Liver Disease During Pregnancy

Cholelithiasis and gallstone disease are seen in 3 to 12% of pregnant women, with higher incidence in the second and third trimesters. Most women are asymptomatic, however, up to 50% will have recurrent pain and worsening symptoms as pregnancy advances. Asymptomatic cholelithiasis requires no treatment. Symptomatic disease should initially be managed conservatively, but up to 35% will fail medication management and require surgical intervention. If possible surgery should be delayed until the second trimester. Likewise, medical management during the third trimester is preferable with surgical intervention following delivery.

Variable outcomes are seen in pregnant women with cirrhosis and portal hypertension. Significant hepatic decompensation (jaundice, ascites, and encephalopathy) can occur. Preexisting portal hypertension may be worsened by increased total blood volume, possibly increasing the risk of bleeding from esophageal varices. Pregnancy is generally uneventful in patients with chronic hepatitis B or C virus infections. Women with autoimmune hepatitis have had successful pregnancies and should continue to be treated with corticosteroids and/or azathioprine. Women with untreated Wilson's disease are generally anovulatory, but can undergo successful pregnancy with following copper chelation treatment. Penicillamine or trientine therapy

TABLE 120-1. Normal Changes During Pregnancy

Serum Test Usual Change

TABLE 120-1. Normal Changes During Pregnancy

Serum Test Usual Change

Albumin

Decreased (mean value 3 g/dL)

AST

Normal

ALT

Normal

Alkaline phosphatase

Two- to fourfold increase

GGT

Normal or slight decrease

Bilirubin

Slight decrease

5'-nucleotidase

Slight increase

Prothrombin time

Normal

Ferritin

Decreased

Ceruloplasmin

Decreased

Cholesterol/Triglycerides

Marked increase

Bile acids

No change

ALT = alanine aminotransferase; AST = aspartate aminotransferase; GGT = y-glutamyl transpeptidase.

ALT = alanine aminotransferase; AST = aspartate aminotransferase; GGT = y-glutamyl transpeptidase.

should be continued in this setting because discontinuation can lead to fulminant liver failure (the potential effects of these medications on the fetus should be discussed with the patient). Alcoholic women with significant liver disease may be anovulatory and thus infertile.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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