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Acute liver failure from autoimmune hepatitis flare — SCE Acute Medicine MCQ

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HardGastroenterology and hepatologyAcute liver failure from autoimmune hepatitis flareSCE Acute Medicine

A 41-year-old woman with autoimmune hepatitis presents with jaundice, confusion and easy bruising after stopping immunosuppression. ALT is 1650 U/L, bilirubin 210 micromol/L, INR 3.1 and glucose 3.2 mmol/L. She has no history of cirrhosis and paracetamol level is undetectable. What is the most appropriate next step in management?

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Correct answer: A — Discuss urgently with a liver transplant centre and give supportive care including glucose correction

Acute liver failure is defined by coagulopathy and encephalopathy in a patient without established cirrhosis and requires early transplant-centre discussion. Paracetamol is a common cause but a negative level does not make this low risk. Hypoglycaemia, rising INR and encephalopathy are red flags for rapid deterioration.

Reference: BSG/BASL acute liver failure guidance; EASL acute liver failure guideline