All patients with clinical or laboratory evidence of moderate to severe acute hepatitis should have an immediate measurement of prothrombin time and careful evaluation of mental status. If the prothrombin time is prolonged by ≈ 4–6 seconds or more (INR ≥ 1.5), and there is any evidence of altered sensorium, the diagnosis of ALF should be strongly suspected, and hospital admission is mandatory. Initial laboratory examination must be extensive in order to evaluate both the etiology and severity. ;Initial laboratory analysis * Prothrombin time/INR * Complete blood count * Chemistries * Liver function test: AST, ALT, alkaline phosphatase, GGT, total bilirubin, albumin * Creatinine, urea/blood urea nitrogen, sodium, potassium, chloride, bicarbonate, calcium, magnesium, phosphate * Glucose * Amylase and lipase * Arterial blood gas, lactate * Blood type and screen * Paracetamol (acetaminophen) level, toxicology screen * Viral hepatitis serologies: anti-HAV IgM, HBSAg, anti-HBc IgM, anti-HCV * Autoimmune markers: ANA, ASMA, LKMA, immunoglobulin levels * Ceruloplasmin level (when Wilson's disease suspected) * Pregnancy test (females) * Ammonia (arterial if possible) * HIV status (has implication for transplantation) History taking should include a careful review of possible exposures to viral infection and drugs or other toxins. From history and clinical examination, the possibility of underlying chronic disease should be ruled out as it may require different management. A liver biopsy done via the transjugular route because of coagulopathy is not usually necessary, other than in occasional malignancies. As the evaluation continues, several important decisions have to be made; such as whether to admit the patient to an ICU, or whether to transfer the patient to a transplant facility. Consultation with the transplant center as early as possible is critical due to the possibility of rapid progression of ALF. Definition Acute liver failure is defined as "the rapid development of hepatocellular dysfunction, specifically coagulopathy and mental status changes (encephalopathy) in a patient without known prior liver disease".page 1557 The diagnosis of acute liver failure is based on physical exam, laboratory findings, patient history, and past medical history to establish mental status changes, coagulopathy, rapidity of onset, and absence of known prior liver disease respectively.page 1557 The exact definition of "rapid" is somewhat questionable, and different sub-divisions exist which are based on the time from onset of first hepatic symptoms to onset of encephalopathy. One scheme defines "acute hepatic failure" as the development of encephalopathy within 26 weeks of the onset of any hepatic symptoms. This is sub-divided into "fulminant hepatic failure", which requires onset of encephalopathy within 8 weeks, and "subfulminant", which describes onset of encephalopathy after 8 weeks but before 26 weeks. Another scheme defines "hyperacute" as onset within 7 days, "acute" as onset between 7 and 28 days, and "subacute" as onset between 28 days and 24 weeks.page 1557
complications of Hepatitis A
complications of Hepatitis B
complications of Hepatitis E
medical cause of Hepatitis
complications of Cholera
complications of Amoebiasis
complications of Primary biliary cholangitis
symptom of Hepatitis B