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Re: Fatty Liver and diabetes in PregnancyFrom: AGrunebaum@aol.comFri Oct 31 06:42:06 1997
In a message dated 97-10-31 08:08:45 EST, you write: << Listmates, I've got a 23 year old G2P1 who presented with a 10 week pregnancy and a history of insulin requiring gestational diabetes with her first. She complained of RUQ pain and we obtained LFT's and an ultrasound . Hepatic enzymes are elevated and the ultrasound is diffusely enlarged and suggestive of fatty infiltration. Biliary system is OK. She has slightly elevated Fasting blood sugars and she's been started on NPH insulin at bedtime. ?Management strategy? Should we send this patient directly to perinatology? How should she be optimally followed? -- Douglas Krell MD -- MZ >> You cannot make a diagnosis of fatty liver conclusively from ultrasound alone. And so early in pregnancy fatty liver is highly unlikely (impossible?) I would work her up the same way any patient with elevated LFTs is worked up (hepatitis A,B,C, drug induced, etc) including if necessary a liver biopsy, which is really the gold standard to make that diagnosis.
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