Diagnosis is based on thrombocytopenia (<100,000 platelets/uL), elevated liver enzymes (>70 IU/L AST), and signs of hemolysis on blood smear. Immediate delivery is usually indicated if HELLP syndrome is diagnosed at or after 34 weeks, while expectant management may be attempted between
1) Pregnancy induced hypertension complicates 5-10% of pregnancies and is a leading cause of maternal mortality. It includes gestational hypertension, preeclampsia, and chronic hypertension.
2) Preeclampsia is diagnosed when a woman develops high blood pressure and protein in the urine after 20 weeks of pregnancy. Symptoms can include headaches, abdominal pain, and vision changes.
3) Management of mild preeclampsia involves outpatient monitoring while management of severe preeclampsia requires hospitalization, magnesium sulfate treatment, and sometimes antihypertensive drugs. Delivery is the definitive treatment when the condition becomes severe or the pregnancy reaches term.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
3. INTRODUCTION
Liver disease in pregnancy encompasses a
spectrum of diseases encountered during
gestation and the postpartum period that
result in abnormal liver function tests,
hepatobiliary dysfunction, or both. It
occurs in 3% to 10% of all pregnancies.
5. Physiologic Changes In LIVER During Pregnancy
Total blood flow to the liver increases
after 28th week driven by the increased
flow to the portal vein. Histology of the
liver remains essentially normal during
pregnancy.
6.
7. Several disorders contribute to liver disease in
pregnancy
These include diseases induced by the
pregnancy such as acute fatty liver of pregnancy
(AFLP) and intrahepatic cholestasis of pregnancy
(IHCP),
diseases that existed before pregnancy that
could potentially flare during pregnancy such as
autoimmune hepatitis and Wilson’s disease,
and diseases not related to the pregnancy but
that could affect the pregnant woman at any
time during gestation such as viral hepatitis.
8. Several disorders contribute to liver disease in
pregnancy
LIVER DISES IN
PREGNANCY
Diseases induced by
Pregnancy.
Preexisting Liver
Disease
Liver Diseases
Coincidental
with Pregnancy
HEG,HELLP Syndrome
Pre-eclampsia/eclampsia
AFLP, IHCP,
Autoimmune hepatitis
Wilson’s disease,
Cirrhosis and
Portal Hypertension
viral hepatitis
Hep:A,B,C & E,
H.SIMPLEX,CMV
10. NTRAHEPATIC CHOLESTASIS OF PREGNANCY
Intrahepatic cholestasis of pregnancy
(ICP) is a reversible condition of
cholestasis that happens usually in the
third trimester. Findings such as pruritus,
high serum bile acids levels, and abnormal
liver function tests usually resolve after
delivery.
12. Clinical presentation
pruritus.
steatorrhea,
malabsorption of fat-soluble vitamins, and
weight loss.
ICP seems also to increase the incidence
of gallstones and cholecystitis.
13. Although ICP is a benign condition for the
mother, poor fetal outcomes can occur.
In some studies ICP resulted in
premature births up to 60%.
Other complications such as fetal distress
and
intrauterine fetal death were reported at
61% and 1.6% respectively.
The onset of pruritus and
higher maternal fasting serum bile acids
were associated with higher risk for
premature delivery.
14. Elevated serum bile acids level confirms
the diagnosis.
Aminotransferases can be elevated as
well up to 2-10 folds.
Alkaline phosphatase levels might not be
helpful due to higher physiological levels
in late pregnancy.
Clinical jaundice is detected in 10%-15%
of the cases only and bilirubin levels rarely
exceed 100 μmol/L.
15. As in all cholestatic patients, women with
ICP tend to have higher low-density
lipoprotein cholesterol and triglycerides.
Liver biopsy can reveal bland cholestasis
(intrahepatic cholestasis without
parenchymal inflammation). Liver biopsy is
usually not indicated.
16. Management
Ursodeoxycholic acid (UDCA) is the first line
therapy for ICP. UDCA has shown significant
decrease in serum bile acids, serum
aspartate aminotransferase and alanine
aminotransferase, serum bilirubin, and was
effective for pruritus.
