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One scheme defines "acute hepatic failure" as the development of encephalopathy within 26 weeks of the onset of any hepatic symptoms. This is sub-divided into "fulminant hepatic failure", which requires onset of encephalopathy within 8 weeks, and "subfulminant", which describes onset of encephalopathy after 8 weeks but before 26 weeks. [24]
Fulminant hepatitis, or massive hepatic cell death, is a rare and life-threatening complication of acute hepatitis that can occur in cases of hepatitis B, D, and E, in addition to drug-induced and autoimmune hepatitis.
Fulminant (/ ˈ f ʊ l m ɪ n ən t /) is a medical descriptor for any event or process that occurs suddenly and escalates quickly, and is intense and severe to the point of lethality, i.e., it has an explosive character. [1] The word comes from Latin fulmināre, to strike with lightning. There are several diseases described by this adjective:
In most cases, liver function will return to normal if the offending drug is stopped early. Additionally, the patient may require supportive treatment. In acetaminophen toxicity, however, the initial insult can be fatal. Fulminant hepatic failure from drug-induced hepatotoxicity may require liver transplantation.
Acute hepatitis B infection does not usually require treatment and most adults clear the infection spontaneously. [86] [87] Early antiviral treatment may be required in fewer than 1% of people, whose infection takes a very aggressive course (fulminant hepatitis) or who are immunocompromised.
It is generally reserved for patients with fulminant liver failure, failure of shunts, or progression of cirrhosis that reduces the life expectancy to one year. [23] Survival rates in Budd–Chiari syndrome after liver transplantation are 76%, 71% and 68% after 1, 5 and 10 years respectively. [2]
Liver failure is the inability of the liver to perform its normal synthetic and metabolic functions as part of normal physiology. Two forms are recognised, acute and chronic (cirrhosis). [1] Recently, a third form of liver failure known as acute-on-chronic liver failure (ACLF) is increasingly being recognized. [2]
Liver transplantation is the standard of care in people presenting with fulminant liver failure or those with the progression of disease despite multiple lines of therapy. [ 33 ] [ 34 ] [ 35 ] Many patients, once started on long-term immunosuppressive therapy, will remain on that treatment for life.