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diagnosis hepatology coagulation hematology obstetrics abnormal aflp aptt obgyn prolonged algorithm alkaline alp biliary cholangitis cirrhosis dic disease disseminated elevation
Liver Disease in Pregnancy Intrahepatic Cholestasis of Pregnancy (ICP) • Onset/Trimester: 25-32 weeks • Typical clinical features:
Pregnancy Intrahepatic ... extensive necrosis and hemorrhage ... often <5 mg/dL, higher ... obstetrics #hepatitis #comparison ... #differential #
Differential Diagnosis for a Prolonged PT and aPTT If the PT and the aPTT are both prolonged,
Differential Diagnosis ... (e.g. heparin contamination ... thrombin inhibitors, heparin ... • Reduced liver ... • Massive hemorrhage
Causes of Abnormal PT and/or aPTT Prolonged Prothrombin Time (PT) 1. Acquired deficiency of FVII
Causes of Abnormal ... Early liver disease ... Reduced liver synthesis ... Massive hemorrhage ... #diagnosis #differential
Alkaline Phosphatase (ALP) Elevation - Differential Diagnosis Algorithm ALP: - Enzymes that catalyze hydrolysis of organic phosphate
phosphatase sources: - Highest ... • Bone • Liver ... Intestine - Other causes ... - Drugs - Pregnancy ... elevation DDX of Hepatic
Acute Fatty Liver of Pregnancy (AFLP) Pathophysiology: • Defect in fetal free fatty acid metabolism products →
of Pregnancy (AFLP ... = nonspecific (nausea ... Antithrombin Ill • Ultrasound ... infiltration) Differential ... #Pregnancy #hepatology
Disseminated Intravascular Coagulation (DIC) Overview Increased Clotting and Consumption of Clotting Factors Findings: • Bleeding • Recent history
• Prolonged PT ... Acral cyanosis • Hemorrhagic ... Fibrinogen: ↓ • PT ... DIC • Severe Liver ... #treatment #management
Primary Biliary Cirrhosis (PBC) - Summary PBC Epidemiology: • Female:Male 9:1 • Common European descent • Age:
intralobular bile ducts causes ... titer 1:40 or higher ... bile ducts Differential ... cholestasis of pregnancy ... malignancies, Hepatic
Postpartum Hemorrhage - Differential Diagnosis and Management Uterine Atony (80%) - Most PPH Will respond to
Postpartum Hemorrhage ... - Differential ... Diagnosis and Management ... CBC, fibrinogen, PT ... compression (using ultrasound
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