Bile acids sequestrants such as
cholestyramine, antihistamines and opioid
antagonists have been used to alleviate the
pruritus.
17. Cholestyramine does not improve
biochemical parameters or fetal outcomes
in ICP.
Some studies suggested 40 μmol/L as a
cut off level of bile acids, after that fetal
complications may happen. No evidence is
strong enough to recommend early
delivery (at 37 wk of gestation) for
mothers with high bile acids levels,
although this strategy is still used in some
practices.
19. ACUTE FATTY LIVER OF PREGNANCY
Acute fatty liver of pregnancy (AFLP) is a
rare but a serious condition that is unique
to pregnancy and happens in the third
trimester.
AFLP can lead to significant maternal and
fetal morbidity and mortality.
Although rare, incidence of 1 per 7270 to
13000 deliveries, outcomes can be grave
with acute liver failure and death.
20. Pathogenesis
Until recently the pathogenesis of AFLP
was unknown and still has not been fully
elucidated. However, molecular advances
over the past decade suggest that AFLP
may result from mitochondrial
dysfunction. Defects in fetal mitochondrial
fatty acid β-oxidation have been linked to
development of maternal AFLP,
particularly fetal defects in LCHAD, which
is part of the mitochondrial trifunctional
protein (MTP) complex
21. Clinical presentation
nausea,
vomiting,
headache, and
fatigue can be the initial presentation.
Right upper quadrant pain or epigastric pain.
jaundice
hypoglycemia,
renal failure,
coagulopathy,
ascites, and
Encephalopathy
Hypertension/
22. AFLP is a medical and obstetric emergency and
diagnosis relying on clinical and laboratory
findings should be prompt.
Liver biopsy can be helpful in early and mild
cases of AFLP especially if diagnosis is not clear.
Liver biopsy is not necessarily needed and
should be avoided in more severe cases were
the risk of bleeding is high and prompt
therapeutic intervention is needed.
Alkaline phosphatase is usually elevated.
Other findings such as leukocytosis,
thrombocytopenia,
disseminated intravascular coagulopathy (DIC),
abnormal prothrombin time, partial
thromboplastin time, and normal fibrinogen can
occur.
23. Ketonuria and proteinuria can be present.
Elevated blood urea nitrogen and creatinine
indicate renal insufficiency.
Low serum albumin and hypoglycemia can
occur.
Uric acid and ammonia levels can be increased.
Hyperuricemia can be an early indicator and
develop before hyperbilirubinemia.
Liver biopsy usually displays microvesicular
steatosis.
Electron microscopy can show mitochondrial
disruption.
Imaging studies can be useful to exclude other
pathologies; but have limited utility in the
diagnosis of AFLP.
24. Management
Stabilization of the mother and early
recognition and delivery are the keys for
successful management.
Close monitoring and management of
associated complications is necessary to
improve outcomes.
Plasmapheresis was used in few series in
severe cases with reported success
26. PREECLAMPSIA/ECLAMPSIA
Preeclampsia is a disorder defined by
the triad of hypertension, edema,
and proteinuria.
It affects about 5%-10% of all
pregnant women and usually occurs
late in the second trimester or in the
third trimester.
Eclampsia involves all features of
preeclampsia and includes neurologic
symptoms such as headaches, visual
disturbances, and seizures or coma.
27. 10- to 20-fold elevation in
aminotransferases,
elevations in alkaline phosphatase levels
bilirubin elevations of less than 5 mg/dL.
Liver histology generally shows hepatic
sinusoidal deposition of fibrin along with
periportal hemorrhage, liver cell necrosis,
and in severe cases, infarction; these
changes are likely due to vasoconstriction
of hepatic vasculature.
28. The only effective treatment for
preeclampsia is delivery of the
fetus and placenta.
However, if evident before 36 wk
g estation, one may consider
expectant management with
intensive monitoring.
antihypertensives such as
calcium channel blockers.
