Differential diagnosis

No other condition presents with deep jaundice, gross prolongation of INR, and encephalopathy in the absence of established liver disease. The major issue is to recognize the circumstance where a patient with chronic liver disease presents with an acute deterioration in liver function. This can usually be differentiated by the clinical history and the presence of signs of chronic liver disease such as spider naevi and ascites on clinical examination. Acute massive hepatic vein thrombosis or Budd-Chiari syndrome should be considered, particularly if the liver is of normal size or enlarged. In these circumstances ALF may be reversed by prompt treatment.

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