AFLP

Question 1

What is the differential diagnosis for AFLP?

Answer 1

• PET/HELLP
• Viral hepatitis
• Autoimmune hepatitis
• Drug-induced liver failure
• Gallstone disease
• Budd-Chiari syndrome

Question 2

List Swansea criteria and how many abnormalities needed to fulfil criteria:

Answer 2

• Need at least 6
• Vomiting
• Abdo pain
• Polydipsia/polyuria
• Encephalopathy
• Elevated bilirubin
• Hypoglycaemia
• Elevated urea
• Leucocytosis >11
• Ascites or bright liver on USS
• Elevated AST, ALT
• Elevated ammonia
• Renal impairment
• Coagulopathy: prolonged PT or APTT
• Microvesicular steatosis on liver biopsy

Question 3

Outline investigations you would request if you suspected AFLP

Answer 3

• Bloods:
  
  • FBC
  • LFTs
  • U&Es, Cr, ammonia, urea
  • Coagulation studies
  • Blood gas: lactic acidosis, hypoglycaemia
  • Lipase
• Urine: MSU, urine PCR
• Liver imaging: USS, MRI or CT
• Biopsy liver

Question 4

Outline important management considerations for AFLP:

Answer 4

• MDT: ICU, liver specialist
  
  • May need liver transplant
• Urgent delivery regardless of gestation:
  
  • NICU, steroids, MgSulf
  • IOL or CS
• Hypoglycaemia:
  
  • IV dextrose infusion
• High risk of sepsis: Tazocin, fluconazole.
• Coagulopathy:
  
  • Vitamin K
  • FFP
  • Active third stage mgmt
  • IVL, FBC, G&H
• Diabetes insipidus with high Na+:
  
  • Give DDAVP