Methyldopa
Magnesium sulfate may be
administered if eclampsia
develops.
30. HEMOLYSIS, ELEVATED LIVER TESTS
AND LOW PLATELETS
HELLP syndrome is a multisystemic disorder of
pregnancy involving hemolysis, elevated liver
tests, and low platelets.
About 70% of cases occur antenatally, and most
cases occur during the last trimester of
pregnancy.
The pathogenesis of HELLP is thought to
involve alterations in platelet activation,
increases in proinflammatory cytokines, and
segmental vasospasm with vascular endothelial
damage.
31. Most patients present with
right upper quadrant abdominal pain,
nausea,
vomiting,
malaise, and
edema with significant weight gain.
Less commonly associated conditions include renal failure (with
increased uric acid),
diabetes insipidus, and
antiphospholipid syndrome.
Other late findings include disseminated intravascular coagulopathy
(DIC),
pulmonar y edema,
placental abruption, and
retinal detachment.
Hypertension and proteinuria may be seen, but in 20% of patients,
hypertension is absent[19].
32. Laboratory findings include hemolysis with
increased bilirubin levels (usually less than
5 mg/dL) and
lactate dehydrogenase (LDH) levels
greater than 600 IU/L,
moderately elevated aspartate
aminotransferase (AST) and ALT levels
(200 IU/L to 700 IU/L), and
thrombocytopenia (less than 100 000/mL).
33. In early stages, prothrombin time and
activated partial thromboplastin time are
normal, but in later phases it will be de-
ranged,
34. The reported maternal mortality from
HELLP is 1%, and the perinatal
mortality rate ranges from 7%-22%
and may be due to premature
detachment of placenta,
intrauterine asphyxia, and
prematurity
acute renal failure,
adult respiratory distress syndrome,
pulmonary edema,
stroke,
liver failure, and
hepatic infarction.
35. The only definitive treatment for HELLP
syndrome is delivery. If the pregnant woman is
greater than 34 wk gestation, immediate
induction is recommended.
If gestational age is between 24 wk and 34 wk,
corticosteroids are administered to accelerate
fetal lung maturity in preparation for delivery 48
h later.
After delivery, close monitoring of the mother
should continue,
For patients with ongoing or newly developing
postpartum symptoms of HELLP, modalities such
as antithrombotic agents,
plasmapheresis, and
dialysis may be employed.
37. Preexisting Liver Disease and Pregnancy
The outcome of a pregnancy is greatly
affected by the medical condition of the
liver before conception. Diagnosis and
treatment of a liver disorder before
conception will minimize potential
exacerbations that could lead to liver
failure and fetal loss.
38. Cirrhosis and Portal Hypertension
The prevalence of cirrhosis in reproductive-age
women approximates 0.45 cases per 1000.
Etiology of cirrhosis in pregnancy is similar to
that in the nonpregnant state and commonly
includes alcohol and viral hepatitis C and B.
Patients with cirrhosis and noncirrhotic portal
hypertension are at high risk for premature
deliveries.
.
39. Hepatic decompensation with jaundice, bleeding
from esophageal varices, ascites, and fulminant
liver failure can occur.
In general, diuretics and spironolactone, are
not advisable during pregnancy or lactation
because of the potential for teratogenicity.
Banding of bleeding esophageal varices and
octreotide are safe during pregnancy.
Meperidine (Demerol) and midazolam (Versed)
safe to use during endoscopy.
40. Wilson’s Disease
Wilson’s disease is an inherited autosomal recessive
defect of copper transport.
Fertility in Wilson’s disease is decreased but can
improve with therapy.
Treatment should be initiated before conception and
should not be interrupted during pregnancy, because of
the risk of fulminant liver failure.
The treatment of choice in pregnancy is zinc sulfate
50 mg three times daily, because of its efficacy and
safety for the fetus.
Patients who are treated with d-penicillamine or trientin
before pregnancy require a dose reduction by 25% to
50% of that in the pre-pregnancy state especially during
the last trimester, to promote better wound healing if a
cesarean section is to be performed.
