Fulminant hepatitis B 許瑜真

Definition the rapid development of severe acute liver injury with impaired synthetic function and encephalopathy in a person who previously had a normal liver or had well-compensated liver disease – encephalopathy within eight weeks  previously healthy liver – encephalopathy within two weeks  previous underlying liver dysfunction

Etiology Virus: hepatitis virus, EBV, CMV, herpes simplex virus, and varicella zoster  HHV-6 Toxins: 最常見於 acetaminophen Vascular: portal vein thrombosis, hepatic vein thrombosis, veno-occlusive disease, and ischemic hepatitis Metabolic: Wilson's disease, acute fatty liver of pregnancy, and Reye's syndrome Miscellaneous: malignancy, heat stroke, sepsis, and autoimmune hepatitis

Treatment Spontaneous recovery is more likely with lower grades of encephalopathy : – Grade I to II — 65 to 70 percent – Grade III — 40 to 50 percent – Grade IV — <20 percent Liver transplantation – one-year survival rates of greater than 80 percent