Liver Complaints

Acute liver failure
Acute liver failure (ALF), also known as fulminant hepatic failure is a rare manifestation of liver disease and constittes a medical emergency.
Syndrome results from loss of hepatic parenchyma that can result from a variety of insults in the liver.
Despite advances in medical management and the availability of liver transplantation, mortality rates among patients with Alf remain important. It has been estimated that in the United States, 2000 deaths per year are attributable to ALF.

Definition:
ALF was defined by three criteria: (1) the rapid development of hepatocellular dysfunction (eg, jaundice, bleeding disorders), (2) encephalopathy, and (3) no history of disease liver
ALF was originally defined by an interval between the onset of disease and the onset of encephalopathy within 8 weeks, but there is significant heterogeneity among patients with respect to the temporal progression of the disease .

Definition:
The time course of ALF etiology, biological, and prognostic significance. For example, a disease of 1 week or less before the development of encephalopathy is typical of the ALF caused by hepatic ischemia or toxicity of acetaminophen.
In contrast, an interval of more than four weeks is more likely to be caused by viral hepatitis and ALF of unknown etiology.

Definition:
Patients with disease duration longer than 2 weeks before onset of encephalopathy were more likely to develop manifestations of portal hypertension such as ascites or renal failure.

Definition:
Some researchers have suggested that the term fulminant hepatic failure be reserved for cases in which encephalopathy develops within 2 weeks after onset of jaundice and liver failure subfulminant the term be applied to cases in which encephalopathy developed between 2 weeks and three months after the onset of jaundice
Others have proposed that ALF is redefined to consist of three distinct syndromes:

Definition:
Hyperacute liver failure (onset of encephalopathy within 1 week of jaundice), Acute liver failure (development of encephalopathy between 1 and 4 weeks of jaundice), and subacute liver failure (development of encephalopathy in 5-12 weeks of jaundice).
Unfortunately, there is a large overlap in the prognosis in patients with different presentations, whatever nomenclature is used. Furthermore, the universally accepted nomenclature has been adopted.
Causes:
The most common causes of ALF are:
Drugs
Hepatotropic virus
However, many other conditions can lead to ALF, albeit infrequently. Despite advances in serological and molecular diagnosis of viral infections, ALF of unknown etiology remains a significant proportion of patients with this syndrome.

Drug
Most cases result ALF drug-related overdoses of acetaminophen. In fact, acetaminophen is the single most common cause of ALF.
Acetaminophen is directly hepatotoxic and produces predictable hepatocellular necrosis with an overdose (> 12 g). Because of its easy access, acetaminophen is a common method of suicide, and sometimes a cause of accidental overdose.

Drug
Even the recommended therapeutic doses of acetaminophen (as low as 4 g) can sometimes lead to LFA patients who are fasting or chronic consumption of alcohol or drugs that induce cytochrome oxidase.
Many other drugs, including halothane, isoniazid, sodium valproate, sulfonamides, phenytoin, thiazolidinediones, and certain herbal remedies, have been implicated in ALF. In most cases, drug-related ALF is rare and singular.

Hepatotropic viruses:
Hepatitis A and hepatitis B viruses are major causes of ALF.
Infectio.