Fulminant Hepatic Failure and Liver Transplantation

Posted by e-Medical PPT Thursday, October 21, 2010
Fulminant Hepatic Failure is defined as appearance of severe complications rapidly after the first signs of liver disease (such as jaundice), and indicates that the liver has sustained severe damage (loss of function of 80-90% of liver cells). The complications are hepatic encephalopathy and impaired protein synthesis.Hepatic encephalopathy occurring within 8 weeks of onset of illness defines FHF.
Common causes for acute liver failure are paracetamol (acetaminophen) overdose,excessive alcohol intake,viral hepatitis (hepatitis A,B or E) and acute fatty liver of pregnancy. Reye syndrome is acute liver failure in a child with a viral infection;it appears that aspirin use may play a significant role. Wilson's disease may infrequently present with acute liver failure.
In Fulminant Hepatic Failure, cerebral edema leads to hepatic encephalopathy, coma, brain herniation and eventually death.Patients presenting as acute and hyperacute liver failure are at greater risk of developing cerebral oedema and grade IV encephalopathy.There is a build up of toxic substances like ammonia, mercaptan, endogenous benzodiazepines and serotonin/tryptophan in the brain. This affects neurotransmitter level and neuroreceptor activation. Autoregulation of cerebral blood flow is impaired and is associated with anaerobic glycolysis and oxidative stress.
Coagulopathy is another cardinal feature of FHF.Hepatocellular necrosis leads to impaired synthesis of many coagulation factors and their inhibitors. the former produces a prolongation in Prothrombin time which is widely used to monitor severity of hepatic injury.Renal failure is common, present in more than 50% of FHF patients, either due to original insult such as paracetamol resulting in acute tubular necrosis or from hyperdynamic circulation leading to hepatorenal syndrome.

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