American Board of Internal Medicine (ABIM) Certification Practice Exam

Which of the following is a defining criterion for acute liver failure?

1. History of chronic liver disease

2. Clearance of bilirubin

3. Jaundice, hepatic encephalopathy, and coagulopathy

4. Elevated liver enzymes without encephalopathy

The correct answer is: Jaundice, hepatic encephalopathy, and coagulopathy

Acute liver failure is characterized by a rapid decline in liver function, and the defining criteria include the presence of jaundice, hepatic encephalopathy, and coagulopathy. Jaundice is a clinical manifestation resulting from the impaired excretion of bilirubin, reflecting liver dysfunction. Hepatic encephalopathy indicates that the liver is unable to adequately remove toxins from the bloodstream, leading to neurological disturbances. Coagulopathy refers to the liver's inability to produce clotting factors, leading to an increased risk of bleeding. The combination of these symptoms distinguishes acute liver failure from other liver conditions and signifies a critical loss of hepatic function. The other options do not encompass the complete picture necessary for diagnosing acute liver failure. For instance, a history of chronic liver disease can lead to acute on chronic liver failure but does not define an acute liver failure episode. Clearance of bilirubin can be an indicator of recovery but is not a defining feature. Elevated liver enzymes without encephalopathy would indicate liver damage but would not meet the criteria for acute liver failure, as encephalopathy is a key component of the condition.