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14 - Liver and renal disease

from Section 4 - Metabolic disorders

Published online by Cambridge University Press:  19 October 2009

By
M. J. Paech  and
K. Scott
Edited by
David R. Gambling ,
M. Joanne Douglas  and
Robert S. F. McKay
M. J. Paech
Affiliation:
School of Medicine and Pharmacology, The University of Western Australia, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Subiaco, Western Australia
K. Scott
Affiliation:
Specialist Registrar in Anaesthesia, Oxford Radcliffe Hospitals, NHS Trust, Oxford, UK
David R. Gambling
Affiliation:
University of California, San Diego
M. Joanne Douglas
Affiliation:
University of British Columbia, Vancouver
Robert S. F. McKay
Affiliation:
University of Kansas
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Summary

Liver disease

Effects of pregnancy on the liver

Pregnancy induces anatomic, physiologic, and functional changes in the liver because of an increase in serum estrogen and progesterone. These changes reverse postpartum, but can cause diagnostic difficulties during pregnancy if liver disease is present. For example, spider nevi and palmar erythema are stigmata of liver disease, but may be seen in some pregnant women in response to increased estrogen levels.

In normal pregnancy, liver size does not change significantly so hepatomegaly suggests liver disease. Hepatic blood flow remains unchanged, despite the physiologic increase in blood volume and cardiac output. In fact, the portion of cardiac output delivered to the liver falls by 35%. There is increased splanchnic, portal, and esophageal venous pressure in late pregnancy, and 60% of healthy women will develop esophageal varices that resolve postpartum. Clearance of drugs dependent on hepatic blood flow is reduced because of a larger volume of distribution.

Serum albumin concentration falls by up to 60% secondary to an increase in plasma volume, leading to a fall of total serum protein by 20% in mid-pregnancy. Serum globulins alter slightly, with an increase in α and β fractions, and α-fetoprotein concentration, but a reduction in γ-globulin. There is increased production of fibrinogen and factors VII, VIII, IX, X and von Willebrand factor. Ceruloplasmin and transferrin levels increase, as do several specific binding proteins (e.g. thyroxine, vitamin D, and corticosteroids). There are minor changes in porphyrin metabolism.

Type
Chapter
Information
Obstetric Anesthesia and Uncommon Disorders , pp. 249 - 268
Publisher: Cambridge University Press
Print publication year: 2008

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  • Liver and renal disease
    • By M. J. Paech, School of Medicine and Pharmacology, The University of Western Australia, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Subiaco, Western Australia, K. Scott, Specialist Registrar in Anaesthesia, Oxford Radcliffe Hospitals, NHS Trust, Oxford, UK
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.015
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  • Liver and renal disease
    • By M. J. Paech, School of Medicine and Pharmacology, The University of Western Australia, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Subiaco, Western Australia, K. Scott, Specialist Registrar in Anaesthesia, Oxford Radcliffe Hospitals, NHS Trust, Oxford, UK
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.015
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Save book to Google Drive

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  • Liver and renal disease
    • By M. J. Paech, School of Medicine and Pharmacology, The University of Western Australia, Department of Anaesthesia and Pain Medicine, King Edward Memorial Hospital for Women, Subiaco, Western Australia, K. Scott, Specialist Registrar in Anaesthesia, Oxford Radcliffe Hospitals, NHS Trust, Oxford, UK
  • Edited by David R. Gambling, University of California, San Diego, M. Joanne Douglas, University of British Columbia, Vancouver, Robert S. F. McKay, University of Kansas
  • Book: Obstetric Anesthesia and Uncommon Disorders
  • Online publication: 19 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544552.015
Available formats
×