Fulminant Hepatic Failure
What
is it?
Fulminant hepatic failure is another name for
acute liver failure. Acute means it has a rapid
onset and follows a short, severe course. The
liver performs many important functions, including
the production of bile, which helps change
substances in the foods we eat into proteins,
fats, and carbohydrates, and the absorption of
harmful substances such as chemicals, drugs, and
alcohol from the body. If liver cells are damaged
and die, the remaining cells are not able to
perform all of the liver’s functions. As toxins
build up, the patient’s health begins to fail.
Who
gets it?
Fulminant hepatic failure is more common in
infants and children with certain diseases and
metabolic defects that damage and destroy liver
tissue. Children who take immunosuppressive drugs
or have a disease that compromises the immune
system are also at higher risk for liver failure
as a complication of the herpes virus.
What
causes it?
Fulminant hepatic failure in infants under four
weeks old can be caused by viruses such as herpes
simplex; adenovirus, which causes conjunctivitis
and upper respiratory tract infections; or
enteroviruses, which affect the gastrointestinal
tract. Other causes in very young infants include
neonatal iron storage disease, certain metabolic
disorders such as tyrosinemia and galactosemia,
fructose intolerance, familial erythrophagocytic
histiocytosis, peroxisomal diseases, and defects
in respiratory chain and fatty acid oxidation or
synthesis of bile acid. Older infants and children
are more likely to develop fulminant hepatic
failure from viral hepatitis (HBV, HEV, NANBNC) or
parvovirus (which causes fifth disease). Other
causes of liver failure in older children can
include Wilson’s disease, fatty liver,
acetaminophen overdose, chronic alcohol abuse,
exposure to toxins (such as poisonous mushrooms),
leukemia, Reye’s syndrome, cardiomyopathy, and
autoimmune hepatitis. In some cases, the cause of
liver failure is unknown.
What
are the symptoms?
Symptoms of fulminant hepatic failure include a
build up of fluid in the abdomen, which causes
swelling called ascites; a yellowish tone to the
skin, called jaundice; light-colored bowel
movements; a tendency to bruise or bleed easily;
fever; abdominal pain; itchy skin; dark urine;
nausea; loss of appetite; fatigue; and weakness.
As the condition progresses, it causes confusion
and erratic behavior as the build up of toxins in
the blood affects brain function. This is called
liver encephalopathy. Liver failure can also cause
kidney failure, coma, and death.
How is
it diagnosed?
To
diagnose fulminant hepatic failure, a doctor will
study the patient’s medical history and perform a
thorough physical examination. While the
characteristic symptoms are enough to indicate
liver failure, the doctor will order tests to
confirm the diagnosis and determine the cause.
These might include blood and urine tests,
ultrasound or computed tomography (CT) scans, and
a liver tissue biopsy.
What
is the treatment?
Treatment for fulminant hepatic failure is based
upon the cause and the symptoms. The child will
receive intravenous (IV) fluids to carefully
balance fluids, electrolytes, and glucose levels.
If the child is comatose, he or she may need to be
intubated to help with breathing. Medications,
blood transfusions, and hemodialysis can be used
to remove toxins from the body. However, liver
damage cannot be reversed. The most effective
treatment is liver transplant. The survival rate
for patients who receive a liver transplant is
higher than those who do not.
Self-care tips
If your
child has been diagnosed with fulminant hepatic
failure, work with your doctor to learn all you
can about your child’s condition. You will find
that knowledge is your best defense and will help
you make the right decisions for your child. When
your child comes home from the hospital, carefully
follow your doctor’s orders for diet and
medication to keep your child as healthy as
possible.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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