Acute hepatic insufficiency, liver transplantation

1. Big picture

Acute hepatic insufficiency usually refers to acute liver failure (ALF): a rapid, life-threatening loss of liver function in a patient without pre-existing cirrhosis. The liver suddenly cannot detoxify ammonia, synthesize clotting factors, maintain glucose homeostasis, metabolize lactate, or control inflammation.

The exam wants you to think:

Jaundice + high INR + encephalopathy = acute liver failure until proven otherwise.

The most important causes to remember:

• Paracetamol/acetaminophen overdose
• Acute viral hepatitis: HAV, HBV, HEV, HSV in special groups
• Drug-induced liver injury
• Amanita phalloides mushroom poisoning
• Autoimmune hepatitis