Acute liver failure differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Acute_liver_failure]] | |||
{{CMG}} {{AE}} {{HS}} | {{CMG}} {{AE}} {{HS}} | ||
==Overview== | ==Overview== | ||
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==Differentiating Acute Liver Failure from other Diseases== | ==Differentiating Acute Liver Failure from other Diseases== | ||
Acute liver failure must be differentiated from other diseases that cause signs and symptoms of jaundice, coagulopathy, and encephalopathy. | Acute liver failure must be differentiated from other diseases that cause signs and symptoms of [[jaundice]], [[coagulopathy]], and [[encephalopathy]].<ref name="pmid17370334">{{cite journal| author=Escorsell A, Mas A, de la Mata M, Spanish Group for the Study of Acute Liver Failure| title=Acute liver failure in Spain: analysis of 267 cases. | journal=Liver Transpl | year= 2007 | volume= 13 | issue= 10 | pages= 1389-95 | pmid=17370334 | doi=10.1002/lt.21119 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17370334 }} </ref><ref name="pmid17608778">{{cite journal| author=Bower WA, Johns M, Margolis HS, Williams IT, Bell BP| title=Population-based surveillance for acute liver failure. | journal=Am J Gastroenterol | year= 2007 | volume= 102 | issue= 11 | pages= 2459-63 | pmid=17608778 | doi=10.1111/j.1572-0241.2007.01388.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17608778 }} </ref><ref name="pmid20196116">{{cite journal| author=Kumar R, Shalimar. Bhatia V, Khanal S, Sreenivas V, Gupta SD et al.| title=Antituberculosis therapy-induced acute liver failure: magnitude, profile, prognosis, and predictors of outcome. | journal=Hepatology | year= 2010 | volume= 51 | issue= 5 | pages= 1665-74 | pmid=20196116 | doi=10.1002/hep.23534 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20196116 }} </ref><ref name="pmid22213561">{{cite journal| author=Lee WM, Stravitz RT, Larson AM| title=Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011. | journal=Hepatology | year= 2012 | volume= 55 | issue= 3 | pages= 965-7 | pmid=22213561 | doi=10.1002/hep.25551 | pmc=3378702 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22213561 }} </ref> | ||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center" | {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center" | ||
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* [[Jaundice]] and [[coagulopathy]] may be present. | * [[Jaundice]] and [[coagulopathy]] may be present. | ||
* Severe acute hepatitis is followed very closely as it has a potential to develop into acute or subacute hepatic failure. | * Severe [[acute hepatitis]] is followed very closely as it has a potential to develop into acute or subacute hepatic failure. | ||
* Acute hepatitis would not be considered acute liver failure unless hepatic encephalopathy is present. | * Acute hepatitis would not be considered acute liver failure unless [[hepatic encephalopathy]] is present. | ||
* Common causes are viral hepatitis, acetaminophen overdose, alcoholic hepatitis, autoimmune hepatitis and metabolic disorders such as Wilson's disease and hemochromatosis. | * Common causes are [[viral hepatitis]], [[acetaminophen overdose]], [[alcoholic hepatitis]], [[autoimmune hepatitis]] and [[Metabolic disorder|metabolic disorders]] such as [[Wilson's disease]] and [[hemochromatosis]]. | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Hepatic encephalopathy is absent. | * [[Hepatic encephalopathy]] is absent. | ||
* Grades of hepatic encephalopathy are: | * Grades of hepatic encephalopathy are: | ||
** Grade 1: Trivial lack of awareness; [[euphoria]] or [[anxiety]]; shortened attention span | ** Grade 1: Trivial lack of awareness; [[euphoria]] or [[anxiety]]; shortened attention span. | ||
** Grade 2: Lethargy or [[apathy]]; minimal [[disorientation]] for time or place; subtle personality change; inappropriate behavior; impaired performance of subtraction. | ** Grade 2: Lethargy or [[apathy]]; minimal [[disorientation]] for time or place; subtle personality change; inappropriate behavior; impaired performance of subtraction. | ||
** Grade 3: [[Somnolence]] to semi-stupor, but responsive to verbal stimuli; [[confusion]]; gross disorientation. | ** Grade 3: [[Somnolence]] to semi-stupor, but responsive to verbal stimuli; [[confusion]]; gross disorientation. | ||
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| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Cholestasis | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Cholestasis | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Jaundice can be seen due to | * [[Jaundice]] can be seen due to intra or extrahepatic [[biliary obstruction]], as well as intrahepatic [[cholestasis]] due to conditions like drug-induced liver injury. | ||
