Acute fatty liver

Question 1

What is the acute fatty liver of pregnancy?

Answer 1

A rare condition which occurs in the third trimester of pregnancy where there is a rapid accumulation of fat within the liver cells causing acute hepatitis.

Question 2

What is the risk?

Answer 2

Liver failure and mortality for both the mother & fetus.

Question 3

How does acute fatty liver occur?

Answer 3

Impaired processing of fatty acids in the placenta as a result of a genetic condition in the fetus that impairs fatty acid metabolism.

Question 4

What is the most common genetic cause of acute fatty liver of pregnancy?

Answer 4

Long chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHAD) in the fetus which is an autosomal recessive condition.

This enzyme is important in fatty acid oxidation, breaking them down to be used as fuel.

Question 5

What happens due to LCHAD deficiency?

Answer 5

The fetus & placenta are unable to break down fatty acids which enter maternal circulation & accumulate in the liver. Accumulation leads to inflammation & liver failure.

Question 6

Presentation?

Answer 6

General malaise & fatigue, nausea & vomiting, jaundice, abdominal pain, anorexia, ascites.

Question 7

What will bloods show?

Answer 7

LFTs will show elevated ALT and AST, raised bilirubin, raised WBC count, deranged clotting, low platelets.

Question 8

What differential should you think of?

Answer 8

If liver enzymes & low platelets = HELLP as it’s more common. HELLP is a differential.

Question 9

Management?

Answer 9

Obstetric emergency which requires prompt admission and delivery of baby - most pts recover after delivery.

Treat acute liver failure if it occurs.