Clinical Course of Acute Liver Failure

by Michael_Koger

The clinical manifestations of acute liver failure are complex as these patients are at risk for death.

Individuals who develop this illness may present with fatigue, nausea, poor appetite, dark urine, jaundice, and discomfort in the right upper quadrant of the abdomen. They have hepatic encephalopathy, which also occurs in clients with chronic liver disease, from excessive alcohol intake. However, these are two separate medical conditions, and one should not confuse them in terms of diagnosis [1, 2].

Nevertheless, encephalopathy presents with mental confusion and drowsiness. When this decline is severe, there will be either stupor or coma. These are quite serious. There may be asterixis, or jerky movement of the hands or other parts of the body, and this is especially present when the hands are outstretched [2].

Mental Status Abnormalities

On mental status examination, they tend to exhibit personality alterations, memory problems, and irrational behavior.  These patients may become violent.  The usual day-night pattern of wakefulness can also undergo a reversal.  Many of these psychiatric symptoms tend to take place early in the appearance of hepatic encephalopathy [2].

These changes are usually the result of brain swelling or cerebral edema.  This finding is the most common cause of death in these clients [1].

Pathophysiologic Disturbances

On physical examination, there may be ascites or swelling of the abdomen as well as edema of the extremities.  There are disturbances of the human body’s ability to regulate clotting of the blood, and laboratory tests will indicate prolongation of clotting times [2].

Disturbances in electrolytes and other chemistry levels of the blood will, of course, contribute to the individual’s discomfort.  The health care provider will need to monitor all of these abnormalities and manage them with intravenous fluids and other measures in order to stabilize the situation [1].

Moreover, the blood tests which measure the functional ability of the liver will be dramatically high.  Some people, especially those who have taken an overdose of acetaminophen, will have liver enzyme elevations of more than one thousand units per liter [1].

Other matters which make this disease a life-threatening one include the development of gastrointestinal bleeding from stress ulcers of the stomach.  It is possible to manage the gastrointestinal bleeding with medication such as proton-pump inhibitors or histamine-2 receptor antagonists [1].

Finally, there is risk of infection in these patients [1].


Acute liver failure is a well-known medical situation.  Its clinical management is complex and requires an aggressive health care team in order to yield a good outcome.


  1. Hanouneh, M., Garber, A., Tavill, A. et al.  (2016).  A tale of two sisters with liver disease.  Cleveland Clinic Journal of Medicine, 83, 109-115.
  2. United States National Library of Medicine.  National Institutes of Health.  (2016).  Acute liver failure.  Retrieved February 25, 2016.
  3. The photo is of a library at the Centers for Disease Control and is reprinted with permission from that organization.


The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.


Updated: 03/09/2016, Michael_Koger
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