Monday, April 13, 2009

The Itch

A 25 year old G1P0 woman at 30 weeks gestational age presents with intolerable itching, worse at night, mostly on the palms and soles of her feet. Exam only shows excoriations from scratching. The only laboratory abnormalities are elevated serum bile acid and alkaline phosphatase. GGT (gamma glutamyl transpeptidase) is normal. She has no history of liver disease and on ultrasound, biliary ducts and hepatic parenchyma appear normal.

Challenge: What's the diagnosis?

1 comment:

Craig Chen said...

The Itch

This is intrahepatic cholestasis of pregnancy, suggested by pruritis and elevated serum bile acids in a woman in her second or third trimester. The risks to the fetus include prematurity, meconium stained amniotic fluid, intrauterine demise, and neonatal respiratory distress syndrome. Treatment is symptomatic with ursodeoxycholic acid to increase bile flow and early delivery. Maternal outcomes are good.

Source: UpToDate.