OTHER STUDIES ON LIVER-DISEASE

Liver disorders in pregnancy range from mild reversible changes to sev ere fulminant fatal disease. Intrahepatic cholestasis is common in Sca ndinavia and Chile and the pathogenesis remains unknown. The use of in travenous S-adenosyl-L-methionine for symptomatic and biochemical impr ovement has been encouraging. In severe liver disease associated with pregnancy, liver transplantation has been performed and has been succe ssful. Conception after liver transplantation has also been documented , unassociated with any teratogenicity or intrauterine growth failure. A high incidence of preeclampsia has been noted, however. It is advoc ated that patients wait 9 to 12 months after transplantation before tr ying to conceive. The recommended contraception is a barrier method, n ot an intrauterine device because of risk of infection, nor oral contr aceptives, which may cause difficulty with cyclosporine dosing. Ischem ic hepatitis is a common disorder, frequently self-limiting, depending on the underlying pathogenesis. Rapid elevation of the aminotransfera ses and lactic dehydrogenase is associated with an equally rapid resol ution in this disorder. Renal impairment, carbohydrate intolerance, an d mental confusion appear to be additional factors in the clinical man ifestation. Ascites can be associated with a severe pleural effusion o ften resistant to standard management. The use of the transjugular int rahepatic portosystemic stent-shunt procedure has been documented to b e effective in the management of this entity.