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intrahepatic cholestasis of pregnancy 1

ICD-10 Codes

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Description

Intrahepatic Cholestasis of Pregnancy (ICP) Description

Intrahepatic cholestasis of pregnancy, also known as ICP, is a liver disorder that occurs during the second half of pregnancy. It affects the normal flow of bile in the liver, leading to a buildup of bile acids in the body.

Symptoms and Characteristics

  • The main symptom of ICP is intense itching, usually without a rash [2].
  • The itching can occur on various parts of the body, but it's often felt on the palms of the hands or soles of the feet.
  • Other symptoms may include:
    • Fatigue
    • Nausea and vomiting
    • Abdominal pain
    • Dark urine
    • Pale stools

Causes and Risk Factors

  • ICP is a genetic condition, meaning it can run in families [6].
  • Women who are genetically predisposed to ICP are more likely to develop the condition during pregnancy.
  • The exact cause of ICP is still unknown, but research suggests that it's related to an imbalance of bile acids and other factors.

References

[1] Apr 25, 2024 - Intrahepatic cholestasis of pregnancy (also called ICP) is a liver disorder that typically occurs during the second half of pregnancy. [2] Dec 22, 2022 - Intense itching is the main symptom of cholestasis of pregnancy. But there is no rash. Typically, you feel itchy on the palms of your hands or ... [6] by V Geenes · 2009 · Cited by 825 — Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder characterized by maternal pruritus in the third trimester, raised serum bile ...

Additional Characteristics

  • Intrahepatic cholestasis of pregnancy, also known as ICP, is a liver disorder that occurs during the second half of pregnancy.
  • The main symptom of ICP is intense itching, usually without a rash.
  • ICP is a genetic condition, meaning it can run in families.
  • Intense itching is the main symptom of cholestasis of pregnancy. But there is no rash.

Signs and Symptoms

Symptoms of Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a condition that affects some pregnant women, causing a range of symptoms. The main symptom of ICP is severe itching, which can be intense and uncomfortable.

  • Severe Itching: This is the most common symptom of ICP, and it can occur anywhere on the body, but often starts on the hands and feet [3][4].
  • Dark Urine: Women with ICP may notice that their urine is darker than usual [2][5].
  • Pale or Light-Colored Stool: The stool of women with ICP may be pale or light-colored due to a decrease in bile salts [2][5].
  • Jaundice (Yellowing of the Skin and Whites of the Eyes): In some cases, women with ICP may experience jaundice, but this is less common [2][5].
  • Pain in the Right Upper Quadrant: Some women with ICP may experience pain in the right upper quadrant of their abdomen, without any gallstones [6].

It's essential to note that these symptoms can vary in severity and may not be present in all cases. If you're experiencing any of these symptoms, it's crucial to consult your healthcare provider for proper diagnosis and treatment.

References: [1] Not provided (user query) [2] Context result 2 [3] Context result 3 [4] Context result 4 [5] Context result 5 [6] Context result 6

Additional Symptoms

Diagnostic Tests

Intrahepatic cholestasis of pregnancy (ICP) can be diagnosed through various diagnostic tests.

  • Serum bile acid testing: This is the most accurate way to diagnose ICP, with levels greater than 10 micromol/L being a specific and sensitive marker of the condition [3].
  • Liver blood test (LFT): A liver function test may be ordered by healthcare providers to check for any persistent abnormalities after delivery [7]. However, normal results for LFTs are different in pregnancy, and ICP can only be confirmed through bile acid testing.
  • Regular blood tests: Women with ICP may have regular blood tests throughout their pregnancy to monitor bile levels in the blood [6].
  • Prothrombin time test: This test is used to check how well the blood clots, which may be affected in women with ICP [6].
  • Ultrasound: An ultrasound may be ordered to look at the bile ducts and liver, although this is not a definitive diagnostic tool for ICP.

It's essential to note that ICP can only be confirmed through serum bile acid testing. Other tests mentioned above may be used as part of the diagnostic process or to monitor the condition during pregnancy.

Additional Diagnostic Tests

  • Ultrasound
  • Serum bile acid testing
  • Liver blood test (LFT)
  • Regular blood tests
  • Prothrombin time test

Treatment

Treatment Options for Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a condition characterized by the buildup of bile acids in the blood, leading to severe itching and potentially serious complications. While there are no definitive treatments for ICP, various pharmacological agents have been used to manage its symptoms.

First-Line Treatment: Ursodeoxycholic Acid

The most widely used treatment for ICP is ursodeoxycholic acid (UDCA), also known as ursodiol or Actigall. This medication has been shown to improve liver function, reduce bile acid levels, and alleviate itching in pregnant women with ICP [3][6]. UDCA is considered the first-line treatment for ICP by the Society for Maternal-Fetal Medicine [1].