41. Autoimmune Hepatitis
Autoimmune hepatitis is a progressive liver disease that
predominantly affects women of all ages and can
manifest at any time during gestation and the
postpartum period.
The disease activity of autoimmune hepatitis is usually
attenuated during pregnancy, and dosages of medication
can be decreased because of the state of immune
tolerance induced by the pregnancy.
There is an increased risk of prematurity, low-birth-
weight infants, and fetal loss.
Pregnancy does not contraindicate immunosuppressive
therapy. Both prednisone and azathioprine ( at dosages
<100 mg/day) are considered safe during pregnancy
and lactation.
In one meta-analysis, prednisone given during the first
trimester was linked to a marginal risk of oral cleft defect
in the newborn.
43. Viral Hepatitis
Acute viral hepatitis is the most common
cause of jaundice in pregnancy, with an
incidence of approximately 1 to 2 per
1000. The outcome is usually benign,
except in viral hepatitis E and herpes
simplex virus (HSV) hepatitis.
44. Viral Hepatitis
Acute viral hepatitis E is transmitted via
the fecal-oral route and is associated with
high morbidity and a maternal mortality
rate of 30%.
Vertical transmission of HEV to the
newborn occurs in 50% of cases if the
mother is viremic at the time of delivery.
Treatment is supportive, and judicious
hand washing prevents contamination.
45. Herpes Simplex Hepatitis
Approximately 2% of women acquire HSV
during pregnancy.
HSV hepatitis is a rare condition but may
be devastating when primary infection
occurs in pregnancy because it is
associated with a 40% risk for fulminant
liver failure and death.
Treatment of choice for severe primary
HSV infection is intravenous acyclovir .
46. Acute Viral Hepatitis A
Acute hepatitis A virus (HAV) infection is
usually self-limited during pregnancy.
Transmission to the newborn can occur
when delivery takes place during the
incubation period because of viral
shedding and contamination during
vaginal delivery.
Treatment of the mother is supportive.
Passive immunoprophylaxis should be
given to the newborn.
47. Viral Hepatitis B
Acute and chronic HBV infections during
pregnancy do not seem to affect the
course of pregnancy but are associated
with an increased risk of transmission to
the newborn.
The risk of vertical transmission of HBV is
minimal if the infection is acquired and
resolves in the first trimester.
48. The risk is high, ranging from 60% to
90% if the infection is acquired during the
third trimester or if the infected mother is
positive for the envelope antigen (eAg)
and the viral DNA count is elevated.
Therefore, active and passive
immunoprophylaxis should be
administered to newborns of HBV-infected
mothers.
49. Viral Hepatitis C
The prevalence of hepatitis C virus (HCV)
infection in women of childbearing age in the
United States is approximately 1%.
Treatment of HCV infection is contraindicated in
pregnancy because of the teratogenicity of the
drugs used.
There is a 3.8% rate of vertical transmission to
infants born to mothers who are viremic at the
time of delivery.
Breast-feeding should not be discouraged and
the indication for cesarean section should be
based on obstetrical reasons.
50. Summary
Signs and symptoms of liver disease in pregnancy are
not specific, but the underlying disorder can have
significant morbidity and mortality effects on the mother
and fetus. Early recognition can be lifesaving.
Acute viral hepatitis is the most common cause of
jaundice in pregnancy. The outcome is usually benign.
Intervention might not be required except in cases of
viral hepatitis E and herpes simplex hepatitis.
51. Women with well-compensated cirrhosis and
noncirrhotic portal hypertension may become
pregnant. Preconception care and management
of pregnant women with portal hypertension
should be similar to that for nonpregnant
women.
Fertility may be restored after liver
transplantation and pregnancy might have a
good outcome.
Vigilance in recognizing liver disorders in
pregnancy and early coordinated management
among the primary care physician, obstetrician,
liver specialist, and transplant surgeon are
essential for promoting good maternal and fetal
outcomes.