Buku Medicine


Acute liver failure: A syndrome caused by the sudden loss of liver function in a person without pre-existing liver disease – as evidenced by 

  • Acutely deranged liver function tests 
  • Coagulopathy (INR > 1.5) and altered consciousness secondary to hepatic encephalopathy 
  • The absence of underlying chronic liver disease 

Acute liver injury: 

  • Acutely deranged liver function tests 
  • Coagulopathy but NO encephalopathy 

Acute on chronic liver failure: 

  • Acute liver failure in patients with underlying chronic liver disease 

Some definitions use the time from development of jaundice to development of encephalopathy to further categorise acute liver failure  

  • Hyperacute <7 days 
  • Acute 8-28 days 
  • Subacute 1-6 months 


Subacute liver failure 

  • This can be challenging to recognise as the clinical and radiological changes (small liver, ascites and mild splenomegaly) can mimic cirrhosis. It should be considered and discussed with a transplant unit early if it is a possibility.  


  • Drugs 
    • Paracetamol 
    • Flucloxacillin 
    • Anti-tuberculous medication 
    • Ecstasy 
  • Viruses 
    • Hepatitis A, B, C, E, CMV, HSV 
  • Autoimmune hepatitis 
  • Vascular 
    • Ischaemic hepatitis 
    • Budd-Chiari syndrome 
  • Wilson’s disease 
  • Malignant infiltration 
  • Seronegative hepatitis (causes subacute liver failure) 
  • Pregnancy 
    • Acute fatty liver of pregnancy 
    • HELLP (haemolysis elevated liver enzymes and low platelets) 

Assessment & management

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