GIT DSEASES With PREGNANCY

1. بسم الله الرحمن الرحـيـم GIT DSEASES With PREGNANCY Dr. Afaf I. Alnoury

2. GIT DISAESES DURING PREGNANCY • The alimentary tract is altered physiologically and anatomically during pregnancy • 90% of women will experience bother some GIT symptoms @ sometimes during pregnancy • The diagnosis of GIT disorders is more difficult during pregnancy Dr. Afaf I. Alnoury

3. GIT DISAESES DURING PREGNANCY NAUSEA & VOMITING • 60 – 80 % of women will experience some nausea and vomiting (motion sickness) • 3 - 4/1000 the symptoms may be severe or persist throughout pregnancy. • THEORIES: • The endocrine changes of pregnancy alter the emetic threshold centrally, sensitizing the pregnant women to nausea and vomiting. • TREATMENT • supportive Dr. Afaf I. Alnoury

4. GIT DISAESES DURING PREGNANCY HYPEREMESIS GRAVIDARUM • Pathologic state of nausea & vomiting. • This syndrome is defined • as vomiting sufficiently pernicious to produce weight loss, dehydration, acidosis (starvation) or alkalosis (loss of HCL in vomitus) and hypokalemia. • In severe cases weight loss, acetonuria, ketonemia with accompanying neurological, hepatic and renal damage. • More common in women with infertility, immature &/or passive dependant personality types Dr. Afaf I. Alnoury

5. GIT DISAESES DURING PREGNANCY HYPEREMESIS GRAVIDARUM • LABORATORY: • U & E’s • Tests for ketoacidosis and acidosis • Urine analysis • LFT, Kidney function, CBC • TREATMENT: • Hospitalization • correction of dehydration • Electrolyte replacement • Nutritional support • Ant emetic therapy • Psychological and social support Dr. Afaf I. Alnoury

6. GIT DISAESES DURING PREGNANCY • REFLUX ESOPHAGITIS (PYROSIS) • Raising the head of the bed • Oral antacids • Endoscopy in persistent cases • ACHLAIA • Is a motor disorder of esophageal smooth muscle in which the lower sphincter doesn't relax properly with swallowing and there are abnormal esophageal contractions • PEPTIC ULCER • Is uncommon during pregnancy • CONSTIPATION Dr. Afaf I. Alnoury

7. GIT DISAESES DURING PREGNANCY ACID ASPIRATION SYNDROME • Predisposing factors • Patient has eaten sometimes prior to labour • Delayed gastric emptying • Lower esophageal sphincter tone • sedative Dr. Afaf I. Alnoury

8. GIT DISAESES DURING PREGNANCY DISEASES OF THE LIVER • CATEGORIZED: • Hepatic disorders not related to pregnancy • Hepatic disorders occurring as a result of pregnancy associated disease • Pregnancy specific hepatic disorders • LIVER IN NORMAL PREGNANCY: • Size • Blood flow • Histologically • Clinically spider angiomata • palmar erythema • Hepatic excretory function BSP clearance decrease in 2nd half • serum cholic acid increase Dr. Afaf I. Alnoury

9. GIT DISAESES DURING PREGNANCY DISEASES OF THE LIVER • HEPATIC ENZYMES & PROTEIN DURING PREGNANCY: • Albumin  • Globulin • Fibrinogen • SGPT • SGOT • PRIMARY HEPATIC DISEASE : • Viral Hepatitis • Is the most common cause of jaundice in pregnancy 6 types • 78% hepatitis B • 8% hepatitis A Dr. Afaf I. Alnoury

10. GIT DISAESES DURING PREGNANCY DISEASES OF THE LIVER • Hepatitis A: • Immune globulin prophylaxis can be given during pregnancy • Hepatitis A virus doesn't traverse the placenta • Maternal infection late weeks of pregnancy – neonate infection • Hepatitis B: • HBV (acute) • 1st trimester no transmission to the fetus • 2nd trimester 6% transmission to the fetus • 3rd trimester 67% transmission to the fetus • Postpartum 100% transmission to the fetus • Chronic • Antenatally • intrapartum • postpartum Dr. Afaf I. Alnoury

