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Hepatic, Biliary, and Pancreatic Disorders

All except which of the following liver-related changes are physiological in pregnancy?

a. Hypolipidemia

b. Spider angiomas

c. Palmar erythema

d. Elevated serum alkaline phosphatase levels

The cytochrome P450 system is altered by which of the following during pregnancy?

a. Estrogen levels

b. Progesterone levels

c. Placental expression

d. All of the above

Which of the following pregnancy-related complications has the capacity to demonstrate the most prominent alterations of normal hepatic, renal, hematological, and coagulation laboratory studies?

a. Preeclampsia

b. Hyperemesis gravidarum

c. Acute fatty liver of pregnancy

d. Intrahepatic cholestasis of pregnancy

Which of the following findings can narrow the differential of elevated liver enzymes to exclude intrahepatic cholestasis of pregnancy?

a. Jaundice

b. AST 800 U/L

c. Liver biopsy showing bile plugs in the hepatocytes

d. All of the above

Which of the following viral infections has been associated with a marked increase in the risk for intrahepatic cholestasis of pregnancy?

a. Hepatitis B

b. Hepatitis C

c. Cytomegalovirus

d. Human immunodeficiency virus

A 27-year-old multigravida comes to you for her postpartum visit. Both of her pregnancies were complicated by intrahepatic cholestasis of pregnancy. She desires another child in about 2 years. Which of the following methods of contraception do you recommend?

a. Vaginal ring

b. Copper intrauterine device

c. Combination oral contraceptive pills

d. None of the above

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