Table 1.

Initial investigations to help establish the cause of acute liver failure

Toxicology for drugs including paracetamol/salicylate
Viral hepatitis screen:

  • hepatitis A, B, C, E

  • herpes simplex virus

  • varicella-zoster virus

  • Cytomegalovirus

  • Epstein–Barr virus

  • parvovirus.

Autoimmune hepatitis screen:

  • antinuclear antibodies, anti-smooth muscle antibodies, anti-soluble liver antigen, globulin profile, anti-neutrophil cytoplasmic antibodies.

Other investigations dependent upon clinical situation:

  • pregnancy test

  • ammonia measurement

  • caeruloplasmin/slit-lamp examination for Kayser–Fleischer rings if Wilson’s disease suspected

  • bone marrow / lymph node biopsy if lymphoma suspected.

Doppler ultrasound / computed tomography of the liver to assess patency of portal vein, hepatic artery and hepatic veins.