Makindo Medical Notes

⚠️ Acute liver disease ≠ Acute liver failure. Many conditions cause acute hepatocellular injury without progressing to failure — the distinction lies in synthetic function (coagulopathy, encephalopathy).

🩺 About

• Represents a wide spectrum of conditions causing acute hepatocellular damage.
• Some are self-limiting; others may progress to acute liver failure.

🧾 Causes

• Infectious: Hepatitis A–E, EBV, CMV, HSV, VZV, adenovirus, dengue, COVID-19
• Drug/Toxin: Paracetamol (dose-dependent), antibiotics, anticonvulsants, NSAIDs, statins, herbal remedies; toxins (Amanita mushroom 🍄, carbon tetrachloride)
• Alcoholic hepatitis
• Autoimmune hepatitis
• Cholestatic disease: PBC, PSC
• Metabolic: NAFLD, Wilson’s disease, haemochromatosis, alpha-1 antitrypsin deficiency
• Pregnancy: HELLP, acute fatty liver, preeclampsia
• Vascular/Ischaemic: Cardiogenic shock, Budd–Chiari, cocaine/amphetamine use, heatstroke, sinusoidal obstruction
• Other: Malignancy, Reye’s syndrome, graft non-function post-transplant

📋 Clinical Features

• Non-specific: malaise, fatigue, anorexia, nausea
• Specific: RUQ pain, jaundice, pale stools, dark urine, hepatomegaly
• HBV tip-off: sudden distaste for cigarettes 🚬
• Complications if severe: coagulopathy, encephalopathy, ascites

🔬 Investigations – Liver Damage vs Function

• LFT pattern:
  • AST/ALT >1000 → paracetamol, viral hepatitis, ischaemic hepatitis
  • 100–500 → alcohol, NAFLD, chronic hepatitis
• ALP + GGT raised: cholestatic/drug-induced, obstruction, malignancy
• INR, albumin: markers of synthetic function/prognosis
• Other: FBC, U&E, viral serology, autoimmune screen, copper/iron studies, ultrasound ± Doppler

⚡ Management

• Supportive: fluids, electrolytes, nutrition, monitoring
• Stop hepatotoxins: alcohol, offending drugs, herbal supplements
• Cause-specific:
  • Paracetamol → N-acetylcysteine (NAC)
  • Autoimmune → steroids
  • Wilson’s → chelation (penicillamine, trientine)
  • HBV/HSV → antivirals; HAV/HEV → supportive
  • Pregnancy-related → deliver fetus
• Complications: treat encephalopathy, coagulopathy, ascites
• Transplant referral: early if encephalopathy + coagulopathy (true acute liver failure)

📚 References

• NCBI – Acute Liver Disease

💡 Clinical Pearl: Always check synthetic markers (INR, albumin) — they distinguish simple hepatocellular injury from life-threatening liver failure. AST/ALT >1000? Think viral hepatitis, paracetamol, or ischaemia.