Differential Diagnosis for Isolated Increased GGT in Pregnancy with Increased Bile Acid

• Single Most Likely Diagnosis
  • Intrahepatic Cholestasis of Pregnancy (ICP): This condition is characterized by an isolated increase in GGT and bile acids during pregnancy, often presenting with pruritus. It is a common cause of liver dysfunction in pregnant women and typically resolves after delivery.
• Other Likely Diagnoses
  • Viral Hepatitis: Although less common, viral hepatitis (such as hepatitis A, B, or C) can cause elevated liver enzymes, including GGT, and increased bile acids. The clinical presentation may include jaundice, fatigue, and loss of appetite.
  • Preeclampsia: In some cases, preeclampsia can lead to liver dysfunction, manifesting as elevated GGT and bile acids. However, it is usually accompanied by other symptoms like hypertension and proteinuria.
• Do Not Miss Diagnoses
  • Acute Fatty Liver of Pregnancy (AFLP): This is a rare but life-threatening condition that can present with elevated liver enzymes, including GGT, and increased bile acids. It often occurs in the third trimester and can lead to severe complications if not promptly recognized and treated.
  • HELLP Syndrome: A variant of preeclampsia, HELLP syndrome can cause liver dysfunction, including elevated GGT and bile acids. It is characterized by hemolysis, elevated liver enzymes, and low platelet count, and requires immediate medical attention.
• Rare Diagnoses
  • Primary Biliary Cholangitis (PBC): Although rare in pregnancy, PBC can cause chronic cholestasis, leading to elevated GGT and bile acids. It is an autoimmune disease that primarily affects the bile ducts.
  • Primary Sclerosing Cholangitis (PSC): This is a rare chronic liver disease characterized by inflammation and scarring of the bile ducts, which can lead to elevated GGT and bile acids. It is often associated with inflammatory bowel disease.