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Table 32.7

Acute Fatty Liver of Pregnancy

ElementComment
SymptomsGradual onset of nausea, anorexia and malaise, severe vomiting and/or abdominal pain, polyuria, polydipsia
Examination findingsHypertension and proteinuria usually mild, RUQ/epigastric discomfort, jaundice or ascites
Blood testsLeukocytosis, coagulopathy, acute kidney injury, elevated transaminases, hypoglycaemia, elevated urate, elevated ammonia
Swansea criteria for diagnosisThe presence of six or more features (in the absence of an alternative diagnosis):
VomitingLeucocytosis
Abdominal painElevated transaminases
Polydipsia/polyuriaAcute kidney injury
EncephalopathyElevated ammonia
Elevated bilirubinHypoglycaemia
Elevated urateCoagulopathy
Ascites or bright liver on ultrasoundMicrovesicular steatosis on liver biopsy