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Fulminant Hepatic Failure


What is fulminant hepatic failure?

Fulminant hepatic failure (FHF) is also called acute liver failure. FHF occurs when your liver is damaged and suddenly stops working properly. This may cause damage to other tissues or organs, such as your brain. Brain problems may happen within 2 weeks to 3 months after your FHF starts.

What causes FHF?

The exact cause of FHF is unknown. The following may increase your risk:

  • Autoimmune diseases may cause your body to attack and damage your liver cells.
  • Cancer metastasis is when cancer has spread and reached your liver from other parts of your body.
  • A viral infection may cause hepatitis. Hepatitis causes your liver to get inflamed (swollen). Hepatitis can lead to FHF.
  • Herbal supplements or medicines such as acetaminophen may cause FHF. Acetaminophen is used for fever or pain. If more than the recommended dosage of this medicine is taken, it may damage your liver. Certain herbal and diet supplements may also lead to FHF.
  • Other diseases such as Wilson disease or Reye syndrome may cause FHF. Heart failure, heat stroke, and blood vessel diseases such as Budd-Chiari syndrome can also cause FHF. Women with acute fatty liver during pregnancy are also at risk for FHF.

What are the signs and symptoms of FHF?

  • Abdominal and back pain
  • Changes in mood and sleeping habits
  • Trouble thinking clearly
  • Itchy skin and a swollen abdomen, feet, and legs
  • Light-colored bowel movements and decreased or dark-colored urine
  • Loss of appetite, nausea, and vomiting
  • Fatigue and weakness
  • Yellowing of your skin, gums, and the whites of your eyes

What other conditions may occur with FHF?

  • Blood problems such as blood clots or disseminated intravascular coagulation (DIC) may occur with FHF. DIC is a condition that causes your blood to clot throughout your whole body.
  • Encephalopathy occurs when harmful substances, such as ammonia, build up and cause brain damage.
  • Heart and lung problems such as hypotension (decreased blood pressure) and pulmonary edema (swollen lungs) may occur. You may also get respiratory distress syndrome, which causes damage to the small blood vessels in your lungs.
  • Infections, such as respiratory and urinary tract infections, may occur with FHF.
  • Other health problems such as kidney failure, hypoglycemia (decreased blood sugar level), and pancreatitis may occur. Pancreatitis is when your pancreas is inflamed (swollen). Your FHF may also cause adrenal insufficiency.

How is FHF diagnosed?

Your healthcare provider will ask what symptoms you have, when they started, and how bad they are. He will ask if you had any liver problems or infections. He may ask what medicines you have taken or are presently taking. He will also check for other conditions that may be causing your symptoms. You may need any of the following tests:

  • A liver biopsy is a procedure to remove a small piece of your liver. It is sent to a lab for tests. Healthcare providers will numb the area and put a needle through the wall of your abdomen or between your ribs. The needle is put into the liver and a small piece is taken out.
  • Blood and urine tests may show infection and liver function. They may also be done to get information about your overall health.
  • An abdominal ultrasound uses sound waves to show pictures of your abdomen on a monitor.
  • A CT, or CAT scan, is a type of x-ray that is taken of your liver. You may be given contrast dye to help healthcare providers see your liver better. Tell the healthcare provider if you have ever had an allergic reaction to contrast dye.

How is FHF 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. You may need any of the following:

  • Medicines:
    • Blood thinners help prevent blood clots. Examples of blood thinners include heparin and warfarin. Clots can cause strokes, heart attacks, and death. The following are general safety guidelines to follow while you are taking a blood thinner:
      • Watch for bleeding and bruising while you take blood thinners. Watch for bleeding from your gums or nose. Watch for blood in your urine and bowel movements. Use a soft washcloth on your skin, and a soft toothbrush to brush your teeth. This can keep your skin and gums from bleeding. If you shave, use an electric shaver. Do not play contact sports.
      • Tell your dentist and other healthcare providers that you take anticoagulants. Wear a bracelet or necklace that says you take this medicine.
      • Do not start or stop any medicines unless your healthcare provider tells you to. Many medicines cannot be used with blood thinners.
      • Tell your healthcare provider right away if you forget to take the medicine, or if you take too much.
      • Warfarin is a blood thinner that you may need to take. The following are things you should be aware of if you take warfarin.
        • Foods and medicines can affect the amount of warfarin in your blood. Do not make major changes to your diet while you take warfarin. Warfarin works best when you eat about the same amount of vitamin K every day. Vitamin K is found in green leafy vegetables and certain other foods. Ask for more information about what to eat when you are taking warfarin.
        • You will need to see your healthcare provider for follow-up visits when you are on warfarin. You will need regular blood tests. These tests are used to decide how much medicine you need.
    • Antibiotics help treat or prevent a bacterial infection.
    • Antivirals help treat or prevent a viral infection. Antiviral medicine may also be given to control symptoms of a viral infection that cannot be cured.
    • Antioxidants may be given if your FHF is caused by too much acetaminophen.
    • Steroids may be given to decrease inflammation.
    • Laxatives may help reduce the amount of ammonia in your blood by drawing it into your colon. It then leaves your body in your bowel movements.
  • Artificial liver support may be needed. A machine is used to clean your blood when your liver cannot. Chemicals and waste products are removed from your blood by a filtering machine. Your blood is passed through a filter and then returned to your body.
  • Plasmapheresis removes antibodies from your blood. Some of your blood will be removed through an IV. The blood is then put in a machine that spins and separates the red blood cells from the antibodies. The cleaned blood is then put back in your body through the IV.
  • Surgery may be needed. You may need a liver transplant if your liver is badly damaged. All or part of your damaged liver is removed or replaced with a healthy liver from a donor.

When should I contact my healthcare provider?

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

When should I seek immediate care or call 911?

  • You feel lightheaded or have fainted.
  • You have shaking chills and a high fever.
  • You have trouble thinking clearly, or you are confused.
  • You have sudden shortness of breath.

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. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2017 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.