See Explanation
[]
Obstetrics
prenatal care
acute fatty liver of pregnancy
A 32-year-old gravida 1 para 0 woman at 34 weeks of gestation is admitted to the high-risk obstetrics ward complaining of a 36-hour history of progressively worsening nausea, intractable vomiting, and dull right upper quadrant pain radiating to her back. She also reports increasing fatigue and mild yellowish discoloration of her skin and eyes over the past 12 hours. Her symptoms have not responded to oral analgesics or antiemetics. She has no significant past medical history. On admission, her temperature is 37.9°C, blood pressure is 145/85 mmHg, pulse is 100/min, and respirations are 14/min. Fetal heart rate monitoring shows a baseline of 155/min with reduced variability. Physical examination reveals mild jaundice, diffuse abdominal tenderness, particularly in the epigastric and right upper quadrant regions, without rebound or guarding. The uterus is soft and non-tender to palpation. Her reflexes are 2+. Urinalysis is negative for protein. Considering her clinical presentation and laboratory findings, what is the most likely diagnosis and the immediate definitive management strategy?
| Lab Parameter | Value | Reference Range |
|---|---|---|
| Hemoglobin | 11.8 g/dL | 11.5-15.5 g/dL |
| Leukocyte count | 16.5 x 10^9/L | 4.5-11.0 x 10^9/L |
| Platelet count | 45 x 10^9/L | 150-450 x 10^9/L |
| Sodium | 143 mmol/L | 135-145 mmol/L |
| Potassium | 4.2 mmol/L | 3.5-5.0 mmol/L |
| Chloride | 100 mmol/L | 98-107 mmol/L |
| Creatinine | 95 µmol/L | 44-97 µmol/L |
| Blood Urea Nitrogen (BUN) | 4.0 mmol/L | 2.5-7.1 mmol/L |
| Glucose | 2.5 mmol/L | 3.9-5.6 mmol/L |
| Ammonia | 150 µmol/L | 11-32 µmol/L |
| Total Bilirubin | 130 µmol/L | 5.1-20.5 µmol/L |
| Aspartate Aminotransferase (AST) | 135 U/L | 10-40 U/L |
| Alanine Aminotransferase (ALT) | 250 U/L | 7-56 U/L |
| Prothrombin Time (PT) | 18.5 seconds | 11-13.5 seconds |
| Activated Partial Thromboplastin Time (aPTT) | 42 seconds | 25-35 seconds |
| Fibrinogen | 1.4 g/L | 2.0-4.0 g/L |
Edit question