Acute liver failure history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

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, prognosis and the correct therapy. Specific areas of focus when obtaining a history from the patient include timing of the onset of jaundice, alcohol intake, medications, family history, risk factors of viral hepatitis and past medical history. Common symptoms of acute liver failure include anorexia, malaise, pruritus, bleeding tendencies, confusion, disorientation, and stupor.

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. The hepatic encephalopathic 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:^[1][2][3]

• 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)
• 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

The initial symptoms of acute liver failure can be nonspecific such as nausea, fatigue, and malaise. The patients may have jaundice on initial presentation. The patients with initial subtle mental changes can also rapidly deteriorate to a comatose state.

• Nausea or vomiting
• Loss of appetite
• Anorexia
• Fatigue
• Malaise
• Pruritis
• Right upper quadrant pain
• Diffuse abdominal pain
• Jaundice
• Coagulopathy or increased bleeding tendency
• Abdominal distention
• Disorientation or confusion
• Sleepiness
• Coma

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