Acute fatty liver of pregnancy/es: Difference between revisions

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==Antecedentes==
==Antecedentes==


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[[File:Sobo 1906 389.png|thumb|Vista inferior del hígado con superficie que muestra lóbulos e impresiones.]]
[[File:Sobo 1906 389.png|thumb|Inferior view of the liver with surface showing lobes and impressions.]]
*Complicación rara, potencialmente mortal que se presenta en la segunda mitad del embarazo o (menos comúnmente) a principios del postparto
*Rare, potentially fatal complication that presents in second half of pregnancy or (less commonly) early postpartum
*Etiología exacta poco clara, pero se cree que implica un metabolismo anormal de los ácidos grasos fetales
*Exact etiology unclear, but thought to involve abnormal fetal fatty acid metabolism
*Vesículas de grasa se acumulan dentro de los hepatocitos, interfiriendo con la función hepática
*Fat vesicles accumulate within hepatocytes, interfering with liver function
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==Características clínicas==
==Clinical Features==
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Revision as of 17:12, 10 January 2026

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Antecedentes

Vista inferior del hígado con superficie que muestra lóbulos e impresiones.
  • Complicación rara, potencialmente mortal que se presenta en la segunda mitad del embarazo o (menos comúnmente) a principios del postparto
  • Etiología exacta poco clara, pero se cree que implica un metabolismo anormal de los ácidos grasos fetales
  • Vesículas de grasa se acumulan dentro de los hepatocitos, interfiriendo con la función hepática


Características clínicas


Differential Diagnosis

3rd Trimester/Postpartum Emergencies

Jaundice

Differential diagnosis of hyperbilirubinemia.

Indirect Hyperbilirubinemia

Direct (Conjugated) Hyperbilirubinemia

Hepatocellular damage

Patient will have severely elevated AST/ALT with often normal Alkaline Phosphatase

Pregnancy Related

Transplant Related

Pediatric Related

Additional Differential Diagnosis

Masqueraders

Only bilirubin stains the sclera

  • Carotenemia
  • Quinacrine ingestion
  • Dinitrophenol, teryl (explosive chemicals)


Evaluation


Workup

  • LFTs
    • ALT/AST usually in 300-500 range, alk phos usually elevated in pregnancy
    • Hyperbilirubinemia- more pronounced than in preeclampsia
  • BMP
  • DIC labs
  • CBC
  • UA
  • RUQ US
    • Non-specific; the liver can even be normal in echotexture
    • Useful to rule out other causes of obstructive biliary tract pathology.


Diagnosis

  • Often initially misdiagnosed as preeclampsia/HELLP
    • Hypoglycemia, jaundice, ascites, hypofibrinogenemia all more common in AFLP


Swansea criteria[2]


At least six of the following findings, in the absence of another cause:

  • Vomiting
  • Abdominal pain
  • Polydipsia/polyuria
  • Encephalopathy
  • Elevated bilirubin
  • Hypoglycemia
  • Elevated urea
  • Leukocytosis
  • Ascites or bright liver on ultrasound scan
  • Elevated transaminases (AAT or ALT)
  • Elevated ammonia
  • Renal impairment: elevated creatinine
  • Coagulopathy: elevated prothrombin time or PT
  • Microvesicular steatosis on liver biopsy


Management


Disposition

  • Admit ICU or transfer to center with Ob


See Also


External Links


References

  1. ↑ Ko H, Yoshida EM (2006). Acute fatty liver of pregnancy. Canadian Journal of Gastroenterology. 20 (1): 25–30
  2. ↑ Dey M, Reema K. Acute Fatty liver of pregnancy. N Am J Med Sci. 2012;4 (11): 611-2. doi:10.4103/1947-2714.103339
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