Download e-book for kindle: Jaundice During Pregnancy: With Special Emphasis on by Urs Peter Haemmerli

Diagnosis

By Urs Peter Haemmerli

I. The liver in basic pregnancy.- II. Jaundice in the course of pregnancy.- III. Recurrent jaundice in the course of pregnancy.- Summary.- References.

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Additional info for Jaundice During Pregnancy: With Special Emphasis on Recurrent Jaundice During Pregnancy and Its Differential Diagnosis

Example text

They consist of Kupffer cell proliferation and mobilization, mild thickening of the framework, PAS positive granules in the Kupffer cells, some PAS containing macrophages in the portal spaces and of incipient ballooning of liver cells in the centroacinar areas. TABLE 12. Liver biopsies in non-recurrent intrahepatic cholestasis of pregnancy. (Category VII A) Histological diagnosis Year Author 1947 1953 1956 1959 1961 1961 1963 1963 1963 1964 1964 1966 Nixon et aJ. (case 14) Puyo (case 4) Ljunggren Svanborg & Ohlsson Katz et al.

A rapid fall in SGOT indicated a good prognosis. Jaundice is rare in toxemia, occurs late in the course and often suggests a grave prognosis. 's 44 patients was only slight. Of Verhage's 96 patients with toxemia only 11 had icterus, 2 of which died. In Sheehan's autopsy series of 90 cases only 10 were jaundiced. Sheehan believes the icterus to be due to hemolysis, as his jaundiced patients had hemoglobinuria during life and hemoglobin casts in the kidney tubules at autopsy. Histological liver lesions, so striking at autopsy, are absent in mild and even in some far advanced cases on liver biopsies (Ingerslev and Teilum III).

It usually starts much earlier because the drug is given for hyperemesis during the first trimester and usually clears well before delivery. Onset of chlorpromazine jaundice is within 4 weeks after the drug has been started. There is a prodromal phase of 4 to 5 days' duration, usually acute, with malaise, fever, chills, nausea, mild abdominal pains, myalgias and occasionally skin rashes. Itching may precede jaundice (Werther and Korelitz, Sherlock). These prodromal symptoms are similar to those seen in viral hepatitis and will readily distinguish drug-induced cholestasis from intrahepatic cholestasis of pregnancy, in which there are no prodromi except pruritus.

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