Can Acute Pancreatitis Cause Acute Fatty Liver of Pregnancy?
No, acute pancreatitis does not cause acute fatty liver of pregnancy (AFLP)—rather, AFLP causes acute pancreatitis as a complication of severe disease. The causal relationship flows in the opposite direction: AFLP is the primary pathology that leads to pancreatitis when hepatic and renal dysfunction develop. 1, 2
Understanding the Causal Relationship
AFLP is the underlying disease process that triggers pancreatitis, not the reverse. 1, 2
- Pancreatitis develops as a complication of AFLP, typically occurring only after the onset of hepatic and renal impairment 1, 3
- When pancreatitis occurs in the context of AFLP, it represents severe disease with multiorgan dysfunction 1, 2
- Pancreatitis associated with AFLP is considered a poor prognostic indicator because it correlates with more adverse maternal outcomes 2
Clinical Presentation and Timing
AFLP occurs almost exclusively in the third trimester (week 29 and beyond) or rarely postpartum, which is when associated pancreatitis would develop. 4, 5
- The initial symptoms of AFLP vary considerably, with nausea and vomiting being most common (23% of cases) 3
- Abdominal pain occurs in both conditions, creating diagnostic overlap and making differentiation challenging 1
- Hepatic encephalopathy is a hallmark finding of AFLP and helps distinguish it from other pregnancy-related conditions 6, 5
Diagnostic Challenges and Overlap
The clinical and laboratory features of AFLP and pancreatitis overlap significantly, making it difficult to determine which condition developed first. 1
- Both conditions present with severe abdominal pain, nausea, and vomiting 1, 3
- Laboratory abnormalities in AFLP include elevated transaminases (AST/ALT typically 200-300 U/L), coagulopathy, and hypoglycemia 3, 6
- Imaging may show both fatty liver infiltration and pancreatic inflammation when pancreatitis complicates AFLP 2
- The Swansea criteria (requiring 6 or more findings including vomiting, abdominal pain, elevated transaminases, hypoglycemia, and coagulopathy) help diagnose AFLP without requiring liver biopsy 5, 6
Management Implications
Regardless of whether pancreatitis is present, management of AFLP requires immediate preparation for delivery—do not delay delivery attempting to differentiate between conditions. 4, 6
- Focus on supportive care, correcting coagulopathy, and preparing for expeditious delivery rather than obtaining liver biopsy for definitive diagnosis 4, 6
- When pancreatitis complicates AFLP, treatment includes blood component transfusions, plasma exchange combined with renal replacement therapy, and supportive measures 2
- ICU admission is required for AFLP with encephalopathy, elevated lactate, or Swansea criteria score >7 6, 5
- Early referral to a transplant center is mandatory for severe hepatic impairment or acute liver failure 6
Long-term Sequelae
Chronic pancreatitis can develop as a rare long-term complication following recovery from AFLP with acute pancreatitis. 7