Differential Diagnosis
- Single most likely diagnosis
- Preeclampsia with HELLP syndrome: The patient's rapid increase in blood pressure, severe abdominal pain, and laboratory results showing thrombocytopenia (low platelet count), elevated liver enzymes (AST and ALT), and hemolysis (indicated by low hemoglobin) are all consistent with HELLP syndrome, a complication of preeclampsia.
- Other Likely diagnoses
- Acute fatty liver of pregnancy: The patient's abdominal pain, nausea, vomiting, and elevated liver enzymes could also suggest acute fatty liver of pregnancy, although the presence of hypertension and proteinuria makes preeclampsia with HELLP syndrome more likely.
- Cholestasis of pregnancy: The patient's symptoms of severe itching and abdominal pain, along with elevated alkaline phosphatase and bilirubin, could suggest cholestasis of pregnancy, but the presence of hypertension and thrombocytopenia makes this less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Hepatic rupture: Although rare, hepatic rupture is a life-threatening complication that can occur in pregnant women with preeclampsia or HELLP syndrome, and the patient's severe abdominal pain and tenderness warrant consideration of this diagnosis.
- Pulmonary embolism: The patient's symptoms of nausea, vomiting, and abdominal pain could also be consistent with pulmonary embolism, which is a life-threatening condition that requires prompt diagnosis and treatment.
- Rare diagnoses
- Wilson's disease: Although rare, Wilson's disease is a genetic disorder that can cause liver dysfunction and hemolysis, and could be considered in the differential diagnosis, especially if the patient has a personal or family history of the disease.
- Budd-Chiari syndrome: This rare condition, caused by thrombosis of the hepatic veins, can present with abdominal pain, nausea, and vomiting, and could be considered in the differential diagnosis, especially if the patient has a history of thrombophilia or other risk factors.