What Is Hepatitis?
In simple words, hepatitis can be defined as the swelling or inflammation of the liver. Inflammation in any body tissue occurs when it gets infected, damaged, or injured. Similarly, inflammation of the liver occurs when the liver is damaged. This inflammation directly affects the functioning of the liver. Hepatitis of the liver can be acute or chronic. Acute refers to short-term infection, and chronic refers to long-term infections. Some common causes of hepatitis include viral infections (hepatitis A, B, and C), chronic alcoholism, adverse effects of certain toxins and drugs, or autoimmune conditions (a condition in which the body’s immune system starts attacking healthy cells).
What Is Fulminant Hepatitis?
Fulminant hepatitis is an uncommon condition characterized by rapid and extensive death (necrosis) of liver parenchyma. The condition can escalate quickly, usually within days or weeks, and the liver begins to fail. In the case of fulminant hepatitis, the liver starts to decrease in size, and this state is known as acute yellow atrophy of the liver. People who previously had stable liver disease or had never experienced liver problems are susceptible to this rapid liver failure. Fulminant hepatitis usually occurs after a viral infection, alcoholic liver damage, or drug-induced liver injury. Fulminant hepatitis is a potentially life-threatening condition and requires immediate medical attention.
Who Is Affected by Fulminant Hepatitis?
Fulminant hepatitis can affect the following people:
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People with a history of liver diseases.
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People without any history of liver diseases.
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Chronic alcoholics.
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People with a history of viral infections like hepatitis A, B, or C.
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About 6 percent of all orthotopic liver transplants done in the United States are for liver failure due to fulminant hepatitis.
What Causes Fulminant Hepatitis?
Establishing the etiology of fulminant hepatitis is crucial for three primary reasons: rapidly beginning the appropriate treatment, ruling out or addressing liver transplantation contraindications, and ascertaining the prognosis. Some common causes of fulminant hepatitis include:
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Drug Overdose: Popular painkillers like Acetaminophen and Paracetamol can be found in over-the-counter and prescription medications. The liver can rapidly fail if an individual takes a large dose of these drugs. The same might happen if someone consistently exceeds the dosage for several days.
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Viral Hepatitis: Hepatitis A, B, C, D, or E are among the viruses that can infect people and cause fulminant hepatitis. The hepatitis B virus can frequently cause fulminant hepatitis, and hepatitis D virus co-infection is reported in up to 50 percent of these patients. Moreover, hepatitis A virus-associated fulminant hepatitis is uncommon; Fulminant hepatitis rarely occurs due to the hepatitis E virus, and the role of the hepatitis C virus in fulminant hepatitis is unknown. Moreover, hepatitis A virus-associated fulminant hepatitis is uncommon; however, those with pre-existing liver diseases may be at higher risk.
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Alcoholism: Although fulminant liver failure from alcoholic hepatitis is possible, most patients have a history of excessive drinking and, therefore, most likely have underlying chronic liver disease.
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Prescription Medicines: Certain cancer medicines, and antibiotics can also cause fulminant hepatitis.
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Autoimmune Condition: It is the condition in which the body’s immune system starts attacking the healthy cells. Autoimmune hepatitis has been reported as the cause of fulminant liver failure in some cases.
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Cancer: Cancer that starts or spreads to the liver can cause fulminant hepatitis and liver failure.
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Vein Diseases: Blockages caused by the Budd-Chiari syndrome, a condition that affects the veins in the liver, can result in liver failure.
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Wilson’s Disease: Wilson’s disease causes a copper build-up in the liver, which eventually leads to liver damage and fulminant hepatitis.
What Are the Symptoms of Fulminant Hepatitis?
Fulminant hepatitis symptoms develop and deteriorate very quickly. Portosystemic encephalopathy (brain damage due to the failure of the liver to remove toxins from the blood) develops, which causes patients to decline rapidly. Some of the common symptoms of fulminant hepatitis are:
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Feeling unwell and lethargic.
