Differential Diagnosis for a 28-year-old Pregnant Woman with Nausea, Vomiting, and Right Upper Quadrant Pain
- Single most likely diagnosis:
- A. Acute microvesicular fatty infiltration of hepatocytes (Acute Fatty Liver of Pregnancy): This condition is characterized by nausea, vomiting, abdominal pain, and elevated liver enzymes, which are all present in this patient. The low platelet count and coagulopathy also support this diagnosis.
- Other Likely diagnoses:
- C. Intrahepatic cholestasis: This condition is common in pregnancy and can cause pruritus, nausea, vomiting, and abdominal pain. However, the liver function tests and coagulopathy in this patient are more severe than typically seen in intrahepatic cholestasis.
- D. Premature placental separation (Placental Abruption): Although this condition can cause abdominal pain and nausea, it typically presents with vaginal bleeding and more severe fetal distress, which are not present in this case.
- Do Not Miss diagnoses:
- E. Systemic microangiopathy and platelet consumption (HELLP syndrome): This condition is a variant of preeclampsia and can cause nausea, vomiting, abdominal pain, and elevated liver enzymes. It is a life-threatening condition that requires prompt diagnosis and treatment.
- B. Antibody-mediated platelet destruction (Immune Thrombocytopenic Purpura): Although this condition can cause thrombocytopenia, it is less likely in this case due to the presence of other symptoms such as nausea, vomiting, and abdominal pain.
- Rare diagnoses:
- Other rare causes of liver dysfunction in pregnancy, such as viral hepatitis or autoimmune hepatitis, could be considered but are less likely given the patient's presentation and laboratory results.