Acute fatty liver of pregnancy

Introduction Acute fatty liver in pregnancy, also known as obstetric acute pseudo-yellow liver atrophy, is a rare and rare disease in the late pregnancy. The disease has a rapid onset and the condition changes rapidly. The clinical manifestations are similar to those of fulminant hepatitis. Previous reports reported that the maternal and child mortality rates were 75% and 85%, respectively. However, if early diagnosis, early treatment, and timely termination of pregnancy can be achieved, the disease can be reduced. With maternal mortality, infant mortality can be reduced to 58.3%. In addition, viral infection, poisoning, drugs (such as tetracycline), malnutrition, hypertensive disorder complicating pregnancy and other factors may also be related to the damage of mitochondrial fatty acid oxidation.

Cause

The cause of AFLP is unknown. Because AFLP occurs in the third trimester of pregnancy and only hopes to heal after termination of pregnancy, it is speculated that the hormone changes caused by pregnancy may cause obstacles in fatty acid metabolism, resulting in accumulation of free fatty acids in liver cells, kidney, pancreas, brain, etc. Other organs cause multiple organ damage. In recent years, there have been many cases of recurrent cases and their offspring have reported genetic defects, so some people may have congenital diseases.

an examination

Related inspection

Blood routine red blood cell serum total bilirubin serum alanine aminotransferase serum aspartate aminotransferase

1. Blood routine: Peripheral blood white blood cell count increased, up to (15.0 ~ 30.0) × 109 / L, poisoning particles appeared, and see red blood cells and basophilic red blood cells, platelet count decreased, peripheral blood smear showed hypertrophy Platelets.

2. The serum total bilirubin is moderately or severely elevated, mainly direct bilirubin, generally not exceeding 200 mol/L, blood transaminase is mildly or moderately elevated, ALT is not more than 300 U/L, and there is enzyme-biliary Separation phenomenon, blood alkaline phosphatase was significantly increased, serum albumin was low, and -lipoprotein was elevated.

3. Blood sugar can be reduced to the normal value of l / 3 ~ 1/2, is a prominent feature of AFLP, blood ammonia is elevated, when the occurrence of hepatic encephalopathy can be up to 10 times the normal value.

Differential diagnosis

Acute severe viral hepatitis

Liver failure is the main manifestation of acute severe viral hepatitis. It is clinically very similar to AFLP and should be specifically identified.

2. Intrahepatic cholestasis of pregnancy

Intrahepatic cholestasis of pregnancy manifests as itching, elevated transaminases, jaundice, and elevated bile acids, while AFLP has no pruritus and elevated bile acids. The histological changes of cholestasis during pregnancy are mainly cholestasis in the central capillary of the hepatic lobules, and bile deposition in the placenta tissue. The liver cells of AFLP are mainly infiltrated with fat droplets, and the placenta has no obvious changes.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.