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By Desmond Winter Hall

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Replacement will depend on the extent of deficiency and response to treatment. 6 outlines the vitamins that can be monitored and replaced if deficient. Evaluation of therapy is monitored by 24-hour urine calcium after 3 months if vitamin D was low, followed by yearly 25-OH vitamin D levels. Annual vitamins A and E levels and prothrombin time can be monitored. Jaundice in pregnancy Consider other coincidental causes of jaundice. The following are specific conditions related to pregnancy. Hyperemesis gravidarum – occurs in the first trimester.

27 SECTION 1 Approach to Specific Presentations History, examination, routine blood tests Alkaline phosphatase or transaminases abnormal? Evaluate for haemolysis, hereditary hyperbilirubinaemia Ultrasound abdomen Dilated bile ducts Non-dilated bile ducts High likelihood of biliary obstruction Low likelihood of biliary obstruction MRCP, ERCP, EUS or PTC Biliary obstruction Therapeutic invervention No biliary obstruction Biochemical tests for specific liver disease Observe, consider liver biopsy unlikely to be due to stones.

Bile acids or bile salts are soluble, amphipathic end products of cholesterol metabolism formed in the pericentral hepatocytes and accounts for approximately 85% of the constituents of bile. Cholestasis is characterized by the constellation of physiological, morphological and clinical manifestations that result from the impairment of the bile excretory system in the liver and biliary tree. Reduced bile flow results in the accumulation of conjugated bilirubin, bile salts and cholesterol in the blood.

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