⚠️ 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
💡 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.
