Abstract

This is a case report of a 37-year-old female who presented with deranged liver function tests, epigastric pain, fevers, vomiting, mild hypertension, and proteinuria in pregnancy. This was on a background of gestational diabetes, dyspepsia, and previous cholecystectomy. This case report highlights the importance of considering various causes of liver pathology during pregnancy besides those specifically associated with pregnancy, as well as the necessity of early specialist input to investigate symptomatic choledocholithiasis in pregnancy.

Highlights

  • Gallstone-related complications are relatively common during pregnancy, with reports of biliary sludge in 5–31% and cholelithiasis in 2–11% of expectant mothers [1]

  • About 1% of these women will develop complications secondary to cholelithiasis, which may lead to increased fetal and maternal morbidity and mortality (Ko et al, 2005) [2]. This case highlights the importance of considering a broad spectrum of hepatobiliary disorders during pregnancy, including choledocholithiasis and considering urgent endoscopic retrograde cholangiopancreatography (ERCP) as a safe option for those women with symptomatic complicated cholechodolithiasis

  • Choledocholithiasis was considered in the differential diagnosis

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Summary

INTRODUCTION

Gallstone-related complications are relatively common during pregnancy, with reports of biliary sludge in 5–31% and cholelithiasis in 2–11% of expectant mothers [1]. A 35-year-old female, Gravida 5, Para 4, presented to antenatal clinic at 31 weeks of gestation with 3 days of epigastric pain and vomiting She had a body mass index of 47 and a background of depression, migraine, dyspepsia, and previous cholecystectomy. The lack of associated symptoms such as upper abdominal pain, decrease in urine output, persistent headache or blurring of vision, and tendency to bleed as well as relatively normal bloods made this less likely Hepatobiliary causes of this presentation were considered, and specialist input was sought. Choledocholithiasis was considered in the differential diagnosis (despite previous cholecystectomy and negative abdominal ultrasound scan) Other diagnoses such as non-alcoholic fatty liver disease, viral and autoimmune hepatitis are usually not associated with severe abdominal pain and were excluded by relevant blood tests. She was induced at 38 weeks due to obstetric complications, had a quick vaginal delivery following that, and her postnatal follow-up was uneventful

DISCUSSION
C Reactive Protein 90
Findings
CONCLUSION
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