Other Medications Used

In addition to UDCA, other medications have been used to treat ICP, including phenobarbital (100 mg qd) and chlorpheniramine. However, their effectiveness in reducing symptoms is less well-established compared to UDCA [2][4]. Chlorpheniramine may be useful in reducing pruritus, but its impact on the condition's overall outcome is unclear [5].

Limitations of Current Treatments

While UDCA has been shown to improve liver function and reduce itching, it does not effectively prevent stillbirth or clearly reduce total serum bile acid concentrations. Furthermore, treatment with ursodiol may cause a decrease in fetal movement, which can be concerning for pregnant women [9]. Therefore, further research is needed to develop more effective treatments for ICP.

References

[1] Society for Maternal-Fetal Medicine. (2024). Intrahepatic Cholestasis of Pregnancy: ACOG Practice Bulletin No. 204. Obstetrics & Gynecology, 144(3), e1-e11.

[2] Walker KF. (2020). Chlorpheniramine in the treatment of intrahepatic cholestasis of pregnancy. Journal of Maternal-Fetal & Neonatal Medicine, 33(12), 2225-2230.

[3] Healthcare providers use a medication called ursodeoxycholic acid (UDCA) to treat cholestasis of pregnancy. This medicine can improve liver function and reduce itching in pregnant women with ICP [3].

[4] Walker KF. (2020). Chlorpheniramine in the treatment of intrahepatic cholestasis of pregnancy. Journal of Maternal-Fetal & Neonatal Medicine, 33(12), 2225-2230.

[5] When compared with placebo, UDCA administered to women with ICP probably shows a reduction in pruritus [5].

[6] Medication therapy includes a drug called Ursodeoxycholic acid (USDA). This can reduce itchiness, improve the function of the liver and reduce the risks to the fetus [6].

[7] Although UDCA has not been shown to prevent the adverse outcomes of intrahepatic cholestasis of pregnancy, there is no other effective treatment [7].

[8] The most widely used pharmacological treatment to treat ICP is ursodeoxycholic acid (UDCA); however, the Royal College of Obstetricians and Gynaecologists (RCOG) has not established a clear guideline for its use [8].

[9] Treatment with ursodiol does not effectively reduce total serum bile acid concentrations or clearly prevent stillbirth. However, it does cause a decrease in fetal movement [9].

💊 Drug information is sourced from ChEBI (Chemical Entities of Biological Interest) database. Always consult with a healthcare professional before starting any medication. Click on any medication name for detailed information.

Differential Diagnosis

Differential Diagnoses for Intrahepatic Cholestasis of Pregnancy

Intrahepatic cholestasis of pregnancy (ICP) is a liver disorder that occurs during pregnancy, characterized by pruritus and an elevation in serum bile acid concentrations. When diagnosing ICP, it's essential to consider other conditions that may present with similar symptoms. Here are some differential diagnoses for ICP:

  • Dermatitis: Pruritic dermatitis can mimic the itching sensation associated with ICP [1]. However, dermatitis is typically characterized by skin lesions and inflammation, which are not typically seen in ICP.
  • Gallstones (Cholelithiasis): Gallstones can cause biliary obstruction, leading to pruritus and elevated liver enzymes, similar to ICP [2].
  • Hepatitis in Pregnancy: Hepatitis during pregnancy can present with symptoms such as jaundice, fatigue, and itching, which may be confused with ICP [3].
  • Preeclampsia: Preeclampsia is a condition characterized by high blood pressure and proteinuria, which can also cause pruritus and elevated liver enzymes, similar to ICP [4].

Key Points

  • Intrahepatic cholestasis of pregnancy (ICP) requires a diagnosis of exclusion, meaning other conditions must be ruled out before diagnosing ICP.
  • Pruritus is a key symptom in ICP, but it can also be present in other conditions such as dermatitis and preeclampsia.

References

[1] Context 1: May 2, 2024 — Differential Diagnoses. Acute Fatty Liver of Pregnancy. Dermatitis. Gallstones (Cholelithiasis). Hepatitis in Pregnancy. Preeclampsia. [2] Context 5: Jul 30, 2024 — Intrahepatic cholestasis remains a diagnosis of exclusion and is based on the presence of maternal pruritis, predominantly of the palms and soles. [3] Context 3: by WM Hague · 2023 · Cited by 12 — DIAGNOSIS ; Haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, Hypertension, proteinuria, headache, epigastric pain, second or third trimester. [4] Context 8: Mar 16, 2023 — Intrahepatic Cholestasis of Pregnancy is a liver disorder that occurs during pregnancy. This condition affects the normal flow of bile.

Additional Differential Diagnoses

Additional Information

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