Acute liver failure diagnostic study of choice
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]
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Overview
Acute liver failure is a sudden loss of hepatic function in a patient without any evidence of underlying liver disease. Acute liver failure should be suspected in a patient with mental status changes, jaundice, and right upper quadrant pain or nonspecific symptoms such as malaise, nausea and fatigue of fewer than 26 weeks. The further evaluation should include liver function tests (aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase, gamma-glutamyl transpeptidase [GGT], total and direct bilirubin, albumin) and prothrombin time/INR. The diagnosis of acute liver failure is made in the presence of coagulopathy (international normalized ratio (INR), >1.5), hepatic encephalopathy and illness duration of fewer than 24 weeks.
Diagnostic Criteria
- Acute liver failure is a sudden loss of hepatic function in a patient without any evidence of underlying liver disease.[1][2][3]
- Acute liver failure should be suspected in a patient with mental status changes, jaundice, and right upper quadrant pain or nonspecific symptoms such as malaise, nausea and fatigue of fewer than 26 weeks. The further evaluation should include liver function tests (aspartate aminotransferase [AST], alanine aminotransferase [ALT], alkaline phosphatase, gamma-glutamyl transpeptidase [GGT], total and direct bilirubin, albumin) and prothrombin time/INR.
- The diagnosis of acute liver failure is made in the presence of:
- Coagulopathy (International normalized ratio [INR] > 1.5)
- Hepatic encephalopathy
- Illness duration of fewer than 24 weeks
References
- ↑ Lee WM, Squires RH, Nyberg SL, Doo E, Hoofnagle JH (2008). "Acute liver failure: Summary of a workshop". Hepatology. 47 (4): 1401–15. doi:10.1002/hep.22177. PMC 3381946. PMID 18318440.
- ↑ Bernal W, Hyyrylainen A, Gera A, Audimoolam VK, McPhail MJ, Auzinger G; et al. (2013). "Lessons from look-back in acute liver failure? A single centre experience of 3300 patients". J Hepatol. 59 (1): 74–80. doi:10.1016/j.jhep.2013.02.010. PMID 23439263.
- ↑ Wlodzimirow KA, Eslami S, Abu-Hanna A, Nieuwoudt M, Chamuleau RA (2012). "Systematic review: acute liver failure - one disease, more than 40 definitions". Aliment Pharmacol Ther. 35 (11): 1245–56. doi:10.1111/j.1365-2036.2012.05097.x. PMID 22506515.