Monday, 2 December 2013

Liver diseases in pregnancy - Liver diseases coincidental with but not induced by pregnancy - part 7

Alcohol use - related diseases:
Women are two to four times more likely than men to develop alcoholic liver disease for the same amount of alcohol ingested, and they exhibit a tendency to disease progression even with abstinence.
Continued drinking during pregnancy may lead to miscarriage, stillbirth, prematurity, growth retardation, and the fetal alcohol syndrome (growth retardation, behavioral disturbances, brain defects, cardiac defects, spinal defects and craniofacial anomalies).
Alcohol abstinence throughout pregnancy should be emphasized.

 Gallstone disease:
Pregnancy is a risk factor for sludge and gallstone  formation.
By the end of the third trimester, 10% to 12% of pregnant women have gallstones.
Most gallstones disappear spontaneously without causing symptoms.
Laparoscopic surgery seems to be safe and should be considered.
The optimal time for it appears to be during the second trimester, when fetal organogenesis is completed and the size of the uterus does not interfere with the surgery.

Budd-Chiari syndrome:
Budd-Chiari syndrome is very often insidious, manifesting after delivery.
It is characterized by thrombosis of the hepatic veins and portal hypertension.
Its clinical manifestations include ascites, hepatomegaly and abdominal pain.
Proper diagnosis and management require imaging studies such as Doppler ultrasonography and CT and liver biopsy.
Treatment with anticoagulants, thrombolytics, diuretics and portocaval shunting may be required.
Liver transplantation is indicated when hepatic decompensation develops.

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