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AFLP — RACP Adult Medicine MCQ

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HardGastroenterologyAFLPRACP Adult Medicine

A 32-year-old woman at 36 weeks gestation presents with malaise, nausea, jaundice, and confusion. LFTs: bilirubin 120 μmol/L, ALT 350 U/L. She has hypoglycaemia (glucose 2.0 mmol/L), elevated ammonia, DIC (fibrinogen 0.6 g/L, platelets 80 × 10⁹/L), and AKI. She has no hypertension. What is the most likely diagnosis?

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Correct answer: B — Acute fatty liver of pregnancy

Hepatic failure with hypoglycaemia (key differentiator from HELLP), hyperammonaemia, DIC, and AKI in the third trimester without hypertension is acute fatty liver of pregnancy (AFLP). Swansea criteria aid diagnosis. AFLP has significant maternal mortality (~10%) if not recognised and delivered urgently. Screen neonate for LCHAD deficiency (associated genetic link). Recovery typically occurs within days-weeks of delivery.

Reference: SOMANZ – 2023 – AFLP; Swansea Criteria