الفهرس 
Anatomy of the LiverOnly 14 pages are availabe for public view
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Abstract
The liver is the largest gland in the body that lies under diaphragm in the right upper abdomen having dual blood supply from hepatic arteries and hepatic portal vein .various functions are carried out by the liver such as reservoir function, blood cleansing effect, metabolic function, coagulation effect, bile formation and other functions.
Fatty liver (FL) affects approximately 25-35% of the general population and commonly associated with alcohol or metabolic disease such as diabetes, hypertension, obesity and dyslipidemia, but can also be due to nutritional causes such as malnutrition, weight loss, refeeding syndrome, gastric bypass. In addition, it may be due to drugs and toxins as amiodaron, methotrexate, tetracycline, diltiazem, glucocorticoids and tamoxifen and could be a pregnancy related disorder. Most individuals of fatty liver are asymptomatic and are usually discovered incidentally because of abnormal liver function tests or hepatomegaly noted in unrelated medical conditions. Elevated liver biochemistry is found in 50% of patients with simple Steatosis. However, fatty liver may be also complicated to cirrhosis or liver cell failure.
Pregnancy is a special clinical state with several normal physiological changes that influence body organs including the liver. Liver disease can cause significant morbidity and mortality in both pregnant women and their infants.
Acute fatty liver of pregnancy is life-threatening complication of pregnancy that occurs in the third trimester or the immediate period after delivery. It is thought to be caused by a disordered metabolism of fatty acid by mitochondria in the mother. The condition was previously thought to be universally fatal, but aggressive treatment by stabilizing the mother with intravenous fluids and blood products in anticipation of early delivery has improved prognosis.
Acute fatty liver of pregnancy is one of the causes of acute liver failure,it is hard to distinguish it from other causes of liver failure during pregnancy as many diseases can resemble the picture of AFLP like eclampsia, pre-eclampsia and their severe form HELLP syndrome, intra hepatic cholestasis of pregnancy and hyperemesis gravidarum. Reaching a timely and accurate diagnosis of such conditions can be challenging. The timing of the condition in relation toward which trimester it starts at is a key. Accurate diagnosis can be made using specific clinical findings and blood tests. Some entities have well-defined criteria that help not only in making the diagnosis, but also in classifying the disease according to its severity.High level of suspicion is advisable to carry out treatment plan.
Management of these conditions range from simple medical remedies to measures such as immediate termination of the pregnancy. In specific conditions, it is prudent to have expert obstetric and medical specialists teaming up to help improve the outcomes.
The optimal management of AFLP involves expeditious delivery of the baby and this practice has led to improved outcomes for both mother and child. Severe cases should be admitted to an intensive care unit where they can be observed by a multidisciplinary team, as multisystem failure requiring ventilation and dialysis may occur.
Treatment mainly supportive to correct complications of liver failure like encephalopathy ,brain oedema and hypoglycaemia., there should be careful monitoring of coagulation with aggressive correction of coagulopathies by the administration of appropriate clotting factors.
Plasmapheresis and molecular absorbent re-circulating system (MARS) had been found to be useful in some severe cases of AFLP especially if they started early after delivery, and finally liver transplantation should be considered for those women with fulminant hepatic failure due to AFLP, who manifest signs of irreversible liver failure despite delivery and aggressive supportive care. Recommendations that liver transplantation should be reserved for those patients with hepatic encephalopathy, severe metabolic acidosis or worsening coagulopathy or those with liver rupture complicated by hepatic necrosis as indicated by computed tomography.
All women who have had AFLP should be made aware of the potential for recurrence and counselled regarding future pregnancies. Any future pregnancies should be managed in a specialist setting.