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    Prof. of Hepatology & Gastroenterology, Cairo University.

    Consultant of Hepatology,Gastroenterology and Endoscopy

    Management Positions: •

    Chief of Hepatology unit El Manial University Hospital (1994-1998).

    • Chief of Gastroentero ICU in Cairo university hospital (1997-2000)

    • President of the board of AlfaScope GI Specialized center (2004-2014).

    • Head of Endoscopy Unit in Cairo University Hospitals (2005-2010).       

     

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    استاذ الكبد و الجهاز الهضمى بكلية الطب جامعة القاهرة

    استشارى الكبد و الجهاز الهضمى و المناظير

    دكتوراه امراض الكبد و الجهاز الهضمى من كلية الطب جامعة القاهرة

    الرئيس السابق لقسم الامراض الباطنية بكلية الطب جامعة ٦ اكتوبر

    الرئيس السابق لوحدة مناظير الجهاز الهضمى و مركز الكبد و الرعاية المركزة بقصر العينى

     

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Tuesday, Aug 20th

Last update01:52:33 AM

        

Acute fatty liver of pregnancy

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Acute fatty liver of pregnancy (AFLP)

Definition:

A disorder which is unique to human pregnancy, characterized by microvesicular fatty infiltration of hepatocytes. 

Epidemiology:

AFLP is rare with an approximate incidence of 1 in 15,000 deliveries. It is more common with multiple gestations and possibly in women who are underweight.

Pathogenesis:

It is suggested that some affected women and their fetuses might have an inherited enzyme (LCHAD) deficiency in beta-oxidation of fatty acids in mitochondria, that predisposes the mother to this disorder.

The accumulation of long-chain 3-hydroxyacyl metabolites produced by the fetus or placenta is toxic to the liver and may be the cause of the liver disease.

Clinical Picture:

AFLP occurs typically in the third trimester. The most common symptoms are anorexia, nausea or vomiting, abdominal pain, usually epigastric, and jaundice. 50% of patients have signs of preeclampsia at presentation or at some time during the course of illness.

Extra-hepatic complications can occur, as infection, pancreatitis,  intra-abdominal bleeding & diabetes insipidus.

Investigations:

1. Laboratory tests:

Aminotransferases: elevated and may reach up to 1000 IU/L.

Serum bilirubin: usually elevated.

Platelet count: may be decreased with or without signs of DIC.

In severe cases: increased INR, hypoglycemia and increased creatinine & uric acid may occur.

2. Imaging:

 Ultrasonography & CT may be used to exclude other diagnoses.  

3. Liver biopsy:

 Liver biopsy is diagnostic, showing microvesicular fatty infiltration of the hepatocytes. Liver biopsy, being with risks, should be reserved for cases in which the diagnosis is in doubt.

Differential diagnosis:

It may be difficult to differentiate AFLP and

 HELLP syndrome (characterized by hemolysis, elevated liver enzymes, and a low platelet count). However, evidence of hepatic insufficiency such as hypoglycemia or encephalopathy is suggestive of AFLP.

Treatment:

 Urgent delivery, after stabilization of the patient’s condition.

Prognosis:

liver functions and coagulopathy start to normalize shortly after delivery.

A transient worsening of liver & renal functions and coagulopathy may be observed during the first few days after delivery followed by a definitive improvement.

In most severe cases, there may be many more days of illness requiring maximal supportive management in ICU.

Most patients recover and have no sequelae of the liver disease.

AFLP can recur in subsequent pregnancies, but the exact risk of recurrence is unknown. 

Last Updated on Sunday, 18 November 2012 19:54

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  • عنوان: 98 شارع التحرير , ميدان الدقي, القاهرة , مصر
     
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حقوق الملكية

 المعلومات الواردة في مختلف صفحات موقع د.سامح لبيب على الإنترنت هي معلومات صادرة عنه لأغراض تعليمية-خدميه. وتلك المعلومات محمية بموجب قوانين  حماية المصنفات الأدبية والفنية واتفاقيات دولية أخرى وبمقتضى القوانين الوطنية الخاصة بحقوق التأليف والحقوق المرتبطة بها. ويجوز استعراض أجزاء من المعلومات الواردة في الموقع أو نسخها أو ترجمتها لأغراض البحث أو لإجراء دراسة شخصية ولكن ليس لبيعها أو استخدامها لأغراض تجارية.

©  د.سامح لبيب ـ2012-2107

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