Acute Fatty Liver In Pregnancy: Do Not Confuse With Hellp Syndrome And Pre-eclampsia

We have heard about many liver diseases, especially liver disease during pregnancy. Unlike viral liver disease, acute fatty liver in pregnancy is a non-contagious liver disease, the severity of which is not anticipated.
What is acute fatty liver during pregnancy?
Amplified Fragment Length Polymorphism (AFLP) is a rare disorder during pregnancy, liver cells are invaded by small fat particles.
The disease affects only 1 in 10,000 to 20,000 pregnancies each year, mainly occurring in the last 3 months of pregnancy (weeks 34 - 37), resulting in high maternal and fetal mortality. ALFP is more common in women with multiple pregnancies and has a higher rate of male pregnancies than girls

.
AFLP affects only the liver, but can affect other organs. It is usually diagnosed late in pregnancy before birth, but can also occur soon after birth.
Nearly half of AFLP cases come with symptoms that can be mistaken for preeclampsia and HELLP syndrome
Fatty liver status
The cause of acute fatty liver
The cause of AFLP for pregnant women is a genetic disorder that leads to beta oxidation that can be deficient in fatty acids because of the long-chain deficiency of 3-hydroxyacyl-CoA dehydrogenase (LCHAD), which causes anemia.



fat in the liver.
It can be said that the power of cells, mitochondria, does not break down fatty acids into smaller molecules that help the body process proteins, carbohydrates and lipids (fats). This genetic problem causes fat to accumulate in liver cells and possibly in the kidneys, placenta and other locations.
The most common maternal G1528C mutation leads to AFLP, but other mutations can also disrupt or prevent the normal processing of fatty acids by cells.
These fatty acids then accumulate in tissues, clogging the mother's liver and hindering her normal liver function. The liver is especially important in pregnancy for the health of the mother and baby because a healthy liver removes toxins and other harmful substances from the body.
What are the symptoms of the disease?
When liver function gradually worsens, patients' health will decline significantly The most common symptoms of AFLP include:
Nausea or vomiting
Abdominal pain or epigastric pain
Excessive fatigue and drowsiness
Loss of appetite
Jaundice (in severe cases)
Fever, weight loss
Ascites
Hepatic encephalopathy
Pre-eclampsia occurs in more than 50% of AFLP cases, sometimes with pre-eclampsia
The symptoms of epigastric pain (pain in the upper right area of the abdomen) may be similar to that in patients with HELLP syndrome.



A gradual loss of normal liver function with an increase in acidity can also lead to changes in the mother's mental state and damage to the baby's health.
Symptoms are sometimes not obvious and difficult to recognize until the appearance of inspiration in the fetus or fetus passed away in the womb. Because these symptoms are usually only noticeable as the AFLP progresses, the diagnosis is usually made late in the case of the patient or even after birth.
Diagnosis of acute fatty liver
Because the disease is rare and difficult to diagnose, AFLP is often diagnosed at a clinic or hospital based on how a patient's symptoms are and a combination of laboratory tests.
clinical
Vomit
Stomachache
Thirsty, pee a lot
Hepatic encephalopathy
Test results
Hyperbilirubinemia
Hypoglycemia
Increased uric acid
Leukocytosis
Ascites or liver brighten on ultrasound
Increased AST / ALT
Increase NH3
CKD
Coagulation disorders
Small fat degeneration on ultrasound
Doctors sometimes detect AFLP around the time of emergency cesarean section due to fetal heart rate abnormalities measured in the baby. The standard laboratory test looks for a combination of abnormal blood clotting problems, signs of liver problems, increased serum ammonia, very low blood sugar, high serum, uric acid and evidence of kidney damage.
Test
Increased liver enzymes, decreased PT, increased uric acid and bilirubin
Bad prognosis for hypoglycemia
Severe cases are increased NH3 and lactic acidosis, kidney failure
Ultrasound and CT scan
Images of fatty liver
Determine hematoma in the liver, rupture or hepatic infarction
Nearly half of all patients with AFLP will have pre-eclampsia, until further diagnosis of AFLP is available. As with pre-eclampsia and HELLP syndrome, AFLP can appear in different ways depending on the individual patient, which can increase the difficulty of diagnosis.




How is acute fatty liver different from HELLP syndrome?
AFLP is distinguished from HELLP syndrome and pre-eclampsia by differences in how the disease develops. Although the symptoms may be the same, the main difference between the two diseases can be seen in testing a patient's blood coagulation capacity and their platelet level.
Diagnosis of HELLP syndrome will be based on clinical symptoms of pre-eclampsia and laboratory disorders:
Hemolysis phenomenon, abnormal peripheral blood smear, LDH> 600IU / L, total bilirubin> 1.2 mg / dL
Increased liver enzymes, AST> 70 U / L, ALT> 50 U /.

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