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Disorders of the liver, gallbladder, and pancreas together comprise a formidable list of complications that may arise in pregnancy, including some unique to pregnancy. Their relationships with pregnancy can be fascinating, intriguing, and challenging.

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It is customary to divide liver diseases complicating pregnancy into three general categories. The first includes those specifically related to pregnancy that resolve either spontaneously or following delivery. Examples are hepatic dysfunction from hyperemesis gravidarum, intrahepatic cholestasis, acute fatty liver, and hepatocellular damage with preeclampsia—the “HELLP syndrome” (Hay, 2008). The second category includes acute hepatic disorders that are coincidental to pregnancy, such as acute viral hepatitis. The third category includes chronic liver diseases that predate pregnancy, such as chronic hepatitis, cirrhosis, or esophageal varices.

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Hepatic Physiology in Pregnancy

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Pregnancy may induce appreciable changes in some clinical and laboratory manifestations related to the liver (see Chap. 5, Liver and Appendix). Findings such as elevated serum alkaline phosphatase, palmar erythema, and spider angiomas, which might suggest liver disease, are commonly found during normal pregnancy. However, histological liver findings with uncomplicated pregnancies are unchanged compared with those of nonpregnant subjects (Ingerslev and Teilum, 1945).

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Hyperemesis Gravidarum

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Pernicious nausea and vomiting are discussed in detail in Chapter 49, Disorders of the Upper Gastrointestinal Tract. The liver may be involved, and there may be mild hyperbilirubinemia with serum transaminase levels elevated in up to half of women hospitalized (Table 50-1). Levels, however, seldom exceed 200 U/L. Liver biopsy may show some fatty changes (Knox and Olans, 1996).

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Table 50-1. Clinical and Laboratory Findings with Acute Liver Diseases in Pregnancy
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Intrahepatic Cholestasis of Pregnancy

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This disorder also has been referred to as recurrent jaundice of pregnancy, cholestatic hepatosis, and icterus gravidarum. It is characterized clinically by pruritus, icterus, or both. It may be more common in multifetal pregnancy (Lausman and colleagues, ...

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