← All chapters
Cross-Cutting· Chapter 35

GI in Pregnancy

Pregnancy physiology and the normal-lab ranges that catch fellows out, the ICP / HELLP / AFLP triage in the third trimester, hyperemesis gravidarum, GERD and PUD management with safe drug classes, IBD medication safety per PIANO, post-bariatric pregnancy, and biliary disease management when the patient is pregnant.

Sign in to study →
52 MCQs
  • Audio chapter
    Attending-narrated, listen on the commute.
  • ABIM-format MCQs
    5-option vignettes with full wrong-answer teaching.
  • Study guide
    Tables, decision trees, primary sources.
  • AI tutor
    Chapter-grounded, answers the question you're stuck on.

What this chapter covers

  • Section 35.1: Pregnancy physiology, normal labs, and imaging

    Pregnancy produces predictable physiologic and laboratory changes that must be distinguished from pathology.

  • Section 35.2: Nausea, vomiting, and hyperemesis gravidarum

    Nausea and vomiting of pregnancy (NVP) affects 70 to 80 percent of pregnancies and typically resolves by the 20th week of gestation.

  • Section 35.3: GERD and PUD in pregnancy

    Approximately two-thirds of pregnant women experience heartburn, driven by three pregnancy-specific mechanisms acting together: progesterone reduces lower esophageal sphincter pressure, the gravid uterus elevates intra-abdominal pressure, and gastric emptying is slowed.

  • Section 35.4: Intrahepatic cholestasis of pregnancy

    Intrahepatic cholestasis of pregnancy is the most common pregnancy-specific liver disease, with a US prevalence of approximately 1 to 2 percent and a strikingly higher prevalence in some Hispanic populations (up to 27 percent in Araucanian Indians of Chile) reflecting genetic predisposition.

  • Section 35.5: Preeclampsia, HELLP, AFLP, and hepatic rupture

    These third-trimester liver emergencies share the feature that delivery is the only definitive treatment.

  • Section 35.6: Viral hepatitis in pregnancy

    Pregnancy-specific decisions for viral hepatitis live here; the underlying serology, treatment, and vertical transmission framework is in Ch 18, with HEV genotype-specific severity and HSV ALF detailed in Ch 19.

  • Section 35.7: Pre-existing liver disease in pregnancy

    The principle for pre-existing liver disease in pregnancy is that pregnancy modulates immune activity (Th2 dominance during pregnancy, return of cellular immunity postpartum), changes hepatic synthetic and metabolic demand, and alters drug pharmacokinetics.

  • Section 35.8: IBD in pregnancy

    The cross-cutting framework for IBD in pregnancy lives here; the disease-specific decisions about which biologics fit which IBD phenotype belong with Ch 14.

  • Section 35.9: Post-bariatric pregnancy

    Post-bariatric pregnancy carries specific risks driven by the altered anatomy, malabsorption, and altered carbohydrate handling that the surgery created.

  • Section 35.10: Cholelithiasis and procedural decisions in pregnancy

    Gallstones develop in approximately 10 percent of pregnancies through the lithogenic mechanism described in Section 35.1.

Podcast episodes

  1. 01

    Physiology and Hyperemesis

    This episode covers pregnancy physiology and nausea and hyperemesis gravidarum: the pregnancy-shifted normal labs, the ultrasound-and-non- contrast-MRI imaging menu, and hyperemesis management with thiamine before any glucose to prevent Wernicke encephalopathy.

  2. 02

    GERD and PUD

    This episode covers GERD and peptic ulcer disease in pregnancy, which test as a stepwise pharmacologic sequence built on local-then-systemic safety logic, with misoprostol prohibited because it contracts the uterus.

  3. 03

    Pregnancy Specific Liver

    This episode covers the pregnancy-specific liver diseases: intrahepatic cholestasis of pregnancy with elevated bile acids and ursodeoxycholic acid, the preeclampsia, HELLP, and AFLP spectrum where delivery is the definitive treatment, and hepatic rupture as the catastrophic complication.

  4. 04

    Incidental Liver Disease

    This episode covers the incidental liver disease of pregnancy: viral hepatitis with virus-specific transmission and antiviral decisions, and pre-existing liver disease where pregnancy changes the management.

  5. 05

    IBD in Pregnancy

    This episode covers inflammatory bowel disease in pregnancy: biologic continuation through delivery as the standard rather than holding biologics in the third trimester, and the FcRn-mediated placental transfer that distinguishes the anti-TNF agents from certolizumab.

  6. 06

    Bariatric and Biliary

    This episode covers the last two luminal problems of pregnancy: post- bariatric pregnancy with internal hernia as the catastrophic post-RYGB complication, and cholelithiasis with the procedural decisions, including ERCP using second-trimester preference and lead shielding and pulsed fluoroscopy.