The diagnosis of AFLP is primarily clinical, supported by laboratory findings. The Swansea criteria are commonly used for diagnosis, requiring the presence of six or more of the following features in the absence of another explanation:
- Vomiting
- Abdominal pain
- Polydipsia/polyuria
- Encephalopathy
- Elevated bilirubin (>14 μmol/L)
- Hypoglycaemia (<4 mmol/L)
- Elevated uric acid (>340 μmol/L)
- Leucocytosis (>11 x 109/L)
- Ascites or bright liver on ultrasound
- Elevated transaminases (AST or ALT >42 IU/L)
- Elevated ammonia (>47 μmol/L)
- Renal impairment (creatinine >150 μmol/L)
- Coagulopathy (PT >14 seconds or APTT >34 seconds)
- Micro vesicular steatosis on liver biopsy
In this case, the patient's initial symptoms, rapid progression to multi-organ failure, including renal dysfunction and coagulopathy, along with the presence of ascites, is highly suggestive of AFLP.
