724
KAZUISTIKY512322701004696138190209248289309356404
Liver35443370100314884119143
cirrhosis3703337010030456994132171201216245
and396433701003471110
pregnancy:40903370100376196135173207245276313330
a4437337010033
case44873370100296593129
report46323370100245997136160189
and483833701003371110
review49643370100235894110145198
of517833701003858
literature5252337010015305792116151178216241275
|5584227010018
E295617227010066104147
/34868043010757
Vnitř35628043010771118137165192
Lék3773804301074184122
2021;3915804301074386128167177
67(e3):4112804301074485105146190211225
e24–e274357804301074487127174221264306
/46828043010757
VNITŘNÍ47598043010792152173218266326347
LÉKAŘSTVÍ5126804301074285131189236281326379401
www.casopisvnitrnilekarstvi.cz42580430107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
onemocněním425547012156113164249305352408460516540625
jater,107254701213281114164198214
ale130854701215781132
u1462547012163
pacientek1547547012158108153177228285318368417
s1985547012148
dekompenzovanou2055547012164116164219304362414471515570618668724780837
jaterní291454701213281114164198255279
cirhózou321454701215377110167223266321378
můžeme3614547012192147191242327379
očekávat4015547012163109159207257305355388
vysokou4425547012156107148204252307364
míru4810547012192116150206
komplikací.5038547012155110195253277301349399445468489
Portální425687012153105137173221244298321
hypertenze76668701215297153204236271320375417466
spojená125368701213691147170219274321
s1595687012136
těhotenstvímpatří165268701213281135190222270325363397447470552626674706737760
mezi2433687012179129172195
vysoce264868701214594133188233281
rizikové29506870121295294117162215262310
situace.32816870121365891145192236284304
V3606687012151
obou3678687012151107163217
případech391668701215385108164212268317362416
dochází4353687012152107152206253296319
k4692687012143
hemodynamickým4756687012152101184238295342397444526549593639688771
změnám,425827012143126177232280363384
kdy830827012150105153
potřeby1004827012157113146178228285331
rostoucího135782701213589129163217272317340397452
plodu183082701216084139196251
mohou2102827012186142197253308
dále2431827012159107131181
zhoršovat2633827012146101156189229284332380413
portální3067827012159115148184233256312335
hypertenzi3423827012158103161212245281330386429452
a3897827012151
tím396982701213659142
se413282701214293
zvyšuje424682701214596147186241265315
riziko458282701213659102125172226
krvácení482982701214983135183228277333356
z5206827012145
varixů527382701214896129152199254
a425967012148
dekompenzace494967012156106153207290347397453496545590639
jaterního115496701212168101150182238261318373
onemocnění.1548967012151106157240295340395445501524544
I2113967012121
přes215596701215689138178
výše235496701214495134184
zmíněné2559967012140123146201251306356
možné2936967012180135177232283
komplikace,324096701214397180236260283329378423472492
mateřsko-fetální3753967012179127160209241281327381414444494527576599654677
morbidita4451967012180135167224248304327360408
a4880967012145
úmrtnost4946967012155138170206261316355389
byla535696701215399124171
snížena425110701214095119162212268317
současným7631107012147102158203252292347393478
vývojem12621107012156107159213237287372
v16551107012155
hepatologii,17321107012156106164213246300324380437460484504
prevenci2258110701216497147195245301346369
krvácení2649110701215488140189234283339363
z30331107012150
varixů3104110701214998130154201257
medikamentózně/endoskopickou33821107012191142200223270320403454511543597640696746781827883940996103510821136119412181263131013641419
ligací,4823110701213154110159204227247
zlepšením5092110701215074124182222272328352435
transplantace425124701213366114169208265289337392424473518567
jater1013124701212472105154187
a12211247012148
rostoucími1291124701213287126160214269314337420444
zkušenostmi1756124701214390145184234290345384418501525
v23021247012148
této2371124701213382116170
problematice.2562124701215790144202226276360408440463508557577
Prezentujeme425138701215486137181231288321376400451536587
případ1034138701216598122180229286
31leté13421387012159106124175209259
pacientky16221387012165115160183234291324371422
s20661387012147
jaterní2134138701212574107157190247271
cirhózou,2426138701215376109165221264319375396
která2844138701215591141174224
po30891387012165122
zavedení32321387012151101148198256307364387
