2019 Research Forum

Presenter: Tamara Hilvers MS IV Principal Investigator & Faculty Sponsor: Arash Heidari MD

Hyperbilirubinemia and Transaminitis Secondary to Hyperemesis Gravidarum

Simmer Kaur MD R2, Tamara Hilvers MS IV, Arash Heidari MD

INTRODUCTION Nausea and vomiting is common in pregnancy beginning in the first trimester and usually resolves spontaneously by the second trimester. Hyperemesis gravidarum occurs in up to 2% of pregnancies and is characterized by intractable nausea and vomiting. It can be associated with severe dehydration, electrolyte imbalances and liver abnormalities. However, very rarely patients do present with bilirubinemia and jaundice. DISCUSSION A 22-year-old Hispanic female presented to the hospital with an intrauterine pregnancy at 5 weeks gestation complaining of nausea and vomiting. This patient was treated with ondansetron and she showed significant clinical improvement. She was sent home with an anti-emetic and was advised to follow-up with her Obstetrician. In August 2017, this patient presented again to the emergency department at 13 and 4/7 gestation with a chief complaint of severe nausea and vomiting and a significant weight loss of 37 pounds since the last visit. Physical examination was significant for scleral icterus, moderate RUQ tenderness, and tachycardia. On neurological examination, there was bilateral motor weakness in both upper and lower extremities. Initial total bilirubin level was elevated at 6.3 mg/dl, conjugated bilirubin or 4.8 mg/dl, aspartate aminotransferase of 416 U/L, alanine aminotransferase of 869 U/L and alkaline phosphatase of 92 U/L. Hepatitis panel was nonreactive. Ultrasound of the gallbladder showed coarse echogenicity of the liver suggestive of a cirrhotic liver and sludge within the gallbladder with no mass or cyst and normal appearing bile ducts. She underwent an MRI of the abdomen that showed no evidence of common bile duct obstruction or filing defect. MRCP was performed which was also negative for any biliary obstruction. CONCLUSION Hyperemesis gravidarum could be associated with liver dysfunction and elevations in liver enzymes in 15% of cases. Rarely jaundice may develop without any underlying liver disease. Management is supportive with hydration and the condition usually resolves with treatment.

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