hepatic and biliary disorders
Acute Liver Failure
Key Points
The most common causes of acute liver failure are viral hepatitis (in countries where sanitation is poor) and drugs and toxins (in countries that have effective sanitation). Acute liver failure is characterized by jaundice, coagulopathy, and encephalopathy. Confirm the diagnosis by finding prolongation of INR and clinical manifestations of encephalopathy in patients with hyperbilirubinemia and elevated aminotransferase levels. Determine the cause by assessing history of drug use and exposure to toxins and doing hepatitis virus serologic tests, autoimmune markers, and other tests based on clinical suspicion. Acute liver failure should be managed in the intensive-care setting and referral to a transplant center should be promptly initiated. ConsiderN-acetylcysteineforacetaminophen-induced liver failure and liver transplantation for patients with poor prognostic factors (eg, age<10 or>40, severe encephalopathy, severe prolongation of INR, idiosyncratic drug reaction, Wilson disease). 