transjugulárního3641138701214174123179218241297354410433482515572595653709
intrahepatického4372138701213087119152202258309367416449473518565615672727
portosystemového51211387012165121155191246286335375425152701213382166221268317373428
shuntu8741527012147102156212244299
(TIPS)1194152701213588112165214242
úspěšně14571527012162101157208247302353
otěhotněla1831152701216294144199254287343393417465
a23171527012155
těhotenství2393152701213382138193226275331369403454478
a28921527012155
následný29681527012162110149173223280336381
porod33701527012164120153207265
proběhl3656152701216396151208259315338
bez40151527012164115158
komplikací.41951527012153107191247271294341390435458479
Nicméně,4695152701217296140224274330380400
251161527012158
roky5195152701214094142192
po54081527012164120
porodu,4251667012157113146200258312333
pacientka7791667012161110155178228284316362412
onemocněla12121667012159115165249304349405455479527
lymfobastickým1760166701212875159188243300349388422445490536587671
lymfomem2452166701212875159188243327377461
a29341667012152
i30081667012123
přes3053166701215689139178
intenzivní3253166701212782115164220263286334390414
terapii3688166701213786119168224248271
tohoto3980166701213791147202235289
onemocnění42901667012159115166249304350405455511534
zemřela4845166701214797181213263287335
ve52011667012152101
věku53231667012153102149204
404251807012151104
let.550180701212474107129
Nenašli7001807012166116172220259283305
jsme1027180701212463146196
žádnou1245180701214292149204259314
souvislost1581180701213994150198222261284339378412
mezi20141807012184134178201
jaterní2236180701212573105154187243266
cirhózou2523180701214568101156211253308363
a29071807012148
lymfoproliferativním2977180701212371155184239296329383407430460510543591624647695751774858
onemocněním.38561807012155111161245300345401451506530613634
Klíčová425197501235885111155211261312
slova:758197501234267124174225248
těhotenství,1027197701213382138193226275331370403454478498
gravidita,1547197701215588137183207264287320369390
játra,1958197701212472104137186207
cirhóza,2186197701214567100156211252302323
varixy,2530197701214997129153200250266
transjugulární2817197701213466115170209231286342397420468501557580
intrahepatický3418197701212379111143192247298355404436459504550600
portosystemový40401977012157113145181235275323362396445529584631682
shunt,4743197701214095150205237258
lymfom.5022197701212471156185240323345
Introduction425241401383296141188251315379429474508570634
Liver565258301074161103148176
cirrhosis76125830107486895123173223258277311
is1093258301072660
the1173258301073685131
final1324258301073252102144163
stage1508258301074171114165210
of1739258301075681
progressive1840258301075886135186214258293327347389434
development22942583010757103145189209259311387433482510
of2825258301075681
various425272301074182109128176224257
liver70227230107203980123149
diseases871272301075069102146186219264297
and1188272301074290140
is1347272301072153
associated1420272301074276109157199217258285327377
with1817272301076686114162
significant1999272301073553102150169193212253294342369
morbidity23882723010775123150200220269287315358
and2766272301074290139
mortality4252863010774122149180221240259287330
(1).7742863010727678497
Varices891286301074988114134174216250
are1161286301074370113
a12932863010744
frequent135728630107245194144192236284311
complication1687286301074390164214233252292333360379427476
of2183286301075074
liver227728630107224081125151
cirrhosis244828630107436188115163212245264296
and2764286301074492141
a4253003010740
leading484300301071961101149167214262
cause765300301073676123155198
of982300301074467
mortality10683003010769116143173213231249276318
in1405300301071562
patients1486300301074586112130173220246280
with1785300301076079106153
liver195730030107163373115141
cirrhosis,211730030107365480106153201233251283298
the2434300301072471114
incidence2567300301071562102119167210257297338
of425314301074873
varices518314301074890117136177220255
was7933143010772114148
significantly961314301074159109158177201221262304353380400441
higher1422314301075574124173217244
in1686314301072675
patients1781314301075799127146190239266302
with2103314301077292120169
Child-Pugh22933143010758107126145195223270318368417
class2730314301074766108141175
B/C425328301074678128
than573328301073583125173
in766328301072674