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Feeling tired.
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Nausea and vomiting.
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Abdominal pain and discomfort.
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Jaundice (yellowing skin and eyeballs due to increased bilirubin levels).
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Confusion and lack of concentration.
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Feeling sleepy.
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Irritability, disorientation, and lack of motivation.
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Bleeding and bruising easily.
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Swelling in the stomach.
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Cerebral edema over days and weeks (swelling of the brain).
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Disseminated intravascular coagulation (a condition affecting blood flow, the ability of blood clotting, and stopping bleeding).
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Loss of kidney function (functional renal failure).
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Increased prothrombin time.
How Is Fulminant Hepatitis Diagnosed?
The diagnosis of fulminant hepatitis is made in the following ways:
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Clinical Evaluation: The patient's medical history, prior medication usage, and whether they have been exposed to toxins will all be noted. The patient's mental alertness will also be evaluated, along with any hepatitis symptoms that may be present.
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Blood Examination: Liver function will be done to check the functioning of the liver. Several criteria are measured in a liver function test that includes the levels of; bilirubin, albumin, aminotransferase, alkaline phosphatase, etc. This test requires a blood sample.
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Prothrombin Time Test: The measurement of PT/INR (prothrombin time and international normalized ratio). This test measures the time taken to form a blood clot. An INR of 1.1 or less in healthy individuals is considered normal. However, in the case of fulminant hepatitis, blood does not clot within the average time.
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Imaging Tests: CT scans (computed tomography scans) or MRI (magnetic resonance imaging) may be advised by the doctor to check for abnormalities like tumors, liver damage, vein problems and so on. An ultrasound may also be recommended to check the same.
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Biopsy: A liver biopsy may also be advised by the doctor to check for any malignancy (cancer). A biopsy is done by collecting a tissue sample from the liver, which is then sent to the laboratory for investigation.
How Is Fulminant Hepatitis Treated?
The treatment options available for fulminant hepatitis are:
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Antidotes: This particular class of medication is used to mitigate the effects of toxins. The doctor may provide N-acetylcysteine as an antidote if the liver suddenly fails due to an Acetaminophen overdose. Acute liver failure from other causes may also be treated with this medication.
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Hepatitis Medicine: Some types of viral hepatitis are treated by doctors using antiviral medications. For instance, a hepatitis B antiviral medication can treat the infection if it is the cause of liver failure. Steroids may be prescribed if fulminant hepatitis occurs due to an autoimmune condition.
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Liver Transplant: The patient might require a new liver if existing therapies fail to restore liver function. A surgeon removes the diseased liver during a liver transplant and replaces it with a donor liver in good condition. Patients who survive a liver transplant usually recover completely.
How Can Fulminant Hepatitis Be Prevented?
Fulminant hepatitis can be prevented in some cases. Some of the most common causes of fulminant hepatitis are Acetaminophen overdose and viral infection. Taking the recommended dose of Acetaminophen and cautiously reading and following label instructions before taking any over-the-counter painkiller can prevent overdose and eventually prevent fulminant hepatitis. Moreover, keeping a distance from other people's bodily fluids and blood is a must. This may reduce the risk of contracting the hepatitis virus. In addition, there are vaccines available for hepatitis A and hepatitis B, which can also help in preventing fulminant hepatitis.
Conclusion:
Fulminant hepatitis is a rare yet life-threatening condition. This condition occurs due to several causes, including; viral hepatitis infection, Acetaminophen overdose, chronic alcoholism, autoimmune diseases of the liver, and so on. The treatment and prognosis of fulminant hepatitis depend on the condition's etiology. The prognosis of various treatment modalities also depends on the timing of the treatment. For example, a liver transplant to treat fulminant hepatitis-associated liver failure can have a good prognosis if done early. A liver transplant that is done very late can even worsen the prognosis of the disease.
