Table 2:

Differential diagnosis for a young adult patient with acute liver injury

Diagnosis	Key features and investigations
Viral hepatitis	Aminotransferase levels can exceed 1000 U/L Positive viral serologies (e.g., hepatitis A–E, herpes simplex virus, varicella zoster virus, cytomegalovirus, Epstein–Barr virus)
Ischemic hepatitis	Aminotransferase levels can exceed 1000 U/L Often associated with an episode of shock or hemodynamic instability
Drug-induced liver injury	Thorough medication history, including prescribed and nonprescribed medications, mushroom ingestion, herbals, dietary supplements Elevated acetaminophen and alcohol levels
Hepatic thrombosis	Review prothrombotic risk factors Abdominal ultrasonography with Doppler
Autoimmune hepatitis	Occurs predominantly in females Positive anti-nuclear antibodies, anti-smooth muscle antibodies, anti-liver–kidney antibodies Elevated total immunoglobulin G
Wilson disease	Can have psychiatric or neurologic manifestations Slit lamp examination for Kayser–Fleischer rings, decreased serum ceruloplasmin and elevated 24-h urinary excretion of copper
α-1 antitrypsin deficiency	May be associated with lung manifestations (e.g., early-onset emphysema) Decreased serum α-1 antitrypsin level
Hypertensive disorders of pregnancy	Features of hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome Severe hypertension with less prominent liver dysfunction as in HELLP
Acute fatty liver of pregnancy	Usually presents between 30 and 38 wk gestation Rapid development of acute liver failure