Introduction

Acute liver failure describes the rapid onset of hepatocellular dysfunction leading to a variety of systemic complications.

Epidemiology

  • Incidence: 1.00 cases per 100,000 person-years
  • Peak incidence: 40-50 years
  • Sex ratio: more common in males 2:1
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Aetiology

Causes
  • paracetamol overdose
  • alcohol
  • viral hepatitis (usually A or B)
  • acute fatty liver of pregnancy

Clinical features

Features*
  • jaundice
  • coagulopathy: raised prothrombin time
  • hypoalbuminaemia
  • hepatic encephalopathy
  • renal failure is common ('hepatorenal syndrome')

*remember that 'liver function tests' do not always accurately reflect the synthetic function of the liver. This is best assessed by looking at the prothrombin time and albumin level.