Gastrointestinal disorders during pregnancy
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| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2003
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| Schriftenreihe: | Gastroenterology clinics of North America
32,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
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| 245 | 1 | 0 | |a Gastrointestinal disorders during pregnancy |c Mitchell S. Cappell guest ed. |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 2003 | |
| 300 | |a XIII, 462 S. |b Ill., graph. Darst. | ||
| 336 | |b txt |2 rdacontent | ||
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| 490 | 1 | |a Gastroenterology clinics of North America |v 32,1 | |
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Datensatz im Suchindex
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| adam_text | GASTROINTESTINAL DISORDERS DURING PREGNANCY
CONTENTS
Preface xi
Mitchell S. Cappell
General Considerations
Abdominal Pain During Pregnancy 1
Mitchell S. Cappell and David Friedel
Abdominal pain during pregnancy presents unique clinical chal¬
lenges. The differential diagnosis during pregnancy is extensive,
in that the abdominal pain may be caused by obstetric or gyneco¬
logic disorders related to pregnancy, as well as intraabdominal
diseases incidental to pregnancy. Gastroenterologists, as well as ob¬
stetricians, gynecologists, internists, and surgeons, should be famil¬
iar with the medical and surgical conditions that can present in
pregnancy and how these conditions affect and are affected by
pregnancy. This article reviews obstetric, gynecologic, medical,
and surgical causes of abdominal pain during pregnancy, with a
focus on aspects of abdominal diseases unique to pregnancy.
Nutritional Assessment and Support During Pregnancy 59
Elie Hamaoui and Michal Hamaoui
This article thoroughly updates the authors previous review of nu¬
tritional assessment and support during pregnancy. After briefly
reviewing nutrient metabolism and requirements, the authors dis¬
cuss the nutritional assessment of the pregnant woman and review
the nutritional support principles in hyperemesis gravidarum and
other conditions that can compromise the nutritional health of
mother or fetus.
The Fetal Safety and Clinical Efficacy
of Gastrointestinal Endoscopy During Pregnancy 123
Mitchell S. Cappell
More than 12,000 pregnant patients in the United States per annum
have conditions that are normally evaluated by esophagogastro
duodenoscopy (EGD). More than 6000 pregnant patients in the
VOLUME 32 • NUMBER 1 • MARCH 2003 V
United States per annum have conditions that are normally eval¬
uated by sigmoidoscopy or colonoscopy. About 1000 more have
symptomatic choledocholithiasis during pregnancy, a strong indi¬
cation for endoscopic sphincterotomy in nonpregnant patients. En
doscopy during pregnancy raises the unique issue of fetal safety.
Endoscopic medications comprise a significant component of fetal
endoscopic risks. EGD, sigmoidoscopy, and endoscopic retrograde
cholangiopancreatography (ERCP) should be performed during
pregnancy when strongly indicated: EGD for significant upper gas¬
trointestinal bleeding, sigmoidoscopy for nonhemorrhoidal rectal
bleeding, and ERCP for symptomatic choledocholithiasis when
sphincterotomy is contemplated. Percutaneous endoscopic gastro
stomy (PEG) and colonoscopy are currently considered experimen¬
tal during pregnancy because of insufficient data on fetal safety.
Several cases of PEG and colonoscopy have been successfully per¬
formed during pregnancy. Performance of endoscopy during preg¬
nancy should increase with further technical refinements, and
greater awareness of procedure safety.
Gastrointestinal Surgery and Pregnancy 181
Mark A. Malangoni
During pregnancy, gastrointestinal disorders that require surgery
often mimic the symptoms and signs of conditions that do not re¬
quire surgery. Anatomic and physiologic changes of pregnancy can
alter the usual clinical presentation of gastrointestinal disorders.
These alterations can be a challenge to diagnosis. Prompt treatment
is critical to successful management. Most elective and urgent op¬
erations can be performed during pregnancy with minimal mater¬
nal and fetal risk. The condition of the mother should always take
priority because proper treatment of the mother usually benefits
the fetus, as well.
