Differential Diagnosis for Epigastric Abdominal Pain and Elevated LFT in a 21-Week Pregnant Female
Single Most Likely Diagnosis
- Intrahepatic Cholestasis of Pregnancy (ICP): This condition is characterized by pruritus and elevated liver enzymes, often presenting in the second or third trimester. The symptoms and elevated LFTs in a pregnant woman at 21 weeks make ICP a strong consideration.
Other Likely Diagnoses
- Gallstones: Pregnancy increases the risk of gallstone formation due to bile stasis and increased cholesterol secretion. Epigastric pain and elevated LFTs could be indicative of gallstones, especially if there's a history of similar symptoms.
- Acute Viral Hepatitis: Although less common, viral hepatitis can cause elevated liver enzymes and abdominal pain. The diagnosis would depend on serological tests and clinical presentation.
- Preeclampsia: While more commonly associated with hypertension and proteinuria, preeclampsia can also present with epigastric pain and elevated liver enzymes, particularly in severe cases.
Do Not Miss Diagnoses
- HELLP Syndrome: A variant of preeclampsia, characterized by Hemolysis, Elevated Liver enzymes, and Low Platelet count. It's crucial to diagnose promptly due to its high morbidity and mortality.
- Acute Fatty Liver of Pregnancy (AFLP): A rare but life-threatening condition that can present with abdominal pain, elevated liver enzymes, and coagulopathy. Early recognition is critical for management.
- Hepatic Rupture or Infarction: Although rare, these conditions can occur in pregnancy, especially in the setting of preeclampsia or other vascular diseases, and require immediate medical attention.
Rare Diagnoses
- Budd-Chiari Syndrome: A condition caused by thrombosis of the hepatic veins, leading to liver dysfunction. It's rare but should be considered in the differential diagnosis of liver disease in pregnancy.
- Wilson's Disease: A genetic disorder leading to copper accumulation in the liver. Pregnancy can precipitate symptoms in undiagnosed cases, presenting with liver dysfunction and potentially neuropsychiatric symptoms.
- Autoimmune Hepatitis: Although rare, autoimmune hepatitis can present during pregnancy and requires immunosuppressive treatment to manage the disease and prevent complications.