A 37-Year-Old Primigravida at 14 Weeks Gestation Comes to the Office

A 37-year-old primigravida at 14 weeks gestation comes to the office for an initial prenatal visit.  She has had some nausea but no vomiting, abdominal pain, or vaginal bleeding.  The patient has type 2 diabetes mellitus and hypertension.  She used to drink 1 or 2 glasses of wine a night but quit a year ago in anticipation of becoming pregnant.  Temperature is 37.5 C (99.5 F) , blood pressure is 138/88 mm Hg, pulse is 85/min, and respirations are 14/min.  BMI is 36 kg/m².  On examination, the sclerae are anicteric.  Cardiopulmonary examination is normal.  The abdomen is nontender, and the liver edge is palpated 3 cm below the right costal margin.  Laboratory results are as follows: A right upper quadrant ultrasound reveals a hyperechoic-appearing liver, several gallstones without gallbladder wall thickening, and a normal-appearing common bile duct.  Which of the following is the most likely cause of this patient's abnormal liver studies?

A) Acute fatty liver of pregnancy
B) Alcoholic hepatitis
C) Gallstone disease
D) Intrahepatic cholestasis of pregnancy
E) Nonalcoholic fatty liver disease
F) Preeclampsia

Correct Answer:

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