Liver ultrastructure and function in icteric and non-icteric women using oral contraceptive agents.

Abstract

This is a report of the morphological findings observed in cases wit h no or minimal findings of hepatic dysfunction and in cases of jaundice or severe pruritis caused by oral contraceptives. There were 6 cases with abnormal liver function tests. None had been jaundiced before but 4 had developed generalized pruritis during previous pregnancies. In all cases of hyperbilirubinemia most of the bilirubin was in conjugated form. After the jaundice had subsided cholecystography was performed in 4 patients. 1 was found to have gall stones. Liver biopsies were done on all. Hepatocellular damage and intrahepatic cholestasis were shown in all. The levels of serum transaminases and of alkaline phospha tase were abnormal in all cases of jaundice or severe pruritis. The fall of these elevated values did not follow a regular pattern. The hyp erbilirubinemia disappeared within 1 or 2 months. There were no signs of residual hepatic dysfunction. In 6 cases with normal liver function tests all of whom had been taking oral contraceptives for 2-13 months liver biopsies were performed and found to be normal under the optical microscope. However the ultrastructural examination in some revealed alterations in the bile canaliculi and mitochondria. The clinical significance of these changes is not known. Results suggest that idiopathic liver dysfunction during pregnancy and during treatment with oral contraceptives agents have some common etiological factor. General pruritis during pregnancy is the first and often the only subjective symptom of early hepatic dysfunction.