Other studies on liver disease

Abstract

Liver disorders in pregnancy range from mild reversible changes to severe fulminant fatal disease. Intrahepatic cholestasis is common in Scandinavia and Chile and the pathogenesis remains unknown. The use of intravenous S-adenosyl-l-methionine for symptomatic and biochemical improvement has been encouraging. In severe liver disease associated with pregnancy, liver transplantation has been performed and has been successful. Conception after liver transplantation has also been documented, unassociated with any teratogenicity or intrauterine growth failure. A high incidence of preeclampsia has been noted, however. It is advocated that patients wait 9 to 12 months after transplantation before trying to conceive. The recommended contraception is a barrier method, not an intrauterine device because of risk of infection, nor oral contraceptives, which may cause difficulty with cyclosporine dosing. Ischemic hepatitis is a common disorder, frequently self-limiting, depending on the underlying pathogenesis. Rapid elevation of the aminotransferases and lactic dehydrogenase is associated with an equally rapid resolution in this disorder. Renal impairment, carbohydrate intolerance, and mental confusion appear to be additional factors in the clinical manifestation. Ascites can be associated with a severe pleural effusion often resistant to standard management. The use of the transjugular intrahepatic portosystemic stent-shunt procedure has been documented to be effective in the management of this entity.

Current Opinion in Gastroenterology 1993, 9:456-461