妊娠急性脂肪肝医学ppt课件.ppt

Acute Fatty Liver With Pregnancy Incidence and Characteristics 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% LABORATORY FEATURES Leukocytosis (15~30)*10E9/L, Thrombocytopenia 100*10E9/L , Erythroblast available Liver test abnormalities conjugated hyperbilirubinemia (usually between 5 and 15 mg/dL) modest increases in serum aminotransferases (usually300 IU/L) Urine routine: urine bilirubine (-) Renal dysfunction: UA↑,BUN↑,Scr↑ PT ↑,APTT↑,FIB↓,PLT↓ Continous severe Hypoglycemia Serum NH3↑, Alb ↓ Imaging Techniques Sonography, CT, MRI Histopathology fatty metamorphosis by liver biopsy: The emergency therapeutic decisions usually are made without waiting for a histologically proven diagnosis. The mild jaundice and modest increase in serum aminotransferases are important signs the Pruritus and late occurrence of jaundice and quick recovery of hepatic function after delivery are Complications cerebral edema, renal failure (60%), hypoglycemia (53%), infections (45%) gastrointestinal hemorrhage (33%), coagulopathy (30%), fetal death severe postpartum hemorrhage Intensive medical support: Low-fat, low-protein, high-glucose diet, Glucose infusion, Fresh blood tranfusion, Vitamine C, AA, ATP, Prevent drugs that harms liver We recommend that patients with persistent nausea, vomiting, or epigastric pain in the third trimester receive evaluation of liver enzymes, renal function, and a complete blood count to rule out the diagnosis of acute fatty liver of pregnancy. Acute fatty liver of pregnancy in 3 tertiary care centers. Fesenmeier MF, Coppage KH, Lambers. Am J Obstet Gynecol May 2005; 192(5):1416-9 Summary AFLP is a rare disorder of unknown aetiology that is diagnosed typically in the third trimester or early postpartum period. The obstetric team must have a high index of suspicion of this pathology,