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Liver Failure

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Acute liver failure = Fulminant liver failure = liver failure without prior disease and encephalopathy Caused by widespread necrosis, due to advanced disease or significant toxin damage.

Liver failure can be hyperacute (within 1 week), acute (within 1 month), or subacute (within 6 months)


  • Paracetamol overdose (commonest cause)
  • High alcohol intake
  • Hepatitis A , Hepatitis B, (commonly E in pregnant women) CMV
  • Wilson’s disease
  • HELLP (in pregnancy)
  • Primary Biliary Cirrhosis


  • Jaundice
  • Hepatic Encephalopathy
  • Hepatic Flap
  • Coagulopathy – raised PPT
  • Renal failure
  • Metabolic derangement
  • Systemic inflammatory syndrome, can progress to multi organ failure

Hepatic Encephalopathy

  • Grade 0: No change in mental status
  • Grade 1 : Altered behaviour
  • Grade 2: Drowsy/confused/slurred speech
  • Grade 3: Incoherent
  • Grade 4: Coma


Bedside: Pregnancy Test (in females)

Routine Bloods: FBC (look for infection, blood loss), U+E (hepatorenal syndrome?), LFT (extent of liver damage)

Coagulation Screen, Group & Save, Blood glucose (Cx of hypoglycaemia), Blood cultures (sepsis)

Viral Hepatitis Serology, Toxicology Screen (paracetamol levels), Autoantibodies (AMA) , Caeruloplasmin, Ferritin

Arterial Blood Gas (lactate?)

Imaging: Abdo USS


Assess severity with Kings College Criteria -> Consult transplant team early


Hourly Obs

Look for treatable causes: if suspect paracetamol OD , Give NAC

Treat complications: encephalopathy (lactulose), hypoglycaemia, bleeding, sepsis

Prevent malnutrition (thiamine/folate supplements)

Treat any renal failure (haemodialysis)