those860328301073584133167212
with1092328301077291120169
Child-Pugh12813283010758107126145194223270317367416
class1717328301074766108141175
A19123283010760
(35–43%1992328301072467109156203244323
vs.233532830107488299
48–72%)2454328301075197144185229307329
(1).280332830107317189102
Pregnancy425342301074571114164212253301341384
is828342301072154
relatively90234230107297291132159177219262281321
rare124334230107297097140
in1402342301072169
women14913423010767115189233282
with1792342301076887115163
liver197534230107214081124150
cirrhosis214534230107436188115163212245264296
(2).246134230107266991104
Infertility258534230107216993136163194213231250278320
is425356301071951
anticipated495356301073885112130170189237279305347397
in911356301071663
cirrhosis99435630107375581108156204237255287
because1301356301074690131172219252295
of1616356301074468
the1703356301072573116
altered183935630107375683125152194244
endocrine2102356301074088137185225252271318362
metabolism24833563010770114141182231280299318350422
and425370301074189138
anovulatory583370301074795144184233251292319366393436
cycles1038370301074789129148192225
(3–7).1283370301073073119158183196
In1499370301072573
pregnant1592370301075683125176224264312339
women19513703010771119193237285
with2256370301077191119167
cirrhosis,244337030107466591118167215249267300316
the2778370301073583127
most4253843010773121153182
common626384301073682155228275323
and969384301073784132
most11213843010769117150178
serious1318384301073074100118166213245
complication1583384301073682155203223241280321347366413461
is2063384301071547
variceal2129384301073778104123162204243262
bleeding.2410384301074665108152201220267315331
Due27603843010754102145
to425398301072874
worsening5193983010766114141175219267286334383
of922398301074872
portal10143983010751100127158199218
hypertension1252398301074987138183209240283331364382430479
because1750398301075196137179226259303
of2073398301074973
increased2165398301072068108135178218251295346
circulating253039830107416086125173192232259278326375
blood425412301075171121171223
volume668412301074897118166242287
and976412301074898149
the1145412301073585130
direct1296412301075776103148190221
pressure1538412301075785129164199247274319
of1877412301075681
the1978412301073585130
gravid2129412301075784127168188239
uterus2388412301075685129156206240
on26484123010756106
the2775412301073584130
inferior42542630107196790134160179227254
vena699426301074689138178
cava,897426301074687127168184
impairing1101426301072498147189208234253301350
venous1471426301074690138186234267
return,1758426301073275103151177226242
variceal2019426301074788114134174216257276
bleeding2314426301075675119164214233280330
occurs2664426301075394133181207241
mainly4254403010773112130177195234
during678440301074591117135182230
the927440301072471114
second1060440301073073113159206254
trimester133344030107245069140184216244286311
and1663440301073784132
the1814440301072471114
in1947440301071662
the2028440301072471114
second2161440301073073113159206254
stage243444030107305898147189
of2642440301074467
labor2728440301071655104152178
(2).42545430107246789102
Pregnancy547454301074672115165213254302342385
in952454301072068
cirrhosis103945430107426187114163211245263296
carries1354454301074283110137156200234
even1607454301074586129177
more18044543010775124151194
risks201745430107284880118154
such2191454301073582123171
as2381454301074376
higher2477454301074968117165209236
rates273245430107287097140173
of425468301074873
spontaneous518468301074191140190217259308353403451485
abortion1023468301074898148176207227275325
than1368468301073584125174
the1562468301073584129
general17114683010756101150194221264283
population20144683010757107158207226267295314363412
(30–40%2446468301073174119167215261340
vs.280646830107488299
15–20%),425482301074379124162204278299312
prematurity,755482301074571113184224250296321340367408419
pulmonary1192482301074592110181228275315340382
hypertension,1592482301074481130174199229270316348365412459474
splenic208448230107307796139185203242
artery234448230107376292133158200
aneurysm2563482301073683125172197238271342
rupture,425496301072674123150198224266280
abruption725496301073786112160209236255302350
placentae,1095496301074665105145187235261302345360
stillbirth,14744963010730597795114162181207238285300
