HELLP vs Acute Fatty Liver vs Intrahepatic cholestasis of pregnancy - USMLE Forums
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Old 07-21-2012
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Liver HELLP vs Acute Fatty Liver vs Intrahepatic cholestasis of pregnancy

Please tell clues in question stems to differentiate between HELLP from Acute Fatty Liver of Pregnancy (AFLP) from Intrahepatic cholestasis of pregnancy
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Old 07-21-2012
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intense itching

Quote:
Most women with this condition present in third trimester with intense itching without a rash. Generally, the itching is localized to the abdomen, legs, palms, and soles, but can be generalized.

Hallmarks of ICP include the following symptoms:
Most common:
Itching, in particular but not limited to that of the palms of the hands and soles of the feet, without presence of a rash
Itching that increases in the evening
Itching that does not respond favorably to anti-histamines or other anti-itch remedies
Often, elevated LFT results as well as serum bile acid counts
Deranged clotting, which requires Vitamin K
Quote:
The diagnosis of acute fatty liver of pregnancy is usually made on clinical grounds by the treating physician, but differentiation from other conditions affecting the liver may be difficult.[1] The diagnosis of acute fatty liver of pregnancy is suggested by jaundice with a lesser elevation of liver enzymes, elevated white blood cell count, disseminated intravascular coagulation, and a clinically unwell patient
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Old 07-21-2012
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to add...always look out for HELLP + hypoglycemia + hyperammonemia= AFLP (approx)
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Old 07-22-2012
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In a nutshell:

Acute fatty liver of pregnancy>>>>>Hepatitis featues (disordered metabolism of fatty acids by mitochondria caused by deficiency in the LCHAD enzyme).

Intrahepatic cholestasis of pregnancy>>>>>> Obstructive features (cholestasis by reduced bile acid uptake by hepatocytes).

HELLP syndrome >>>>>>>>> Liver injury features (a microangiopathic hemolytic anemia, liver cells suffer ischemia, leading to periportal necrosis)
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Old 10-18-2015
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Thanks guys this differentiation really helped me a lot!!!
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