fulminant hepatitis

Appearance of severe liver injury with coagulopathy & hepatic encephalopathy within 8 weeks of the onset of hepatitis in a previously healthy individual. Etiology: 1) hepatitis B 2) hepatitis A 3) cryptogenic hepatitis (non A, B or C) 4) drug-induced liver disease 5) parvovirus B19 Epidemiology: 1) 2000 cases yearly in USA 2) 6% of liver-related deaths Complications: - mortality is 30-85% depending upon cause Management: 1) drug-induced fulminant hepatitis carries a very poor prognosis, except for acetaminophen-induced in which spontaneous recovery generally occurs 2) liver transplantation a) refer early b) indications: 1] spontaneous recovery is unlikely 2] transplant recovery is probable 3) treat infections 4) treat hemodynamic abnormalities 5) minimize brain edema

References

Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998