Regardless of etiology, much of the liver damage has often occurred by the time of presentation. However, this should not result in a failure to define the cause since the treatment options may vary. For example, liver transplantation would be inappropriate for a patient with malignant infiltration, while chemotherapy is indicated as early as possible for lymphoma. Thus the work-up and management of all patients with acute hepatic necrosis should address etiology. Investigations and imaging will be dictated by the clinical scenario, but may include some or all of those shown in Table,!.
Table 1 Investigation of acute liver failure
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