Differential Diagnosis for a 26-year-old Pregnant Woman with Jaundice
Single Most Likely Diagnosis
- Preeclampsia with HELLP syndrome: This condition is characterized by the onset of hypertension and often proteinuria after 20 weeks of gestation, and can lead to liver dysfunction and coagulopathy. The patient's high blood pressure (165/100 mm Hg), elevated liver enzymes (AST 485, ALT 500), and bilirubin level (total bilirubin 4) are consistent with this diagnosis. The presence of jaundice and elevated alkaline phosphatase also supports liver involvement.
Other Likely Diagnoses
- Acute viral hepatitis: Although less likely given the patient's presentation, acute viral hepatitis (e.g., hepatitis A, B, or E) can cause jaundice and elevated liver enzymes during pregnancy. However, the absence of other symptoms such as nausea, vomiting, and abdominal pain makes this less likely.
- Intrahepatic cholestasis of pregnancy (ICP): ICP is a condition characterized by pruritus and elevated bile acids, often accompanied by elevated liver enzymes. While it's a possibility, the patient's presentation with jaundice and significant hypertension points more towards preeclampsia with HELLP syndrome.
Do Not Miss Diagnoses
- Acute fatty liver of pregnancy (AFLP): Although rare, AFLP is a life-threatening condition that can present with jaundice, elevated liver enzymes, and coagulopathy. It is crucial to consider AFLP due to its high mortality rate if left untreated.
- Hemolysis, Elevated Liver enzymes, and Low Platelet count (HELLP) syndrome without preeclampsia: While the patient has hypertension, HELLP syndrome can occasionally occur without significant hypertension. It's essential to monitor for signs of hemolysis and thrombocytopenia.
Rare Diagnoses
- Budd-Chiari syndrome: This rare condition involves hepatic vein thrombosis, which can cause jaundice and elevated liver enzymes. However, it is less likely given the patient's age and lack of other risk factors for thrombosis.
- Wilson's disease: A genetic disorder that can cause liver dysfunction and elevated liver enzymes. Although possible, the acute presentation and lack of other neurological symptoms make this diagnosis less likely.