intrauterine179449630107156389115156203231273299318365409
growth2222496301074672118182213260
retardation,250249630107236593134159207247274292340388403
postpartum4255103010751102137167219262290322372448
hemorrhage8945103010756102178229257285336378429475
and1390510301074999150
hepatic15615103010756102154197225245287
decompensation18695103010757103146194271322369419453497525545595645
(7,253551030107327784
8).264051030107527589
Preconceptional2750510301075481125425524301074087135176218268296314362411452471
model9155243010773121172216235
for117052430107227097
end-stage1286524301074391141168202231273322366
liver167252430107183677120147
disease183952430107476699143183216261
(MELD)2119524301072391133173231253
score2392524301073273120147190
≥1026015243010753108147
had2768524301074788137
83%425538301074488167
sensitivity612538301074186135168187215235276296325368
and1000538301074897147
specificity1168538301074090136178197221242282301330373
for1562538301073078106
predicting1688538301075784128179198239270289338388
liver209653830107264587131158
decompensation22745383010756101143190265315361410444486514533582631
during425552301074996123142190239
pregnancy684552301075077120170218258306347389
(2).109355230107246789102
The565566301074190133
lymphoblastic717566301071655128177224272321340380412440458498
lymphoma1234566301071555128176224271344384
(LBL)1637566301072059104143166
is1823566301071547
a18895663010737
rare194556630107266692134
aggressive2098566301073785134159201234267284325367
lymphoproliferation,248456630107155512817622427132034739342558030107193862106132174202221269318333
with778580301077292120169
B-lineage966580301075382102121169213254303348
differentiation133458030107557498126170196240288315334375402421469518
far187258030107307399
more19915803010781130157200
scarce2211580301074081123150189232
than2463580301073483124172
that2655580301073483124151
of2826580301075579
T-lineage.4255943010741638299146189227275318332
An775594301074995
estimated889594301073972100117189228254295344
incidence1252594301071461100118165208255294335
of1605594301074467
B-lineage169159430107416887105151194233281323
LBL2033594301073680119
is2171594301071546
about2236594301073684132179206
0.1/1,000,000246059430107405592118158168211255299313357401445
annually.425608301074188136183223242260300312
The756608301073988132
overall907608301074585127154195214232
prognosis1158608301074773120170217265298316349
of1526608301074568
LBL1614608301073782122
is1755608301071648
quite1823608301074592111139181
favorable2023608301072162102149175217266285329
with2371608301076281108156
about2547608301073786135183211
half2777608301074586104128
of425622301074770
the514622301072471113
patients646622301074686112130172219245279
cured943622301073683108150198
by1160622301074584
modern12626223010769116165208233281
combined1562622301073581153201219266309357
chemotherapy1938622301073683126197244271318360386426474513
regimens2469622301072365113131202245292324
(9).28126223010720598193
Case4256474013856117169228
report6886474013846105170232278325
We5656643010774117
describe7036643010757102137178206226277323
the1047664301073585130
case1198664301074890125170
of1389664301075681
a14906643010749
31-year-old1560664301074585109150195236264289341361412
female1993664301073175150192212257
patient22716643010758100129148193243271
who25636643010772122172
was27566643010772115149
admitted425678301074089162181209240282332
for77767830107216895
primary89267830107467393166206233276
detection1188678301074589117160201231250298346
of1554678301074569
liver164367830107163576119145
cirrhosis180867830107375682110158206240258291
decompensation2119678301074689131177250300344392425467494513561610
with2748678301076281110158
developed425692301074995137182203252304351402
hepatosplenomegaly,8486923010757102154197225273309359380426476526602647699741762803816
portal16856923010758109137169212232
hypertension1938692301075797149196223256300350384404453503
and2462692301074999150
ascites.2633692301074984126146175219254272
At425706301075380
the526706301073080125
hospital6717063010752101135185206234277297
admission988706301074494169188222256275324374
was13827063010769111145
the1548706301073080125
patient1693706301075396124143188237265
diagnosed1978706301075272113163212262296341392
as2391706301074478
Child-Pugh24907063010754103122142192221268316366415
B.425720301074663