Upper Gastrointestinal Disorders
Nausea and Vomiting During Pregnancy 201
Kenneth L. Koch and Christine L. Frissora
The differential diagnosis of nausea and vomiting is extensive and
the underlying cause can be difficult to diagnose. Treatment of
nausea and vomiting also can be unsatisfactory because the avail¬
able pharmacotherapy does not correct the fundamental under¬
lying pathophysiologic abnormalities. In contrast, the diagnosis
of nausea and vomiting of pregnancy generally is straightforward.
Almost 80% of women have some degree of nausea in the first tri¬
mester of pregnancy, and the diagnosis of pregnancy is established
easily by the patient or physician. The spectrum varies from mild
nausea to hyperemesis gravidarum. Various treatment approaches
are addressed.
Gastroesophageal Reflux Disease During Pregnancy 235
Joel E. Richter
Gastroesophageal reflux disease (GERD) with heartburn and acid
regurgitation is exceedingly common in pregnancy. The pathophy
siology involves primarily a decrease in lower esophageal sphinc¬
ter pressure. Most, if not all, of these patients are managed by
obstetricians, but gastroenterologists may be consulted in diffi¬
cult to treat cases. Because of the concern about the use of systemic
medications during pregnancy and lactation, it is important for
gastroenterologists to understand the pathogenesis, natural history,
and diagnostic and therapeutic options available for treating GERD
during pregnancy.
Gastric and Duodenal Ulcers During Pregnancy 263
Mitchell S. Cappell
Peptic ulcer disease (PUD) in pregnancy should be considered se¬
parately from PUD in the general population. This article focuses
on how the clinical presentation, natural history, medical therapy,
and surgical therapy of PUD differ in pregnancy from that in the
general population to help the clinician to evaluate, manage, and
treat PUD during pregnancy and to stimulate the researcher to
study the role of Helicobacter pylori in ulcerogenesis and to perform
controlled endoscopic studies during pregnancy.
Lower Gastrointestinal Disorders
Constipation, Diarrhea, and
Symptomatic Hemorrhoids During Pregnancy 309
Arnold Wald
Constipation, diarrhea, and symptomatic hemorrhoids are disor¬
ders common in the general population, particularly in women.
These conditions, if mild, often are self treated with various home
remedies or nonprescription preparations. Few of these patients,
moreover, are referred to gastroenterologists, as primary care pro¬
viders generally are confident managing these conditions, unless
they are severe, refractory to conventional management, or require
additional diagnostic studies.
Inflammatory Bowel Disease in Pregnancy 323
Sunanda Kane
The term inflammatory bowel disease (IBD) refers to ulcerative co¬
litis and Crohn s disease, two chronic conditions of unknown
cause. Whereas the incidence of ulcerative colitis has remained
stable, the incidence of Crohn s disease has increased during the
past few decades. The consequence of this trend is a growing
CONTENTS vii
population of women in their childbearing years with concerns
about the effects of IBD on fertility and pregnancy. Important is¬
sues concerning a woman with IBD who is pregnant or contem¬
plating pregnancy include inheritance of IBD in the offspring,
fertility, the effect of pregnancy on IBD, and, conversely, the effect
of IBD on the pregnancy, as well as the safety of drugs on the de¬
veloping fetus and nursing newborn. A male partner afflicted with
IBD also raises concerns regarding fertility and potential terato
genicity of prescribed medications. This article reviews these issues
with a focus on recent studies and developments.
Colon Cancer During Pregnancy 341
Mitchell S. Cappell
Colon cancer in pregnancy is a distinct entity from colon cancer in
the general population. Pregnancy affects the clinical presentation,
evaluation, therapy, and prognosis of the colon cancer. Pregnant
patients typically present with advanced colon cancer that is, un¬
fortunately, usually the result of delayed diagnosis. Patients fre¬
quently postpone self referral because of confusion of symptoms
from cancer, such as rectal bleeding or constipation, with symp¬
toms of a normal pregnancy. Physicians may delay diagnostic tests
because of potential fetal risks and because of inattention to the
potential significance of symptoms given the relative rarity of co¬
lon cancer in this young population. Diagnostic delays often lead
to the tragic demise of a young woman from a potentially curable
disease and of an otherwise viable fetus. Arguably, colon cancer
should be diagnosed expeditiously during pregnancy because of
frequent obstetric office visits. This article reviews this uncommon,
but not rare, entity with a focus on the special and unique fea¬
tures of colon cancer in pregnancy to facilitate earlier diagnosis,
to optimize the therapy, and to improve the maternal and fetal
outcomes.
