Differential Diagnosis for Elevated LFTs in a 6-Week Pregnant Woman
Single Most Likely Diagnosis
- Acute Viral Hepatitis: This is a common cause of elevated liver function tests (LFTs) in pregnant women, especially during the first trimester. Viral hepatitis can be due to hepatitis A, B, C, D, or E, with hepatitis E being particularly severe in pregnant women.
Other Likely Diagnoses
- Hyperemesis Gravidarum: Although primarily known for severe nausea and vomiting, hyperemesis gravidarum can also lead to elevated LFTs due to malnutrition and dehydration.
- Gallbladder Disease: Pregnancy increases the risk of gallstones due to increased bile stasis and cholesterol secretion. Gallbladder disease can cause elevated LFTs, especially alkaline phosphatase.
- Pregnancy-Induced Hypertension: While more commonly associated with later stages of pregnancy, early onset can occur, and liver function can be affected, leading to elevated LFTs.
Do Not Miss Diagnoses
- Acute Fatty Liver of Pregnancy (AFLP): A rare but potentially life-threatening condition that usually occurs in the third trimester but can occasionally present earlier. It's crucial to diagnose AFLP early due to its high morbidity and mortality.
- HELLP Syndrome: A variant of preeclampsia, characterized by Hemolysis, Elevated Liver enzymes, and Low Platelet count. It can present at any time during pregnancy and requires immediate medical attention.
- Budd-Chiari Syndrome: A condition caused by thrombosis of the hepatic veins, which can lead to acute liver failure. It's rare but can be fatal if not promptly diagnosed and treated.
Rare Diagnoses
- Wilson's Disease: A genetic disorder leading to copper accumulation in the liver, which can cause liver dysfunction. It's rare and usually presents in younger individuals but can be considered in pregnant women with unexplained liver disease.
- Autoimmune Hepatitis: A chronic inflammatory liver disease that can present at any age, including during pregnancy. It's less common than other causes of elevated LFTs but should be considered in the differential diagnosis.
- Drug-Induced Liver Injury: Certain medications can cause liver injury, and the risk may be increased during pregnancy due to changes in drug metabolism. A thorough medication history is essential in any pregnant woman with elevated LFTs.