liver disease Archives - Granite Peaks Gastroenterology of Utah

Liver Disease in Pregnancy

Posted on September 12, 2018April 18, 2019 by R. Kyle Barnett

By R. Kyle Barnett, MD

Abnormal liver tests occur in approximately 3-5% of pregnant women. For some women, test results that would otherwise suggest liver or gallbladder dysfunction in a non-pregnant woman may, in fact, be normal in a pregnant woman. Abnormal test results should be evaluated by a specialist since some diseases, newly diagnosed in pregnancy, may require more immediate intervention for the expectant mother or unborn fetus.

Additional Testing

Managing a pregnant woman with liver disease is a common medical scenario that involves unique challenges, since the mother AND fetus must be considered in any clinical treatment decisions. Pregnant patients who have had abnormal liver tests can expect to undergo some level of additional testing, to address initial testing results.

A standard workup, just as any non-pregnant individual with similar results would have, is the first step. Most liver test results remain the same during pregnancy, except for those produced by the placenta. Abnormalities seen with certain liver tests require further evaluation.

Ultrasound testing is safe and is the preferred imaging type in abnormal liver assessment that suggests gallbladder disease. MRI and CT scans may be used but only under certain conditions in later pregnancy.

Endoscopy may be necessary during pregnancy, but if possible, not until after the second trimester. Sedation with propofol is acceptable for pregnant patients.

Liver Diseases Unique to Pregnancy

Hyperemesis gravidarum (HG), is a condition which includes severe morning sickness, with symptoms which can include nausea, vomiting, jaundice, weight loss and dehydration which can affect liver function, urine output, blood pressure, cognition and heart rate. Treatment for HG may require hospitalization to ensure the pregnant woman receives fluids and nutrients necessary for her own health as well as that of the fetus, usually followed by bedrest.

Preeclampsia with liver involvement can progress to the level of Severe Preeclampsia, prompting delivery after 36 weeks to limit maternal and fetal complications.

HELLP syndrome, is an unusual set of symptoms that may be related to preeclampsia. It affects liver function, causes the breakdown of red blood cells and produces a low platelet count, which negatively affects blood clotting ability. Immediate delivery is recommended (especially after 34 weeks).

Other Condition That Can Occur

Gallbladder and Biliary System

If symptoms indicate, gall bladder removal is possible during pregnancy using laparoscopic surgical techniques.

Patients with liver masses should be treated prior to pregnancy when possible. Most conditions do not require routine imaging, but those with certain lesions should be monitored by ultrasound to track growth.

Hepatitis

Current recommendations for pregnant women with chronic hepatitis B virus infection include vaccinating infants born to HBV-infected mothers and antiviral medication given during the third trimester to reduce transmission to the newborn. At present, chronically hepatitis B-infected women can still breastfeed, as no strong evidence indicates otherwise.

Women with risk factors for hepatitis C should be screened with blood tests, but screening is not indicated in women without risk factors. Invasive procedures, including an elective C-section, should be avoided if possible in women with chronic hepatitis C, to prevent transmission of hepatitis C to the fetus.

Women with acute hepatitis should be tested for common causes of acute liver injury including viral hepatitis and herpes hepatitis. Those with acute hepatitis suspected to be caused by herpes virus should be treated with antiviral medication.

Women suspected of cirrhosis should have an upper endoscopy to screen for esophageal varices in the second trimester. Those with large esophageal varices should be treated accordingly.

More

There are more liver conditions that could be present during pregnancy for certain at-risk patients. Pregnant women under a doctor’s care will be able to address any health concerns that could affect the mother or fetus.

Patients who know they have hepatitis or feel there is a risk of exposure, have liver conditions that require medical care or have hereditary factors that may indicate liver problems, should consult with their doctor prior to becoming pregnant to ensure the healthiest start for themselves and their baby.

Liver Cirrhosis – Am I At Risk?

Posted on August 8, 2018April 18, 2019 by Granite Peaks

Liver Cirrhosis is a dangerous, sometimes deadly, disease caused by various risk factors. According to the American College of Gastroenterology liver cirrhosis affects approximately 5.5 million people in the United States, causing 26,000 deaths each year. It is among the top ten killers of adults age 25-64.

