It is a picture characterized by encephalopathy and coagulopathy as a result of sudden and severe deterioration of hepatic functions.
Etiology:
• Paracetamol is the most common cause in the Western World, and hepatitis B and A respectively in developing countries.
• The risk of fulminant course increases up to 20% in delta superinfection and acute hepatitis E in pregnant women.
Pathology: Histologically, diffuse parenchymal necrosis is the most common.
Clinic
• One of the most important findings is the development of brain edema.
• Hepatic encephalopathy is the main manifestation of acute hepatic failure.
• Flapping tremor when the hands are extended is characteristic but may not always be observed.
• Jaundice develops.
• It could be fetor hepaticus.
Lab
• Prothrombin time prolongs rapidly and is the laboratory test with the highest prognostic value.
• Increase in bilirubin level is also valuable in prognosis.
• Hypoglycemia may occur and indicates severe hepatocellular insufficiency.
• Plasma albumin concentration generally remains normal.
• Arterial ammonia level may increase in correlation with clinical course.
• Serum aminotransferase levels are not associated with prognosis.
treatment
• Supportive treatment: Volume replacement, treatment of hypoglycemia, prophylactic antibiotics, close monitoring and treatment of complications should be performed.
• Treatment for the agent: Specific antiviral drugs are given in acute B and C infections.
• N-acetylcysteine: It can also be given in fulminant hepatitis due to all toxic (especially paracetamol) causes.
• Liver transplantation: It is the most effective treatment method.
Prognosis All over the world, the most common King's College criteria are still used for prognosis and transplantation indication.