1. Q2 OC
A 24 year old primigravida at 32 weeks gestation reports to the clinic with a complaint of itching over palms and soles which gets worse at night. There is no obvious rash. She is advised Liver Function test and Bile acids. The lab results are as follows- AST - 332 IU/L, ALT - 200 IU/L and Bile acid 24 micromol/L. What will be the next investigations? ( Select all that apply)
The tests are done to rule out other causes of Liver Dysfunction.
The presence of autoantibodies should point to presence of Autoimmune causes.
In such cases , there is usually the presence of other Autoimmune Disorders.
The antibodies pointing to specific autoimmune disorders are as follows-
AMA, ANA- Primary biliary cirrhosis.
ANA, aSMA- Primary sclerosing cholangitis .
ANA, aSMA, LKM1, Anti-soluble liver antigen Anti-liver pancreas antibodies --Autoimmune hepatitis.
A thorough drug history including use of over the counter or alternative medicines should be taken to rule out possibility of Drug Induced Liver Injury.
( AMA = anti-mitochondrial antibodies;
ANA = anti-nuclear antibodies;
pANCA = perinuclear anti-neutrophil cytoplasmic antibodies; aSMA = anti-smooth muscle antibodies;
LKM1 = anti-liver kidney microsomal antibodies.)
Obstetric Cholestasis is a diagnosis of exclusion. If any other causes are found, review by Physician should be sought.
Coagulation profile should be done in cases of liver dysfunction.
In case of abnormal liver function , pre-eclampsia and Acute Fatty Liver of Pregnancy should be kept in mind.
