Definition
Fulminant hepatitis is a rare syndrome characterized by massive necrosis of the hepatic parenchyma. The result is a severe impairment of liver function, which often leads to the death of the patient. This violent reaction usually occurs in viral or alcohol-induced hepatitis, toxic agents (eg drugs and toxins from the Amanita phalloides fungus) and some drugs (eg excessive intake of paracetamol).
Hepatitis B virus (HBV) is responsible for most cases, especially in co-infection with HDV. The fulminant hepatitis from hepatitis A, C and E viruses, on the other hand, is quite rare. Infections with Epstein-Barr virus (EBV), cytomegalovirus and herpes simplex may also contribute to the onset. Other cases recognize a vascular, autoimmune and metabolic origin.
Most common symptoms and signs *
- Anorexia
- Asthenia
- Cachexia
- Coma
- Difficulty concentrating
- Temporal and spatial disorientation
- Mood disorders
- Abdominal pain
- Pain in the upper part of the abdomen
- Bruising
- Brain edema
- Gastrointestinal hemorrhage
- Ease of bleeding and bruising
- I made clear
- Increased blood urea
- Jaundice
- Lethargy
- Leukopenia
- Nausea
- oliguria
- thrombocytopenia
- itch
- Drowsiness
- Confusional state
- Dark urine
- He retched
Further indications
Fulminant hepatitis evolves very rapidly and leads to acute liver failure. At the onset, pain appears in the upper right part of the abdomen, nausea, vomiting, jaundice (yellowing of the skin and sclera of the eyes), fetor hepaticus (breath with sweet odor) and a sense of general malaise. Coagulopathies, bleeding, electrolyte abnormalities and hepatorenal syndrome (rapidly progressive and fatal) may develop.
In a few days, the process leads to a reduction in the size of the liver (acute yellow atrophy) and leads to porto-systemic encephalopathy. This condition manifests itself with mood alterations, difficulty concentrating, confusion, disorientation and drowsiness. In an advanced stage the coma takes over, sometimes with cerebral edema and ischemic picture.
Prolongation of prothrombin time, porto-systemic encephalopathy and renal failure have a fatal significance. Few treatments are effective and improve the outcome of fulminant hepatitis complications. Currently, a liver transplant performed with maximum urgency represents the best hope for survival. In the absence of a transplant, fulminant hepatitis is related to a very high mortality rate.
