Acute fatty liver of pregnancy: Difference between revisions
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**[[Hypertension]] | **[[Hypertension]] | ||
**Edema | **Edema | ||
**Proteinuria | **[[Proteinuria]] | ||
*[[Hypoglycemia]] | *[[Hypoglycemia]] | ||
*Often, signs/symptoms of [[DIC]] | *Often, signs/symptoms of [[DIC]] | ||
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**DIC present in as many as 70% of patients<ref>Ko H, Yoshida EM (2006). Acute fatty liver of pregnancy. Canadian Journal of Gastroenterology. 20 (1): 25–30</ref> | **DIC present in as many as 70% of patients<ref>Ko H, Yoshida EM (2006). Acute fatty liver of pregnancy. Canadian Journal of Gastroenterology. 20 (1): 25–30</ref> | ||
*CBC | *CBC | ||
**Often shows leukocytosis | **Often shows [[leukocytosis]] | ||
*[[UA]] | *[[UA]] | ||
**Proteinuria | **[[Proteinuria]] | ||
==Management== | ==Management== | ||
Revision as of 17:51, 16 October 2019
Background
- Rare, potentially fatal complication that presents in second half of pregnancy or (less commonly) early postpartum
- Exact etiology unclear, but thought to involve abnormal fetal fatty acid metabolism
- Fat vesicles accumulate within hepatocytes, interfering with liver function
Clinical Features
- Usually presents in 3rd trimester, but may occur any time in 2nd half of pregnancy to early postpartum
- Nausea/vomiting (commonly severe)
- Jaundice
- Findings consistent with preeclampsia in some women:
- Hypertension
- Edema
- Proteinuria
- Hypoglycemia
- Often, signs/symptoms of DIC
- +/- encephalopathy, ascites
Differential Diagnosis
- Often initially misdiagnosed as preeclampsia/HELLP
- Hypoglycemia, jaundice, ascites, hypofibrinogenemia all more common in AFLP
3rd Trimester/Postpartum Emergencies
- Acute fatty liver of pregnancy
- Amniotic fluid embolus
- Chorioamnionitis
- Eclampsia
- HELLP syndrome
- Mastitis
- Peripartum cardiomyopathy
- Postpartum endometritis (postpartum PID)
- Postpartum headache
- Postpartum hemorrhage
- Preeclampsia
- Resuscitative hysterotomy
- Retained products of conception
- Septic abortion
- Uterine rupture
Indirect Hyperbilirubinemia
- Hemolytic
- G6PD
- Drug related
- Autoimmune hemolytic anemia
- Hematoma resorption
- Ineffective erythropoiesis
- Gilbert's
Direct (Conjugated) Hyperbilirubinemia
- Choledocholithiasis
- Cholecystitis
- Ascending cholangitis
- AIDS cholangiopathy
- Stricture
- Neoplasm
- Pancreatic head
- Gallbladder
- Primary liver (e.g. hepatocellular carcinoma
- Metastatic
- Obstructing AAA
Hepatocellular damage
Patient will have severely elevated AST/ALT with often normal Alkaline Phosphatase
- Viral hepatitis
- Fulminant hepatic failure
- alcoholic hepatitis
- Ischemia
- Toxins
- Isoniazid
- Phenytoin
- acetaminophen
- Ritonavir
- Halothane
- Sulronamide
- Autoimmune hepatitis
- Primary biliary cirrhosis
- HELLP Syndrome
- Congestive Hepatopathy
Pregnancy Related
Transplant Related
Pediatric Related
- Inborn error of metabolism
- Neonatal jaundice (physiologic)
Additional Differential Diagnosis
- Reye syndrome
- TPN
- Heatstroke
- Budd-Chiari (with acute ascites)
- Wilson's disease
- Sarcoidosis
- Amyloidosis
Evaluation
- LFTs
- ALT/AST usually in 300-500 range, alk phos usually elevated in pregnancy
- Hyperbilirubinemia- more pronounced than in preeclampsia
- BMP
- DIC labs
- Low fibrinogen, coagulopathy
- DIC present in as many as 70% of patients[1]
- CBC
- Often shows leukocytosis
- UA
Management
- Emergent Ob/Gyn consult
- Delivery typically results in rapid hepatic recovery
- Dextrose for hypoglycemia
- FFP, cryoprecipitate, and/or platelets for coagulopathy (see DIC)
Disposition
- Admit ICU or transfer to center with Ob
See Also
External Links
References
- ↑ Ko H, Yoshida EM (2006). Acute fatty liver of pregnancy. Canadian Journal of Gastroenterology. 20 (1): 25–30