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Q. Can high blood pressure and proteinuria during pregnancy lead to liver damage?

Answered by
Dr. Sandeep V Nair
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Jun 20, 2021

Hello doctor,

I am a 28-year-old female with a height of 5'7" feet and weigh 149 pounds. Routine medical check-up found elevated bilirubin of 1.6 mg/dL. AST 23 U/L and ALT 19 U/L. Repeat laboratory tests a week later show bilirubin of 1.4 mg/dL, AST 23 U/L, ALT 19 U/L. Doctor ordered an ultrasound. Findings were non-specific, mildly coarse echotexture of the liver and mildly echogenic portal triads, consider an underlying liver parenchymal disease. The pancreas and gallbladder are normal. The visualized hepatic and portal veins are patent with the proper directional flow. No free fluid, nobiliary dilation, or free fluid. No Focal Lesion. Hepatitis not excluded. All other blood tests were within normal range. There are no other symptoms, and I am otherwise healthy. There is a history of alcohol use and cigarette smoking, as well as dietary fasting. I have four kids, and during two of my pregnancies, I had high blood pressure and protein in my urine. Could this have lead to liver damage? It has been three years since I gave my last birth. I have stopped drinking after these issues, and my family doctor had no idea and referred me to a GI specialist. I am worried about this. What disease could this be? Could this be normal?

#

Hi,

Welcome to icliniq.com.

I think it is more likely to be Gilbert Syndrome. It is a benign condition and does not require any treatment.

However, to come to the diagnosis, I need to know the complete liver function test and the blood tests. If your indirect fraction is high, then it is Gilbert syndrome. It occurs due to deficiency of an enzyme in the liver, and so it shows up as elevated indirect and total bilirubin. The bilirubin can go up to 5 mg/dl, especially during stress and fasting.

It does not require any treatment and will not cause any long-term liver problems. The issues you had in pregnancy are not the reason for your current lab test abnormality. Please relax.

Regards.

Thank you for the reply, doctor,

I have uploaded the images of the blood test. I am not sure if you are asking the indirect fraction. That is good you suggest Gilbert's Syndrome as that takes away some stress. Would Gilbert's syndrome cause or explain the mild course echotexture and mild echogenic portal triads found on my ultrasound, or is that a normal finding or seen when using alcohol? Thank you. Please note that my mom had non-alcoholic steatohepatitis.

#

Hi,

Welcome back to icliniq.com.

Thank you for uploading the reports (attachment removed to protect the patient's identity). I see that you have included only the total bilirubin value. Could you look up again if you have missed out on direct and indirect bilirubin values?

Gilbert syndrome would not result in coarsened echotexture. As your mother has a history of non-alcoholic steatohepatitis (NASH), you too have a risk of getting it. You do not have steatohepatitis at present as your liver enzymes AST (aspartate aminotransferase) and ALT (alanine aminotransferase) are within normal limits. You have a fatty liver which is a predecessor of NASH. The presence of fat in the liver or fatty liver can cause coarsening of liver echoes. Alcohol use also leads to coarsening of liver echoes. I would suggest you cut down high sugar and high fat in your diet, exercise regularly, consume more fiber, increase coffee intake, and cut down alcohol use.

Regards.

Thank you doctor,

I want to have a follow-up and so I am sharing current laboratory results. I need your current opinion on what you think. I saw a GI yesterday. She believes that I have gilbert's syndrome. But she is unsure of the ultrasound findings of my liver. So she ordered some blood work. My liver enzyme is not normal with abnormal iron levels. I did not see her for four weeks. Is it fine to wait for four weeks with iron levels in my body at these levels?

#

Hi,

Welcome back to icliniq.com.

Your current report shows that you have high iron saturation values and high hematocrit. It suggests the possibility of hemochromatosis. It is a disorder of having deposition of iron in liver cells which leads to liver disease. Some more tests should be done before confirming it. It is a treatable condition and you have to be on regular follow-up with a GI (gastrointestinal) specialist. You need to do a peripheral smear, ferritin levels, and other blood tests also. Regards.

Thank you doctor,

Thank you for your reply. My ferritin levels are normal. On the lower end, my TIBC is also normal. Is it safe for me to see a doctor in person after four weeks with high iron levels in my blood? or Would you recommend it sooner?

#

Hi,

Welcome back to icliniq.com.

It is good to hear that your ferritin levels are normal. Even if you have hemochromatosis, it remains inactive. Yes, it is absolutely safe for you to wait for a month before you see the doctor. The tests mentioned help to establish a diagnosis or helps to rule out a diagnosis for your liver problem. It could also be non-alcoholic steatohepatitis with mild iron overload. The doctor may order a genetic test for hemochromatosis depending on the population and prevalence of the disease. Please do not be worried. It is nothing urgent. Meanwhile, just stick to the basics such as avoiding heavy fatty meals and doing exercise. Regards.

Thank you doctor,

I received my final diagnosis of gilbert's syndrome. Everything is fine. The changes seen in my liver were from alcohol usage. Is there anything to do to lower indirect bilirubin? I have had yellow discoloration in my eyes, under my lower eyelid, and corner of my eyes for two months now. Is there anything that I can make it to go away? Will I have yellow eyes forever?

#

Hi,

Welcome back to icliniq.com.

That is great news. Gilbert's syndrome is totally a benign condition. The bilirubin values in this condition never go above 5 mg/dL. Yellow eyes may take some time to resolve. But if I remember correctly, your bilirubin was never above 3 mg/dL. Bilirubin shows up in the eyes usually when it is above 3 mg/dL. So yellowish discoloration is not due to bilirubin. If you have stopped alcohol use, then bilirubin will come down after some time. Do not be worried about yellow eyes. If it persists beyond a month, then consult an ophthalmologist. Regards.


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