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Acute Fatty Liver of Pregnancy — RACP Adult Medicine MCQ

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HardGastroenterologyAcute Fatty Liver of PregnancyRACP Adult Medicine

A 35-year-old woman at 36 weeks gestation presents with jaundice, nausea, and abdominal pain. She has polydipsia and polyuria. Labs: bilirubin 95 μmol/L, ALT 450 U/L, ammonia elevated, glucose 2.5 mmol/L (hypoglycaemia), fibrinogen 0.8 g/L (DIC), creatinine 200 μmol/L. Platelets are 100 × 10⁹/L. What is the most likely diagnosis?

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Correct answer: A — Acute fatty liver of pregnancy

Jaundice with hepatic failure features (hypoglycaemia, elevated ammonia, DIC, renal failure) in late pregnancy is acute fatty liver of pregnancy (AFLP). Key differentiator from HELLP: AFLP has hypoglycaemia, hyperammonaemia, and DIC (HELLP typically does not). Swansea criteria aid diagnosis. AFLP is a medical emergency requiring urgent delivery. Screen for LCHAD deficiency in the neonate.

Reference: SOMANZ – 2023; Swansea Criteria