Fulminant hepatitis, or acute liver failure, is a condition in which the liver tissue deteriorates rapidly. This happens when more than 80 percent of the cells in the tissue are damaged, and as a result, the liver suddenly isn't able to do what it's supposed. A complete shutting down of the organ can happen within weeks, or even days, and the speed of tissue destruction, as well as the outcome, depends on the underlying cause of this condition. And the causes of acute liver failure are many.
What are the causes of fulminant hepatitis?
There are a few different causes that can lead to acute liver failure. It would be easiest if we were to divide them into infectious and non-infectious causes.
As for the infectious causes, several forms of viral hepatitis can cause acute liver failure. Hepatitis A is viral infection of the liver spread through unsanitary water or food. In most cases, it resolves in a few months without any major problems, except for the extreme discomfort this condition causes. However, in rare cases, it can lead to liver failure. Hepatitis B, which is a blood borne virus, can also cause acute liver failure, and even more so, the co-infection of hepatitis B and D. On the other hand, hepatitis C rarely causes acute liver failure. As for hepatitis E, we do know that it can sometimes cause fulminant hepatitis, but this virus hasn't been researched that much. With regard to other viruses, it is known that, in some cases, something as seemingly harmless as a chickenpox infection can cause acute liver failure in children.
The non-infectious causes of fuliminant hepatitis, meanwhile, range from poisoning to inherited diseases. A paracetamol overdose can cause acute liver failure. Other drugs, such as tetracycline and aspirin, have also been linked to this condition. Eating poisonous mushrooms can cause this condition, as well as eating food spoiled by bacteria. In this case, it's not the bacteria that cause the liver failure, but their toxins. Alcoholism and binge drinking can both cause the liver to shut down. Some hereditary conditions, such as Wilson's disease, are believed to cause this condition as well.
What are the symptoms of fulminant hepatitis?
Fulminant hepatitis starts with general, non-specific symptoms. A person usually experiences fever, abdominal pain, nausea, and vomiting, and, generally, not feeling well. These symptoms can easily be misinterpreted, as they are shared between a number of conditions, ranging from mild food poisoning to stomach cancer.
But, as the state of the liver worsens, other symptoms start emerging. Jaundice, which is a condition in which the skin, the white of the eyes and the mucosa are colored yellow, can show. Confusion, stomach swelling, and issues with coagulation can also appear.
How is fulminant hepatitis diagnosed?
There are three different types of tests that should be done.
The first one are blood testes, to test the levels of liver enzymes, such as AST, ALT, and ALP. The levels of GGT should also be tested. Higher levels of these enzymes point to liver damage. Albumin and protein levels should also be checked. Since albumin is a protein which is synthesized in the liver, if the liver is damaged, the levels of this protein will be lower than normal. Bilirubin is the end product of hemoglobin metabolism, and is excreted from the organism with the help of the liver. If the liver is damaged, it lacks the capacity to deal with all the bilirubin, and bilirubin levels in the blood rise. Prothrombin time should also be measured, since the liver synthesizes blood clotting factors too. If it isn't able to do so, due to damage, the time needed to form a clot will be longer than normal.
Imaging tests should also be done. An ultrasound, CT or MRI scan can be carried out to determine the shape and the state of the liver, as well as to check the blood vessels, and the presence of tumors.
Lastly, a liver biopsy is recommended. In this procedure, small piece of the liver is taken, and, after preparations, checked under the microscope.
But, aside from the laboratory tests, the history of the patient should also be checked, to find out if there has been a poisoning, wether by medicine, or by food. The patient should also be checked for infectious diseases, such as HIV, and hepatitis B and A.