Fulminant Hepatic Failure: Causes, Symptoms, and Treatment

Fulminant Hepatic Failure: Causes, Symptoms, and Treatment

Question. Write short note on fulminant hepatic failure.

Answer.

Fulminant hepatic failure:

Fulminant hepatic failure is seen in a healthy person which develop acute hepatitis and goes into hepatic encephalopathy within the 8 weeks of illness.

Etiology

• Acute viral hepatitis
• Drugs all hepatotoxic drugs
• Pregnancy with hepatitis
• Wilson’s disease
• Due to Reye’s syndrome.

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Clinical Features Fulminant Hepatic Failure

• Cerebral features: Poor alertness, slurred speech, drowsiness, confusion, disorientation, convulsion and coma.
• Jaundice is present.
• Fetor hepaticus
• Flapping tremors are present.
•  Signs of portal hypertension are present, i.e. ascites, edema.
• Cerebral edema is present.

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Investigations Fulminant Hepatic Failure

• Bilirubin levels are high
• Serum transaminase levels are high
• Prothrombin time is prolonged
• Urine may contain urobilinogen and bilirubin
• Serum ammonia levels are high
• USG of liver shows reduced liver size.

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Treatment Fulminant Hepatic Failure

• Phenobarbitone or 5 mg IV diazepam is given to patient.
• Care of pulse, blood pressure, bowel and bladder is taken.
• 5 to 10% of glucose drip IV is given.
• IV vitamin K is given 10 mg for 3 days.
• IV vitamin C is given 500 mg daily for prevention of bleeding.

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• IV ranitidine is given 50 mg twice daily.
• Encephalopathy is treated by with drawl of protein intake; Sterilization of gut by neomycin 1 gm orally for 6 hours; increased fecal output of nitrogen by changing bacterial flra with lactulose 30 to 60 mL orally after 2–3 hours till loose stool is produced.
• Infections should be treated with amoxicillin or ceftzxime.