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Thursday, January 24, 2008

Acute liver failure (Fulminant Hepatitis)

What is it and what causes it?

  1. Acute Liver Failure (ALF) occurs when a lot of the cells in the liver die in a short period of time (usually within few days to weeks), so that most of the liver's function is lost.

  2. It usually develops rapidly and demands immediate care.

  3. ALF should not be confused with other types of liver failure due to Cirrhosis or Chronic Hepatitis, which normally take years to develop.
  4. The common causes are Hepatitis B, Hepatitis A, Hepatitis E, pregnancy, toxic doses of paracetamol (Crocin, Tylenol) and other drugs, and Wilson's disease (defect of copper metabolism). In a third of cases, the cause remains unknown
Symptoms


  1. These include all the symptoms of Hepatitis, including fatigue, nausea, vomiting, and jaundice (yellow discoloration of the skin and whites of the eyes) which may deteriorate rapidly.

  2. At a certain point, most patients become confused or sleepy and may go into coma.

  3. They can also bleed from the gums or stomach, and they can bruise easily due to poor blood clotting.
  4. Early on, ALF is difficult to diagnose because it resembles other illnesses and is quite rare.
Treatment of Acute Liver Failure

  1. Since ALF progresses so quickly, time is of the essence. It is important that patients with ALF be seen at by doctors experienced in treating ALF and in liver transplantation.

  2. Majority of patients can be successfully treated in a dedicated Liver Unit with ICU support and medicines by specialised liver physicians (Hepatologists).
  3. However, a third of the patients may continue to deteriorate despite the best medical treatment and may need consideration for an urgent liver transplant. The indicators that this may be necessary are: high level of jaundice (more than 12mg/dl), worsening clotting defect indicated by prothrombin time (PT) higher than 50 seconds, worsening mental status or coma, when the interval between beginning of jaundice and mental confusion/sleepiness is longer than 7 days, when the patient's age is less than 10 or more than 40 years, when the cause of the ALF is not known, and worsening kidney function. Patients who have 3 or more of these indicators have less than 10% chance of surviving without a transplant and about 60% chance with one.

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