Acute Fatty Liver of Pregnancy (AFLP) Pathophysiology: • Defect in fetal free fatty acid metabolism products → Intermediate fatty acid metabolism accumulate → Fat infiltrates maternal hepatocytes → Liver dysfunction Presentation: • Typically 3rd trimester (range: 18 wks - postpartum): • Initial symptoms = nonspecific (nausea, vomiting, abdominal pain, headache, malaise) → Acute liver failure rapidly develops (DIC, ascites, jaundice, hypoglycemia, encephalopathy) → Multiorgan failure Findings: • ↑AST/ALT (5-10x ULN), ↑Tbili/Dbili/AP, ↑INR, ↑BUN/Cr, ↓Glucose, ↓PLT, ↓Fibrinogen, ↓Antithrombin Ill • Ultrasound = nonspecific (fatty infiltration, brightness) • Biopsy is rarely needed (microvesicular fatty infiltration) Differential Diagnosis: Viral Hepatitis, Preeclampsia, HELLP, Intrahepatic Cholestasis Management: • Maternal Support - Critical care support, Transfer to a liver transplant center • Prompt Delivery - Regardless of gestational age • Monitor and Treat Complications by Dr. Yi Feng @yfeng_MD via @iMedEducation #AFLP #Fatty #Liver #Pregnancy #hepatology #obstetrics #obgyn #diagnosis #management #pathophysiology
