Cholestatic hepatosis is a serious metabolic disorder in hepatocytes. It is characterized by an increased content of yellow pigments in the liver. This disease often develops during pregnancy. Can it be cured? And how dangerous is it for the unborn child? We will consider these issues in the article.
What is this
Cholestatic hepatosis is a pathology in which bile pigments accumulate in the liver. They interfere with the normal absorption of protein by hepatocytes. As a result, the liver parenchyma undergoes degenerative changes. The patient's lipid and bile acid metabolism is disrupted, resulting in liver cell damage and bile stasis.
Reasons
Why does cholestatic hepatosis appear? The exact origin of this disease is unknown, but doctors suggest that there is a hereditary predisposition to this pathology. The following factors can provoke the onset of the disease:
- toxin poisoning;
- long-term use of drugs (antibiotics, hormonal contraceptives, testosterone-based drugs);
- pregnancy.
Most often, pathology is observed in the later stages of gestation.
Symptomatics
In mild cases, the pathology proceeds without obvious signs. It can be discovered by chance during a preventive medical examination. In the middle and severe stages of the disease, the following symptoms of cholestatic hepatosis are noted:
- Yellowish coloration of the skin, whites of the eyes and tongue. This shade of the epidermis and mucosa is associated with an excess of bile pigments.
- Pain on the right side under the ribs. In the early stages of the disease, they are temporary, and then become permanent.
- Itching of the skin and urticaria-like rashes. These phenomena indicate stagnation and changes in the biochemical composition of bile.
- Light-colored feces and dark-colored urine. This sign indicates an increase in bile pigments in the blood.
The intensity of symptoms can vary. In the acute form of the disease, the manifestations of pathology are clearly expressed. If the pathology has become chronic, then the signs of liver damage can be erased and occur only during an exacerbation.
Features of pathology in pregnant women
Cholestatic hepatosis during pregnancy is a fairly common occurrence. During the period of gestation, this pathology is diagnosed in approximately 2 out of 1000 patients.
During pregnancy, this disease manifests itself in severe skin itching, which patients often mistake for signs of allergies. At the same time, different parts of the skin itch, and sometimes the whole body (generalized itching). Women experience frequent mood swings and sleep disturbances. These initial signs of the patient's illness are most often not associated with liver pathology.
Yellowness of the skin and dyspeptic symptoms do not appear immediately. They develop as bile acids accumulate in the body. Patients complain of nausea, vomiting, loss of appetite. However, women often take such phenomena as signs of toxicosis.
Cholestatic hepatosis of pregnancy (CHP) usually resolves after childbirth. However, this disease is far from harmless. It does not pose a serious threat to the he alth of a woman, but it can have an extremely negative impact on the condition of the fetus. We will consider the consequences of this disease for the unborn child further.
Complications
If the pathology occurs during the period of gestation, then complications may be as follows:
- About 4 times the risk of embryo death.
- Increases chance of preterm birth.
- Hepatosis can provoke developmental disorders and hypoxia in the unborn baby.
- Women with CHB are more likely to have miscarriages and have abnormal births. These patients are more likely to have a caesarean section.
Doctors suggest that bileacids that accumulate in the mother's body and pass to the placenta.
If the disease is not associated with pregnancy, then in advanced forms it can lead to the development of hepatitis, pancreatitis, cholangitis.
Diagnosis
If cholestatic hepatosis is suspected, the doctor prescribes a biochemical blood test for the following pigments and lipids:
- bilirubin;
- cholesterol;
- leucine aminopeptidase;
- alkaline phosphatase.
Bile acid levels in this condition are usually higher than reference values.
It is necessary to do an ultrasound of the liver and gallbladder. This will help determine the size and structure of the organs.
When in doubt about the diagnosis, a biopsy is prescribed. Under local anesthesia, a small piece of liver tissue is taken for analysis. When examining the puncture material in the cells, an accumulation of yellow pigments and dystrophic changes are revealed.
During pregnancy, it is necessary to conduct not only an examination of the mother's body, but also to assess the condition of the fetus. For this purpose, dopplerography of the embryo is prescribed. This allows you to determine the speed of blood flow and identify possible circulatory disorders in the unborn baby.
