because the intrahepatic cholestasis in pregnancy is a diagnosis of exclusion,i am wondering if liver viral panel,Anti-smooth muscle Antibody,Anti- Mitochondrial Antibody,Prothrombin Time ,are needed in every case to confirm the diagnosis or the bile acid is enough?
Increased serum bile salts, alkaline phosphatase in pregnant female having possible genetic predisposition [mutation in ABCB11/ABCB4, offspring with PFIC]. D/D includes gallstones, viral hepatitis A, B or E, infections with CMV, EBV. Autoimmune liver disease also need exclusion [AMA, ANA,ASMA]. Other pregnancy associated conditions like preeclampsia, AFLP or side effects of medications also need consideration.
Serum bilirubin levels are elevated in virtually all patients with cholestasis.
Total serum bile salt concentration levels are elevated in virtually all cholestatic diseases, especially Direct Bilirubin.
The total serum cholesterol level is elevated in virtually all obstructive cholestatic diseases, whereas the high-density lipoprotein (HDL) level is within the reference range or low. Total cholesterol is within the reference range in certain hepatocellular cholestatic diseases, whereas the HDL level is within the reference range or low. Serum lipoprotein-X levels are elevated in virtually all obstructive cholestatic diseases.
Serum alkaline phosphatase levels, serum 5'-nucleotidase levels, and serum gamma-glutamyl transferase (GGT) levels are elevated in virtually all obstructive cholestatic diseases and most hepatocellular cholestatic diseases.
The serologic and autoimmune panel is useful to do in these cases to exclude possible etiologic cases
To exclude extrahepatic association during a MRI study of the liver and biliary tree
Lifer function tests,viral studies and auto immune profile.I realise that you did not ask imaging modalities.
The imagin modalities are conveniente to take for excluding extrahepatic cholestasis indeed
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