2998 Hyperemesis Gravidarum Syndrome Mimicking Recurrent Pancreatitis

Abstract

INTRODUCTION: Nausea and vomiting are common complaints of pregnant patients. Hyperemesis gravidarum (HG) is a condition characterized by severe nausea, vomiting, weight loss, and dehydration associated with electrolyte imbalances and nutritional deficiencies. Some patients with HG have a complicated picture in the setting of elevated laboratory findings including liver enzymes and lipase. Although rare, pancreatitis has been demonstrated in a pregnancy. This case highlights a patient with HG which mimicked recurrent pancreatitis. CASE DESCRIPTION/METHODS: A 35 year old Hispanic female presented at 12 weeks of intrauterine pregnancy for persistent nausea and vomiting. Her medical history was significant for obesity and fatty liver disease. Baseline LFTs demonstrated AST of 85 U/L, ALT of 188 U/L, lipase of 45 U/L, and t.bili 1.3 mg/dL. The patient improved after hydration and antiemetics. The patient was readmitted four times during her pregnancy for worsening abdominal pain, nausea, and vomiting. Ultrasound and MRI were negative. Viral work up was negative for CMV, Hep C, Hep B, Hep A, HSV, ANA, anti-sm ab and VZV. On her last admission her LFTs peaked to an AST of 645, ALT of 1240, t bili of 2.2, ALP of 142, and lipase of 192. Each admission improved with hydration. The patient was lost to follow up and repeat liver function testing was not repeated after delivery. DISCUSSION: The patient in this case had clinical findings and history concerning for HG. HG affects 1% of pregnant women. There are reports of elevated lipase among patients with HG without a diagnosis of pancreatitis. The patient had an elevation of LFTs including AST, ALT and total bilirubin which initially was thought to be due to hepatic steatosis in the setting of her obesity and pregnancy. Throughout each hospitalization the patient had elevation of her LFTs which peaked to an AST of 645 U/L and ALT of 1240 U/L. Although HG has been associated with elevations of LFTs with ALT up to 200 U/L, this patient had a significant increase of LFTs above the expected range. The diagnosis of pancreatitis in pregnancy includes characteristic symptoms and laboratory and radiographic findings. This patient had nausea/vomiting and an elevation of lipase and LFTs however acute pancreatitis was not diagnosed. Radiographic findings were negative. This case speculates whether patients with HG need a different diagnostic criterion for pancreatitis. Overall further research should be done to define the relationship of HG with liver and biliary pathologies.