In the third trimester, fetal cardiotocography is performed. This study helps to determine the heart rate and detect hypoxia in time.
Medicated treatment
In the treatment of cholestatic hepatosis, patients are prescribed the following types of drugs:
- Drugs that suppress bile production: "Lestyramine","Polifepan". These drugs help reduce the harmful effects of bile acids.
- Medicines that stimulate the outflow of bile: "Ursosan", "Ursofalk". They relieve bile stasis.
- Hepatoprotectors: Karsil, Gepabene, Essentiale, Heptral, Galstena.
- Glucocorticoid drugs: "Prednisolone", "Dexamethasone". These funds are prescribed in severe cases. They help maintain the structure of the liver and protect cells from damage.
- Multivitamin complexes with tocopherol. Vitamin E is indicated for pregnant women. Tocopherol contributes to the proper formation and strengthening of the placental barrier. As a result, the harmful effect of bile pigments on the fetus is reduced.
How to treat cholestatic hepatosis in pregnant women? Clinical guidelines indicate that drug treatment should be combined with hemosorption and plasmapheresis. These procedures help cleanse the blood of toxins.
According to the observations of doctors, in pregnant patients after hemosorption and plasmapheresis, miscarriages, premature births and fetal death are much less common. After such complex treatment, not a single case of embryonic hypoxia and bleeding during childbirth was observed. This is due to the fact that cleansing the blood can reduce the load on the liver. As a result, this organ begins to actively produce special enzymes that promote blood clotting.
It is important to remember that this disease is not considered an indication for abortion. However, in order to carry the baby safely, a woman needs to be under the close supervision of a doctor.
Diet
This form of hepatosis requires a strict diet. Drug therapy will not be effective without proper nutrition.
Foods that are harmful to the liver should be excluded from the diet:
- sweet carbonated drinks;
- fatty and fried foods;
- spicy dishes;
- alcohol;
- pastry;
- sweets.
You should also stop drinking strong coffee and black tea. These drinks should be replaced with freshly squeezed juices, rosehip broth or green tea.
When hepatosis is forbidden to eat cold food. Food should be warm, but not hot.
It is important to remember that with this form of hepatosis, a serious protein deficiency forms in the liver. Therefore, it is necessary to include meals rich in proteins in your daily menu:
- chicken white meat;
- turkey fillet;
- rabbit meat;
- sea fish;
- seafood (mussels, oysters).
Meat and fish are boiled or steamed. Frying in oil is not allowed.
You should eat dairy products more often: hard cheeses, cottage cheese, sour cream, yogurt, kefir. Also useful are cereals from cereals (semolina, oatmeal, buckwheat). They are recommended to cook on the water. These dishes will help saturate the body with proteins.
Forecast
Cholestatic hepatosis is easily treatable. As already mentioned, the prognosis of the disease for a pregnant woman is favorable. Signs of hepatosis disappear 1-2 weeks after birth. In this case, the patient does not have any signs of liver damage. However, with a second pregnancy, hepatosis may reappear.
The prognosis for the embryo is unfavorable. The risk of fetal death and the occurrence of pathologies in the unborn baby increases several times.
However, such sad consequences occur only when the form of cholestatic hepatosis is advanced. Timely diagnosis and treatment of this disease is essential for the expectant mother. The sooner this pathology is detected, the less impact bile pigments will have on the fetus.
Prevention
Specific prevention of this disease has not been developed, as it has an unexplained etiology. We can only advise pregnant women to adhere to the following recommendations:
- Regularly see an obstetrician-gynecologist and take a blood test for yellow pigments.
- Itching and rashes should not be attributed solely to allergies, especially if these manifestations are combined with weight loss and dyspeptic symptoms. In these cases, it is necessary to undergo a comprehensive examination by a gynecologist and a hepatologist.
- Pregnancy screening should be done regularly. This will help identify possible abnormalities in the fetus.
- Before planning pregnancy, you should avoid takingantibiotics and hormonal drugs. You should also protect yourself from exposure to toxins and food poisoning. Any intoxication adversely affects the liver cells.
Attentive and responsible attitude to one's he alth will help maintain pregnancy and successfully bear the baby.