Extensive509720301074991123167216250269311356
ascites885720301074983125145174217252
can1158720301074890139
be13187203010757103
seen1442720301074187133182
on16457203010755105
computer1771720301074795170221270300343371
tomography2163720301073583158208259286329380429469
(CT)2653720301073182128157
in2831720301072675
figure42573430107244494143170214
1.659734301075163
As742734301076096
part858734301075699126158
of1037734301075479
the1136734301073584129
differential128673430107557599128172199243292320340381401
diagnosis,1708734301075575116166215264299318351368
a20977343010747
transjugular216573430107285699148181201249299348367409436
liver262273430107254486131158
biopsy2801734301075676425748301074899133175
was6217483010770112146
performed,7887483010754100127155204232307352403419
describing1228748301075499133175202222273293342392
chronic1640748301074594121169219238280
active1940748301074687118138180224
hepatitis2185748301075398148191219239268287321
with2527748301076989118168
signs2715748301073858108157190
of425762301074872
cirrhosis51876230107375784111161209244263296
(Fig.83476230107226382132149
2a-d),1003762301074183111163188202
etiologically122676230107416989137158206257276317359379398439
toxonutritive.1685762301072573111159208256285312332361380422466481
Small21867623010740113155174193
gastric2400762301074687121151178198239
varices2659762301073981108128169212246
unsuitable425776301074897131179198227269320340385
for831776301072877104
ligation95677630107244393135163182231281
were12577763010770114142186
found1463776301072877126175225
on17097763010752102
the1831776301073382127
initial197977630107237291120140181201
gastroscopy,2201776301075395129159186234269310358409449462
so2683776301073888
we27917763010770114
started3047524301073566110139172217270
treatment3339524301073766111154184261308359388
with3749524301077596127178
non-selective39495243010757109160191227274295342386418439483529
beta-blockers.45005243010759107137181211265287338382422468497534552
The50745243010751104151
patient52465243010760104133154201252281
gradually3047538301074976119169217259279298339
became34075383010755100143185259305
stabilized3732538301073969111161182201221258302353
and4105538301074695146
was42715383010770113147
released443853830107327696141182216261312
for4771538301072977105
home48965383010754103178223
treatment.5140538301073360104145173248293342370387
Unfortunately,30475523010756104128176204235284332373401444464505517
the3584552301072674119
patient3723552301074790117137181230257
continued4000552301073885134162181229277322372
to4393552301072572
abuse4485552301073989138171216
alcohol472155230107395899146195244264
and5006552301073887136
moreover,51635523010771120147191240281325352364
thanks3047566301072877119167206244
to3311566301072673
noncompliance3405566301074696145186234309359380399440489531574
to4000566301072573
therapy4094566301072574119147189240280
after439556630107386395139166
half4582566301074687107132
a47355663010738
year4794566301074085126153
the4967566301072675120
patient5108566301074890118138182232259
was53885663010763105139
again3047580301074192134154203
acutely3271580301074991140170214234276
admitted3568580301074999175195224256300351
for3940580301073281109
bleeding4070580301075878124170222242291342
from4433580301073160109184
the4638580301073686131
esophageal4790580301075287137188239281332377419439
varices,5250580301074891119140181225260277
solved3047594301073484105148193245
by3313594301075899
endoscopic34335943010752102153203238280328380401443
ligation389759430107274798140169189239289
during42075943010757106134155205256
urgent4484594301075684134180229258
gastroscopy4763594301075799134165193242277319368419461
and5245594301074998150
followed5416594301073181304760830107193988153198249
by3316608301075595
the3432608301073382127
maximum35806083010779121161181256304378
possible39796083010755105139174193243264309
conservative4308608301074693143176222249294336364384426470
therapy.4799608301073382127154197247288300
Due51206083010763113158
to5298608301073381
the5400608301073382127
high3047622301074868118167
risk323462230107335387125
of3380622301075479
rebleeding3480622301073377127148193238289309358408
we39086223010772116
indicated4045622301072574124144185227255299350
TIPS4415622301074870115158
(transjugular459362230107315885128177211230278328377397438465
intrahepatic5079622301072574102129172221266317359387407448
