Obstetrics - Liver Disease Unique to Pregnancy - Acute Fatty Liver Disease

Question 1

Liver Disease Unique to Prgnancy?

Acute Fatty Liver Disease?

What is it?

Causes?

Symptoms?

Answer 1

Causes:

• Microvascular steatosis (form of liver fat acum) in liver
• Associated with eclampsia
• Inc risk in women with dehydrogenase (LCHAD) deficiency
• Dysf of mitochondria in fatty acid oxidation

Symptoms:

• Non specific - Lethargy, nausea/vomitting
• Abdominal pain: Epigastric, RUQ
• Assoc Upper GI haemorrhage: AKI, pancreatitis, hypoglycaemia, hepatic failure
• Encephalopathy: Altered mental state
• Jaundice

Question 2

Acute Fatty Liver Disease?

Investigations?

Treatment?

Complications?

Answer 2

Investigations:

• Monitor fetal distress - CTG (Cardiotocography)
• Bloods:
  
  • FBC, Platelets<100 000mm3,
  • fibrinogen level=low,
  • antithrombin III, U&E, BUN,
  • LFTs AST/ALT>300iu/l
  • DIC (disseminated intravascular coagulation)
  • glucose levels=decreased
• Urinalysis
• Maternal USS
• Fetal USS

Treatment:

• Resus IV fluids, IV glucose, fresh frozen plasma, cryoprecipitate
• Delivery of Fetus
• Liver transplant may be required

Complications:

• Mother - Hepatic failure, DIC (small blood clots)
• Encephalopathy
• Death<20%
• Fetal mortality=45%