Fulminant Hepatic Failure – Causes, Symptoms, Possible Consequences and Treatment

Fulminant Hepatic failure

, also known as FHF is a condition indicating acute liver failure. This condition occurs when the liver cells are severely damaged and lose their ability to repair and regenerate. The onset of the disease is very sudden as the word “fulminant” suggests and liver failure occurs within 8 weeks of diagnosis of the underlying cause. This disease not only affects the primary organ but also impacts other secondary organs like the brain causing a condition called Encepahalopathy.

Damaged Liver

Causes of Fulminant Hepatic Failure

  • Paracetamol/ Acetominophen overdose

    : Persistent paracetamol use as in headaches, body aches, fever and congestion can cause this condition.

  • Alcohol Abuse

    : Chronic alcohol abuse is another major reason of this disease.

  • Reaction to medication

    : Some individuals develop severe liver complications followed by liver failure on being administered with certain medications like Tetracycline, Troglitazone etc.

  • Viral Hepatitis

    : Patients can develop serious liver complications from Hepatitis A and Hepatitis B. This could lead to the failure of the said organ.

  • Idiopathic

    : This disease can manifest itself without establishing any definite reason for it.

  • Reye Syndrome

    : Predominantly seen in children, this could be the side effect of a viral infection like chicken pox or measles.

  • Poisoning

    : Sometimes poisoning from herbs or mushrooms could cause it.

  • Prolonged Aspirin use

    : Primarily an analgesic (relieves body ache, fever), it is used in low doses to prevent blockages in the arteries. However, one of its most undesirable side effect could be necrosis (death) of the liver cells.

  • Wilson’s Disease

    : A genetic condition characterized by the abnormal accumulation of copper on the liver could lead to this irreversible ailment.

Symptoms of Acute Liver failure(ALF)

Symptoms are quite non indicative and are very general in nature to begin with. Some of the symptoms are as follows:

  • Nausea
  • Loss of Appetite
  • Vomiting
  • Jaundice
  • Fatigue
  • Itchy skin
  • Increased susceptibility to bruising and bleeding
  • Ascites, characterized by the abnormal retention of fluids in the abdomen
  • Cerebral edema or retention of fluid in the cellular cavities of the brain tissue
  • Mental confusion and delirium

Diagnosis of Irreversible hepatic failure

Physicians generally confirm the diagnosis by conducting a battery of pathological tests. As the disease discussed has every potential to turn fatal, the tests become very important in assisting the physician to rule out anything else and start treatment. The tests conducted are as follows:

  • Ultrasound of the abdomen
  • Blood and urine tests
  • Liver Biopsy
  • Endoscopy of the upper gastro intestinal tract including the esophagus and duodenum
  • CT scan of the brain tissue

Possible consequences of Acute Liver Failure

  • Encephalopathy

    : Cerebral edema can lead to confusion, delirium, decreased alertness, increased pressure in the brain tissue or even coma. This condition is called Encephalopathy and is due to the impact of built up toxins on the brain. This condition can lead to severe mental retardation and death.

  • Coagulopathy

    : It is also known as the bleeding disorder or the clotting dysfunction. Coagulation is clotting property of blood which prevents the loss of blood in case of an injury. The liver plays a major role in synthesizing the coagulating factors (the elements which helps in clotting blood). The damaged liver cells fails in doing the above task in case of ALF.

  • Platelet dysfunction

    : Platelets are also affected both in quantity as well as quality.

  • Kidney Dysfunction

    : More than 50% of patients suffering from ALF report impaired kidney function. Because of decreased liver functions and intracellular damage the kidneys start showing signs of cell necrosis and dysfunction.

  • Inflammation and Infection

    : Systemic inflammatory syndrome irrespective of the presence of infection is seen in about 60% of these patients. It is an inflammatory tendency in the body due to the accumulation of toxins. This particular condition causes the infection to spread throughout the body and leads to multi organ failure.

Treatment of Fulminant Hepatic Failure

  • The detection and management of the underlying cause manifesting the condition prevents fatality in most of the cases.
  • It is an irreversible liver damage and may require a liver transplant.
  • Doctors generally prescribe a special diet low in sodium and protein during the treatment. Vitamin supplements are also prescribed to ensure proper nutrition.
  • A concept called “Liver Dialysis” has been introduced. Medications to remove the toxins in the body are administered. They take on the task of the liver in flushing toxins like ammonia out of the body. Medications to treat edema or to remove the fluid in the brain and other body parts are also prescribed.
  • The treatment requires intensive care at the hospital and the patient is kept under close observation. It is a very serious condition which if detected early and diagnosed properly can be life saving.

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