A lady presents with Jaundice, abdominal distension and pedal edema after delivering a normal baby. Her clinical condition deteriorates with increasing abdominal distension and severe ascites. Her bilirubin is 5 mg/dl, S.alkaline phosphatase was 450 u/L and ALT 345 u/L. There is tender hepatomegaly 6 cm below costal margin and ascitic fluid show protein less than 2 mg%. Diagnosis is
a) Acute fatty liver of pregnancy
b) HELLP syndrome
c) Acute fulminant liver failure
d) Budd chiari syndrome
Correct answer : d) Budd chiari syndrome
Acute fatty liver of pregnancy is seen after 34 weeks of pregnancy.
HELLP syndrome is a complication of pre eclampsia. But it usually resolves after delivery.
Acute fulminant liver failure – the symptoms usually subside after delivery
Budd Chiari syndrome – presents within a few weeks after delivey, but it can also occur during pregnancy. Tender hepatomegaly is a hallmark of budd chiari syndrome.