* The absence of hepatic encephalopathy and coagulopathy will differentiate it from acute liver failure. | * The absence of [[hepatic encephalopathy]] and [[coagulopathy]] will differentiate it from acute liver failure. | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Absence of hepatic encephalopathy. | * Absence of [[Hepatic encephalopathy|hepatic encephalopathy.]] | ||
* Normal PT/INR. | * [[INR|Normal PT/INR.]] | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Hemolysis | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Hemolysis | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* May have jaundice with increased | * May have [[jaundice]] with increased ([[Unconjugated bilirubin|unconjugated]]) indirect serum [[bilirubin]]. | ||
* Liver dysfunction may not be present. So, coagulopathy and hepatic encephalopathy would not be there. | * Liver dysfunction may not be present. So, [[coagulopathy]] and [[hepatic encephalopathy]] would not be there. | ||
* Common examples are hemolytic anemias. | * Common examples are [[hemolytic anemias]]. | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Absence of hepatic encephalopathy. | * Absence of [[Hepatic encephalopathy|hepatic encephalopathy.]] | ||
* Normal PT/INR. | * Normal [[Prothrombin time|PT/INR]]. | ||
* Abnormal peripheral blood smear. | * Abnormal [[Peripheral blood smear|peripheral blood smear.]] | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |N | ||
|N | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |↑ | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | | style="padding: 5px 5px; background: #F5F5F5;" align="center" | + | ||
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| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anemia | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Anemia | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |Truma or surgery in history | | style="padding: 5px 5px; background: #F5F5F5;" align="center" |Truma or surgery in history | ||
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Latest revision as of 21:40, 8 February 2019
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]
Overview
Acute liver failure must be differentiated from other diseases that cause signs and symptoms of jaundice, coagulopathy, and encephalopathy. The differentials include acute hepatitis, cholestatic jaundice, and hemolytic jaundice. The common causes of acute hepatitis causing acute liver failure include acetaminophen toxicity, viral hepatitis, alcoholic hepatitis, autoimmune hepatitis, acute fatty liver of pregnancy, Wilson's disease, ischemic hepatitis and hepatic congestion due to right heart failure and Budd–chiari syndrome.
Differentiating Acute Liver Failure from other Diseases
Acute liver failure must be differentiated from other diseases that cause signs and symptoms of jaundice, coagulopathy, and encephalopathy.[1][2][3][4]
| Condition | Differentiating signs and symtoms | Differentiating Tests |
|---|---|---|
| Acute hepatits |
|
|
| Cholestasis |
|
|
| Hemolysis |
|
|
Abbreviations:
RUQ= Right upper quadrant of the abdomen, LFT= Liver function test, SIRS= Systemic inflammatory response syndrome, ERCP= Endoscopic retrograde cholangiopancreatography, N= Normal, AMA= Anti mitochondrial antibodies, LDH= Lactate dehydrogenase, GI= Gastrointestinal, CT= Computed tomography
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References
- ↑ Escorsell A, Mas A, de la Mata M, Spanish Group for the Study of Acute Liver Failure (2007). "Acute liver failure in Spain: analysis of 267 cases". Liver Transpl. 13 (10): 1389–95. doi:10.1002/lt.21119. PMID 17370334.
- ↑ Bower WA, Johns M, Margolis HS, Williams IT, Bell BP (2007). "Population-based surveillance for acute liver failure". Am J Gastroenterol. 102 (11): 2459–63. doi:10.1111/j.1572-0241.2007.01388.x. PMID 17608778.
- ↑ Kumar R, Shalimar. Bhatia V, Khanal S, Sreenivas V, Gupta SD; et al. (2010). "Antituberculosis therapy-induced acute liver failure: magnitude, profile, prognosis, and predictors of outcome". Hepatology. 51 (5): 1665–74. doi:10.1002/hep.23534. PMID 20196116.
- ↑ Lee WM, Stravitz RT, Larson AM (2012). "Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011". Hepatology. 55 (3): 965–7. doi:10.1002/hep.25551. PMC 3378702. PMID 22213561.