A Multidisciplinary Approach to Acute Liver Failure: An Internist's Perspective

Acute liver failure (ALF) in the dog is characterized by an acute severe decompensation in liver function marked by increases in serum liver enzymes that are accompanied by the development of hyperbilirubinemia, prolongation of prothrombin time and neurologic signs compatible with hepatic encephalopathy all in an animal without known pre-existing liver disease.   Causes of ALF in the dog include drug reactions, toxin exposure, infections, immune reactions, neoplasia, and vascular disorders. Closely related to ALF is the clinical syndrome of acute on chronic liver failure (ACLF) in which a sudden decompensation is observed in dogs with pre-existing chronic liver disease.  The sudden decompensation is typically associated with some event that leads to hepatocyte injury that triggers severe systemic inflammatory response. Both ALF and ACLF are associated with very high morbidity and mortality.  This first session will discuss the cause of ALF and ACLF, the clinical presentation, clinical pathology and imaging findings, how best to approach identifying the etiology by tissue sampling or toxicological testing and specific treatment modalities.  The goal of this session and the subsequent session on controlling complications is to begin discussion of how the veterinary community can begin to improve the prognosis for these patients.