Pregnancy in Patients with Non-cirrhotic Portal Hypertension: A Literature Review / Gravidez em pacientes com hipertensão portal não cirrótica: Uma revisão da literatura

Abstract Pregnancy in non-cirrhotic portal hypertension (NCPH) is an uncommon condition. Its management is challenging both to the obstetricians as well as to the gastroenterologists due to the lack of more extensive studies and standard clinical practice guidelines. These patients are at increased risk of portal hypertension (PTH) complications, especially variceal bleeding, and with an increased incidence of adverse maternal and fetal outcomes. Hence, a multidisciplinary approach is required for management of pregnancy in NCPH. This short review describes the different aspects of pregnancy with NCPH, emphasizing specific strategies for preventing and managing PTH from the preconceptional period to postpartum.

Resumo A gravidez na hipertensão portal não cirrótica (HPNC) é uma condição incomum. Seu manejo é desafiador tanto para os obstetras quanto para os gastroenterologistas devido à falta de estudos mais extensos e diretrizes de prática clínica padrão. Esses pacientes apresentam risco aumentado de complicações da hipertensão portal (PTH) especialmente sangramento por varizes e têm maior incidência de desfechos maternos e fetais adversos. Portanto uma abordagem multidisciplinar é necessária para o manejo da gravidez na NCPH. Esta breve revisão descreve os diferentes aspectos da gravidez com HPNC enfatizando estratégias específicas para prevenção e manejo do PTH desde o período pré-concepcional até o pós-parto.

Semiología renal y genitourinaria en pediatría: segunda parte / Nephrologoy and urology semiology in children: second part

Entre las patologías renales en niños, se encuentra la injuria renal aguda; que es la pérdida súbita de la función renal; el síndrome nefrótico que es el espectro más grave de proteinuria; el síndrome nefrítico caracterizado por la riada edema, hematuria macro o microscópica e hipertensión arterial.

Among the renal pathology in children is acute kidney injury, which is the sudden loss of kidney function, the nephrotic syndrome is the most severe spectrum of proteinuria, the nephrotic syndrome characterized by the triad of edema, macro or microscopic hematuria and arterial hypertension.

Hipertensión porta / Portal hypertension

La hipertensión porta en niños es un síndrome que resulta del aumento de la presión dentro del sistema venoso porta por encima de 10 mm Hg. Inicialmente puede ser asintomática, luego se puede manifstar con hematemesis, esplenomegalia, anemia, ascitis y circulación colateral. En la hipertensión porta prehepática las pruebas de función del hígado (aminotransferasasy niveles de albúmina) y las hematológicas están mínimamente alteradas. En hipertensión porta losniños se puede complicar con variasmanifestaciones, pero cuando se presenta el sangrado de vías digestivas altas por ruptura de várices esofágicas, puede ser realmente alarmante porque algunas veces es profuso, este generalmente es más frecuente ante un hígado cirrótico porque se suele acompañar con peor función hepática.

Portal hypertension in children is a syndrome that results from increased pressure within the portalvenous system above 10 mm Hg. May be asymptomatic initially, then may manifest with hematemesis, splenomegaly, anemia, ascites and collateral circulation. In prehepatic portal h y p e r t e n s i o n o f l i v e r f u n c t i o n t e s t s (aminotransferase and albumin levels) and hematologic are minimally altered. Portal hypertension in children is complicated by several events, but when presented with upper GI bleeding from ruptured esophageal varices, can be very alarming because sometimes it is heavy, this usually is more common to a cirrhotic liver because it is usually accompanied with poor liverfunction.

Hipertensión portal / Portal hypertension

Siendo la hipertesnsión portal un síndrome que acompaña a la mayoría de las hepatopatías crónicas y es responsable de gran parte de las graves y frecuentes complicaciones de estos pacientes: hemorragia digestiva por rotura de várices esófago-gástricas, ascitis, encefalopatía hepática, peritonitis bacteriana espontánea, hiperesplenismo y síndrome hepato-pulmonar, hemos considerado necesaria una revisión de dicha patología, para actualizar conceptos y pautas terapéuticas con el fin de mejorar la calidad de vida de nuestros pacientes.

Hypertension portale chez l'enfant. [a propos de 75 cas]

This study had based on 75 cases of the portal hypertension [PHT] at the children's hospital of Casablanca at the Pediatry 3, during a period of 12 years [January 85 to December 97]. The age of our patients varies from 4 months to 16 years. The patients had presented a splenomegaly in 69 cases [92%], a digestive haemorrhage in 42 cases [56%], a collateral venous circulation in 46 cases [68%], an ascites in 40 cases [53%] and a hepatomegaly in 20 cases [27%]. In 58 fibroscopy examinations, the esophageal varices were found in 52 cases [89%]. The echography objectived PHT's signs in all the cases. The etiology was the cirrhosis [37 cases]: post-hepatitis [16 cases], metabolic [12 cases] and biliary [6 cases]. The portal venous obstruction was observed in 15 cases. The authors wanted to emphasize the management's difficulties of variceal bleeding in our context