American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the immediate action required following a diagnosis of acute liver failure (ALF)?

1. Start antiviral therapy

2. Contact a liver transplant center

3. Order a liver biopsy

4. Refer to a gastroenterologist

The correct answer is: Contact a liver transplant center

Following a diagnosis of acute liver failure (ALF), the immediate action required is to contact a liver transplant center. This is crucial because ALF can lead to rapid deterioration in liver function, often requiring urgent intervention. The management of ALF hinges on assessing the severity of liver damage and determining if the patient is a candidate for liver transplantation. Early involvement of a transplant center ensures that the patient can be evaluated and prioritized for transplantation if necessary. Timely referral to a transplant center is essential given the high risk of complications, including hepatic encephalopathy, coagulopathy, and multi-organ failure. The window for successful transplant is limited, so the quicker the process begins, the better the chances for the patient. In contrast, starting antiviral therapy may be relevant if the ALF is due to viral hepatitis, but it does not address the immediate need for liver transplantation. Ordering a liver biopsy is typically not appropriate in acute liver failure scenarios since it can lead to complications and doesn't provide the critical information needed for immediate management. Referring to a gastroenterologist is also important for ongoing care and management, but it does not fulfill the urgent need for possible transplantation that is central to managing ALF effectively.