What is Cirrhosis?

Chronic liver injury eventually causes scarring, leaving the liver unable to function normally. The scarring is called cirrhosis. Since the liver filters our blood, removes toxins from our system and extracts nutrition from our digestive tract, this complex organ is critical to our good health.

The most common cause of liver cirrhosis in the U.S. is excessive alcohol consumption and Hepatitis. This may be why new studies suggest binge drinking among young people and Hepatitis (possibly undiagnosed and untreated) in baby boomers may be contributing factors to the upswing in liver disease cases in recent years. Fatty liver disease, viruses, autoimmune disease and bile duct disorders are among several other possible causes.

How Do I Know Whether I Have Cirrhosis?

Symptoms aren’t always noticeable at first. However as liver cirrhosis progresses, initial symptoms could include fatigue and itching. Patients may also experience swelling, usually in the legs, an abnormal amount of fluid retention in the abdomen, digestive tract bleeding, jaundice (yellowing of the white of the eyes and skin), and possible damage to the brain due to the insufficient filtering of waste from the blood. Talk to your doctor if you are experiencing any of these symptoms.

How Can I Reduce My Risk?

Alcohol use is a common factor in cirrhosis cases. Women consuming more than 1-2 alcoholic beverages per day or men consuming 2-3 over a long period of time significantly increase their risk of developing cirrhosis. Some people can develop cirrhosis with less than this amount of alcohol consumption.

Obesity and Diabetes are significant risk factors that cause liver injury whether alcohol is involved or not. Obesity is predicted to become the leading cause of cirrhosis as vaccines and awareness help the number of viral hepatitis cases dwindle.

Get Vaccinated! The Hepatitis A&B vaccination is easy to get and is very effective. There is no vaccine for Hepatitis C, but you can reduce or eliminate the risk by avoiding intravenous drug use, unprotected sexual contact and taking appropriate precautions when handling blood products.

If You Suspect You Have Liver Disease

See your doctor! Treatments are available for liver disease. Once properly screened and diagnosed, patients with liver disease, with the help of their gastroenterologist or hepatologist, may be able to improve their liver function and delay further decline.

There are various treatments available depending on your particular condition, the type and severity of the liver disease, and how you respond to treatments.

This is a very brief overview of how liver cirrhosis may affect an individual. The first step toward better health is seeing a gastroenterologist. They will determine the details of your digestive health and tell you how to proceed. Our doctors at Granite Peaks specialize in this type of disease. Reach out and get the help you need to work toward better liver function and better health.

Liver Wellness and Healthy Eating

Posted on January 19, 2017January 19, 2017 by fuelmarketing

How does a healthy diet help your liver wellness?

For your liver to function well, it requires eating a healthy diet. An unhealthy diet can lead to liver disease. Eating lots of fatty foods puts you at higher risk of being overweight and having a non-alcoholic fatty liver disease.

If you have liver disease, eating a healthy diet can assist your liver in performing its job functions and can help repair some damage. Eating poorly can lead to further stress on your liver and cause additional damage.

What are the best foods to eat for good liver health?
–Eating foods such as grains, proteins, dairy, fruits, vegetables and healthy fats from the food groups
–Fiber is an essential component to a healthy liver. Eating, fresh fruits and vegetables, whole grain breads, rice and cereals are recommended

If you have liver disease, there are important diet changes you should make such as:
–Do not eat uncooked shellfish such as oysters and clams
–Limit foods with a lot of sugar or salt
–Limit eating fatty foods

Following is a suggested diet from the American Liver Foundation for specific liver diseases.

Source: American Liver Foundation

If you are currently experiencing symptoms of liver disease or have a family history of liver disease, schedule an appointment with Granite Peaks Gastroenterology for an evaluation.

Immunizations for People with Liver Disease

Posted on March 31, 2016May 4, 2017 by fuelmarketing

For patients with chronic liver disease, getting another acute disease such as hepatitis, influenza, or pneumococcal pneumonia may be more serious than for people without underlying liver disease. Therefore, immunization against these diseases is very important.

