Liver disease - acute
Description
- Spectrum: acute hepatitis -> severe acute liver injury -> acute liver failure (ALF)
Definitions
- Acute liver failure = all three, in a patient without pre-existing liver disease:
1. INR >=1.5 (coagulopathy)
2. Any degree of hepatic encephalopathy
3. Onset within a defined short window (classically <26 weeks)
- Jaundice is usually present but is not part of the definition
- Severe acute liver injury = coagulopathy without encephalopathy - not yet ALF
By interval jaundice -> encephalopathy
| Interval | Typical cause | Cerebral oedema | |
|---|---|---|---|
| Hyperacute | <7 days | Paracetamol, HAV/HEV, ischaemic | Highest risk |
| Acute | 8-28 days | HBV | Intermediate |
| Subacute | 29 days - 12 weeks | Drug (non-paracetamol), seronegative | Low (but worst transplant-free survival) |
- Counter-intuitive: the more hyperacute the presentation, the better the spontaneous survival
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