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Hepatic Disease Associated with Pregnancy
Pre-eclampsia Hypertension, proteinuria, dependent pitting edema in the third trimester HELLP syndrome hemolytic anemia with schistocytes, elevated liver enzymes, low platelet (due to DIC) Morphology: fibrin deposition in periportal sinusoids hemorrhage into space of Disse periportal hepatocellular coagulative necrosis
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Congested liver of HELLP syndrome
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Hepatic Disease Associated with Pregnancy
Acute fatty liver of pregnancy (AFLP) sub-clinical hepatic dysfunction to hepatic failure, coma and death Abnormality in beta-oxidation of fatty acids 3rd trimester; with multiple metabolic defects diagnosis depends on: high index of suspicion characteristic microvesicular steatosis demonstrated on frozen tissue sections OR with stain (oil red-O or Sudan black) Treatment: termination of pregnancy
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Acute fatty liver of pregnancy: lobular parenchyma characterized by microvesicular steatosis and a small number of lymphocytes. (H&E)
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Hepatic Disease Associated with Pregnancy
Intrahepatic cholestasis of pregnancy Characteristics: onset of pruritus in 3rd trimester darkening of urine with occ. light stools jaundice – conjugated hyperbilirubinemia Mechanism: altered hormonal state + biliary secretion defects cholestasis Increased incidence of fetal distress, stillbirth and prematurity
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