Acute Liver Failure

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Question 1 of 10

1. Question
An 18-year-old girl presents with right upper quadrant pain gradually appearing over the past day. She denies past medical history and the use of any drugs. She appears well and is haemodynamically normal. On clinical examination she is tender over her right upper quadrant but she has no signs of peritonism.

Which of the following describe the most appropriate initial management in the emergency department (ED)?
- Full blood count (FBC), urea and electrolytes (U&Es), liver function tests (LFTs), glucose, amylase
- Chest x-ray
- Abdominal x-ray
- Ultrasound scan
- Analgesia and discharge if pain settles
Question 2 of 10

2. Question
The pain has improved but is still present. The blood results are mostly normal but you notice a markedly raised ALT at 7000 and a glucose of 3.4, and suspect a diagnosis of acute liver injury. There is no change in the history

What is the most appropriate next step in this patient’s management?
- Urgent ultrasound scan
- Surgical admission
- Refer to General Medicine
- CT abdomen
- Perform an urgent arterial blood gas, coagulation screen and paracetamol assay, and start N-acetylcysteine
Question 3 of 10

3. Question
The arterial blood gas shows a pH of 7.33. Her INR is 4.8 and her paracetamol levels are not detected. You also notice that she appears mildly confused. What do you do?
- Commence vitamin K and fresh frozen plasma (FFP) and refer to General Medicine
- Arrange a CT head, commence vitamin K and FFP, continue N-acetylcysteine and refer to the ICU
- Continue N-acetylcysteine, and refer to the specialist liver unit
- Stop the N-acetylcysteine and consider other causes of liver failure
- Discuss with the haematologist and look for other causes of her coagulopathy
Question 4 of 10

4. Question
In the intensive care unit she becomes increasingly drowsy and requires intubation. Which of the following management options are most appropriate?
- She should be hyperventilated until transplant becomes available
- She should be commenced on mannitol and have an intracranial pressure monitoring device placed
- She should be listed for transplant urgently and commenced on mannitol
- She should be adequately sedated with head elevation and consideration of an intracranial pressure monitor whilst listed for transplant
- She should be hyperventilated, commenced on mannitol and listed for transplant
Question 5 of 10

5. Question
What is the most common cause of acute liver failure worldwide?
- Paracetamol poisoning
- Drug reactions
- Viral hepatitis
- Alcohol
- Autoimmune hepatitis
Question 6 of 10

6. Question
Which of the following statements regarding acute liver failure is true?
- All patients should be given prophylactic antibiotics due to the increased mortality associated with sepsis
- All patients should be ideally managed by a specialist referral centre in an intensive care unit setting
- All patients require an ultrasound scan of the liver
- Coagulopathy should be urgently corrected
- Patients should be sedated cautiously if they start to become agitated
Question 7 of 10

7. Question
Which of the following indicates a poorer prognosis?
- Paracetamol toxicity as the aetiology
- Hepatitis A as the aetiology
- Wilson's disease as the aetiology
- Grade II encephalopathy
- INR >5.0
Question 8 of 10

8. Question
Which of the following signs may you elicit on physical examination of the patient with acute liver failure (as opposed to acute-on-chronic liver failure)? (Select all that apply)
- Ascites
- Encephalopathy
- Jaundice
- Hepatic tenderness
- Spider naevi
Question 9 of 10

9. Question
Which of the following statements is correct with regard to N-acetylcysteine in patients with acute liver failure?
- It should be administered immediately until paracetamol levels are back
- It should be administered to all patients when the cause is unknown
- It is contraindicated in patients who have previously had an allergic reaction
- It is only indicated if commenced within the first 24 hours since paracetamol ingestion
- It should only be administered once the paracetamol levels are back to normal
Question 10 of 10

10. Question
Which of the following treatments improve survival in all causes of acute liver failure?
- Transplantation
- Antibiotics
- N-acetylcysteine
- Reversing coagulopathy
- Albumin infusion

3 Comments

Collapse Comments

Ms Samantha Elden-Lee August 27, 2024 at 4:03 pm

Good learning bites!

Dr Chidi Casmine Anyanwu November 15, 2024 at 6:00 pm

An excellent review of ALF

Dr Simon Ugochukwu Mbaekwe, Doctor in training (Group Leader) December 15, 2025 at 3:53 pm

Very precise and rich information

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