Acute Liver Failure

Question 1

What is the definition of acute liver failure

Answer 1

Occurs after a severe insult to the liver in a patient with no pre-existing liver disease

Question 2

How can you classify acute liver failure

Answer 2

Hyperacute
Acute
Subacute

Based on the onset of hepatic encephalopathy

Question 3

What is hyperacute liver failure

Answer 3

Onset of hepatic encephalopathy with 7 days of onset of symptoms

Question 4

What is acute liver failure

Answer 4

Onset of hepatic encephalopathy within 8-28 days of onset of symptoms

Question 5

What is subacute liver failure

Answer 5

Onset of hepatic encephalopathy after 28 days of onset of symptoms

Question 6

What are some precipitants of acute decompensation of liver disease

Answer 6

Intercurrent infection - spontaneous bacterial peritonitis
Acute GI bleed
Constipation
Drugs - sedatives, diuretics
Metabolic abnormalities - hypoglycaemia
Major surgery
Progression of disease

Question 7

What are some causes of acute liver failure

Answer 7

Drugs:-
Paracetamol
NSAIDs
Antibiotics - isoniazid, penicillins, erythromycin

Viral:-
Hep A and B

Pregnancy related:-
Acute fatty liver of pregnancy
HELLP - haemolytic anaemia, raised liver enzymes, reduced platelets

Malignancies:-
Lymphoma
Malignant infiltration

Vascular:-
Budd-Chiari syndrome - occlusion of hepatic veins that drain the liver
Ischaemic injury to the liver

Others:-
Wilson’s disease
Autoimmune hepatitis