Pregnancy and gastrointestinal disorders:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1998
|
| Schriftenreihe: | Gastroenterology clinics of North America
27,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIII, 288 S. Ill., graph. Darst. |
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| 245 | 1 | 0 | |a Pregnancy and gastrointestinal disorders |c Mitchell S. Cappell guest ed. |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 1998 | |
| 300 | |a XIII, 288 S. |b Ill., graph. Darst. | ||
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Datensatz im Suchindex
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|---|---|
| adam_text | I PREGNANCY AND GASTROINTESTINAL DISORDERS
CONTENTS
Preface xi
Mitchell S. Cappell
General Considerations
Abdominal Pain During Pregnancy 1
Ira E. Mayer and Hamid Hussain
Abdominal pain in the pregnant patient may be a manifestation
of obstetric, gynecologic, gastrointestinal, urologic, extra abdomi¬
nal, or systemic disease. Some of these disorders are unique to
the pregnant patient. Other conditions may occur in both preg¬
nant and nonpregnant individuals, but the presentation and clini¬
cal course in pregnant patients may be altered by the anatomic
and physiologic changes that normally occur during pregnancy.
Although accurate diagnosis and prompt intervention may be
necessary to ensure a satisfactory outcome for mother and child,
the diagnostic approach and treatment in pregnant patients may
be different than in nonpregnant patients.
The Safety and Efficacy of Gastrointestinal Endoscopy
During Pregnancy 37
Mitchell S. Cappell
More than 12,000 pregnant patients in the United States per year
have conditions normally evaluated by esophagogastroduodenos
copy (EGD). More than 6000 pregnant patients in the United
States per year have conditions normally evaluated by sigmoidos
copy or colonoscopy. Endoscopy during pregnancy raises the
unique issue of fetal safety, and endoscopic medications comprise
a significant component of fetal risks from endoscopy. This article
GASTROENTEROLOGY CLINICS OF NORTH AMERICA VOLUME 27 • NUMBER 1 • MARCH 1998 V
analyzes the safety of endoscopic medications during pregnancy,
reviews the literature on the safety of gastrointestinal endoscopy
during pregnancy, proposes guidelines for endoscopic indications
during pregnancy, and describes modifications of gastrointestinal
endoscopy during pregnancy to increase fetal and maternal safety.
Gastrointestinal Surgery During Pregnancy 73
Michael S. Firstenberg and Mark A. Malangoni
Gastrointestinal surgical problems often mimic symptoms and
signs of nonsurgical conditions that occur during pregnancy. This
mimicry presents a particular challenge to diagnosis because
avoiding a delay in treatment is critical to successful manage¬
ment. Some of these conditions, such as acute appendicitis and
biliary colic, are common in younger women; however, the ana¬
tomic and physiologic changes of pregnancy can alter their usual
manner of presentation. Many elective and urgent operations can
be performed during pregnancy with minimal risk to the mother
and fetus. The mother s condition should always take priority
because her proper treatment usually benefits the fetus as well.
Nutritional Assessment and Support During Pregnancy 89
Elie Hamaoui and Michal Hamaoui
Proper nutrition during pregnancy is critically important to
mother and fetus. For most healthy women, the only nutritional
intervention required may be adequate iron and folate intake;
however, for others, who begin pregnancy in a malnourished
state or whose nutritional intake deteriorates during pregnancy,
invasive nutritional support, including tube feeding or parenteral
nutrition, may be indicated. To guide nutritional therapy and to
avoid its potential complications, it is necessary to evaluate the
patient s nutritional state. Such evaluation must focus not only
on body composition and substrate reserves but also on the
patient s changing nutrient requirements and any impediments
to the patient s capacity to ingest and assimilate food.
Upper Gastrointestinal Disorders
Nausea and Vomiting of Pregnancy 123
Crystal N. Broussard and Joel E. Richter
Nausea and vomiting of pregnancy is a clinical syndrome ranging
from common, mild to moderate symptoms that occur in up to
90% of women to rare, intractable symptoms associated with
electrolyte and metabolic disturbances that occur in hyperemesis
gravidarum. Although the pathogenesis is poorly understood, the
overall prognosis is excellent in women with typical nausea and
vomiting in pregnancy. Study results of the prognosis of women
with hyperemesis gravidarum are conflicting; the management of
yi CONTENTS
these patients can be challenging because of the risk of teratoge
nicity from medication.
Gastroesophageal Reflux Disease During Pregnancy 153
Philip O. Katz and Donald O. Castell
This article reviews the presentation, pathophysiology, diagnosis,
and treatment of gastroesophageal reflux in the pregnant patient.
Particular emphasis is placed on symptom presentation, use of
endoscopy in pregnancy, and approach to treatment.
Gastric and Duodenal Ulcers During Pregnancy 169
Mitchell S. Cappell and Arlene Garcia
The frequency, symptoms, and complication rate of peptic ulcer
disease appear to decrease during pregnancy significantly. Clini¬
cians, however, often have to treat dyspepsia or pyrosis of unde¬
termined cause because the frequency of pyrosis increases during
pregnancy. Physicians are reluctant to perform esophagogastrodu
odenoscopy (EGD) during pregnancy for pyrosis to reliably dif¬
ferentiate gastroesophageal reflux from peptic ulcer disease. Dys¬
pepsia or pyrosis during pregnancy first should be treated with
dietary and lifestyle changes, together with antacids or sucralfate.
