Differentiating Acute Liver Failure from other Diseases
Acute liver failure must be differentiated from other diseases that cause signs and symptoms of jaundice, coagulopathy, and encephalopathy.[1][2][3][4]
Severe acute hepatitis is followed very closely as it has a potential to develop into acute or subacute hepatic failure.
Acute hepatitis would not be considered acute liver failure unless hepatic encephalopathy is present.
Common causes are viral hepatitis, acetaminophen overdose, alcoholic hepatitis, autoimmune hepatitis and metabolic disorders such as Wilson's disease and hemochromatosis.
Hepatic encephalopathy is absent.
Grades of hepatic encephalopathy are:
Grade 1: Trivial lack of awareness; euphoria or anxiety; shortened attention span; impaired performance of addition. 67% of cirrhotic patients may have 'minimal hepatic encephalopathy.
Grade 2: Lethargy or apathy; minimal disorientation for time or place; subtle personality change; inappropriate behavior; impaired performance of subtraction.
Grade 3: Somnolence to semi-stupor, but responsive to verbal stimuli; confusion; gross disorientation.
Grade 4: Coma (unresponsive to verbal or noxious stimuli).
Cholestasis
Jaundice can be seen due to Intra or extrahepatic biliary obstruction, as well as intrahepatic cholestasis due to conditions like drug-induced liver injury..
The absence of hepatic encephalopathy and coagulopathy will differentiate it from acute liver failure.
Absence of hepatic encephalopathy.
Normal PT/INR.
Hemolysis
May have jaundice with increased indirect (unconjugated) serum bilirubin.
Liver dysfunction may not be present. So, coagulopathy and hepatic encephalopathy would not be there.