Patient's question:
Because it was detected that there is acute fatty liver during pregnancy, but some symptoms of the disease are very similar to this, worried about easy confusion.Doctor's answer:
Hello, Acute Fatty Liver of Pregnancy (AFLP) can be easily confused with other symptoms, which are detailed as follows:1. Acute Severe Viral Hepatitis: Liver failure is the primary manifestation of acute severe viral hepatitis, and it is clinically very similar to AFLP, requiring special attention for differentiation. Serological immune tests for acute severe viral hepatitis are often positive (including detection of hepatitis virus antigens and antibodies); transaminase levels are extremely elevated, often >1000 U/L; and urine bilirubin is positive. Blood uric acid levels do not increase significantly, white blood cell count is normal, and renal function abnormalities appear later. Peripheral blood smears show no reticulocytes or polychromatophilic cells. Liver histology reveals widespread and extensive hepatocyte necrosis and destruction of liver lobular structure.
2. Intrahepatic Cholestasis of Pregnancy: Intrahepatic cholestasis of pregnancy is characterized by pruritus, elevated transaminases, jaundice, and elevated bile acids, whereas AFLP does not present with pruritus or elevated bile acids. The histological changes in cholestasis of pregnancy primarily involve bile stasis in the central hepatic capillaries and bile deposition in placental tissue. In contrast, AFLP shows mainly fat droplet infiltration in hepatocytes, with no significant changes in the placenta.
3. Hypertensive Disorders of Pregnancy (HDP) Liver Damage and HELLP Syndrome: In AFLP, renal tubular epithelial cells accumulate free fatty acids, leading to impaired tubular reabsorption, resulting in water and sodium retention, which manifests as nausea, vomiting, hypertension, proteinuria, and edema—similar to symptoms of HDP. Severe HDP can also cause dysfunction in liver, kidney, and coagulation functions. When HDP progresses to HELLP syndrome, its clinical and laboratory findings are highly similar to AFLP. The differentiation between the two must be given clinical attention. HDP preeclampsia and HELLP syndrome rarely present with hypoglycemia and hyperammonemia, which are not only important differential points but also markers of AFLP severity, indicating liver failure and poor prognosis. Ultrasound and CT scans of the liver region are helpful for differential diagnosis, but definitive diagnosis relies on liver biopsy. HDP preeclampsia rarely leads to liver failure or hepatic encephalopathy, with histological findings showing periportal hemorrhage, fibrin deposition in liver sinusoids, and hepatocyte necrosis; liver tissue also shows inflammatory cell infiltration. Immunohistochemical examination of liver tissue shows prominent staining for tumor necrosis factor (TNF) and neutrophil elastase.