The Irritable Bowel Syndrome During Pregnancy 385
William L. Hasler
The irritable bowel syndrome (IBS) is characterized by altered bo¬
wel habits and abdominal discomfort in the absence of organic dis¬
ease. No markers exist for IBS, and the definition of IBS is based on
the presence of specific symptoms. The Rome II criteria for defin¬
ing IBS include abdominal pain or discomfort for 12 weeks or
longer, which need not be continuous, over the past 12 months
plus two of the following: (1) relief of discomfort with defecation;
(2) association of discomfort with altered stool frequency; and
(3) association of discomfort with altered stool form. Nine per¬
cent to 22% of the population report symptoms consistent with
IBS. IBS is the most prevalent digestive disease, representing
12% of visits to primary care physicians and 28% of referrals to
gastroenterologists.
Other Disorders
Pregnancy and Liver Disease 407
Bimaljit S. Sandhu and Arun J. Sanyal
Liver disease has an impact on women s health during pregnancy
because of the complex interactions between the physiologic
changes induced by pregnancy and the pathophysiologic changes
of liver disease. In particular, liver diseases that predominantly af¬
flict females, such as primary biliary cirrhosis and autoimmune he¬
patitis, pose a special problem for conception and management of
pregnancy. Pregnancy, moreover, specifically is associated with
several potentially life threatening liver diseases. This article re¬
views comprehensively the impact of liver diseases on pregnancy
and of pregnancy on liver function and liver disease.
Human Immunodeficiency Virus and Pregnancy 437
Donald P. Kotler
The recent spread of HIV infection into the heterosexual population
in the United States, Europe, and Australia, as well as its earlier
heterosexual presence in the developing world, has led to increased
scientific and clinical attention to the role of HIV infection in preg¬
nancy. In managing a pregnant HIV positive woman, it is most im¬
portant to treat the patient as someone who is HIV positive rather
than someone who is pregnant. Withholding antiviral or prophy¬
lactic therapies from the mother for fear of harming the child is
not justified, because failure to treat the mother increases the fetal
risk. The most important parameter to follow is the maternal
plasma HIV RNA level, and the most important treatment issue
is to reduce this level because it is directly related to the risk of
vertical transmission.
Index 449
CONTENTS ix
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| institution | BVB |
| language | English |
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| physical | XIII, 462 S. Ill., graph. Darst. |
| publishDate | 2003 |
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| publisher | Saunders |
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| series | Gastroenterology clinics of North America |
| series2 | Gastroenterology clinics of North America |
| spellingShingle | Gastrointestinal disorders during pregnancy Gastroenterology clinics of North America Gastrointestinale Krankheit (DE-588)4114483-1 gnd Schwangerschaft (DE-588)4053724-9 gnd |
| subject_GND | (DE-588)4114483-1 (DE-588)4053724-9 (DE-588)4143413-4 |
| title | Gastrointestinal disorders during pregnancy |
| title_auth | Gastrointestinal disorders during pregnancy |
| title_exact_search | Gastrointestinal disorders during pregnancy |
| title_full | Gastrointestinal disorders during pregnancy Mitchell S. Cappell guest ed. |
| title_fullStr | Gastrointestinal disorders during pregnancy Mitchell S. Cappell guest ed. |
| title_full_unstemmed | Gastrointestinal disorders during pregnancy Mitchell S. Cappell guest ed. |
| title_short | Gastrointestinal disorders during pregnancy |
| title_sort | gastrointestinal disorders during pregnancy |
| topic | Gastrointestinale Krankheit (DE-588)4114483-1 gnd Schwangerschaft (DE-588)4053724-9 gnd |
| topic_facet | Gastrointestinale Krankheit Schwangerschaft Aufsatzsammlung |
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