Acute Liver Disease

Epidemiology
Worldwide, the leading cause of acute liver disease leading to acute liver failure is viral hepatitis.^. In the UK, though, paracetamol overdose is the most common cause. Other notable causes include alcohol, drug-induced liver injury and acute fatty liver of pregnancy.

Diagnosis
Clinical features: ALD presents with a spectrum of symptoms ranging from mild jaundice and fatigue to severe complications like coagulopathy and hepatic encephalopathy. Nausea, vomiting and right upper quadrant pain are common. Fulminant hepatic failure, characterised by rapid-onset encephalopathy and impaired synthetic function, is a severe form.

Investigations: Initial evaluation involves liver function tests, revealing elevated transaminases, bilirubin and alkaline phosphatase levels. Prothrombin time is often prolonged. Other specific tests will be based on suspected aetiology, such as viral hepatitis serologies, autoimmune markers and paracetamol levels.

Imaging, typically ultrasound, is recommended to assess liver size, texture and biliary tree. In certain cases, liver biopsy might be necessary for definitive diagnosis, particularly in unclear cases.

Treatment
Management of ALD focuses on supportive care and treating the underlying cause. Stabilisation of vital signs, correction of fluid and electrolyte imbalances, and management of encephalopathy are critical. Specific treatments depend on cause, for example:

• Viral hepatitis: Antiviral therapy.
• Drug-induced liver injury: Immediate cessation of the offending drug and monitoring.
• Alcohol-related liver disease: Abstinence from alcohol, nutritional support and thiamine supplementation.
• Severe cases might require management in a specialist liver unit, and liver transplantation is considered in fulminant cases or those with poor prognostic indicators.

Prognosis
The prognosis of ALD varies widely based on the cause and severity at presentation. Early diagnosis and intervention can significantly improve outcomes. Mortality in fulminant hepatic failure remains high, despite advances in critical care and liver transplantation.