Acute Hepatitis Including Acute Liver Failure

Case 1
• 52 year old Caucasian male
• GP referral to surgeons with “obstructive jaundice”
• US and MRCP (stones in gall bladder, spleen 13 cm)
• liver biochemistry
• refer to physicians (seen 2 weeks later in clinic)
• ALT 1263, bilirubin 250, INR 1.1 (and stable for 2 weeks)
• viral serology negative
• immunology
• antinuclear antibody and anti smooth muscle antibody positive
• slightly elevated immunoglobulins
• diagnosis: aetiology and severity?
• acute autoimmune hepatitis (can be underlying chronic damage)
• no evidence of liver failure (not incipient)
• liver biopsy