Assessment of cause

In general, the clinical features of ALF reflect the degree of hepatocellular damage and are independent of the cause. However, determination of the cause is important because specific therapy may be indicated in some instances, as determination of the etiology has implications for the spontaneous return of liver function and it may indicate the need for screening of family members (e.g. Wilson's disease) or other close contacts (hepatitis).

Important features to note in the history are shown in Tibie 1. The clinical examination is usually unhelpful in establishing the cause of ALF; however, if fulminant

Wilson's disease is suspected, it is important to examine the eyes for Kayser-Fleischer rings. If present, these confirm the diagnosis, but their absence does not exclude it. Laboratory tests used to determine the cause of ALF are shown in Table.!.

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