Fulminat hepatic failure

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Characterised by 

Ø      Altered mental status

Ø      Abnormal coagulation results

Ø      Abdominal pain, jaundice.

 

Aetiological agents

ü      Hepatitis A

ü      Hepatitis B

ü      Hepatitis C

ü      Hepatitis D

ü      Hepatitis E

 

               Rarely

·        EBV

·        Cytomegalovirus

·        Chickenpox

·        Yellow fever

 

In Immunocompromised patients

Ø        CMV

Ø        Adenovirus

Ø        HHV 6

 

Assessments

History

Date of onset

Fever, nausea, vomiting

Jaundice, abdominal pain

Altered mental status

History of travel

History of vaccination

History of contact with patients having similar symptoms

 

Physical examination

Body temperature

Jaundice

Tender liver

Hepatomegaly

Tremor and altered state of consciousness

 

Investigations

CBC
LFT

Bleeding time

Glucose level

 

Tests

Hepatitis A IgM, HB sAg, or anti HCV.

EBV VCA IgM, CMV IgM

Testing for Hepatitis D or Hepatitis E is carried out if there is any suspicion.

Immunocompromised patients should be tested for CMV, Adenovirus and HHV 6 by PCR.

 

Management

Refer patients to gastroenterologists or hepatologists.

Liver transplant

 

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