11. GIT DISAESES DURING PREGNANCY DISEASES OF THE LIVER • Hepatitis C: • Higher risk for developing chronic active hepatitis • Pregnant women at higher risk of contracting hepatitis C • At higher risk of fulminating hepatitis, hepatic necrosis and death Dr. Afaf I. Alnoury

12. GIT DISAESES DURING PREGNANCY DISEASES OF THE LIVER • Hepatic disease in pregnancy associated disorders: • PIH • Mild PIH  associated alteration in LFT • Severe PIH  associated alteration in LFT • Diagnosis: • History • Clinical examination • LFT, PT, PTT, Platelet • Subcapsular hematomas or liver rupture • Prompt recognition and diagnosis • Aggressive support with fluids • Cardiovascular support • Blood transfusion • Partial liver resection &/or hepatic a. ligation • Mortality maternal 76% perinatal 75% Dr. Afaf I. Alnoury

13. GIT DISAESES DURING PREGNANCY DISEASES OF THE LIVER • PREGNANCY APECIFIC HEPATIC DISORDERS: • Intrahepatic Cholestasis: • The 2nd most common cause of jaundice in pregnant women. • Mediterranean, Scandinavian • Common in 3rd trimester • Associated with HLA BW 16 antigen • Pruritis followed by mild jaundice, darkened yellow urine, normal • colored stool. • LFT – bile acid increased (7-10 folds) • SGOT, SGPT mild increase • Serum bilirubin increased 5 mg% • Coagulation profile is normal, but PT may be prolonged (absorption of vit. K) • Fetus at risk from prematurity, death, asphyxia Dr. Afaf I. Alnoury

14. GIT DISAESES DURING PREGNANCY DISEASES OF THE LIVER • PREGNANCY SPECIFIC HEPATIC DISORDERS: • Acute fatty liver of pregnancy • Rare • Lethal disease • maternal mortality 80% • fetal mortality 75% • C/P • Develops in primigravida, third trimester 36 – 40 weeks) • May be earlier @ 30 weeks • Rare in immediate postpartum • Low grade fever • Nausea, vomiting • Abdominal pain • Jaundice • Tachycardia, hypertension, proteinuria Dr. Afaf I. Alnoury

15. GIT DISAESES DURING PREGNANCY DISEASES OF THE LIVER • PREGNANCY SPECIFIC HEPATIC DISORDERS: • Acute fatty liver of pregnancy • Laboratory findings • Leukocytosis • Increased liver enzymes • Increased bilirubin level 10 -20 mg/100ml • Severe hypoglycemia • Prolonged PT, PTT & decrease platelets • Treatment • Meticulous attention to fluids, electrolytes, cardiovascular function & coagulation • Hypotension should not be overlooked • Frequent microbiologic assessments • Antacids (stress ulcer) • Cause of death • Renal • DIC Dr. Afaf I. Alnoury

16. GIT DISAESES DURING PREGNANCY DISEASES OF THE LIVER • HEPATIC NEOPLASM: • OCP increased incidence of hepatoma, adenoma • pregnancy may be increased incidence of hepatoma and adenoma • Clinically: • Systemic symptoms in advanced cases • Pain and tender in right hypochondrium • Enlarged liver • Severe pain in case of hemorrhage • LFT affected • Ultrasound, CT, MRI • Needle Bx Dr. Afaf I. Alnoury

17. GIT DISAESES DURING PREGNANCY DISEASES OF THE LIVER • CIRRHOSIS AND PORTAL HYPERTENSION: • Frequently women sterile, however pregnancy is possible • Higher risk of hepatic dysfunction • Patient with successful partocaval shunt may conceive and deliver without risk of increasing dysfunction • Obstetric management: • Stabilization and then delivery on obstetric basis • Survival mother and fetus – no significant disability and long term hepatic dysfunction • No recurrence Dr. Afaf I. Alnoury

18. Thank You Dr. Afaf I. Alnoury