**Question:** All the following are TRUE about cholestasis of pregnancy EXCEPT

A. Cholestasis of pregnancy is caused by a deficiency in liver enzymes, particularly gamma-glutamyl transpeptidase (GGT).
B. The condition presents when the bile acid levels in the blood are abnormally high.
C. The main symptoms include pruritus (itching) and elevated liver enzymes.
D. Treatment involves addressing the underlying cause, such as removing a gallstone.

**Correct Answer:** D. Treatment involves addressing the underlying cause, such as removing a gallstone.

**Core Concept:** Cholestasis of pregnancy is a liver disorder that occurs during pregnancy, characterized by elevated bile acid levels in the blood and pruritus. The liver enzymes, particularly GGT, are typically deficient in cholestasis of pregnancy.

**Why the Correct Answer is Right:** The correct answer (D) highlights that the primary treatment for cholestasis of pregnancy focuses on alleviating symptoms, rather than addressing the underlying cause. In most cases, the primary cause is the physiological changes occurring during pregnancy, which inhibit bile flow and lead to the aforementioned symptoms and liver enzyme abnormalities. Removing a gallstone (option D) is not the primary treatment for cholestasis of pregnancy as it is not the primary cause of the condition.

**Why Each Wrong Option is Incorrect:**

**Option A:** This is incorrect because cholestasis of pregnancy is caused by the physiological changes during pregnancy, not a deficiency in liver enzymes. Gamma-glutamyl transpeptidase (GGT) is elevated rather than deficient in cholestasis of pregnancy.

**Option B:** This is incorrect because treating the underlying cause (physiological changes during pregnancy) is not the primary treatment approach. Instead, the focus is on alleviating symptoms, such as pruritus and elevated liver enzymes.

**Option C:** This is also incorrect because addressing the symptoms (pruritus and elevated liver enzymes) is the primary treatment strategy, rather than removing the underlying cause. The elevated liver enzymes and pruritus are secondary to the physiological changes during pregnancy, not due to a gallstone.

**Core Concept (Highlighted in Explanation)**: Cholestasis of pregnancy is a pregnancy-related liver disorder primarily characterized by elevated bile acid levels, pruritus, and elevated liver enzymes. The condition is caused by physiological changes during pregnancy, which inhibit bile flow, leading to these symptoms and enzyme abnormalities. Treatment focuses on alleviating symptoms rather than addressing the underlying cause (e.g., removing a gallstone) which is not the primary cause of the condition.