When symptoms persist, H2 receptor antagonists are recom¬
mended. If symptoms continue and are severe despite these inter¬
ventions, the patient should be evaluated for possible EGD or
proton pump inhibitor therapy during the second or third trimes¬
ter.
Lower Gastrointestinal Disorders
Constipation and Diarrhea in Pregnancy 197
Eugene S. Bonapace, Jr, and Robert S. Fisher
Constipation and diarrhea are common during pregnancy, oc¬
curring in up to one third of women. Constipation is often the
result of physiologic changes that occur during pregnancy, usu¬
ally from hormonal effects on gastrointestinal motility. Diarrhea,
on the other hand, is often caused by the same disorders responsi¬
ble for diarrhea in the nonpregnant patient. The incidence, patho¬
physiology, evaluation, and treatment of constipation and diar¬
rhea during pregnancy are reviewed in this article.
Inflammatory Bowel Disease and Pregnancy 213
Burton I. Korelitz
Despite the lack of prospective studies on the relationship be¬
tween inflammatory bowel disease (IBD) and pregnancy, the evi¬
dence strongly supports the conclusions that fertility is compro¬
mised in active Crohn s disease; heredity plays an important role
CONTENTS vii
in type and location of disease; fetal outcome is essentially no
different than in the general population, except in the presence
of active Crohn s disease during pregnancy; and the course of
IBD during pregnancy is influenced by disease activity or lack of
it before pregnancy. The major influence on outcome of preg¬
nancy, fetal outcome, and course of IBD is the favorable effect of
drug therapy on the disease. Most drugs, including sulfasalazine,
5ASA products, corticosteroids, and immunosuppressives, are
safe, certainly safer than permitting the disease to be active and
allowing for the possibility of surgical intervention during preg¬
nancy. Episiotomy is contraindicated in women with Crohn s
disease and perirectal complications. Cesarean section probably
is indicated in most patients with Crohn s disease with colonic
involvement.
Colon Cancer During Pregnancy: The Gastroenterologist s
Perspective 225
Mitchell S. Cappell
Colon cancer during pregnancy is uncommon but not rare, with
an estimated incidence of several hundred cases per year in the
United States. This type of cancer tends to have a poor prognosis
that is attributable to delays in diagnosis and advanced disease
at diagnosis. The diagnosis frequently is delayed because symp¬
toms of colon cancer, such as rectal bleeding, nausea and vom¬
iting, and constipation, often are attributed to normal pregnancy
or minor complications of pregnancy. Pregnancy affects the diag¬
nostic evaluation and therapy of colon cancer because of fetal
risks of diagnostic tests and therapy. Appropriate medical evalua¬
tion of significant lower gastrointestinal complaints during preg¬
nancy can lead to an earlier and improved diagnosis.
Cancer of the Colon, Rectum, and Anus During Pregnancy:
The Surgeon s Perspective 257
Ciaran Walsh and Victor W. Fazio
Colorectal carcinoma presenting during pregnancy is uncommon.
Most patients present late in pregnancy, and more than 80% have
rectal tumors. Pregnant patients with unexplained rectal bleeding
should be evaluated by anorectal examination and flexible sig
moidoscopy. Treatment is individualized to each patient; we rec¬
ommend a strategy of immediate surgical resection when a diag¬
nosis is made early in pregnancy and allowing the fetus to
develop to safe delivery before treating when the diagnosis is
made late in pregnancy. Most patients present with advanced
tumors and have poor prognoses, but prognosis by stage is not
different from that in the general population. Adjuvant radiation
and chemotherapy have limited roles in the treatment of pregnant
women with colon and rectal carcinoma. Future challenges are
aimed at improving survival through earlier diagnosis and the
development of adjuvant therapies that are effective in patients
with advanced disease.
Vlii CONTENTS
Special Topics
HIV in Pregnancy 269
Donald P. Kotler
Pregnancy in individuals infected with HIV has become an im¬
portant problem because of a fourfold rise of infection in women
of childbearing age in the developed world. The incidence of
vertical transmission varies in different continents and is highest
in Africa. Transmission may occur in utero (antepartum), during
delivery (intrapartum), or after birth (postpartum), occurring dur¬
ing the latter period, in many cases, through breastfeeding. Mater¬
nal viral burden around the time of delivery is the strongest
determinant of the risk of disease transmission. While breastfeed¬
ing may account for up to one third of cases of vertical transmis¬
sion in Africa, the benefits of breastfeeding outweigh its risks,
even in HIV infection, and breastfeeding is recommended in
those areas. Treatment of the mother with antiretroviral agents
significantly decreases the risk of vertical transmission.
Index 281
Subscription Information Inside Back Cover
CONTENTS ix
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| title | Pregnancy and gastrointestinal disorders |
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| title_full | Pregnancy and gastrointestinal disorders Mitchell S. Cappell guest ed. |
| title_fullStr | Pregnancy and gastrointestinal disorders Mitchell S. Cappell guest ed. |
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