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Query: UMLS:C0015695 (fatty liver)
 13,941 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Liver diseases in pregnancy can occur as a complication of gestation or independently. Acute fatty liver of pregnancy is a rare disease of unknown etiology specifically associated to gestation. The frequency is increased in the first pregnancy, in the last trimester and in multiple pregnancies. Because of the high maternal and perinatal mortality early diagnosis is necessary for prompt termination of pregnancy. This case report is intended to facilitate the differentiation between acute fatty liver of pregnancy and other liver diseases in pregnancy. The differential diagnoses include preeclampsia, HELLP syndrome, intrahepatic cholestasis of pregnancy and acute viral hepatitis.
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PMID:[Acute fatty liver of pregnancy]. 154 19

Diseases of intermediary metabolism include ketosis and fatty liver of dairy cattle and pregnancy toxemia of ewes. These conditions occur when there is a failure of the homeostatic mechanisms regulating the mobilization of fats and the conservation of carbohydrates. The therapeutic approach is to reestablish the normal homeostatic patterns of fuel utilization. Suppression of excessive ketogenesis is the most important factor in reestablishing homeostasis. Ketogenesis can be suppressed by a number of therapeutic agents that act either by suppressing the mobilization of fatty acids or by inhibiting the transport of fatty acids into the hepatic mitochondria, the site at which fatty acids are converted to ketone bodies. Useful therapies include bolus glucose infusions, glucose precursors, and glucocorticoids.
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PMID:Therapy of diseases of ruminant intermediary metabolism. 155 19

Obstetrical deaths at the Mount Hope Women's Hospital, Trinidad, were reexamined from records over 1981-1990, and discussed under the categories poor prenatal care, clinical management or provision of medical facilities. There were 19 obstetrical deaths out of 57,012 live births, giving a maternal mortality rate of 33.3/100,000 in this tertiary care hospital. Most of the deaths occurred in women aged 30-34, para 5 or more. 73.7% were related to hypertension in pregnancy, 8 with severe eclampsia and 6 with eclampsia, and the other 5 were due to placental abruption, postpartum hemorrhage, anesthesia complication, acute fatty liver and amniotic fluid embolism. Cases classified as substandard care included the 14 women with hypertensive disorders, none of whom had antenatal care at this specialized unit. In 3 referral by the practitioner was delayed, and 3 others did not comply. A woman listed under failed medical facilities had massive abruptio placenta, and no fresh blood was available, and another had an anaphylactic reaction to a mismatched blood transfusion. Other avoidable deaths were 3 associated with general anesthesia: one woman having emergency cesarean section for severe pre-eclampsia had anoxia and severe brain damage; another short, obese woman had cardiac arrest during a failed attempt at endotracheal intubation; a third died from aspiration of gastric fluid. The high mortality among women with hypertensive disorders is regrettable, considering lack of referral to this specialized unit, but the prognosis of eclamptics even with expert aggressive treatment is poor. This maternal mortality rate ranks midway between those of developed countries and developing countries. It is about four times that of the U.S.
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PMID:Maternal mortality at Mount Hope Women's Hospital, Trinidad. 195 23

Magnetic resonance imaging (MRI) and computed tomography were used to diagnose fatty liver of pregnancy in a patient with preeclampsia and thrombotic thrombocytopenia purpura. The clinical course included multiple system failure that necessitated mechanical ventilation, dialysis, and plasmapheresis. The MRI picture is described in this entity for the first time. Both imaging techniques are discussed and compared.
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PMID:Magnetic resonance imaging and computed tomography scan for the diagnosis of acute fatty liver of pregnancy. 162 28

Pregnancy is associated with altered liver function, particularly in serum enzymes. Anabolic steroids are responsible to some degree in mediating the physiologic and biochemical changes that occur during an uncomplicated pregnancy. However, several liver disorders are unique to pregnancy and include intrahepatic cholestasis of pregnancy, acute fatty liver of pregnancy, and hepatic dysfunction associated with pre-eclampsia and eclampsia. It is imperative for the clinician to diagnose these liver disorders in a timely manner and to institute appropriate management as maternal and fetal outcome are affected in an adverse manner if these conditions are left untreated.
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PMID:Liver disease associated with pregnancy. 220 94

