••• Chapter 15^ Gastrointestinal Disorders in Pregnancy^167
❍ A middle-aged woman presents with a 3-day history of generalized cramping abdominal pain later
becoming colicky in character, and accompanied by intractable nausea and vomiting. On examination, she
has right lower quadrant tenderness, a 10-week-size midline uterus, and right adnexal fullness. Diagnostic
laparoscopy revealed findings in the right pelvis. What is the diagnosis?
Torsion of the appendix. It is a rare case mimicking the more common torsion of the ovary; diagnostic laparoscopy
would have been performed nonetheless to yield the final diagnosis.
❍ A woman presents with malaise, headache, nausea, poor appetite, and abdominal pain during the third
trimester, and later develops hepatic failure with jaundice and encephalopathy. How would you describe the
pattern of fat deposition in the liver biopsy?
Tissue from liver biopsy shows both microvesicular and macrovesicular fat deposition on Oil red O stain,
characteristic of acute fatty liver of pregnancy.
ReFeReNCeS
- Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington, DC: National
Academies Press; 2006. - Lagiou P, Tamimi R, Mucci LA, Trichopoulos D, Adami HO, Hsieh CC. Nausea and vomiting in pregnancy in relation to prolactin,
estrogens, and progesterone: a prospective study. Obstet Gynecol. 2003;101(4):639. - American College of Obstetricians and Gynecologists. Nausea and vomiting of pregnancy. ACOG Practice Bulletin No. 52. Obstet
Gynecol. 2004;103:803–815. - American College of Obstetricians and Gynecologists. Viral hepatitis in pregnancy. ACOG Practice Bulletin No. 86. Obstet Gynecol.
2007;110:941–955. - Rautou PE, Angermayr B, Garcia-Pagan JC, et al. Pregnancy in women with known and treated Budd-Chiari syndrome: maternal
and fetal outcomes. J Hepatol. 2009;51(1):47. - Chamarthi B, Greene MF, Dluhy RG. A problem in gestation. The New England Journal of Medicine. Sept 2011;365:843-848.
- American College of Obstetricians and Gynecologists. Bariatric surgery and pregnancy. ACOG Practice Bulletin No. 105. Obstet
Gynecol. 2009;113:1405–1413. - Gabbe SG, Niebyl JR, Simpson JL. Obstetric: normal and problem pregnancies. Chapter 43: Hepatic and Gastrointestinal Disease.
Philadelphia, PA: Churchill Livingstone, Elsevier; 2007. - Yamazaki JN, Schull WJ. Perinatal loss and neurological abnormalities among children of the atomic bomb. Nagasaki and Hiroshima
revisited, 1949 to 1989. JAMA. 1990;264(5):605.