Acute Fatty Liver of Pregnancy Clinical Presentation

Updated: Feb 14, 2018
  • Author: Michael J Barsoom, MD, FACOG; Chief Editor: Ronald M Ramus, MD  more...
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Presentation

History

Clinical presentation of acute fatty liver of pregnancy (AFLP) is nonspecific, and the patient can present with the following complaints:

  • Malaise

  • Nausea and vomiting (70%); this may present for the first time in the third trimester

  • Right upper-quadrant and epigastric pain (50-80%) [10]

  • Upper gastrointestinal hemorrhage

  • Acute renal failure

  • Infection

  • Pancreatitis

  • Hypoglycemia

  • Fulminant liver failure with hepatic encephalopathy

Women with hepatic and gastrointestinal disease in pregnancy may have atypical symptoms, which can pose a challenge to make the diagnosis and treat the patient. [11] Other diagnostic and treatment challenges include the woman's concerns about the potential use of invasive procedures and pharmacologic teratogenicity. [11]

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Physical

On physical examination, the patient may present with the following:

  • Hypertension

  • Bleeding

  • Confusion and altered mental status

  • Jaundice: Hyperbilirubinemia resulting in jaundice is rarely encountered in patients with severe preeclampsia. When jaundice is present in pregnancy, AFLP should be high on the differential.

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