A woman presented in the third trimester of pregnancy with epigastric pain, elevated liver enzymes, and thrombocytopenia. The frozen-section liver biopsy findings were compatible with acute fatty liver of pregnancy. The light and electron microscopic findings were those of preeclampsia. All clinical and laboratory abnormalities resolved before delivery.
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PMID:Elevated liver enzymes and thrombocytopenia in the third trimester of pregnancy: an unusual case report and a review of the literature. 266 87

Acute renal failure is a most challenging clinical problem when it occurs in pregnancy. It requires an understanding of the normal physiology of the kidney in pregnancy and the natural history of different underlying renal diseases when pregnancy occurs. Because patients with chronic renal disease may present with worsening proteinuria, hypertension, and renal function, these disorders must be excluded from those conditions that cause acute deterioration of renal failure in otherwise normal women during pregnancy. As in all patients who develop acute renal failure, prerenal and obstructive causes must be excluded. Particularly important causes of prerenal azotemia in pregnancy include hyperemesis gravidarum and uterine hemorrhage, especially if it is unsuspected as in abruptio placentae. Infectious causes of acute renal failure in the pregnant woman include acute pyelonephritis and septic abortion. The clinical presentation of both these conditions should be apparent, and appropriate diagnosis and treatment can then be promptly instituted. Renal cortical necrosis is another cause of renal failure that occurs more frequently in pregnancy, and it must be differentiated from the many causes of acute tubular necrosis that may be associated with pregnancy. Those conditions that cause renal failure unique to pregnancy must always be considered when renal function deteriorates in the last trimester or the postpartum period. Severe preeclampsia, acute fatty liver of pregnancy, and idiopathic postpartum acute renal failure may all present similar complications, but the approach to each of these clinical disorders must be individualized. By understanding the causes of renal functional deterioration in pregnancy, a logical differential diagnosis can be established, allowing appropriate therapeutic decisions to preserve both maternal and fetal well-being.
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PMID:Acute renal failure in pregnancy. 305 11

To study the interrelationship between preeclampsia, the syndrome of hemolysis, elevated liver enzymes, and low platelet count, and acute fatty liver of pregnancy, 41 liver specimens from 41 preeclamptic women with and without liver dysfunction were examined for the amount of fat deposited in hepatocytes. All 41 specimens stained with oil red O on frozen sections showed a significant amount of microvesicular fat droplets in varying degrees. In contrast, only 11 of the 41 stained conventionally (with hematoxylin-eosin) showed significant fatty infiltration. The density of hepatocellular fat correlated positively with plasma urate concentration and negatively with the platelet count. These findings suggest that preeclampsia may be one of several microvesicular fatty diseases of the liver and that acute fatty liver of pregnancy may be the most severe form.
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PMID:Preeclampsia: a microvesicular fat disease of the liver? 318 35

A new case of a preeclamptic who developed the diagnostic criteria for the hemolytic uremic syndrome and who was treated with plasmapheresis is presented. Fourteen case reports of gravidas with preeclampsia treated by exchange plasmapheresis with fresh frozen plasma for maternal indications are reviewed. Only four cases had been reported as eclampsia or preeclampsia. The other cases had been reported as thrombotic thrombocytopenic purpura, the postpartum hemolytic uremic syndrome, or fatty liver of pregnancy. The possible role of plasmapheresis in treating very carefully selected cases of preeclampsia is discussed.
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PMID:Possible role for exchange plasmapheresis with fresh frozen plasma for maternal indications in selected cases of preeclampsia and eclampsia. 372 46

Renal morphological changes are described in four cases of idiopathic acute fatty liver of pregnancy. Light microscopy showed mild glomerular hypercellularity together with thickening and narrowing of capillary loops. In two cases the tubules showed lipid accumulation which included free fatty acids. Electron microscopy showed mesangial cell interposition between the basal lamina and endothelial cells. Glomeruli contained electron dense material in a subendothelial location. Immunoperoxidase stains showed diffuse segmental deposits of fibrin/fibrinogen and IgM in relation to glomerular capillary loops. IgG and C3 were found in three and two cases respectively. Pathogenetic mechanisms including disseminated intravascular coagulation, immune complex deposition and alterations in lipid metabolism are discussed. Coexistent preeclampsia is considered to be an unlikely explanation for the changes. There is a possibility that these renal changes comprise an early feature of idiopathic acute fatty liver of pregnancy.
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PMID:Renal morphological changes in idiopathic acute fatty liver of pregnancy. 638 13


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