Digestive Diseases

Biography

Biography: Assem shaik

Abstract

Gastro-intestinal complaints and disorders are common in women of all ages, including women in their childbearing period, and thus, often occur during pregnancy, while hepatic, biliary, & pancreatic disorders are relatively uncommon but not rare during pregnancy. For example, about 3 per 100 women develop serum liver function test abnormalities during pregnancy, and about 1 per 500 women develop potentially life threatening hepatic diseases during pregnancy that endanger fetal viability. Hepatic, biliary, and pancreatic disorders are often complex and these complaints and disorders, in addition to gastro-intestinal disorders present unique clinical challenge during pregnancy.

First, the differential diagnosis during pregnancy is extensive. Aside from gastrointestinal disorders unrelated to pregnancy, their complaints may be caused by obstetric or gynecologic disorders related to pregnancy or other intra-abdominal diseases incidental to pregnancy. Moreover, some gastro-intestinal conditions, such as hyperemesis gravidarum are unique to pregnancy.

Second, the clinical presentation and natural history of gastro-intestinal & hepatic disorders can be altered during pregnancy as in the case of appendicitis. Indeed, some disorders, as intrahepatic cholestasis of pregnancy, are unique to pregnancy.

Third, the diagnostic evaluation is altered and constrained by pregnancy. For example, radiologic tests and invasive examinations raise concern about their fetal safety during pregnancy.

Fourth, the interests of both the mother and the fetus must be considered in therapeutic decisions during pregnancy. Usually these interests do not conflict, because what is good for the mother is generally good for the fetus. Sometimes, however, maternal therapy must be modified to substitute alternative but safer therapy because of concerns about drug teratogenicity. Rarely, the maternal and fetal interests are diametrically opposed, as in the use of chemotherapy for maternal cancer, a therapy that can be life-saving to the mother, but life-threatening to the fetus.

These conflicts raise significant medical, legal, and ethical issues.

The obstetrician and gynecologist, as well as the Hepatologists, Gastroenterologist and surgeon, should be familiar with the medical and surgical gastro-intestinal conditions, hepatobiliary and pancreatic disorders that can present in pregnancy and how these conditions affect and are affected by pregnancy.

In this article, we are going to revise hepatic, biliary, pancreatic and gastro-intestinal symptoms and disorders during pregnancy, with a focus on aspects of these disorders unique to pregnancy.