Acute liver failure

Dr Daniel J Bell and Dr Henry Knipe et al.

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

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

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

There are many causes for acute liver failure 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 acute liver failure (ALF), although it should be stressed that patients with ALF do not have cirrhosis 3.

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

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

Mortality is high in acute liver failure 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, 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

  • Case 1: drug-induced
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