Fulminant hepatic failure

This is hepatic failure with encephalopathy (a neuropsychiatric condition developing as a consequence of liver disease) developing in less than 2 weeks in a patient with a previously normal liver, or in patients with an acute exacerbation of underlying liver disease. Cases that evolve at a slower pace (2-12 weeks) are called subacute or subfulminant hepatic failure. It is an infrequent complication of acute liver damage from any cause and occurs as a result of massive liver cell necrosis. In the UK, viral hepatitis and paracetamol overdose are the most common causes. Presentation is with hepatic encephalopathy of varying severity accompanied by severe jaundice and marked coagulopathy. The complications include cerebral oedema, hypoglycaemia, severe bacterial and fungal infections, hypotension and renal failure (hepatorenal syndrome). Most patients should be managed with supportive treatment in a specialist liver unit. Emergency liver transplantation has become a useful treatment, depending on the cause, for the very severe cases (grade IV encephalopathy), of which 80% might otherwise die.