Updated: 1/16/2017

Fulminant Liver Failure

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  • A 55-year-old homeless alcoholic male with hepatitis C well-known to the local medical staff is brought to the ED by ambulance after being found down near a bench in the park. He is jaundiced with icteric sclerae and mumbling. He was lost to follow-up by the community health clinic and rehabilitation center, despite multiple attempts at providing medical management and social support. The man is admitted to the MICU and passes soon after of multiorgan failure. On gross pathology, his liver is cirrhotic. The suspected cause of death is fulminent hepatic failure. 
Introduction
  • Liver failure + ecephalopathy
    • onset < 8 weeks post hepatic dysfunction
  • Caused by
    • Reye syndrome
    • Drugs (e.g. acetaminophen)
    • infection (e.g. viral hepatitis)
Presentation
  • Symptoms
    • vomiting
    • stupor
    • coma
    • death
  • Physical exam
    • jaundice
      • not typically seen in Reye's
    • hepatomegaly
Evaluation
  •  Labs
    •  or normal transaminases
      • depends on the cause of liver damage
    • ↑ PT time
      • due to ↓ synthesis of clotting factors from liver
    • ↑ ammonia
      • poor functioning of urea cycle in failing liver
 Treatment
  • Surgery
    • liver transplant
 

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