Chapter 49
Hepatic Disorders
From acute failure to cirrhosis
Acute Liver Failure
Acute liver failure (ALF) is a rapid deterioration of liver function (less than 26 weeks) causing jaundice, coagulopathy (INR >= 1.5), and hepatic encephalopathy in previously normal individuals. The most common causes are drug-induced liver injury, viral hepatitis, autoimmune liver disease, and hypoperfusion. Diagnosis requires a prolonged prothrombin time plus altered mentation.
ALF can progress rapidly, so patients are admitted to the ICU, the specific cause is sought and treated, and liver transplantation is considered. In the US, acetaminophen (APAP) is the leading cause of acute liver failure.
The Diagnostic Trigger
In moderate-to-severe acute hepatitis, check the prothrombin time. If it is prolonged by ~4-6 seconds (INR >= 1.5) with altered sensorium, ALF is diagnosed and hospital admission is mandatory.
📖 “ALF: rapid liver deterioration (<26 wk) -> jaundice, coagulopathy (INR >=1.5), hepatic encephalopathy. Causes: drug-induced, viral hepatitis, autoimmune, hypoperfusion. Diagnose with prolonged PT (INR >=1.5) + altered sensorium; admit ICU; consider transplant. APAP is leading cause.”