Fatty Liver and Pregnancy

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Fatty Liver and Pregnancy. Shahin Merat, M.D. Professor of Medicine Digestive Disease Research Institute Tehran University of Medical Sciences. Case 1. 23 y/o female, GA 32 wk First pregnancy, Twin 37 kg before pregnancy Severe nausea and vomiting - PowerPoint PPT Presentation

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Fatty Liver and Prgnancy

Fatty Liver and PregnancyShahin Merat, M.D.Professor of MedicineDigestive Disease Research Institute Tehran University of Medical Sciences

1Case 123 y/o female, GA 32 wkFirst pregnancy, Twin37 kg before pregnancySevere nausea and vomitingAST: 420, ALT: 350, AlkP: 382, Bil: 2.7/1.9Hgb: 11.2, WBC: 11,200, Plt: 107,000Urea: 50, creat: 2.1PreeclampticSono: increased echogenicity

2Case 234 y/o female, GA 2372 kg before pregnancyMild nausea and vomitingAST: 100, ALT: 130, AlkP: 340, Bil: 1.3/0.7Hgb: 11.2, WBC: 9,300, Plt: 249,000Urea: 22, creat: 0.7Diabetes of pregnancySono: increased echogenicity3

4/54Acute fatty liver of pregnancy Prevalence: 1 in 7000 to 1 in 20,000 deliveriesIn the second half of pregnancy, usually close to termSome patients may be diagnosed after delivery Over half of patients have preeclampsiaMaternal mortality: 18%Fetal mortality: 23%.Recurrent liver disease in up to 25%.5Acute fatty liver of pregnancy Microvesicular fatty infiltration of hepatocytes without inflammation or necrosis, perhaps due mitochondrial injuryUltrasound detects the increased fat in liver.More frequent in multiple pregnancy, nulliparity, male fetus, or signs of toxemia.Maybe more frequent in underweight mothers6Acute fatty liver of pregnancy

7SymptomsNausea and vomiting (75%)Abdominal pain (50%), AnorexiaJaundice8Lab DataBilirubin usually elevatedAbnormal LFT (up to 1000 IU/L)Platelet count may be decreased, especially if with DICIncreased WBCPT prolongationHypoglycemiaElevations in serum ammoniaARF in up to 60%HyperuricemiaOverlap with HELLPEvidence of liver failure (eg hypoglycemia, encephalopathy)9ComplicationsInfectionIntraabdominal bleedingTransient central DIRenal dysfunctionPancreatitis10TreatmentImmediate terminationSupportive careFFP, platelets, glucose, dialysisUsually stabilize in 7-10 days after deliveryNo liver sequelMight repeat in next pregnancy (up to 25%)1112/54

12Nonalcoholic Steatohepatitis (NASH)Macrovesicular fatPart of the metabolic syndromeThree major factorsObesityDiabetes (or FHx of it)Hyperlipidemia (especially TG)13NASH

14NAFLDSimple Fatty LiverOnly deposition of fat in liverNo inflammationNo fibrosisNot believed to progress to cirrhosisUp to 25 % of some populations!Non-Alcoholic Steatohepatitis (NASH)15/5415NASH - DefinitionModerate to gross macrovesicular fatty change with inflammation (lobular or portal) with or without Mallory bodies, fibrosis, or cirrhosisNegligible alcohol consumption (