Acute Hepatitis

Contents

• Acute Hepatitis

• Acute Liver Failure

• Acute Liver Injury

• Liver Cirrhosis

Acute Hepatitis

Causes

Similarities with list of conditions that cause liver cirrhosis. 

• Infective

  • Viral Hepatitis A-E

  • CMV (Cytomegalovirus) 

  • EBV 

• Toxicology

  • Intentional Overdose: Paracetamol , Alcohol 

  • Iatrogenic: 

    • Cholestatic: penicillins- co-amoxiclav

    • Hepatocellular injury: 

• Metabolic

  • Alcoholic hepatitis, MASLD, Haemochromatosis , Wilson's Disease

• Shocked Liver- commonly from sepsis

Acute Liver Failure

Diagnosis

• Diagnostic criteria: clinical- acute liver decompensation in a healthy liver- jaundice, coagulopathy (INR > 1.5) or encephalopathy

• Severity: King's College criteria for referral; for liver transplant

Core causes: 

• Paracetamol Overdose ,

• Viral Hepatitis

  • • HAV, HBV, HEV, 

    • CMV, EBV, VZV, HSV

• Drug causes- nitrofuratoin, phenytoin, 

• Shocked liver

Rarer

• Auto-immune hepatitis

• Wilson's Disease

• Budd Chiari Syndrome

• Malignancy infiltration

• Acute fatty liver of pregnancy

• Leptospirosis

King's College Criteria's

Referral to Liver Transplant Unit- paracetamol OD

• Arterial pH < 7.3 (after fluid resuscitation), OR

• 3/3

  1. INR > 6.5

  2. Cr > 300

  3. Grade III, IV encephalopathy

Referral to Liver Transplant Unit- non paracetamol OD

• INR > 6.5 OR

• 3/5

  1.  Age < 10, > 40yrs

  2. Viral hepatitis (not HAV, HBV) OR idiosyncratic drug reaction

  3. Duration of jaundice before encephalopathy > 7d

  4. INR > 3.5

  5. Biliruibin > 300

Management

• Supportive

• Liver Transplant

Acute Liver Injury

Acute liver injury is a poorly defined term. It implies a milder form of acute liver failure, i.e. acute liver dysfunction- mild coagulopathy, jaundice, ascites or deranged LFTs. Acute hepatitis, jaundice or acute liver injury are preferred terms. 

Liver Cirrhosis Causes

Commonest causes: 

• Alcoholic Liver Disease (ALD)

• Non Alcoholic Fatty Liver Disease (NAFLD)

Core

• Acute: Paracetamol Overdose , Viral Hepatitis

• Inherited: Haemachromatosis , Wilson's Disease ,  Alpha Trypsin 1 Deficiency , 

• Autoimmune: Autoimmune Hepatitis , Primary Biliary Cirrhosis (PBC) , Primary Sclerosing Cholangitis (PSC) 

• Drugs- methotrexate, amiodarone

Rarer

• Porphyria , Cystic Fibrosis 

Research

Liver Support for Acute Liver Failure

Currently there is no standardised Liver Support Protocol for acute liver failure prior to liver transplant. Carvajal et al, 2026 [2] found a lack of evidence for a standardised liver support protocol. 

Resources and References

1. https://bestpractice.bmj.com/topics/en-gb/1010

2. Martí-Carvajal AJ, Kumburegama BBW, Nikolova D, Pavlov CS, Mauro E, Gluud LL, Monge Martín D, Liu JP, Nicola S, Comunián-Carrasco G, Gemmato-Valecillos MA, Gluud C. Liver support systems for adults with acute liver failure. Cochrane Database Syst Rev. 2026 Apr 28;4(4):CD015059. doi: 10.1002/14651858.CD015059.pub2. PMID: 42047248; PMCID: PMC13122760.

3. Girish V, Royer A, John S. Acute Liver Failure. [Updated 2025 Jul 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482374/

4. Maiwall R, Kulkarni A, Arab J et al. Acute liver failure. The Lancet, 2024; 404, 789-802

Written in 2025