Acute Liver Disease

The rapid development (> 6 months) of hepatic dysfunction without prior liver disease

Aetiology

  • Viral - Hep. A-E, CMV, EBV
  • Drugs (drug induced liver injury - DILI)
    • Antibiotics - amoxicillin + clavulanic acid, co-amoxiclav and flucloxacillin
    • Paracetamol
  • Shock liver
  • Cholangitis
  • Alcohol
  • Malignancy
  • Rare causes - Budd Chiari, acute fatty liver of pregnancy, cholestasis of pregnancy

Clinical presentation

  • Can be no clinical features
  • Jaundice
  • Lethargy
  • Nausea
  • Anorexia
  • Pain
  • Itch
  • Arthralgia

Investigations

  • LFTs - ALT/AST > ALP, ↑ bilirubin, ↓ albumin
    • Hy’s rule (marker of severity for DILI) - if patient has ALT/AST >5x upper limit of normal AND bilirubin >3mg/dl they are at high risk of death/liver transplant
  • ↑ prothrombin time
  • USS
  • Virology
  • Rarely liver biopsy

Management

  • Rest (up to 3 months)
  • Fluids, no alcohol
  • Dietary monitoring
    • Increase calories and protein intake, oral supplements/NG feeding may be required
    • Hyper-metabolic state but intake usually poor
    • High fat foods poorly tolerated
  • For itch (jaundice) - sodium bicarbonate bath, cholestyramine or ursodeoxycholic acid
  • Observe for fulminant hepatic failure