Cholestatic hepatosis is a serious metabolic disorder in hepatocytes. It is characterized by an increased content of yellow pigments in the liver. Such a 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 it is
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 disrupts the metabolism of lipids and bile acids, with damage to the liver cells and stagnation of bile.
Causes
Why does cholestatic hepatosis appear? The exact origin of this disease is unknown, however, doctors suggest that there is a hereditary predisposition to this pathology. The following factors can provoke the onset of the disease:
- poisoning with toxins;
- long-term use of drugs (antibiotics, hormonal contraceptives, drugs based on testosterone);
- pregnancy.
Most often, pathology is noted in the later stages of gestation.
Symptomatology
In mild cases, the pathology proceeds without obvious signs. It can be detected by chance during a preventive medical examination. With moderate and severe stages of the disease, the following symptoms of cholestatic hepatosis are noted:
- Yellowish coloration of the skin, eye proteins 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 rash by type of urticaria. These phenomena indicate stagnation and a change in the biochemical composition of bile.
- Light shade of feces and dark color of urine. This symptom indicates an increase in bile pigments in the blood.
The intensity of symptoms may vary. In the acute form of the disease, manifestations of the pathology are clearly expressed. If the pathology has turned into a chronic form, then 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 about 2 out of 1000 patients.
During pregnancy, this disease manifests itself in severe skin itching, which patients often take for signs of allergies. At the same time, different areas 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 disease.
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 these phenomena for signs of toxicosis.
Pregnant cholestatic hepatosis (CGB) usually disappears after childbirth. However, this disease is far from harmless. It does not pose a serious threat to the health of a woman, but can have an extremely negative effect on the condition of the fetus. The consequences of this disease for the unborn child we will consider further.
Complications
If pathology occurs during the period of gestation, the complications may be as follows:
- About 4 times the risk of embryo death increases.
- The likelihood of premature birth increases.
- Hepatosis can provoke developmental disorders and hypoxia in the unborn baby.
- In women with CGD, miscarriages occur more often, and childbirth occurs pathologically. Such patients often have to do a cesarean section.
Doctors suggest that bile acids, which accumulate in the mother’s body and penetrate the placenta, have a negative effect on the fetus.
If the disease is not associated with pregnancy, then in advanced forms it can lead to the development of hepatitis, pancreatitis, cholangitis.
Diagnostics
If you suspect cholestatic hepatosis, the doctor prescribes a biochemical blood test for the following pigments and lipids:
- bilirubin;
- cholesterol;
- leucine aminopeptidase;
- alkaline phosphatase.
Indicators of bile acids in this disease usually exceed reference values.
It is necessary to do an ultrasound of the liver and gall bladder. This will help determine the size and structure of the organs.
In case of doubt in the diagnosis, a biopsy study is prescribed. Under local anesthesia, a small particle of liver tissue is taken for analysis. When studying puncture material in cells, an accumulation of yellow pigments and degenerative changes are detected.
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 future baby.
In the third trimester, cardiotocography of the fetus is performed. This study helps determine the heart rate and detect hypoxia in time.
Drug treatment
In the treatment of cholestatic hepatosis, patients are prescribed the following types of drugs:
- Medicines that suppress the production of bile: "Lestiramine", "Polyphepan". These drugs help reduce the harmful effects of bile acids.
- Medicines that stimulate the outflow of bile: "Ursosan", "Ursofalk." They reduce biliary congestion.
- Hepatoprotectors: Karsil, Gepabene, Essentiale, Heptral, Galstena.
- Glucocorticoid preparations: Prednisolone, Dexamethasone. These funds are prescribed in severe cases. They help preserve the structure of the liver and protect cells from damage.
- Multivitamin complexes with tocopherol. Vitamin E is indicated for pregnant women. Tocopherol promotes the proper formation and strengthening of the placental barrier. As a result, the harmful effect on the fetus of bile pigments is reduced.
How to treat pregnant cholestatic hepatosis? The clinical recommendations indicate that drug treatment must be combined with hemosorption and plasmapheresis. These procedures help cleanse the blood of toxins.
According to doctors, pregnant patients after hemosorption and plasmapheresis are much less likely to experience miscarriages, premature birth and fetal death. After such complex treatment, not a single case of embryo hypoxia and bleeding during childbirth was observed. This is due to the fact that blood purification can reduce the load on the liver. As a result, this organ begins to actively produce special enzymes that promote blood coagulation.
It is important to remember that this disease is not considered an indication for termination of pregnancy. However, in order to safely inform the baby, a woman needs to be under close medical supervision.
Diet
This form of hepatosis requires a strict diet. Drug therapy will not be effective without proper nutrition.
Products harmful to the liver should be excluded from the diet:
- sweet carbonated drinks;
- fatty and fried foods;
- spicy dishes;
- alcohol;
- flour products;
- sweets.
It is also necessary to abandon the use of strong coffee and black tea. These drinks need to be replaced with freshly squeezed juices, rosehip broth or green tea.
With hepatosis, it is forbidden to eat cold dishes. 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 protein-rich dishes in your daily menu:
- chicken white meat;
- turkey fillet;
- rabbit meat;
- sea fish;
- seafood (mussels, oysters).
Meat and fish are cooked boiled or steamed. Frying in oil is not allowed.
It should be more likely to eat fermented milk products: hard cheeses, cottage cheese, sour cream, yogurt, kefir. Cereals from cereals (semolina, oatmeal, buckwheat) are also useful. They are recommended to cook on water. These dishes will help saturate the body with protein.
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 repeated pregnancy hepatosis may occur again.
The prognosis for the embryo is unfavorable. The danger of fetal death and the occurrence of pathologies in the future baby increases several times.
However, such sad consequences occur only with an advanced form of cholestatic hepatosis. Timely diagnosis and treatment of this disease is extremely necessary for the expectant mother. The sooner this pathology is detected, the lesser the effect of bile pigments on the fetus.
Prevention
Specific prevention of this disease has not been developed, since it has an unexplained etiology. We can only advise pregnant women to adhere to the following recommendations:
- Observe regularly with 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 hepatologist.
- Screening should be done regularly for pregnant women. This will help identify possible abnormalities in the fetus.
- Before planning pregnancy, you should avoid taking antibiotics and hormonal drugs. You should also protect yourself from the effects of toxins and food poisoning. Any intoxication adversely affects the liver cells.
Attentive and responsible attitude to your health will help to maintain pregnancy and successfully endure the baby.