Enfermedades hepáticas y embarazo

  • Luis Guillermo Toro Rendon Hospital San Vicente Fundación
  • Elizabeth María Correa Gutiérrez San Vicente Fundación, Rionegro
  • Luisa Fernanda Calle Tavera San Vicente Fundación, Rionegro
  • Adriana Ocampo Mesa San Vicente Fundación
  • Sandra María Vélez Cuervo Universidad de Antioquia
Palabras clave: embarazo, hiperémesis gravídica, colestasis gestacional, HELL, preeclampsia, virus de la hepatitis B, cirrosis, trasplante hepático

Resumen

La prevalencia de las enfermedades hepáticas en el embarazo no es despreciable, ya que estas se presentan en 3%-5% de todas las gestaciones. Entre las múltiples causas se encuentran cambios fisiológicos del embarazo; enfermedad hepática preexistente, siendo las más comunes las enfermedades colestásicas (colangitis biliar primaria y colangitis esclerosante primaria), hepatitis autoinmune, enfermedad de Wilson, hepatitis virales crónicas, cirrosis establecida de cualquier etiología y paciente con historia de trasplante hepático; enfermedad hepática adquirida durante el embarazo, siendo las principales las hepatitis virales, la toxicidad inducida por medicamentos y la hepatolitiasis; hepatopatía relacionada con el embarazo, en la cual se encuentran 5 entidades principales: hiperémesis gravídica, colestasis intrahepática del embarazo, preeclampsia, síndrome HELLP e hígado graso del embarazo.

La severidad de estas entidades tiene una amplia gama de presentaciones, desde la paciente que es completamente asintomática, hasta la falla hepática aguda e incluso la muerte. La gravedad del cuadro se asocia con una morbilidad y mortalidad significativas tanto para la madre como para el feto, lo cual hace que una evaluación rápida, diagnóstico certero y manejo apropiado por un equipo multidisciplinario (incluida obstetricia de alto riesgo, hepatología, gastroenterología y radiología intervencionista), en un servicio que tenga la posibilidad de ofrecer trasplante hepático, sean fundamentales para obtener buenos desenlaces.

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Biografía del autor/a

Luis Guillermo Toro Rendon, Hospital San Vicente Fundación
Hepatólogo clínico y de trasplantes . Director unidad funcional de enfermedades digestivas y trasplante. Rionegro, Antioquia
Elizabeth María Correa Gutiérrez, San Vicente Fundación, Rionegro
Hepatóloga clínica y de trasplantes
Luisa Fernanda Calle Tavera, San Vicente Fundación, Rionegro
Hepatóloga clínica y de trasplantes
Adriana Ocampo Mesa, San Vicente Fundación
Médico general, estudiante de maestría en epidemiología
Sandra María Vélez Cuervo, Universidad de Antioquia
Especialista en ginecología y obstetricia, jefe de depto.

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Publicado
2019-12-30
Cómo citar
Toro Rendon, L. G., Correa Gutiérrez, E. M., Calle Tavera, L. F., Ocampo Mesa, A., & Vélez Cuervo, S. M. (2019). Enfermedades hepáticas y embarazo. Revista Colombiana De Gastroenterología, 34(4), 385-398. https://doi.org/10.22516/25007440.367
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Revisión de tema