AFLP - Acute Fatty Liver With Pregnancy Dr Mohammed Abdalla...

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Acute Fatty Liver With Pregnancy Dr. Mohammed Abdalla Egypt, Domiat General Hospital
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Historical points (AFLP) was first identified by Sheehan in 1940 The name AFLP has replaced earlier terminologies, “ acute yellow atrophy of pregnancy” and “acute obstetric fatty metamorphosis of liver”
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Incidence and Characteristics once in every 7,000 to 11,000 deliveries
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Acute fatty liver of pregnancy most frequently complicates the third trimester and is commonly associated (or complicated ) with preeclampsia (50 to 100 percent). Riely CA. Hepatic disease in pregnancy. Am J Med 1994;96(1A):18S-22S. 3. Samuels P, Cohen AW. Pregnancies complicated by liver disease and liver dysfunction. Obstet Gynecol Clin North Am 1992;19:745-63 Incidence and Characteristics
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Incidence : 1/7000 -11,000 Age, (mean, range) 26 (16-39) Primiparous (%): 67 Male baby (%) :60 Onset week of pregnancy :33% (28-38) Mortality (%): ( Maternal )18% - ( Fetal) 47% Incidence and Characteristics
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Liver Function Tests liver function tests” describes a panel of laboratory tests profiling discrete aspects of liver function No single liver function test is available to quantify liver disease
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aspartate aminotransferase (AST) and alanine aminotransferase (ALT) evaluate Liver cell injury or necrosis Liver Function Tests Marked ALT elevation (viral hepatitis) Moderate ALT elevation (drug-induced hepatotoxicity, hyperemesis gravidarum, cholelithiasis, HELLP .AFLP.)
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evaluate liver synthetic function (are depressed in cirrhosis or severe acute liver disease ) Liver Function Tests albumin level prothrombin time
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alkaline phosphatase, bilirubin, gamma glutamyl transpeptidase Liver function tests In normal pregnancies, alkaline phosphatase levels may be elevated three- to fourfold, secondary to placental alkaline phosphatase levels evaluate Cholestasis and biliary obstruction
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Pathogenesis The etiology is not known precisely.
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A genetic component has been suggested Recent research suggests that AFLP is associated with a Glu474Gln mutation in the long-chain 3-hydroxy acyl-coenzyme A dehydrogenase (LCHAD), a fatty acid β oxidation enzyme. Matern D, Hart P, Murtha AP, Vockley J, Gregersen N, Millington DS, et al. Acute fatty liver of pregnancy associated with short-chain acyl- coenzyme A dehydrogenase deficiency.
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