Patients with Hepatitis B, Hepatitis C, alcoholic liver disease, fatty liver disease, hemochromatosis, primary biliary cholangitis, primary sclerosing cholangitis, autoimmune hepatitis, Wilson’s disease, alpha one antitrypsin deficiency, or idiopathic cirrhosis should talk to their doctors about the following vaccinations:

Hepatitis A

Hepatitis A virus infection can vary in severity from a mild flu-like illness to severe liver inflammation and death. A person can become infected with Hepatitis A by consuming contaminated food or water or touching a contaminated surface. It is recommended that all patients with chronic liver disease be vaccinated against Hepatitis A. This is given as an injection followed by a booster dose 6-12 months after the first shot. The vaccine is well tolerated with minimal side effects. 95% of patients with liver disease who are vaccinated develop protective antibodies against Hepatitis A. There is no need to check post-immunization blood titers.

Hepatitis B

Hepatitis B virus can cause a chronic infection, which can lead to cirrhosis and/or liver cancer. It is transmitted by contact with an infected individual’s body fluids. It is recommended that all people with chronic liver disease be vaccinated against Hepatitis B. Three injections are given over 6 months. The vaccine is well tolerated with minimal side effects. The response to liver disease vaccinations is not as good as with the Hepatitis A vaccine. 94% of patients with fatty liver disease develop protective antibodies, however for other causes of chronic liver disease, the response is much lower. Therefore, some experts recommend testing for post-immunization Hepatitis B antibody titers in patients with chronic liver disease due to their risk of severe infection. If a patient has not responded to the vaccine, repeat liver disease immunizations with high-dose Hepatitis B vaccine may be considered.

Hepatitis C

There is currently no available Hepatitis C vaccine.

Pneumococcus

This is one of the most common causes of pneumonia. The pneumococcal vaccine is recommended for all adults with chronic liver disease regardless of age. This is a one-time injection. Immunization develops 2-3 weeks after the vaccination. This vaccine is well tolerated with minimal side effects.

Influenza

This is commonly known as the flu. It is recommended that persons with chronic liver disease receive a yearly, seasonal flu shot. It is well tolerated with side effects in fewer than 5% of people.

Other

There are no specific recommendations on the use of other vaccines (measles, mumps, rubella, diphtheria, tetanus, pertussis, herpes zoster) in people with chronic liver disease. However, herpes zoster immunization is recommended in persons 60 and older. And a routine diphtheria/tetanus booster immunization is recommended every 10 years.

Please contact the doctors at Granite Peaks Gastroenterology to discuss your liver disease immunizations needs.

Granite Peaks Welcomes James M. Stewart, MD

Posted on July 22, 2014October 12, 2016 by fuelmarketing

James M. Stewart, MD: “As a gastroenterologist, I believe that gastrointestinal health and well-being are critical to enjoying a healthy lifestyle, and all that Utah has to offer. After completing my gastroenterology training at Banner Good Samaritan/ VA program in Phoenix, Arizona, I am pleased to start practicing at Granite Peaks Gastroenterology in Sandy, Utah and will be serving patients from across the Wasatch Front. My special interests include colorectal cancer prevention, GERD, Inflammatory Bowel Disease, and I’ve done research in obesity-related liver disease and other gastrointestinal cancers. After losing family to gastrointestinal cancers, I am dedicated to promoting screenings for early detection of colorectal and esophageal cancer.”

James M. Stewart, MD will be accepting new patients and provides same and next day availability. Stewart sees patients in our Sandy office, and has procedure time every week. Visit Dr. Stewart’s bio on our Meet the Team page by clicking here.

Fellowship: Gastroenterology, Banner Good Samaritan/ VA Hospital-Phoenix, AZ
Residency: Internal Medicine, University of California, San Diego, CA
Internship: Internal Medicine, Residency Program, University of California, San Diego, CA
Doctor of Medicine: University of Utah, Salt Lake City, UT