Snapshot A 30-year-old G1P0 presents to the emergency room with her husband. She is pregnant with twins at 36 weeks gestation. Earlier that night, her husband noticed that she suddenly seemed more yellow. She then complained of right upper quadrant pain, nausea, and general feeling of malaise. She had not taken any medications. On exam, she is alert and oriented only to person, and she is found to have elevated liver enzymes, coagulopathy, and hypoglycemia. A hepatic ultrasound rules out trauma but doesn’t yield much more information. She is taken to the operating room for a cesarean section immediately for suspected acute fatty liver of pregnancy. Introduction Overview login to view 1 more bullet Epidemiology Incidence login to view 1 more bullet Demographics login to view 1 more bullet Risk factors login to view 2 more bullets ETIOLOGY Pathogenesis login to view 2 more bullets Presentation Symptoms login to view 7 more bullets Physical exam login to view 5 more bullets Imaging Hepatic ultrasound login to view 4 more bullets Studies Serum labs login to view 8 more bullets Invasive studies login to view 7 more bullets Differential Acetaminophen toxicity login to view 4 more bullets HELLP syndrome login to view 2 more bullets Treatment Medical login to view 6 more bullets Surgical login to view 6 more bullets Complications Maternal and fetal death Acute liver failure login to view 2 more bullets Acute renal failure Encephalopathy Prognosis High risk of maternal and fetal mortality After delivery, maternal prognosis is good