Pregnancy and cirrhosis: management of hematemesis by Warren shunt during third trimester gestation.
Considerable pathophysiologic changes accompany cirrhosis. Elevation of portal venous pressure predisposes to esophageal varices and hematemesis. The physiologic changes associated with pregnancy may exacerbate these conditions. Medical management of cirrhosis-associated problems may fail, necessitating surgical intervention. The anesthetic management of a pregnant cirrhotic patient for a Warren shunt is complicated by concerns for pre-existing hepatic dysfunction and pregnancy-induced physiologic changes as well as fetal well-being. The management of such a case is reviewed and relevant pathophysiology discussed.
Duke
J
J
Department of Anesthesiology, University of Colorado Health Sciences Center, Campus Box B113, 4200 East Ninth Avenue, Denver, Colorado 80262, USA.