Abstract
Fulminant hepatic failure (FHF) is an acute and eventually fatal illness, caused by a severe hepatocyte damage with massive necrosis. Its hallmarks are hepatic encephalopathy and a prolonged prothrombin time (< 40%). FHF is currently defined as hyperacute (encephalopathy appearing within 7 days of the onset of jaundice), acute (encephalopathy appearing between 8 and 28 days) or subacute (encephalopathy appearing between 5 and 12 weeks). FHF can be caused by viruses, drugs, toxins, and miscellaneous conditions such as Wilson's disease, Budd-Chiari syndrome, ischemia and others. However, a single most common etiology is still not defined. Factors that are valuable in assessing the likelihood of spontaneous recovery are age, etiology, degree of encephalopathy, prothrombin time and serum bilirubin. The management is based in the early treatment of infections, hemodynamic abnormalities, cerebral edema, and other associated conditions. Liver transplant has emerged as the most important advance in the therapy of FHF, with a survival rate that ranges between 60 and 80%. The use of hepatic support systems, extracorporeal liver support and auxiliary liver transplantation are innovative therapies.
Highlights
Classic: Development of hepatic encephalopathy within 8 weeks of initiation of symptoms in a patient without known chronic liver disease
Mushroom poisoning with severe gastrointestinal symptoms, which occur within hours to a day of ingestion
– Arterial ammonia > 100 mcM/L (N: < 54 mcM/L) – MELD > 32 – All these patients should be treated for PSE
Summary
Classic: Development of hepatic encephalopathy within 8 weeks of initiation of symptoms in a patient without known chronic liver disease. – hepatic encephalopathy and coagulopathy (INR > 1.5) – within 26 weeks from the onset of jaundice, – in patient without known chronic liver disease. – Inverse sleep pattern, personality change, slight change in mental status. (GCS=11-13) – Abnormal EEG with generalized slowing. – 2300-2800/ year in USA; – 6% of adult transplants; – 6% of liver-related deaths; – 0.1% of deaths in USA
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