Acute Liver Failure

Today we discussed an interesting case of acute liver failure in a middle aged woman, which was ultimately diagnosed as autoimmune in etiology.

Here are the learning points:

  • Acute liver failure is characterized by acute liver injury, hepatic encephalopathy, and elevated INR >1.5 in a patient without cirrhosis or preexisting liver disease.
  • It can be subdivided into hyperacute (less than 7 days), acute (7-21 days) or subacute (greater than 21 days, less than 26 weeks).
  • DDx is vast including acetaminophen toxicity, drug-induced liver injury, viral hepatitis, alcoholic hepatitis, autoimmune hepatitis, ischemic hepatopathy, sepsis, Budd-Chiari syndrome, acute fatty liver of pregnancy/HELLP, toxin exposure -- to a name a FEW!
  • Using LiverTox can help you search for possible causes of drug-induced liver injury.

Dr. Anil Sharma had excellent learning points specifically regarding autoimmune hepatitis including:

1) The diagnosis of autoimmune hepatitis is complex and based upon a number of clinical, biochemical, serologic, and histologic findings (and exclusion of other forms of liver disease).

2) AST and ALT are elevated (range from mild elevations to greater than 1000 U/L), ALP is normal to mildly elevated, serum IgG levels are also elevated, anti-smooth muscle or antinuclear antibodies are typically present, and classic histologic findings include interface hepatitis (biliary tree sparing) and lymphoplasmacytic infiltrates.

3) The newer F-actin ELISA seems to be a useful diagnostic tool for autoimmune hepatitis.