Acute liver failure

Dr Jeremy Jones and Dr Henry Knipe et al.

Acute liver failure (ALF), or fulminant hepatic failure (FHF), refers to sudden severe liver dysfunction from injury without underlying chronic liver disease (CLD), although sometimes ALF presents as decompensation of an unknown CLD. 

ALF is rare, with < 1 case per 100,000 in the developed world 5.

Symptoms and signs of hepatic encephalopathy and/or coagulopathy are the most common presentation. 

Aetiology

There are many causes for ALF 1,3,4:

General features may include: 

Features of cirrhosis (i.e. splenomegaly, enlarged collateral vessels, liver surface nodularity) are present in 20-30% of patients with ALF, although it should be stressed that patients with ALF do not have cirrhosis 3.

Ultrasound
  • early: decreased liver echogenicity (cf. right kidney)
  • late: the liver becomes heterogeneously echogenic 1
CT

CT may demonstrate the general imaging features along with heterogeneous enhancement on portal venous phase imaging 3

Mortality is high in ALF at ~50% (range 30-70%) with orthotopic liver transplant considered the definitive treatment 3,4

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Article information

rID: 38693
Tag: cases
Synonyms or Alternate Spellings:
  • Acute hepatic failure
  • Progressive liver failure
  • Progressive hepatic failure
  • Fulminant hepatic failure (FHF)

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Cases and figures

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    Case 1: drug-induced
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