Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0015695 (fatty liver)
 13,941 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Objective: Acute fatty liver of pregnancy (AFLP) is an uncommon, potentially fatal disorder that usually occurs in the late third trimester of pregnancy. We present the first reported case of acute fatty liver in the second trimester of pregnancy.Methods: We report the clinical and laboratory findings in a patient with AFLP who presented in the second trimester of pregnancy.Results: A 37-year-old G5P4 woman presented at 22 weeks gestation (by 18 weeks ultrasound) with nausea and vomiting. She was normotensive, had no proteinuria, had elevated SGOT and SGPT (266 and 261, respectively), negative hepatitis studies and a normal platelet count. She was managed conservatively for presumed cholelithiasis until 24 weeks gestation when she was transferred to our facility because of worsening SGPT and SGPT (368 and 505, respectively), jaundice (total bilirubin of 8.9 mg/dL), hypoglycemia, and laboratory evidence of disseminated intravascular coagulation (DIC) (PT = 18.6, PTT = 56, hypofibrinogenemia and presence of fibrin split products). Ultrasound showed singleton fetus (EFW 450 g) with total placenta previa. Computed tomography scan of the abdomen revealed decreased hepatic density consistent with AFLP. Delivery of a nonviable fetus was effected after transfusion of fresh frozen plasma. Postoperatively, the patient had rapid resolution of DIC, jaundice, and hypoglycemia; liver transaminases normalized 5 days postoperatively and the patient was discharged home in good condition 5 days later.Conclusion: It has been traditionally stated that AFLP occurs in the late third trimester of pregnancy. This case demonstrates that, even in the second trimester of pregnancy, the diagnosis of AFLP should be considered as a cause of deteriorating liver function, jaundice, and DIC.
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PMID:Acute fatty liver in the second trimester of pregnancy. 1083 61

FloSeal (hemostatic gelatin matrix with a human-derived thrombin component; Baxter Healthcare, Deerfield, IL, USA) hemostatic matrix is used as an adjunct to hemostasis when conventional procedures have proved ineffective. In the present case, FloSeal was used in combination with transfusions, NovoSeven (recombinant activated human factor VIIa; Novo Nordisk, Copenhagen, Denmark) and compression to achieve hemostasis in a patient with postpartum bleeding and hypofibrinogenemia due to primary acute fatty liver of pregnancy. The patient presented with signs of acute hepatic failure, modified renal failure and bleeding disorder at week 37 of pregnancy. She suffered persistent hemorrhage after a soft vacuum-assisted delivery. Local hemostasis was achieved, but not maintained and metrorrhagia resumed requiring transfusion. FloSeal was applied intrauterine and to the vaginal walls, and stable hemostasis was achieved after 2 h. At the one-month post-delivery visit, anatomic and physiological status had returned to normal, although the patient had low fibrinogen and prothrombin activity. This case demonstrates the safety and effectiveness of FloSeal in combination with conventional procedures to achieve hemostasis in postpartum bleeding in a patient with hypofibrinogenemia.
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PMID:Use of FloSeal hemostatic matrix in a patient with severe postpartum hemorrhage. 2222 47