Pediatric acute liver failure (PALF) is a life-threatening disorder characterized by acute hepatocellular injury occurring in children without recognized underlying liver disease. The clinicopathologic evaluation of PALF requires a different approach from that in adults. The diagnostic considerations differ depending on the age, personal and family history, geographical region, and clinical presentation. Distinct entities such as gestational alloimmune liver disease, herpes simplex virus infection, and metabolic disorders should be considered in neonates with acute liver failure, while acetaminophen toxicity and autoimmune hepatitis are more frequently seen in older children and adolescents. An identified cause for PALF despite a negative complete evaluation (indeterminate) is lacking in 30 to 50% of cases. Although not routinely performed in the setting of PALF, liver biopsy may be helpful in assessing the etiology, potential mechanisms of injury, determining the appropriateness of liver transplantation, and prognostication of the patients. In this article, we review the clinicopathologic characteristics of PALF with an emphasis on general approach of pathologic evaluation and histopathologic characteristic of selected entities.

中文翻译：

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小儿急性肝衰竭：临床病理学观点。

小儿急性肝功能衰竭 (PALF) 是一种危及生命的疾病，其特征是在没有公认的潜在肝病的儿童中发生急性肝细胞损伤。PALF 的临床病理学评估需要与成人不同的方法。诊断考虑因年龄、个人和家族史、地理区域和临床表现而异。急性肝衰竭新生儿应考虑妊娠同种免疫性肝病、单纯疱疹病毒感染和代谢紊乱等不同疾病，而对乙酰氨基酚毒性和自身免疫性肝炎更常见于年龄较大的儿童和青少年。在 30% 至 50% 的病例中，尽管有负面的完整评估（不确定），但仍无法确定导致 PALF 的原因。虽然在 PALF 的情况下不常规进行，但肝活检可能有助于评估病因、潜在的损伤机制、确定肝移植的适当性以及患者的预后。在本文中，我们回顾了 PALF 的临床病理学特征，重点是病理学评估的一般方法和选定实体的组织病理学特征。