lunes, 6 de abril de 2015

Hígado y embarazo / Liver and pregnancy

Hígado graso agudo del embarazo: Estudio de seguimiento mayor de 6 meses en 25 pacientes
Acute fatty liver of pregnancy: over six months follow-up study of twenty-five patients.
Xiong HF1, Liu JY1, Guo LM1, Li XW1.
World J Gastroenterol. 2015 Feb 14;21(6):1927-31. doi: 10.3748/wjg.v21.i6.1927.
AIM: To evaluate the prognosis of patients with acute fatty liver of pregnancy (AFLP) 6 mo or longer after discharge. METHODS: The records of pregnant patients diagnosed with AFLP at Beijing Ditan Hospital over a 16-year period were reviewed in November 2012. Patients were monitored using abdominal ultrasound, liver and kidney functions, and routine blood examination. RESULTS: A total of 42 patients were diagnosed with AFLP during the study period, and 25 were followed. The mean follow-up duration was 54.5 mo (range: 6.5-181 mo). All patients were in good physical condition, but one patient had gestational diabetes. The renal and liver functions normalized in all patients after recovery, including in those with pre-existing liver or kidney failure. The ultrasound findings were normal in 12 patients, an increasingly coarsened echo-pattern and increased echogenicity of the liver in 10 patients, and mild to moderate fatty liver infiltration in 3 patients. Cirrhosis or liver nodules were not observed in any patient. CONCLUSION: Acute liver failure and acute renal failure in AFLP patients is reversible. Patients do not require any specific long-term follow-up after recovery from AFLP if their liver function tests have normalized and they remain well.
KEYWORDS: Acute fatty liver of pregnancy; Acute liver failure; Acute renal failure; Follow-up study
Hepatopatías del embarazo
Pregnancy-related liver disorders.
Goel A1, Jamwal KD1, Ramachandran A2, Balasubramanian KA2, Eapen CE1.
J Clin Exp Hepatol. 2014 Jun;4(2):151-62. doi: 10.1016/j.jceh.2013.03.220. Epub 2013 Mar 16.
Pregnancy-related liver disorders accounted for 8% of all maternal deaths at our center from 1999 to 2011. Of the three pregnancy-related liver disorders (acute fatty liver of pregnancy (AFLP), HELLP (Hemolysis, elevated liver enzymes, low platelets) syndrome and pre-eclamptic liver dysfunction, which can lead to adverse maternal and fetal outcome, AFLP is most typically under - diagnosed. Risk of maternal death can be minimised by timely recognition and early/aggressive multi-specialty management of these conditions. Urgent termination of pregnancy remains the cornerstone of therapy for some of these life threatening disorders, but recent advancements in our understanding help us in better overall management of these patients. This review focuses on various aspects of pregnancy-related liver disorders.
KEYWORDS: AFLP, acute fatty liver of pregnancy; CS, Caesarean; FAO, fatty acid oxidation; HELLP syndrome; HELLP, hemolysis elevated liver enzymes and low platelets; HG, hyperemesis gravidarum; HbsAg, hepatitis B surface antigen; ICP, intrahepatic cholestasis of pregnancy; LCHAD, long chain hydroxyacyl coA dehydrogenase; LDH, lactate dehydrogenase; LFT, liver function tests; MP, malarial parasite; MTP, mitochondrial tri-functional protein; PFIC, progressive familial intra-hepatic cholestasis; PRLD, pregnancy-related liver disorders; PT, prothrombin time; UDCA, ursodeoxycholic acid; acute fatty liver of pregnancy; maternal mortality; pre-eclampsia
Anestesia y Medicina del Dolor
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