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Acute liver failure (Fulminant Hepatitis)
| What is it and what causes it? |
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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.
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It usually develops rapidly and demands immediate
care.
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ALF should not be confused with other types
of liver failure due to Cirrhosis or Chronic Hepatitis, which
normally take years to develop.
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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
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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.
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At a certain point, most patients become confused
or sleepy and may go into coma.
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They can also bleed from the gums or stomach,
and they can bruise easily due to poor blood clotting.
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Early on, ALF is difficult to diagnose because
it resembles other illnesses and is quite rare.
Treatment of Acute Liver Failure
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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.
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Majority of patients can be successfully treated
in a dedicated Liver Unit with ICU support and medicines by
specialised liver physicians (Hepatologists).
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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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