The rapid development (> 6 months) of hepatic dysfunction without prior liver disease

Aetiology

• Viral - Hep. A-E, CMV, EBV
• Drugs (drug induced liver injury - DILI)
  • Antibiotics - amoxicillin + clavulanic acid, co-amoxiclav and flucloxacillin
  • Paracetamol
• Shock liver
• Cholangitis
• Alcohol
• Malignancy
• Rare causes - Budd Chiari, acute fatty liver of pregnancy, cholestasis of pregnancy

Clinical features

Can be asymptomatic or present with:

Symptoms

• Lethargy
• Nausea
• Anorexia
• Abdominal pain, joint pain
• Itch

Signs

• Jaundice

Investigations