Acute liver failure history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief:
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Overview
A thorough history should be obtained, with special attention given to a history of ingesting medications or other toxins. Symptoms can include symptoms such as fatigue, nausea, vomiting, abdominal distention, diarrhea, disorientation, and an increased bleeding tendency.
History and Symptoms
History
Obtaining the focused history is an important aspect of making a diagnosis of an acute liver failure. It provides insight into the cause, precipitating factors and associated comorbid conditions. The complete history will help determine the correct therapy and helps in determining the prognosis. Encephalopathy patients are disoriented therefore the patient interview may be difficult. In such cases, history from the family members may need to be obtained. The specific history of the symptoms (duration, onset, progression), associated symptoms, drug usage has to be obtained. Specific areas of focus when obtaining the history are:
- Timing of onset of jaundice and other symptoms (malaise, nausea, vomiting or mental status changes)
- History of alcohol use
- Medications intake (prescription, illicit, herbal or recreational) use (prescription and illicit or recreational)
- Family history of liver disease (Wilson disease)
- Viral hepatitis risks (sexual contact, transfusions, travel, occupational, body piercing)
- Hepatic toxins exposure (organic solvents, mushroom poisoning)
- History of renal failure, seizures, bleeding, infection
- Past history of jaundice
- Risk factors of drug overdose (acetaminophen) such as prior history of suicide attempt, depression etc
- Risk factors for hepatic ischemia such has hypotension, heart failure, hypercoagulable state
Symptoms
- Nausea or vomiting
- Loss of appetite
- Fatigue
- Diarrhea
- Jaundice
- Bleeding easily
- Abdominal distention
- Disorientation or confusion
- Sleepiness, even coma
Many of the initial symptoms in patients with acute liver failure are nonspecific [14]. They include:
●Fatigue/malaise ●Lethargy ●Anorexia ●Nausea and/or vomiting ●Right upper quadrant pain ●Pruritus ●Jaundice ●Abdominal distension from ascites As the liver failure progresses, patients who were initially anicteric may develop jaundice, and those with subtle mental status changes (eg, lethargy, difficulty sleeping) may become confused or eventually comatose.