Fulminant Hepatic Failure

What is fulminant hepatic failure?

• Fulminant hepatic failure is also called FHF or acute liver failure. FHF occurs when your liver suddenly stops working often causing problems in other areas of your body. The liver is a large reddish-brown organ in the upper right area of your abdomen (stomach). It breaks down protein, carbohydrates, and fat into energy for your body to use. The liver also makes special substances (things) which can stop abnormal bleeding from a blood vessel injury. Your liver filters (gets rid of) harmful things, such as ammonia and alcohol, in your blood. It also breaks down old red blood cells and helps your immune system (body's defense) work properly.
  
  
• With FHF, your liver is damaged and will not be able to do all of its work. Harmful things may stay, and increase in amount inside your body. They may cause more damage to your liver and other tissues or organs. Your nervous system, including your brain, may become damaged. In some cases, brain problems may happen within 2 weeks to 3 months after your liver problem starts. FHF may cause some or all of your body organs to fail in a short period of time.

What causes fulminant hepatic failure?

The exact cause of FHF is unknown. Caregivers believe most cases of FHF are caused by any of the following:

• Autoimmune diseases: Problems with your immune system may make your body attack and damage your liver cells. When this happens, your liver may not work the way it should.
  
  
• Cancer metastasis: This is when cancer from other parts of your body has spread and reached your liver.
  
  
• Infection: A liver infection from germs called viruses may cause hepatitis. This condition is when your liver gets inflamed (swollen).
  
  
• Medicine poisoning: Acetaminophen medicine is used for fever or pain. If more than the usual dosage of this medicine is taken, it may damage your liver. Taking certain herbal medicines and diet supplements may also lead to FHF. Ask your caregiver for more information on other medicines that may cause FHF.
  
  
• Other diseases: These include diseases such as Wilson disease or Reye's syndrome. Heart failure, heat stroke, and blood vessel diseases such as Budd-Chiari syndrome can also cause FHF. Females with acute fatty liver during pregnancy are also at risk of having FHF. Ask your caregiver for more information about these conditions.

What are the signs and symptoms of fulminant hepatic failure?

You may have any of the following:

• Abdominal (stomach) and back pain.
  
  
• Changes in mood, sleeping habits, and trouble thinking clearly.
  
  
• Itchy skin and a swollen abdomen, feet, and legs.
  
  
• Light-colored stools (bowel movements) and decreased or dark-colored urine.
  
  
• Loss of appetite, nausea (upset stomach), and vomiting (throwing up).
  
  
• Tiredness and weakness.
  
  
• Yellowing of your skin, gums, and the whites of your eyes.

What conditions may come with fulminant hepatic failure?

Ask your caregiver for more information about the following conditions:

• Blood problems: These include having problems making blood clots or disseminated intravascular coagulation (DIC). DIC is a condition where your blood begins to clot throughout your whole body.
  
  
• Encephalopathy: This is when harmful things build-up in your body and cause damage to your brain.
  
  
• Heart and lung problems: Having FHF may also lead to hypotension (decreased blood pressure) and pulmonary edema (swollen lungs). You may also get respiratory distress syndrome, where small blood vessels in your lungs are damaged.
  
  
• Infections: You may get respiratory and urinary tract infections with FHF. These infections may be caused by a bacteria or fungus (germs).
  
  
• Other problems: FHF may cause kidney failure, hypoglycemia (decreased blood sugar level), and pancreatitis. Pancreatitis is when your pancreas is inflamed (swollen). Your FHF may also cause adrenal insufficiency.

How is fulminant hepatic failure diagnosed?

Your caregiver will ask what symptoms you have, when they started, and how bad they are. He will ask if you have had any liver problems or infections in the past. He may ask what medicines you have taken or are presently taking. He may need to know your diet and how much alcohol you drink. He will also check for other conditions that may be causing your symptoms. Ask your caregiver for more information on the following tests:

• Liver biopsy: A liver biopsy is when a small piece of your liver is removed and sent to a lab for tests. Caregivers will clean your skin, and you may be given medicine to numb (lose feeling) in the area. A needle is put through the wall of your abdomen or between your ribs. The needle is put into the liver and a small piece is taken out. A bandage will be placed over the area.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Imaging tests: Certain tests use a special dye to help pictures show up better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your caregiver if you are allergic to shellfish, or have other allergies.
  
