History

The history is dependent, to some extent, upon the cause (Table 1). There is usually a short prodromal influenza-like illness in an individual who was previously well.

Nausea, vomiting, and right upper quadrant pain may be present. Jaundice, manifested by either discoloration of the skin or dark urine, is usually the first specific symptom. The full-blown syndrome of ALF may develop in days or weeks after first presentation. This variability has led to a relatively standardized nomenclature for subsets of ALF (O'Grady et al. 1993).

Table 1 Clinical and laboratory characteristics of the usual causes of ALF

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