Book of Medical Disorders in Pregnancy - Tintash

Chapter No: 8
LIVER DISEASE IN PREGNANCY
Isolated hepatic disease rarely occurs
during pregnancy. A number of
associations between hepatic
dysfunction and pregnancy exist. These
relationships are discussed in the context
of obstetric management.
Fig8.1: Shows surface anatomy of
liver and its relations
The liver serves multiple functions: the
biotransformation of insoluble compounds
(e.g., drugs, toxins, bilirubin), the
metabolism and excretion of choles-terol
and bilirubin, the production of pla-sma
proteins (e.g., albumin, coagulation
factors, alpha- and beta globulins, transferrin,
haptoglobin), and the metabolism
of amino acids, carbohydrates and lipids.
The- main source of bilirubin in the
body is the red cells. There is daily destruction
of about 1% of the total red cell
mass. Hemoglobins when broken produce
globin and hematin, the latter is a
trivalent iron complex of haema. When
iron is removed from hematin, the compound
left behind is protoporphyrin
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which is oxidized later to biliverdin this
in turn is reduced to bilirubin.
The iron released is stored in the liver,
the globin enters the protein pool of the
body and is available for the formation
of new hemoglobin. The bilirubin
however is left behind as a waste
product. Haemoglobin degradation
occurs in the reticuloendothelial system,
particularly in the liver, spleen and bone
marrow. In an average adult women who
has a blood volume of 5 liters and a
hemoglobin concentration of 15 gm per
100 ml; the daily destruction of 1 per
cent of the circulating red cells will
produce 7.5 gm of haemoglobin and
from this about 250 mg of bilirubin is
produced.
Fig8.2: Shows bilirubin transport
roots