Fulminant hepatitis, also called malignant, is characterized by a severe form of the course and occurs as a result of the death of a significant number of hepatocytes. The rapid course of pathology is the cause of death within 10 days after the onset of the first symptoms. In some cases, the progression of the disease is so fast that the symptoms do not even begin to manifest.
The causes of this pathology
As a rule, fulminant hepatitis occurs against the background of damage to the body by viruses that adversely affect liver cells. Quite often, extensive necrosis is observed against the background of an autoimmune or inflammatory disease.
In childhood, the development of the fulminant form of hepatitis can be triggered by type 1, 2, 3, 4 and 6 hepatitis viruses, varicella-zoster, cytomegalovirus, measles pathogens, etc. According to statistics, every second patient with this form of hepatitis is diagnosed with viral type of pathology A, E, B and D in different combinations. Fulminant hepatitis B most often develops simultaneously with hepatitis D.
Type B hepatitis, preceding the development of a malignant form, is detected only in 1% of newborns up to six months of age.
Experts call the following reasons for the development of fulminant hepatitis of a non-infectious nature:
- The detrimental effect on hepatocytes of phosphorus, ethyl alcohol, mushroom poisons and other toxic substances.
- Systematic and uncontrolled use of drugs with hepatotoxic effects. It can be paracetamol, tetracycline antibiotics, anti-TB drugs, NSAIDs, inhaled anesthetics, steroids, etc.
- Injury to liver tissue. It can also occur during surgical abdominal surgery on other organs.
- Hypothermia or overheating of the body.
- Violation of blood circulation in the liver as a result of pathologies of the vascular system.
- Heart failure in acute form.
- Violation of the protective system of the body.
Manifestations of the disease in newborns
Malignant hepatitis in the newborn can occur against the background of metabolic disorders in the body of the child. The following can lead to such disorders:
- Fructosemia, or hereditary fructose intolerance.
- Tyrosinemia when tyrosine metabolism is impaired.
- At an older age, hepatitis can cause uncontrolled intake of paracetamol.
What other forms of viral hepatitis are there? Hepatitis in cryptogenic form is also highlighted when it is not possible to find out the origin of the pathology. A similar diagnosis is made in 30% of cases.
There are no nerve endings in the liver, so its pathologies often develop in a latent form. To prevent possible complications, you should regularly examine the body for the development of various diseases, including hepatitis. Timely intervention of a specialist will help to avoid more complex and severe forms of pathology.
Symptoms of this disease
When the first signs of a malfunction in the liver appear, seek medical help. Fulminant hepatitis is characterized by the following symptoms, which, as a rule, have a rapid course:
- Intensive intoxication of the body is characterized by redness of the skin, pain in the head, weakness and aching in the joints and bones. When the first signs of pathology appear, body temperature can rise to 39 degrees. It is quite difficult for such a patient to move around, he becomes lethargic and constantly experiences drowsiness. In some cases, transient irritability is observed.
- Dyspeptic disorders are accompanied by nausea and frequent vomiting after taking medications, as well as heavy and fatty foods. In the future, the urge to vomit appears spontaneously, for no apparent reason. In the vomit, one can see blood clots resembling coffee grounds.
- Soreness in the right hypochondrium.
- The appearance of bad breath, reminiscent of feces.
If you do not seek medical help with the appearance of the listed symptoms, the fulminant course of hepatitis begins to progress rapidly. In the future, icteric syndrome occurs, characterized by the color of the mucous membranes and skin in yellow. This is the main evidence of the transition of hepatitis to a malignant form.
Other signs of pathology
The fulminant form of hepatitis progresses, and new symptoms appear:
- Slowing down the patient's speech, slurred nature of the spoken words.
- Decreased rate of psychomotor reactions, retardation of actions or thoughts.
- The appearance of indifference and apathy to what is happening around.
- The patient's voice becomes monotonous, the emotional color of speech is absent.
- Dysfunctional bowel disorder, manifested by diarrhea.
- The development of ischuria, when the patient is not able to independently empty the bladder from urine.
By palpation, the doctor can detect a decrease in the size of the liver against the background of the fulminant form of viral hepatitis. The consistency of the body becomes softer. At this stage, the disease begins to progress with renewed vigor, especially with regard to intoxication.
Stages of the development of a malignant form of the disease
There are several stages of development of a malignant form of hepatitis:
- Initial, flowing in latent form.
- The second stage, characterized by the achievement of a precomatous state of the liver as a result of active death of hepatocytes.
- Coma of the liver. This condition develops as a result of inhibition of the functions of the organ. The patient may lose consciousness, experience breathing problems and the circulatory system.
If no action is taken, fulminant viral hepatitis can be fatal.
Diagnosis of this disease
The diagnosis is made on the basis of several criteria, including signs of liver coma and massive death of hepatocytes. Jaundice syndrome in this case is not a fundamental symptom, since with this form of acute viral hepatitis it does not progress.
Hepatologists call the following symptoms of this pathology, indicating the transition of the disease into a malignant form:
- Severe condition of the patient, prone to progression.
- Abrupt changes in the patient’s psychoemotional state, when sudden euphoria comes to replace inhibition, and emotional elevation gives way to irritability.
- Since the size of the glands is constantly changing, the pain syndrome tends to intensify or lose intensity.
- Body temperature can rise up to 40 degrees.
- Teleangiectasia or the appearance of spider veins indicates hemorrhagic syndrome.
- Unpleasant, hepatic breath.
- Shortness of breath, cerebral edema provokes sudden changes in pressure in the arteries.
- Decreased urine output.
Diagnosis of fulminant type hepatitis is carried out by examining the patient with both instrumental methods and laboratory tests. The disease is diagnosed based on the results of the following studies:
- A general blood type test. Shows abnormal neutrophil content in the blood.
