Intrahepatic cholestasis of pregnancy is a unique complication of mid-to-late pregnancy. Although it is a benign disease for pregnant mothers, the impact will not be great, but for babies, it will bring more serious effects, such as fetus Distress, premature birth, intracranial hemorrhage, and even fetal death, so it should be paid attention to. Clinically, we mainly check the serum total bile acid to confirm whether the pregnant mother has intrahepatic cholestasis of pregnancy and to monitor the change of the pregnant mother’s condition and treatment effect. If the pregnant mother’s fasting serum total bile acid exceeds 10umol / L, and there is skin itching, we can diagnose intrahepatic cholestasis of pregnancy. If the total bile acid is 10-39.9umol / L, it is mild cholestasis of pregnancy. If the total bile acid exceeds 40umol / L, or it is accompanied by high-risk factors, such as multiple pregnancy History, high blood pressure during pregnancy, etc., is severe cholestasis of pregnancy. What are the symptoms of intrahepatic cholestasis during pregnancy? Most of the first symptoms of intrahepatic cholestasis in pregnancy are persistent skin itching, which is mild during the day and worse at night. The itching usually starts from the palms of the hands and feet, gradually spreads to the limbs, and even extends to the face. The symptoms of skin itching are an alarm. Often blood is drawn to check the bile acid. The skin itching has occurred before the result of the abnormality has occurred. Therefore, pregnant women should be vigilant when they have the above skin itching. The itching caused by intrahepatic cholestasis during pregnancy is mostly relieved 1-2 days after delivery. In addition, the most common symptom of intrahepatic cholestasis in pregnancy is jaundice. 10-15% of pregnant women will have mild jaundice 2-4 weeks after itching of the skin. Jaundice generally does not follow The increase in gestational week is exacerbated, and it will subside 1-2 weeks after delivery. Pregnant mothers may also experience relatively mild digestive symptoms such as upper abdominal discomfort, nausea, vomiting, abdominal pain, and poor appetite, but they are generally not very serious and affect mental conditions. What should I do with intrahepatic cholestasis during pregnancy? For intrahepatic cholestasis of pregnancy, we still aim to alleviate the symptoms of itching in pregnant mothers, reduce bile acids, improve liver function, and properly extend the gestational week. If the symptoms of skin itching have affected the night sleep of the pregnant mother, sedative drugs can be given appropriately to ensure the pregnant mother’s adequate rest at night. Pregnant mothers pay attention to self-counting fetal movements. Fetal movement reduction and small fetal movement are all signs of hypoxia in the uterus and should be consulted immediately. Starting from the 32nd week of pregnancy, electronic fetal heart rate monitoring is performed every week to assess the baby’s condition. Regularly review the bile acid level, liver function, etc. to understand the development of the disease and the effect of treatment. When necessary, bile acid-lowering drugs need to be used to improve pregnancy outcomes. Because intrahepatic cholestasis of pregnancy may cause sudden fetal death in the uterus, it is necessary to select the best delivery time and method based on the gestational age, the degree of disease development, and the treatment effect. Timing of delivery: The timing of delivery for pregnant mothers with mild intrahepatic cholestasis is 38-39 weeks of pregnancy, while the timing of delivery for pregnant mothers with severe intrahepatic cholestasis needs to be advanced to 34-37 weeks of pregnancy. At that time, it was still necessary to evaluate the comprehensive treatment effect and the baby’s condition and other factors. Delivery methods: Mild intrahepatic cholestasis of pregnancy, no other indications for cesarean section, pregnant mothers less than 40 weeks of pregnancy can try vaginal delivery, but the contractions and fetal heart changes must be closely monitored during the labor process, and appropriate relaxation Indications for cesarean section.
