Investigations
The presentation of acute liver failure is similar regardless of aetiology but the investigations, prognosis and treatment can differ. [1]
| Aetiology | Investigations/Imaging |
|---|---|
| All | International normalized ratio (INR), urea and electrolytes (U&Es), glucose, liver function tests (LFTs), arterial blood gas (ABG), full blood count (FBC), group and save (G&S), (HIV serology required pre transplant) |
| Paracetamol | Paracetamol assay (levels may not be detected) |
| Mushroom | N/A |
| Drug reaction | N/A |
| Viral hepatitis | Hepatatis serology |
| Wilson’s Disease | Ceruloplasmin +/- biopsy Serum and urinary copper levels |
| Autoimmune hepatitis | Autoimmune markers (ANA, ASMA, immunoglobulins) |
| Hemolytic anaemia elevated liver enzymes low platelets (HELLP) syndrome | hCG |
| Acute ischaemic injury | Very high aminotransferase levels (25 to 250 times the upper limit of normal), elevated serum LDH levels |
| Budd-Chiari syndrome | Hepatic flow imaging (CT/USS/MR) |
| Malignant infiltration | CT +/- biopsy |
| Indeterminate | Consider biopsy |