This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Gynaecology & Obstetrics
[{'content': 'A 9 month old pregnant lady presents with jaundice and distension, pedal edema after delivering normal baby. Her clinical condition deteriorates with increasing abdominal distension and severe ascites. Her bilirubin is 5 mg/dl, S. alkaline phosphatase was 450u/L and ALT (345lu). There is tender hepatomegaly 6cm below costal margin and ascetic fluid show protein less than 2 mg% Diagnosis is: \nSelect and explain. \nA. Acute fatty liver of pregnancy, B. HELLP syndrome, C. Acute fulminant, liver failure, D. Budd chiari syndrome', 'role': 'user'}, {'content': 'Answer: D \nExplanation: The most common causes of acute severe liver injury in a young pregnant women are:\n\nViral hepatitis (HAV, HBV)\nEclampsia, preeclampsia (HELLP syndrome)\nAcute fatty liver of pregnancy\nBudd-Chiari syndrome.\n\nLet us discuss each option separately\nPreeclampsia and eclampsia/HELLP syndrome:\n\nIt is the most common cause of abnormal liver function test in women.\nAmniotransferases are modestly elevated.\nBut in these cases delivery of the fetus is followed by rapid normalization of the hepatic abnormalities.\nMoreover the question does not mention any history of PIH, hemolysis and thrombocytopenia (HELLP syndrome).\n\nAcute fatty liver of pregnancy:\n\nAcute fatty liver develops in the third trimester.\nJaundice develops a few days after the onset. The serum bilirubin is rarely above 10 mg/dL.\nAlkaline phosphate is markedly elevated.\nAminotransferases are moderately elevated.\nA markedly raised serum ammonia is the most diagnostic finding in establishing the diagnosis of acute fatty liver of pregnancy and symptoms rapidly abate with parturition in most patients.\n\nFulminant hepatic failure:\n\nThe patient presents with features of severe acute hepatitis leading to the development of hepatic encephalopathy within 8 weeks of onset.\nThe bilirubin increases to 20-30 mg/dL.\nThe aminotransferase levels are very high (>1000)\nAlkaline phosphatase moderately elevated.\nDelivery is usually the best treatment.\n\nBudd-Chiari syndrome:\n\nIt is a disorder characterized by thrombotic occlusion of the hepatitis veins.\nIt is a rare complication of pregnancy.\nMost of the cases presents within few weeks of delivery but in several cases onset occurs during pregnancy.\nClinical triad of Budd-Chiari syndrome includes sudden onset of abdominal pain, hepatomegaly and ascites (ascites with high protein content is almost always present) near term or shortly after delivery.\nTender hepatomegaly is one of the hallmark of Budd-Chiari syndrome.\nAminotransferases are mildly elevated.\nJaundice is seen in only half of the cases.', 'role': 'assistant'}]