Liver disease
Catherine Nelson-Piercy in Handbook of Obstetric Medicine, 2020
Hyperemesis with severe or protracted vomiting in early pregnancy, sufficient to cause fluid, electrolyte and nutritional disturbance, may be associated with abnormal liver function tests in up to 50% of cases. Worldwide, viral hepatitis is the commonest cause of hepatic dysfunction in pregnancy. Causes include: With the important exception of hepatitis E virus and herpes simplex infection, the clinical features of viral hepatitis in the pregnant woman do not differ from those in the non-pregnant woman. The pathogenesis involves a predisposition to the cholestatic effect of increased circulating oestrogens, and progestogens may also play a role. Radiological evaluation with magnetic resonance imaging, computerized tomography or US may sometimes show hepatic steatosis, but the liver may appear normal (as the fat is microvesicular). Recurrence is particularly likely in women who are heterozygous for disorders for fatty acid oxidation, so screening for long-chain 3-hydroxy-acyl-coenzyme a dehydrogenase deficiency and other fatty acid oxidation disorders may be indicated.
Acute Fatty Liver of Pregnancy
Malik Goonewardene in Obstetric Emergencies, 2021
Acute fatty liver of pregnancy (AFLP) is a condition that is unique to pregnancy which may result in fulminant hepatic failure and, if untreated, carries a high risk of maternal and perinatal morbidity and mortality. Acute fatty liver of pregnancy is more frequent in primigravida, older women, women with low Body Mass Index, multiple pregnancy and apparently, also in the presence of a male fetus. Steatosis of the liver impairs liver function and can activate fulminant liver failure and multiorgan dysfunction, which may result in the death of the woman and the fetus. Liver injury can be complicated by haematoma, infarction or rupture. The non-specificity of these symptoms and their resemblance to usual symptoms in pregnancy make an early diagnosis of AFLP difficult. The majority of liver function tests remain within the non-pregnant range during pregnancy, except for alkaline phosphatase and alpha-fetoprotein which increase due to their production by the placenta and albumin which decreases due to haemodilution.
Pre-eclampsia (PET)
Maureen Boyle, Judy Bothamley in Critical Care Assessment by Midwives, 2018
Along with haemorrhage, pre-eclampsia (PET) and associated conditions are likely to be the conditions midwives will most commonly care for in a critical care situation. Predisposing it is acknowledged that PET is a very unpredictable disease and may occur in those with no predisposing factors, it can be useful to identify those at increased risk of developing this condition. Haemolysis, Elevated Liver enzymes and Low Platelets (HELLP) syndrome is a serious complication usually associated with PET but in which many women do not develop significant hypertension or proteinuria. The most common presenting signs for those women with HELLP include epigastric or abdominal pain, nausea or vomiting, headache, visual changes, new-onset hyper-tension and/or new-onset proteinuria. The physiology of acute fatty liver of pregnancy (AFLP) is not yet clearly identified, but it is thought that AFLP may be a variant of PET. It is characterised by hepatic microvesicular steatosis associated with mitochondrial dysfunction.
The cheating liver: imaging of focal steatosis and fatty sparing
Published in Expert Review of Gastroenterology & Hepatology, 2016
Marco Dioguardi Burgio, Onorina Bruno, Francesco Agnello, Chiara Torrisi, Federica Vernuccio, Giuseppe Cabibbo, Maurizio Soresi, Salvatore Petta, Mauro Calamia, Giovanni Papia, Angelo Gambino, Viola Ricceri, Massimo Midiri, Roberto Lagalla, Giuseppe Brancatelli
Focal steatosis and fatty sparing are a frequent finding in liver imaging, and can mimic solid lesions. Liver regional variations in the degree of fat accumulation can be related to vascular anomalies, metabolic disorders, use of certain drugs or coexistence of hepatic masses. CT and MRI are the modalities of choice for the noninvasive diagnosis of hepatic steatosis. Knowledge of CT and MRI appearance of focal steatosis and fatty sparing is crucial for an accurate diagnosis, and to rule-out other pathologic processes. This paper will review the CT and MRI techniques for the diagnosis of hepatic steatosis and the CT and MRI features of common and uncommon causes of focal steatosis and fatty sparing.
Hepatic steatosis and Type 2 diabetes: current and future treatment considerations
Published in Expert Review of Cardiovascular Therapy, 2011
Hepatic steatosis, considered the first step in the pathophysiologic continuum of non-alcoholic fatty liver disease, is estimated to afflict 30% of the US population and over 75% of patients with Type 2 diabetes. Given the expected rise in the prevalence of obesity and Type 2 diabetes in the following decades, hepatic steatosis will, if not already, become an epidemic. The consequences of hepatic steatosis are numerous, and range from progression to chronic liver disease, with its associated morbidity and mortality, to worsening insulin resistance and Type 2 diabetes, as well as being an independent contributor to cardiovascular disease. All such consequences are more likely to occur in patients with Type 2 diabetes who are already at high risk of cardiovascular events. In this article we review the evidence behind the available therapeutic options for hepatic steatosis, and identify challenges and unmet needs in the field.
Organelle dysfunction in hepatitis C virus-associated steatosis: anything to learn from nonalcoholic steatohepatitis?
Published in Expert Review of Gastroenterology & Hepatology, 2011
Venessa Pattullo, Mark W Douglas, Jacob George
Nonalcoholic fatty liver disease (NAFLD) spans a pathological spectrum from nonalcoholic steatosis to steatohepatitis. The pathophysiology of this disorder is complex, but includes insulin resistance and disrupted lipid and carbohydrate homeostasis, which at a subcellular level results in oxidative stress, free fatty acid-mediated lipotoxicity, defects in mitochondrial function, endoplasmic reticulum stress and cytokine-mediated toxicity. In chronic hepatitis C (CHC), systemic metabolic derangements similar to NAFLD may be operative, but in addition, virus-specific factors contribute to steatosis. The mechanisms for steatosis in CHC appear to share common pathways with those observed in NAFLD. This article outlines our current understanding of the subcellular mechanisms of steatosis in NAFLD and CHC, including their similarities and differences.