Compare and contrast Acute Fulminant Liver Failure (AFLF) and Chronic Decompensated Liver Disease (CDLD)
History
| AFLF | CDLD |
| – Acute ingestion (eg paracetamol) – Drug interactions – Viral – Ischaemic – Post-operative – Herbal / alternative Rx eg St John’s Wort | – Chronic liver disease – Encephalopathy – Hepatitis (eg chronic Hep C) – GI bleeds |
Examination
| AFLF | CDLD | |
| Jaundice | YES | YES |
| Coma | YES | YES |
| Intracranial hypertension | COMMON | LESS COMMON |
| Portal hypertension | UNCOMMON | COMMON: eg, – Haematemesis – Asterixis – Spider naevi – Ascites etc |
Biochemical findings
| AFLF | CDLD | |
| BSL | Hypoglycaemia common | Hypoglycaemia rare |
| Na | Hyponatraemia rare | Hyponatraemia common |
| Acidosis | Severe | Less severe |
| Bilirubin | High | High |
| LFTs | Very deranged | Less severely deranged |
| Renal Failure | Common | Less common |
Haematological findings
| AFLF | CDLD | |
| Plt | Normal | Low |
| INR | Very high | somewhat high |
| Fibrinogen | Low | Normal |
Imaging
| AFLF | CDLD | |
| CT Brain | Cerebral oedema | No cerebral oedema |
| CT Abdomen | – Swollen liver – may find vascular cause for AFLF | – shrunken, fibrotic liver – splenomegaly – varices |
Biopsy
| AFLF | CDLD |
| Necrosis | Fibrosis |