- A coprogram or fecal examination may reveal elevated levels of stercobilin, an enzyme in the bile. Discoloration of fecal mass indicates a violation of the metabolism of carbohydrates and fats in the body.
- A urinalysis can detect an increased concentration of urobilinogen, which helps restore bilirubin.
- Biochemical blood test. It shows an increased content of bilirubin, as well as ferritin and iron. This analysis will also show an increase in the activity of liver transaminases, which will allow us to conclude that there are violations in the work of the organ. At the last stage of malignant hepatitis, the number of transaminases decreases. In addition, a biochemical study will show a deficiency in the blood of prothrombin and albumin.
- A blood test for the presence of hepatitis markers of viral origin is also carried out in the diagnosis of fulminant hepatitis. This study allows you to exclude or confirm the infectious nature of the pathological process.
The use of instrumental methods in the examination of the liver makes it possible to assess the degree of damage to the organ, to obtain its visual image. For this, the patient is assigned an ultrasound scan, computed tomography and magnetic resonance imaging, in some cases a biopsy. The latest study involves the collection of liver tissue for histological analysis. This is the most informative diagnostic method, as it allows you to accurately determine the nature of the pathology.
When necrosis becomes extensive, destruction of the entire surface of the liver occurs. Functionality is preserved in only a few cells. A submassive variety of necrosis indicates cell destruction only in the central part of the hepatic lobule. This improves the prognosis of survival prognosis.
Palpation shows a significant decrease in the size of the liver, characterized as an empty hypochondrium. The body acquires a soft and flabby consistency.
Complications of this pathology
The most serious complication of fulminant type hepatitis is liver coma. This condition occurs as a result of extensive death of hepatocytes and is characterized by a complete and irrevocable loss of organ functionality.
In addition, the following pathological processes can become complications of malignant hepatitis:
- Swelling of brain tissue, which is manifested along with inhibition of respiratory function and circulatory disorders. The amount of oxygen in the blood decreases, while the level of carbon dioxide increases. A similar condition manifests itself with symptoms such as pain in the head, redness of the skin on the face, frequent urge to vomit, heart rhythm disturbance, and rapid breathing.
- Bleeding from the digestive system as a result of bleeding disorders.
- Parenchymal kidney failure. Due to narrowing of blood vessels, there is a disruption in the transport of oxygen and various nutrients to the kidneys. This can lead to a dysfunctional disorder in the work of the body, which will cause a decrease in the daily volume of urine produced, dry mouth, an increase in creatinine, urea and non-protein nitrogen in the blood.
- Infectious damage to tissues and organs that occurs as a result of a weakened immune system.
To prevent complications, treatment should be started in a timely manner without delaying a trip to the doctor.
Prognosis for liver disease
In the vast majority of cases, the rapid progression of the fulminant type of hepatitis leads to death. Timely detection of pathology and proper treatment will slow down the death rate of liver cells, however, the disease will not be completely stopped. Complete recovery with this diagnosis is unlikely. The only chance to increase life expectancy under certain circumstances may be a liver transplant.
Fulminant hepatitis: treatment
We will understand what the therapy of this disease consists in.
A patient with an established diagnosis should observe bed rest. He is hospitalized and is hospitalized in the intensive care unit. Getting out of bed is allowed only after manipulations aimed at improving the performance of the tests and reducing the intensity of the symptoms. The patient is hospitalized until the signs of icteric syndrome pass.
The patient is shown symptomatic treatment of fulminant hepatitis with the use of both hepatoprotectors such as Essentiale or Hepabene, and detoxification drugs aimed at cleansing the blood of harmful substances. In some cases, immunomodulating therapy is also prescribed, which consists in taking interferons. Antiviral drugs are not always recommended; the doctor should decide on their administration.
Emergency measures for ailment
Urgent measures in the treatment of malignant forms of viral hepatitis are:
- Reception of steroid preparations in large dosages.
- Interferon therapy.
- Tracheal intubation is performed to restore depressed respiratory function. Sometimes, mechanical ventilation may be required.
- To control the amount of urine excreted per day, a special catheter is placed.
- Gastric lavage is carried out to stop the process of intoxication of the body and the penetration of harmful substances into the walls of the digestive system.
- Taking sedatives can remove emotional arousal.
- Pulse and pressure control in the patient’s arteries.
- Infusion introduction of solutions of polyglucin, glucose, trisol, etc.
- Reception of antibacterial drugs.
- Diuretic treatment.
- Transfusion of plasma, as well as platelet mass.
- Acceptance of antacids.
To eliminate the signs of intoxication, hemosorption is prescribed, which purifies the blood through adsorption, and plasmapheresis, when the patient's blood is purified and poured back into the bloodstream.
In the case when drug treatment does not give positive dynamics, a decision is made on a liver transplant. The operation is quite complicated and has many complications. In addition, the patient may reject transplanted material.
If the course of the disease becomes acute, the introduction of parenteral solutions is prescribed, which allows you to compensate for the energy costs. When the patient's condition can be stabilized, he begins to receive nutrition through the probe.
In the future, the patient is allowed to eat in the usual way, but with a strict diet. Exceptions to the diet should be fried and fatty foods, alcohol, seasonings, canned food and convenience foods. Do not eat acidic vegetables and fruits.
Fulminant hepatitis in children and adults is a serious pathology of the liver, the course of which is rapid and threatens human life. The sooner it is possible to identify the pathological process, the more effective and longer it will be possible to restrain its progress.
After birth, children receive hepatitis vaccination, which should not be ignored. It is important to undergo a routine medical examination every year with the aim of early diagnosis of pathologies of the internal organs.