Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

1200 Preeclamptic Liver Disease/HELLP

Signs and Symptoms

■Often none, other than hypertension. Rare jaundice

tests

Laboratory

■Hemolysis, mild (spur cells on smear)

■Elevated liver tests (AST <ALT)

■Low platelets (100,000)

■Normal PT/INR, fibrinogen, unless very severe

■Elevated or normal uric acid (usually low in pregnancy)

Liver Biopsy

■Periportal hemorrhage and fibrin deposits, may have small amounts

of fat. Usually not needed, base diagnosis on clinical grounds

differential diagnosis

■R/O acute fatty liver of pregnancy (prolonged PT, low fibrinogen)

■Consider viral hepatitis (+serologies, risk factors)

■R/O cholestasis of pregnancy (+hx of itching)

management

What to Do First

■Consult with obstetrician, consider terminating pregnancy

General Measures

■Fetal monitoring, follow PT

specific therapy

■Delivery; temporizing, corticosteriods only with extreme caution

follow-up

■Monitor AST, ALT, PT

■Imaging with CT or MRI to r/o hepatic hematoma with rupture or

infarct

■Expect full recovery

complications and prognosis

■Consider progression to hepatic rupture (shock, hemoperitoneum),

infarct (marked ALT elevations > 4,000, geographic infarcts on CT or

MRI)

■No sequellae, perhaps increased risk for repeat with subsequent

pregnancies