obstetric cholestasis

Introduction

Obstetric cholestasis (also known as Intrahepatic homeostasis of pregnancy (ICP), is the most common liver disease in pregnancy (Glatz, Marschall, Mattsson 2004) it is a multifactoral and pregnancy specific condition and is characterised by it is by puritus, elevated serum aminotransferases and bile acid levels, with the onset in the second or third trimester of pregnancy, with spontaneous relief of signs and symptoms within two to three weeks of delivery (Beuers and Pusl 2006).

ICP is a relatively benign but often significantly distressing condition maternally, the clinical importance of obstetric cholestatis lies in the potential fetal risk, which may include with preterm labour, fetal distress and stillbirths (Egan, Bartels, Kashan, Broadhurst, Joyce, Mullane and O‘Donoghue 2012).

Diagnosis is suggested if a woman in the third trimester, (although earlier presentation has been suggested Saleh and Abdo 2006) develops itching without a rash and at least one biochemical liver abnormality (Walker, Nelson-Piercy and Williamson 2002), The RCOG (2006) recognise that ICP is a diagnosis of exclusion, therefore other more common causes of deranged Liver function test (LFT) must be excluded. This includes pre -eclampsia, acute fatty liver, infective and auto-immune hepatitis and choledocholithiasis (Seong and Valayatham 2013).

Raised liver enzymes (Alanine Transfinite (ALT) and increased Serum bile acids (SBA) usually confirms the diagnosis of ICP (Kenyon, Pier, Girling, Williamson, Tribe and Shennan 2002), with the measurement of SBA considered the most important biochemical marker for the both the diagnosis and monitoring of ICP.

In the case of Mrs X she was admitted in the third trimester with the classical ...

... middle of paper ...

...epatic recirculation is that each bile salt molecule is reused about 20 times.

Hepatocytes initiate bile formation by secreting primary bile, into their canaliculi, as biliary canaliculi poses high surface volume ratio due to their ergonomic structure it favours by means of osmotic gradients the formation of bile flow. Cholangiocytes modify the canaliculi bile by secretory and reabsorptive process as bile passes through the bile ducts (Banales, Prieto, Medina 2006).

The composition of bile is mainly water however phospholipids, cholesterol, and ions including sodium, potassium, calcium are all identified, as too are proteins and peptides such as gluthione (Esteller 2008), and small proportion of bile salts 0.6g (Brites 2002). Bile salts and bile acids which are synthesized by the liver from cholesterol with the organic acid taurine or the amino acid choline