Liver Disease in Pregnancy
Intrahepatic Cholestasis ...
498
Description

Liver Disease in Pregnancy

Intrahepatic Cholestasis of Pregnancy (ICP)

 • Onset/Trimester: 25-32 weeks

 • Typical clinical features: Pruritus, Mild jaundice, Elevated bile acids, Vitamin K ↓

 • Aminotransferases: Mild to 10-20-fold elevation, Bilirubin: <5 mg/dL

 • Hepatic imaging: Normal

 • Histology: Normal-mild cholestasis, no necrosis

HELLP Syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets)

 • Onset/Trimester: 3 or post-partum

 • Typical clinical features: Hemolysis, Thrombocytopenia(<50,000 often)

 • Aminotransferases: Mild to 10-20-fold elevation, Bilirubin: <5 mg/dL unless massive necrosis

 • Hepatic imaging: Hepatic infarcts, Hematomas, rupture

 • Histology: Patchy/extensive necrosis and hemorrhage

Acute Fatty Liver of Pregnancy (AFLP)

 • Onset/Trimester: 3 or post-partum

 • Typical clinical features: Liver failure with coagulopathy, encephalopathy, hypoglycemia. DIC

 • Aminotransferases: 300-500 typical but variable ++, Bilirubin: often <5 mg/dL, higher if severe

 • Hepatic imaging: Fatty infiltration

 • Histology: Microvesicular fat in zone 3



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Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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