Today we come to talk about the placeholders / nodules in the liver! Are the intrahepatic space occupying and intrahepatic nodules all liver cancer? No, definitely not! However, when you get a report with space-occupying or nodular lesions in the liver, I am afraid that many people will feel a little uneasy and not serious? What kind of sickness is this? This article gives you a detailed explanation. Color imaging, CT, MRI and other imaging examination technologies are more and more applied, which provides great help for doctors to understand the condition, diagnosis and treatment. The imaging examination result report “intrahepatic space-occupying / nodular lesions” is also something that clinicians often encounter in their work. How to treat them, how to explain to patients and their families, what to do next, please read on. Collected literature reports of 743 cases of focal liver, intrahepatic nodular / occupying lesions less than 2CM, were confirmed by surgery or hepatic perforation pathology, and the diagnosis involved a variety of diseases. Malignant diseases: hepatocellular carcinoma, cholangiocarcinoma, metastatic liver cancer, etc .; benign diseases: hepatic hemangioma, cirrhotic nodules, inflammatory necrotic nodules, localized heterogeneous fatty liver, focal hyperplasia, etc. Composition ratio: liver cancer (primary, metastatic) 50.8%, hepatic hemangioma 21.6%, cirrhotic nodules 6.5%, and inflammatory necrotic nodules 6.3%. Focal hyperplasia 5.5%, heterogeneous fatty liver 5.2; covers more than 95% diagnosis. It is important to understand the composition ratio, the probability of major diseases is clear to the chest, scientific thinking, scientific decision-making, further examination path and diagnosis direction are clear and identifiable. In the face of a B-ultrasound and CT examination report of nodules or substantial space-occupying lesions found in the liver, the patient and family members are frightened and anxious. They urgently want to understand the diagnosis, but as a doctor, they must not rashly and recklessly draw conclusions. . First read the report carefully and comprehensively, paying attention to the size, number, margins, blood supply, portal vein invasion, lymph node enlargement, bile duct dilatation, cirrhosis, splenomegaly, and ascites , Collateral circulation and other information, comprehensive analysis and discrimination. Typical liver cancer is easy to diagnose, and it may be shown in the report, which is relatively simple. It would be better if you could watch the film. It is more accurate and comprehensive to understand the condition. It is more convenient and more convincing to explain the condition to the patient’s family and the picture. It also shows the doctor’s level. For the uncertain, it is difficult to diagnose at a time when the ability of the doctor is tested. We already know the composition ratio of intrahepatic nodular lesions, grasp the probability of occurrence of various lesions, according to the treatment procedures from high probability to small probability, from simple to complex, scientific thinking and scientific decision-making can greatly improve the diagnosis and treatment. Correct rate. Malignant lesions ↓↓↓ ①Hepatocellular carcinoma (HCC) Hepatocellular carcinoma (HCC) & nbsp. There are chronic liver diseases such as hepatitis B, C, and cirrhosis. CT examination shows that the liver occupies a rapid heterogeneous vascular enhancement in the arterial phase. Rapid elution during the venous phase or delayed phase. It can be diagnosed if the liver occupancy diameter is ≥ 2 cm; the liver occupancy diameter is 1-2 cm, and the serum AFP ≥ 400 μg / L for 1 month or ≥ 200 μg / L for 2 months, the diagnosis of hepatocellular carcinoma can also be established. In patients with liver cirrhosis, B-ultrasound finds that the diameter of the liver lesion is greater than 1 cm, and it should be further examined by CT or MRI. At the same time, blood liver cancer markers, such as alpha-fetoprotein and alpha-fetoprotein heterogeneity, should be detected. Patients with liver cirrhosis have nodules or space occupying, especially hypoechoic substantial space occupying, but there is no typical imaging manifestation, and liver biopsy should be used to confirm the diagnosis. Even if the result of liver biopsy is negative, it should not be easily denied. Follow-up follow-up should be carried out every 3 to 6 months until the lesion disappears, enlarges or presents HCC diagnostic features; if the lesion is enlarged, but it is still not typical If the HCC changes, repeat liver biopsy may be considered. Hepatic arteriography is very important for diagnosis and differential diagnosis. It can be used for patients who have not been diagnosed after other examinations, and may find lesions that cannot be found by other imaging methods. Special emphasis is placed on the importance of early detection, early diagnosis, and early treatment of HCC. ②cholangiocarcinoma. The symptoms of intrahepatic cholangiocarcinoma are not typical, and there is no specific laboratory test. The sensitivity of CA19-9 to intrahepatic cholangiocarcinoma is 62%, and the specificity is 63%. Patients with primary sclerosing cholangitis (PSC) have liver nodules, and the possibility of cholangiocarcinoma should be highly suspected. If ultrasound diagnosis suspects cholangiocarcinoma, CT or MRI should be performed; if the patient is not suitable for surgery, liver biopsy should also be performed to confirm the diagnosis of cholangiocarcinoma