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2006, Number 3

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Ann Hepatol 2006; 5 (3)

Pregnancy and portal hypertension a pathology view of physiologic changes

López-Méndez E, Ávila-Escobedo L

Language: English
References: 39
Page: 219-223
PDF size: 83.89 Kb.


Text Extraction

The coexistent of pregnancy and liver disease represent a complex clinical situation, besides the liver complications that present in pregnancy with a previous health liver, like intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy or HELLP syndrome with bleeding disorders and viral hepatitis, the previous liver damage with portal hypertension associated represent a clear stated of hemodynamic changes which increased risk of variceal bleeding. The portal hypertension syndrome has a splanchnic blood flow increase. During pregnancy an hypervolemic stated developed as consequence there is an increased in portal flow that contributed to more portal pressure transmitted to the collaterals veins which increase variceal bleeding risk in this group of patients. The present review will focus on treatment options to prevent variceal bleeding in this clinical situation.


REFERENCES

  1. Zuckerman H, Sadovsky E, Kallner B. Serum alkaline phosphatasa in pregnancy and puerperium. Obstet Gynecol 1965; 25: 819-24.

  2. Steven MM. Pregnancy and liver disease. Gut 1981; 22: 592-614.

  3. Rolfes DB, Ishak KG. Liver disease in toxemia pregnancy. Am J Gastroenterol 1986; 81: 1138-44.

  4. Barron W. The syndrome of preeclampsia. Gastroenterol Clin North Am 1992; 21: 851-72.

  5. Weinstein L. Syndrome of hemolysis, elevated liver enzymes and low platelet count: a severe consequence of hypertension in pregnancy. Am J Obstet Gynecol 1982; 142: 159-67.

  6. Pritchard JA, Weisman R, Ratnorff OD. Intravascular hemolysis, thrombocytopenia and other hematologic abnormalities associated with severe toxemia of pregnancy. N Engl J Med 1954; 250: 89-98.

  7. Sibai BM, Ramadan MK, Usta I, Salama M, Mercer BM, Friedman SA. Maternal morbidity and mortality in 442 pregnancies with hemolysis, elevated liver enzymes and low platelets (HELLP syndrome). Am J Obstet Gynecol 1993; 169: 1000-6.

  8. Crickshank D, Wigton T, Hays P. Maternal physiology in pregnancy. In: Gabb S, Nieby J, Simpson J, editors. Obstetrics: normal and problem pregnancies. New York: Churchil Livingstone; 1996: 91-109.

  9. Schrier RW, Arroyo V, Bernardi M, Epstein M, Henriksen JH, Rodes J. Peripheral arterial vasodilatation hypothesis: a proposal for the initiation of renal sodium and water retention in cirrhosis. Hepatology 1988; 8: 1151-1157.

  10. Wiest R, Groszmann RJ. The paradox of nitric oxide in cirrhosis and portal hypertension: too much, not enough. Hepatology 2002; 35: 478-491.

  11. Bosch J, García Pagán JC. Complications of cirrhosis. Portal hypertension. J Hepatol 2000; 32: 141-156.

  12. Lebrec D, Bataille C, Bercoff E, Valla D. Hemodynamic changes in patients with portal venous obstruction. Hepatology 1983; 3: 550-3.

  13. Hernandez-Guerra M, Lopez E, Bellot P, Bosch J, García Pagán JC. Systemic hemodynamics, vasoactive systems and plasma volume in patients with severe Budd-Chiari syndrome. Hepatology 2006; 43(1): 27-33.

  14. Bathal PS, Groszmann RJ. Reduction of the increased portal vascular resistance of the isolated perfused cirrhotic rat liver by vasodilators. J Hepatol 1985; 1: 325-29.

  15. Groszmann RJ, Bosch J, Grace ND, Conn HO, García-Tsao G, Navasa M, Alberts J, et al. Hemodynamics events in a prospective randomized trial of propranolol versus placebo in the prevention of a first variceal hemorrhage. Gastroenterology 1990; 99: 1401-07.

  16. Myers JD, Taylor WJ. An estimation of portal venous pressure by occlusive catheterization of a hepatic venule. J Clin Invest 1951; 30: 662.

  17. Bosch J, Mastai R, Kravetz D, Navasa M, Rodes J. Hemodynamic evaluation of the patient with portal hypertension. Semin Liver Dis 1986; 6: 309-17.

