Acute liver failure (Fulminant Hepatitis)

• 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.
• It usually develops rapidly and demands immediate care.
• ALF should not be confused with other types of liver failure due to Cirrhosis or Chronic Hepatitis, which normally take years to develop.
• 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

• 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.
• At a certain point, most patients become confused or sleepy and may go into coma.
• They can also bleed from the gums or stomach, and they can bruise easily due to poor blood clotting.
• Early on, ALF is difficult to diagnose because it resembles other illnesses and is quite rare.

Treatment of Acute Liver Failure

• 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.
• Majority of patients can be successfully treated in a dedicated Liver Unit with ICU support and medicines by specialised liver physicians (Hepatologists).
• 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.