Acute Fatty Liver of Pregnancy

Question 1

When does Acute Fatty Liver of Pregnancy occur

Answer 1

In the third trimester

Question 2

Pathophysiology acute fatty liver of pregnancy

Answer 2

Rapid accumulation of fat within the hepatocytes, causing acute hepatitis due to impaired processing of fatty acids in the placenta

Question 3

Risks of acute fatty liver of pregnancy

Answer 3

Maternal and fetus liver failure and mortality

Question 4

Inheritance pattern of acute fatty liver of pregnancy

Answer 4

Autosomal recessive

Question 5

Presentation of acute fatty liver of pregnancy

Answer 5

General malaise and fatigue
Nausea and vomiting
Jaundice
Abdominal pain
Anorexia (lack of appetite)
Ascites

Question 6

Investigations for acute fatty liver of pregnancy

Answer 6

Abdominal exam
Basic observations

Bloods

• FBC
• U+Es
• LFTs
• Bile acids
• Prothrombin time
• CRP

Question 7

Blood results for acute fatty liver of pregnancy

Answer 7

Elevated liver enzymes (ALT and AST).

Other bloods may be deranged, with:

Raised bilirubin
Raised WBC count
Deranged clotting (raised prothrombin time and INR)
Low platelets

Question 8

Differentials for acute fatty liver of pregnancy

Answer 8

Obstetric cholestasis

HELLP - elevated liver enzymes and low platelets

Question 9

Management of acute fatty liver of pregnancy

Answer 9

Obstetric emergency - prompt admission and delivery of the baby

If liver failure occurs - may need liver transplant