  18. Bosch J, García Pagán JC. Complications of cirrhosis. Portal hypertension. J Hepatol 2000; 32: 141-56.

  19. D´Amico G, Pagliaro L, Bosch J. The treatment of portal hypertension: a meta-analytic review. Hepatology 1995; 22: 332-54.

  20. Kochhar R, Kumar S, Goel RC, Sriram PV, Goenka MK, Singh K. Pregnancy and its outcome in patients with non cirrhotic portal hypertension. Dig Dis Sci 1999; 44: 1356-61.

  21. Whelton M, Sherlock S. Pregnancy in patients with hepatic cirrhosis. Management and outcome. Lancet 1968; 2: 995-8.

  22. Varma RR, Michelson NH, Borkowf HI, Lewis JD. Pregnancy in cirrhotic and non cirrhotic portal hypertension. Obstet Gynecol 1977; 50: 217-22.

  23. Aggarwal N, Sawhney H, Vasishta K, Dhiman RK, Chawla Y. Non cirrhotic portal hypertension in pregnancy. Int J Gynaecol Obstet 2001; 72: 1-7.

  24. Schreyer P, Caspi E, El Hindi JM, Eshchar J. Cirrhosis pregnancy and delivery: a review. Obstet Gynecol Surv 1982; 37: 304-12.

  25. De Franchis R. Updating consensus in portal hypertension : Report of the Baveno III Consensus workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol 2000; 33: 846-52.

  26. D´Amico G, Pagliaro L, Bosch J. Pharmacological treatment of portal hypertension: an evidence-based approach. Semin Liver Dis 1999; 19: 475-505.

  27. Armonis A, Patch D, Burroughs A. Hepatic venous pressure measurement: and old test as a new prognostic marker in cirrhosis? Hepatology 1997; 25: 245-48.

  28. Feu F, García Pagán JV, Bosch J, Luca A, Teres J, Escorcell A, Rodes J. Relation between portal pressure response to pharmacotherapy and risk of recurrent variceal hemorrhage in patients with cirrhosis. Lancet 1995; 346: 1056-59.

  29. Abraldes J, Tarantino I, Turnes J, García Pagán JC, Rodes J, Bosch J. Hemodynamic response to pharmacological treatment of portal hypertension and long-term prognosis of cirrhosis. Hepatology 2003; 37: 902-08.

  30. Villanueva C, López-Balaguer J, Aracil C, Kolle L, Gonzalez B, Miñana J, Soriano G, et al. Maintenance of hemodynamic response to treatment for portal hypertension and influence on complications of cirrhosis. Journal of Hepatology 2004; 40: 757-65.

  31. Imperiale TF, Chalasani N. A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding. Hepatology 2001; 33: 802-7.

  32. De Franchis R. Evolving consensus in portal hypertension : Report of the Baveno IV Consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol 2005; 43: 167-76.

  33. Villanueva C, Miñana J, Ortiz J, Gallego A, Soriano G, Torras X, Sainz S, et al. Endoscopic ligation compared with combined treatment with nadolol and isosorbide mononitrate to prevent recurrent variceal bleeding. N Engl J Med 2001; 345: 647-55.

  34. Patch D, Sabin CA, Goulis J, Gerunda G, Merkel C, Greenslade L, Burroughs AK. A randomized, controlled trial of medical therapy versus endoscopic ligation for the prevention of variceal rebleeding in patients with cirrhosis. Gastroenterology 2002; 123: 1013-19.

  35. Lo GH, Chen WC, Chen MH, Hsu PI, Lin CK, Tsai WL, Lai KH. Banding ligation versus nadolol and isosorbide mononitrate for the prevention of esophageal variceal rebleeding. Gastroenterology 2002; 123: 728-34.

  36. Bosch J, García Pagán JC. Prevention of variceal rebleeding. Lancet 2003; 361: 952-54.

  37. De Franchis R, Primignani M. Endoscopic treatments for portal hypertension. Semin Liver Dis 1999; 19: 439-55.

  38. Lo GH, Lai KH, Cheng JS, Chen MH, Huang HC, Hsu P, Lin CK. Endoscopic variceal ligation plus nadolol and sucralfate compared with ligation alone for the prevention of variceal rebleeding: a prospective, randomized trial. Hepatology 2000; 32: 461-65.

  39. De la Peña J, Brullet E, Sanchez-Hernández E, Rivero M, Vergara M, Martin-Lorente JL, Garcia-Suárez C, et al. Variceal ligation plus nadolol compared with ligation for prophylaxis of variceal rebleeding: A Multicenter Trial. Hepatology 2005; 41: 572-78.




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