Gebelikte Gastrointestinal Hastalıklar
Özet
Gebelik sırasında anatomik yer değiştirmeler ve progesteron gibi hormonal artışlar gastrointestinal sistem (GİS) motilitesini azaltarak mide bulantısı, kusma, kabızlık ve gastroözofageal reflü (GÖR) gibi yaygın şikayetlere yol açar. Karaciğer fonksiyonları genel olarak sabit kalsa da safra kesesi motilitesinin azalması safra taşı riskini artırır. GİS hastalıklarının tanısında ultrasonografi ve MRG anne ve fetüs için güvenli yöntemlerken, X-ray ve tomografi gibi radyasyonlu yöntemlerden kaçınılmalıdır; endoskopik prosedürler ise güvenle uygulanabilir. Gebelikte sık görülen GÖR tedavisinde yaşam tarzı değişiklikleri ve antasitler ilk adımdır; dirençli vakalarda ise PPİ veya H-2 reseptör antagonistleri kullanılır, ancak misoprostol abort riski nedeniyle kesinlikle kontrendikedir. İnatçı kusmalara bağlı olarak üst GİS kanamasına yol açan Mallory-Weiss yırtıkları oluşabilir. Enfeksiyoz diyare vakalarında hidrasyon ve elektrolit dengesi öncelikliyken, İrritabl Barsak Sendromu diyet değişiklikleriyle yönetilir. Crohn ve Ülseratif Kolit gibi inflamatuar bağırsak hastalıkları spontan düşük ve erken doğum riskini artırdığından gastroenterolog eşliğinde takip edilmeli ve sülfasalazin kullanan gebelere folik asit desteği verilmelidir. Akut apandisit ve bağırsak obstrüksiyonu gibi cerrahi acillerde fetomaternal mortaliteyi önlemek için hızlı tanı ve laparoskopik cerrahi müdahale büyük önem taşır.
During pregnancy, anatomical displacements and hormonal increases, such as progesterone, reduce gastrointestinal system (GIS) motility, leading to common complaints like nausea, vomiting, constipation, and gastroesophageal reflux (GERD). While liver functions generally remain stable, decreased gallbladder motility increases the risk of gallstones. In the diagnosis of GIS diseases, ultrasonography and MRI are safe methods for both mother and fetus, whereas radiation-based methods like X-ray and CT should be avoided; endoscopic procedures can be safely performed. Lifestyle changes and antacids are the first steps in treating common GERD during pregnancy; in resistant cases, PPIs or H-2 receptor antagonists are used, but misoprostol is strictly contraindicated due to the risk of abortion. Persistent vomiting can lead to Mallory-Weiss tears, causing upper GIS bleeding. While hydration and electrolyte balance are priorities in infectious diarrhea cases, Irritable Bowel Syndrome is managed with dietary changes. Inflammatory bowel diseases like Crohn's and Ulcerative Colitis increase the risk of spontaneous abortion and preterm birth, so they should be monitored with a gastroenterologist, and folic acid support should be given to pregnant women using sulfasalazine. In surgical emergencies such as acute appendicitis and bowel obstruction, rapid diagnosis and laparoscopic surgical intervention are of great importance to prevent fetomaternal mortality.
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