1. Acute (Fulminant) Hepatic Failure (FHF)
Syndrome in which hepatic encephalopathy results from a sudden severe impairment of hepatic function
Occurring within 8 weeks of onset of the Acute liver disease, in the absence of evidence of pre-existing liver disease (to distinguish it from deterioration in CLD that also leads to HE)
Dr S Chakradhar

2. Any cause of acute liver disease Acute Viral hepatitis (commonest)
Aetiology
Any cause of acute liver disease
Acute Viral hepatitis (commonest)
Drugs e.g. parcetamol in overdose , Halothane, MAO inhibitors
Toxins Aflatoxin , CCl4
Miscellaneous - Wilson’s disease, pregnancy , Reye’s syndrome Shock
Dr S Chakradhar

3. Clinical features 1. Features of cerebral disturbances (Encephalopathy)
Dr S Chakradhar

4. 2. Features of Cerebral oedema
Unequal or abnormally reacting pupils, fixed pupils
Hyperventilation, profuse sweating
Local or general myoclonus, focal fits , decerebrate posturing
Papilloedema does not occur or a late sign
Dr S Chakradhar

5. Weakness , nausea & vomiting Jaundice Fetor hepaticus
3. Others
Weakness , nausea & vomiting
Jaundice
Fetor hepaticus
Enlarged liver (early), later impalpable
Ascites, edema
Features of complications
Dr S Chakradhar

6. Complications
Dr S Chakradhar

7. Prothrombin time - much prolonged
Investigations
Blood Leucocytosis
LFT
Prothrombin time - much prolonged
Plasma amino transferase (ALT& AST) – high initially but fall if liver damaged
Serum Albumin – normal unless course is prolonged
Serum Alkaline phosphatase - variable
Urine – bilirubin , urobilinogen
Liver biopsy contraindicated
Dr S Chakradhar

8. “Starry-sky”
Dr S Chakradhar

9. Measures for encephalopathy See Hepatic Encephalopathy
Management
Pt should be treated in ICU. Close observation so that complication can be corrected promptly
Measures for encephalopathy
See Hepatic Encephalopathy
Measures for cerebral oedema
Mannitol 20% (1gm/kg) iv infusion over 30 minutes repeated if necessary
Dr S Chakradhar

10. Correction of electrolytes
Nutrition
Glucose (300gm/d) orally or into a large central vein as % solution (no protein)
Correction of electrolytes
Improvement of circulatory function - I/V fluids
N acetylcysteine 150gm/kg stat then 10 mg/kg hourly
Respiratory failure – assisted ventilation
Hemorrhage – inj Vit K, Platelets, blood or plasma. H2 blocker
Infection – cefotaxime or augmentin
Liver transplantation in progressive liver failure
Dr S Chakradhar

11. Mild cases - (grade 1 & 2 encephalopathy with drowsiness & confusion)
Course & prognosis
Mild cases - (grade 1 & 2 encephalopathy with drowsiness & confusion)
2/3rd of the pt survive
Severe cases – grade 3 & 4 encephalopathy with stupor or deep coma
Is related to the aetiology
Dr S Chakradhar

12. It is common in children & adolescents Jaundice is not seen
Reye's syndrome
This is a rare acute encephalopathy in which cerebral edema & severe fatty degeneration of the liver develops after an infectious illness such as influenza or chicken pox which has been often treated with aspirin
It is common in children & adolescents
Jaundice is not seen
Dr S Chakradhar