Tuesday, January 26, 2010

Fulminant hepatic failure













Defined as rapid onset of encephalopathy and marked decrease in liver synthetic function within 28d of symptom onset in patient without chronic liver disease

Major etiologies are 1)acetaminophen OD, 2) idiosyncratic drug reaction, 3) Hep B, 4) Hep A, 5) others

Coagulopathy usually precedes encephalopathy, which may quickly progress to coma

It is important to determine the etiology, since specific causes may have specific treatments:
NAC for acetaminophen, penicillin for amanita mushroom poisoning, delivery for acute fatty liver of pregnancy, zinc/trientine for Wilson's.

Pts should be admitted to ICU and transferred to a transplant centre.

Supportive care includes:
glucose (may need d10 drip)
electrolyte replacement
fluids
reversal of coagulopathy
neurochecks >q6h

FFP (4u) may normalize coags for 6h (for procedure or bleeding)

Empiric abx for any sign of infection

Poor prognostic indicators predicting need for transplant:
pH below 7.3 after resuscitation
PTT over 100
Cr over 290
Gr 3 or 4 encephalopathy
Lactate over 3.3 4h post admission


Major causes of transaminases in the thousands:

1) Ischemia
-inflow (hypotension- shock liver, PV thrombosis)
-outflow (CHF, Budd-Chiari)

2) Viral
HAV, HBV (rarely HCV)
Others- EBV, HSV, CMV

3) Drugs/toxins

4) Autoimmune

5) Obstruction/stone

6) Acetaminophen and EtOH both (but rarely EtOH alone)


Link:
Click here for a NEJM case of fulminant hepatic failure from HSV infection that discusses management considerations
Click here for a paper on approach to increased liver enzymes

1 comment:

  1. Am Abdul Hakim so joyful giving this testimony of genius herbalist,Dr Moses anabic herbal home whom cured me of liver cancer.i was diagnosed of liver cancer 2years back I tried to cope with the sickness but unfortunately it had gone so bad,I went to so many medical centres I was told to go for a special xray which was computed tomography scan.it's result came out that my liver was rottening and was told that there was no cure,I collapsed there at the centre after getting myself an individual who came for a test after being cured from hiv,then gave me an email address of dr Moses anabic so I contacted him and he assured me of a total cure after three weeks of administering his herbs and I was cured totally.nothing is impossible for God almighty any individual suffering from any illness or virus no matter how bad it may be,don't ever think it's impossible.contact him through his personal email address via MOSESANABIC@GMAIL.COM or write him on WhatsApp with +2348100661264.thank you very much doctor Moses.

    ReplyDelete