  
  • Abdominal ultrasound: This test is done to see the inside of your abdomen including your liver. Sound waves are used to show pictures of your abdomen on a TV-like screen.
    
    
  • Computerized tomography scan: This is also called a CT scan. A special x-ray machine uses a computer to take pictures of your liver. It may also be used to look at your tissues, bones, muscles, and blood vessels. Before taking the pictures, you may be given dye through an intravenous (IV) tube placed in your vein. An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Urine sample: A sample of your urine is collected and sent to a lab for tests.

How is fulminant hepatic failure treated?

The goal of treatment is to decrease and control your symptoms. You may need to stop taking certain medicines that may be causing your FHF. Pregnant women who have FHF may need to give birth earlier than their expected delivery date. Ask your caregiver for more information about any of the following treatments:

• Medicines: You may be given any of the following medicines:
  
  
  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
    
    
  • Antioxidant medicine: This medicine may be given if your FHF is caused by taking too much acetaminophen.
    
    
  • Antiviral medicine: This is given to prevent or treat an infection caused by a germ called a virus. Antiviral medicine may also be given to control symptoms of a viral infection that cannot be cured.
    
    
  • Clot busters: This medicine helps break apart clots. It is given IV and may be given at the same time as other blood thinners. This medicine could save your life because blood clots in the heart, lungs or brain can kill you. Be careful because you may bleed or bruise easily.
    
    
  • Steroids: This medicine may be given to decrease inflammation.
    
    
  • Synthetic sugar: This medicine may be given if the ammonia levels in your blood are too high.
  
  
• Artificial liver support: This uses a dialysis-like machine to clean your blood when your liver cannot. Chemicals and waste products are removed from your blood by a filtering machine. This is done by having your blood pass through a special filter. Filtered blood is returned back to your body. Caregivers will check your vital signs often during the procedure. Ask your caregiver for more information about liver support for FHF.
  
  
• Plasmapheresis: This treatment removes unhealthy antibodies from your blood. An antibody is something made by your body to protect you from infections. Your blood is put through a machine to take the bad antibodies out of your red blood cells. The good red blood cells are then put back into your body.
  
  
• Surgery: You may need a liver transplant if your liver is badly damaged. This is when your damaged liver is replaced with a healthy liver. Your new liver must come from someone else (a donor). Sometimes, only the damaged parts of your liver may be removed or replaced with healthy ones. Ask your caregiver for more information on the type of surgery that may be right for you.

When should I call my caregiver?

Call your caregiver if:

• You bruise or bleed easily.
  
  
• You have a fever.
  
  
• Your blood pressure reading is higher than your normal.
  
  
• Your symptoms come back after treatment.
  
  
• You have questions or concerns about your condition, medicine, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You feel lightheaded or have just fainted (passed out).
  
  
• You have shaking chills and a high fever.
  
  
• You have trouble thinking clearly or seem more confused.
  
  
• You suddenly have trouble breathing.

Where can I find support and more information?

Having FHF can be hard for you and your family. You may feel angry, sad, and frightened. These feelings are normal. Talk to your caregiver, family, or friends about these feelings. Contact any of the following for more information:

• American College of Gastroenterology
  6400 Goldsboro Rd., Ste 450
  Bethesda , MD 20817
  Phone: 1- 301 - 263-9000
  Web Address: http://www.gi.org
  

• American Gastroenterological Association
  4930 Del Ray Avenue
  Bethesda , MD 20814
  Phone: 1- 301 - 6542055
  Web Address: http://www.gastro.org
  

• American Liver Foundation
  39 Broadway Suite 2700
  New York , New York 10006
  Phone: 1- 212 - 668-1000
  Phone: 1- 800 - 465-4837
  Web Address: http://www.liverfoundation.org
  

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Learn more about Fulminant Hepatic Failure