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Self-Assessment Questions


Gastrointestinal and Liver Disease During Pregnancy: Review Questions

Douglas G. Adler, MD

Dr. Adler is an assistant professor of medicine and Director of Gastrointestinal Endoscopy, University of Texas-Houston Health Science Center, Houston, TX.

Choose the single best answer for each question.

1. A 28-year-old woman is 22 weeks pregnant with her first child. Over the last several weeks, she has developed severe heartburn after eating meals and at bedtime. She wants to take medication to improve her symptoms. Which of the following medications would be most appropriate for first-line use in this patient?
  1. Proton pump inhibitor (PPI)
  2. Histamine type 2 receptor antagonist (H2RA)
  3. Over-the-counter antacid
  4. Promotility agent
  5. Antispasmodic
Click here to compare your answer.

2. A 19-year-old woman who is 10 weeks pregnant develops severe right upper quadrant pain and jaundice with fever and an elevated leukocyte count. Her aspartate aminotransferase (AST) level is 247 U/L and her alanine aminotransferase (ALT) level is 218 U/L. Right upper quadrant ultrasound demonstrates stones in the gallbladder, dilated intra- and extrahepatic bile ducts, and a thickened gallbladder wall as well as some pericholecystic fluid. Amylase and lipase levels are normal. On antibiotics and intravenous fluids, the patient’s fever and leukocytosis abate, but her jaundice does not; her transaminases remain elevated. Which of the following is the best course of action to manage this patient?

  1. Cholecystectomy only
  2. Endoscopic retrograde cholangiopancreatography (ERCP) only
  3. Percutaneous transhepatic cholangiography with drainage tube insertion
  4. ERCP now followed by cholecystectomy in the second trimester
  5. Cholecystectomy now followed by post operative ERCP in the second trimester
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3. A 34-year-old woman develops jaundice and pruritis during her second trimester of pregnancy. She has 3 children, and during each pregnancy she developed similar episodes of jaundice. Each time, the jaundice resolved after parturition. What is the most likely cause of the patient’s recurrent jaundice?

  1. Acute fatty liver of pregnancy
  2. HEELP syndrome (HEmolysis, Elevated liver tests, and Low Platelets)
  3. Intrahepatic cholestasis of pregnancy
  4. Gilbert’s syndrome
  5. Recurrent hepatitis A triggered by each subsequent pregnancy
Click here to compare your answer.

4. A 20-year-old woman is 35 weeks pregnant with her first child. The patient develops vague abdominal pain and nausea and presents to the emergency department. On evaluation, she is found to be mildly icteric, thrombocytopenic, and to have an AST level of 332 U/L and an ALT level of 248 U/L. The patient is presumptively diagnosed with HEELP syndrome. Which of the following is the best management option for this patient?
  1. Platelet transfusion to prevent hemorrhage
  2. Administration of ursodeoxycholic acid to treat jaundice
  3. Observation only
  4. Liver biopsy to confirm the diagnosis before any treatment is started
  5. Induction of labor
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5. A 19-year-old woman takes a vacation to the Caribbean. While there, she develops deep jaundice and right upper quadrant abdominal pain and presents to a local hospital. Hepatitis serologies are obtained, and the patient is diagnosed with acute hepatitis A, presumed to have come from eating contaminated shellfish. The patient terminates her vacation and returns home, where further testing discloses that the patient is 8 weeks pregnant, a fact of which she was unaware. Laboratory studies demonstrate the following: total bilirubin level, 6.6 mg/dL; AST level, 2300 U/L; and ALT level, 1970 U/L. The patient is not coagulopathic. The patient is admitted to the hospital for monitoring and possible therapy. Which of the following is the best management option for this patient?

  1. Administration of hepatitis A vaccine
  2. Administration of hepatitis B immune globulin (HBIG)
  3. Administration of pegylated interferon and ribavirin
  4. Administration of lamivudine
  5. Observation with maternal and fetal monitoring
Click here to compare your answer.

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