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
- Wilson’s disease
- Ischemic hepatitis/shock liver
- Budd-Chiari syndrome
- Pregnancy-related liver disease
The most important management principle:
Airway, Breathing, Circulation → glucose → stop/treat cause → prevent brain edema → manage coagulopathy/infection/renal failure → early liver transplant center referral.
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