Which of the following can cause acute hepatic failure?

• A. Viruses, hepatotoxic drugs, and ischemia.
• B. Chronic alcohol use alone.
• C. Ischemia only.
• D. Biliary obstruction.

Answer: (D)

Acute hepatic failure happens when a sudden, severe injury to the liver leads to widespread hepatocyte death and a rapid loss of liver function, so coagulation fails and mental status can deteriorate. Viruses, hepatotoxic drugs, and ischemia are classic ways the liver can be damaged quickly enough to cause this fulminant picture because they directly injure liver cells or cut off its blood supply.

Biliary obstruction can also precipitate acute hepatic failure, especially if it is acute and severe or complicated by infection. The backup of bile and the resulting inflammation and cellular injury can push the liver into failure in a short time if not relieved. This is why biliary obstruction is a plausible cause of acute hepatic failure in the appropriate clinical context. Chronic alcohol use tends to cause more gradual, chronic liver disease rather than a rapid, fulminant failure, which is why it’s less likely to be the cause by itself.