Answer 1. D
A rising total bilirubin in the setting of acute liver failure with loss of hepatic function is an ominous sign that is likely multifactorial in nature. This may be due to reduced hepatic uptake, decreased bile conjugation, and/or decreased biliary excretion as hepatocyte death progresses.
Serum aminotransferase elevation is usually secondary to hepatocellular injury due to inflammation, toxin, or passive congestion, although there are extrahepatic causes of elevated transaminases as well. Aminotransferases levels may remain stable or trend downward even as bilirubin rises as liver failure and hepatocellular dealt progress, so uptrending AST/ALT do not necessarily reflect loss of hepatic function. Hypoglycemia, not hyperglycemia, may occur as hepatic dysfunction progresses due to loss of glycogen stores and gluconeogenesis within the liver. Factor VII is a clotting protein synthesized in the liver that, when levels decline to less than 12% of normal, may predict fulminant hepatic failure.
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