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Forum Name: Obstetrics

Question: Possible cholestasis????


 shnncof - Wed Oct 12, 2005 10:28 pm

I am 28weeks pregnant and I had my glucose testing yesterday.As the day went on I started having severe itching on the soles of my feet.Then on the palms of my hands too.Then this morning it was all over but still hands and feet were way more severe but NO RASH NO BUMPS NOTHING .My hands and feet are swollen more than normal but not my face.I thought it was related to the glucose test I had. I looked online and found that if you have itching that starts on feet and hands and you have NO rash that it is a chance that I have something called cholestasis. I was unfamiliar with this until reading the info online. When calling to get my glucose test results she revealed I failed and have to have another test with blood drawn every 3 hours.I mentioned the itching but she was not concerned at all.She said there was no way it was from the glucose test but it seems to odd to have started itching like this after the test. Dr. seems unworried too and when I asked for a blood test to check for the cholestasis they just shrugged it all off.

So can the itching be caused by the glucose testing? I had my gallbladder removed years ago so can I still develop cholestasis? I am so worried and am not being taken serious since they say it is so rare. I do not know what to do. Are there any other symptoms besides itching? I do not have jaundice and stools are not pale.But since the itching is the only real sign most often how can I differintiate if it is okay or not since my Dr. is not willing to listen?I need some desperate help!!!! I am already high risk and having problems so I do not need this problem to worry about too.It just came on so suddenly so I am worried.
Shannon
 Theresa Jones, RN - Thu Oct 13, 2005 7:35 am

User avatar Hi shnncof,
Intrahepatic cholestasis occurs inside the liver. A simple lab test to evaluate liver function should assist with identification of this disorder. Often the only apparent symptoms are itching of the hands and feet but when other symptoms arise typically the urine will be a dark color, pale bowel movements, fatigue or exhaustion (which is difficult to distinguish between normal events of pregnancy and this disorder), etc. Keep in mind that this condition is relatively uncommon but I would suggest that you inquire with your physician about having labwork for liver function studies to ensure all is well. Also keep in mind that Gestational Diabetes may also be linked to dry itchy skin and tingling in the hands and feet. I hope this information is somewhat helpful.
Sincerely,
Rntdj
 shnncof - Thu Oct 13, 2005 12:41 pm

Thanks for the reply. I have requested the test to my dr. and he insists on NOT testing me.I was asking my family if anyone had the symptoms or the cholestasis and found out my aunt had it.So now I am even more worried since it is mainly a hereditary thing. The dr. said the tests are not always accurate anyway is he correct? I heard that is the only way to tell and they are very accurate. I am appalled after knowing this IS in my family that he will still not test me.I am to have blood drawn tomorrow 3 times due to failing the firrst glucose test and so it would be no trouble but he still sys NO. I am in tears why? What if this IS cholestasis?How do I insist on having it done when he is telling me no? I have went in for exhaustion 1 week ago it is so bad I was fainting. My urine has been dark for over 2 weeks now and he said it was just a UTI and I am on antibiotics.I went in also 2 weeks ago for less movement with the baby.I can't get a 10 count kick out of her and he said she was just sleeping but it is so bad I feel her move maybe 3 time a day and I pay very close attention. I am freaking out.I stil am itching all over some what but more on my hands and feet.I have made my feet bleed from scartching so much. I do not know what to do.I am so worried.
Shannon
 Theresa Jones, RN - Fri Oct 14, 2005 7:56 am

User avatar Hi shnncof,
Try bringing up the discussion and concerns etc., again with your physician. Liver function studies are generally accurate. If he/she still refuses to acknowledge your concerns get a second opinion (clinic, family physician, etc.) to assure all is normal.
Sincerely,
Rntdj
 shnncof - Fri Oct 14, 2005 6:26 pm

Thank you. Per your advice I did again bring up my concerns and again was denied the simple blood test so I took it upon myself to get a 2nd opinion. My question is he ordered a simple liver functioning test or liver panel, will this detect the chlorestasis? I had no idea what to specifically ask for but I think the nurse taking the blood said it was a liver panel.I just want to make sure they are testing the right way since again this Dr. did not seem to know much of anything about the rare problem and none of the nurses had even heard of it.
Thanks,
Shannon
 Theresa Jones, RN - Sat Oct 15, 2005 8:15 am

User avatar Hi shnncof,
Liver function study/liver panel (same test) will detect if there should be any concerns. My best wishes to you and I hope when your time permits you will consider posting a follow up.
Sincerely,
Rntdj
 shnncof - Mon Oct 17, 2005 10:32 pm

Okay here is another question.I have researched the Intrahepatic Cholestasis and many people have written back.I got my results of my liver panel and they were slightly elevated.Dr. said nothing to worry about BUT everything that I have read and been told says liver panel is NOT the way to diagnose the disorder that blood tests to check bile acid levels were. Dr. is unwilling now to continue to look into this futher even though I had elevated liver panel.
What is the difference in the 2 tests?
If liver panel tests comes back elevated what does this mean?


Shannon
 Theresa Jones, RN - Sat Oct 22, 2005 6:57 am

User avatar Hi shnncof,
Abnormalities with bile acid usually present prior to abnormalities with liver function studies/liver panel etc., but regardless the liver function studies will detect abnormalities. If there are only slight elevations and your physician stated that they are nothing to worry about then the abnormalities must have been quite mild. Gallbladder dysfunction frequently presents during pregnancy so this may contribute to the cause. However, if your symptoms worsen then it would be advisable to get a second opinion.
Sincerely,
Rntdj

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