portosystemic30476363010750100128160208242284319349393467487528
shunt).3596636301074190138187215239254
For3870636301074998126
impending40166363010726101151197247297317366416
acute4453636301074890138168211
on46856363010755105
chronic4810636301074897124173222242283
liver511463630107264688132159
failure529463630107317494113162189233
we30476503010765110
started3178650301074171114141173217268
treatment3467650301073563107149177252298347375
with3863650301077293122171
corticosteroids.4055650301074896124156176217265300330373401449469520554572
Control46476503010759107157185213261282
ultrasound4950650301075575104132175209259308358408
and5379650301074898148
doppler3047664301074998149200221266293
of3361664301074671
TIPS3453664301074162108150
showed3624664301073381131196241292
no3936664301074797
sign4053664301073352102151
of4225664301074671
flow431766430107234695161
failure449866430107236686105153181225
(Fig.474366430107236584134151
3).491566430107436579
Subsequently,5014664301074189140174219270319363413440460501514
the3047678301072879125
patient31946783010758102131152198248277
underwent34926783010757107159205234305350401429
anti-alcohol39436783010749100128149179222242285334385435457
therapy4421678301073687134162206258299
and4742678301074999151
the4915678301073686133
disease5069678301075879113160202237284
was53746783010774118153
compensated3047692301074088163214260309343386414458509
for3577692301073180108
several3706692301074186128172200242262
years3989692301074792133160196
with4205692301077393122172
the4398692301073584130
Child-Pugh45486923010759108128148198227275323373422
A49916923010760
and5072692301074291141
MELD52346923010778121162221
754766923010751
points.3047706301074998117165191226243
She3310706301073986130
visited346070630107385790108136179229
our3708706301074593119
gastroenterology3847706301074687120149176222267315342384411458477525575615
department4482706301074690139181207238311355403430
every4932706301074081124150193
six514570630107314988
months52537063010770118167194242274
and3047720301074190140
we32087203010763107
made33367203010772114164209
an3566720301073988
ultrasound367572030107466694122165199248297346396
of4092720301074671
the4184720301072675120
TIPS4325720301074061107149
and4495720301073988139
of4654720301074671
the4746720301072675120
liver488772030107173779123150
as5058720301073973
hepatocellular5152720301074792142185213260302346304773430107193887106148175
carcinoma3243734301073880107147167215265340381
screening3645734301073173100144190239258307357
including4023734301071665107126175225244293343
AFP4387734301075093137
levels.4545734301071762103148168201219
Despite47847343010756102137187207236279
the5084734301072574119
irregular522473430107174472116167215235276304
menstrual30477483010774119168202232259309350370
cycle,3438748301074689130150195210
at3669748301074775
373764748301075192
years3876748301074691132159194
of4091748301075479
age4190748301074798143
the4353748301073484129
patient4502748301075699127146191240268
had4791748301075496146
an4958748301074796
unexpected50747483010754103148189240286328359403454
pregnancy.3047762301075078122174223265315357400413
The34817623010750101146
pregnancy3648762301075886130182231273323364408
proceeded4077762301075786134177220266318363415
without4513762301077393122172222271301
complications.4835762301074795171222243262304347375395444494529546
We54027623010782125
made30477763010774115166211
an3278776301074896
initial339577630107257494122142183203
endoscopy3619776301075099149198233274322373413
at4053776301074775
the4149776301073483128
beginning42987763010756102153172221270289338388
of4707776301075479
pregnancy4807776301075684127178227269318359403
without5230776301077292121170219268297
Fig.3047244501134770120146
1.3218244501134972
Abdominal3314245301074790134177246262306349365
CT3694245301074484
–37922453010741
contrast3847245301073374118142165206234258
enhanced,4120245301073478121164208244278321335
transversal447024530107224686130158194229253282325342
scan.4826245301072762104148162
Extensive5003245301074783110144188216231267302
ascites5320245301074069103120144178207
(arrows)304725630107246690115158220250270
associated3332256301074473103146184201245270305350
with3697256301076279104149
portal3861256301074590115142184202
hypertension4078256301074680125163188215251296325341385431