Fulminant hepatitis, also called malignant, is characterized by a severe course and occurs as a result of the death of a significant number of hepatocytes. The rapid course of the 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 rapid that symptoms do not even begin to appear.
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 hepatitis viruses types 1, 2, 3, 4 and 6, varicella-zoster, cytomegalovirus, measles pathogens, etc. According to statistics, eachthe second patient with this form of hepatitis is diagnosed with a 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, which precedes the development of a malignant form, is detected in only 1% of newborns under six months of age.
Experts call the following reasons for the development of fulminant hepatitis of 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. These can be paracetamol, tetracycline antibiotics, anti-TB drugs, NSAIDs, inhalational anesthetics, steroids, etc.
- Injury to liver tissues. It can also occur during a surgical abdominal operation on other organs.
- Hypocooling or overheating of the body.
- Impaired blood circulation in the liver as a result of pathologies of the vascular system.
- Acute heart failure.
- Disruption of the body's defense system.
Manifestations of the disease in newborns
Malignant hepatitis in newborns can occur against the background of a violation of metabolic processes in the child's body. These disorders can lead to:
- Fructosemia, or hereditary fructose intolerance.
- Tyrosinemia when tyrosine metabolism is disturbed.
- At an older age, uncontrolled use of paracetamol can cause hepatitis.
What other forms of viral hepatitis are there? Hepatitis is also isolated in a cryptogenic form, 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, the organ should be regularly examined 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
At the first signs of liver dysfunction, you should seek medical help. Fulminant hepatitis is characterized by the following symptoms, which are usually rapid:
- Intense intoxication of the body is characterized by reddening 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 rather difficult for such a patient to move, he becomes lethargic and constantly experiences drowsiness. In some cases, there is transient irritability.
- 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, blood clots can be seen, resemblingcoffee grounds.
- Pain in the right hypochondrium.
- The appearance of bad breath, reminiscent of feces.
If you do not seek medical help when these symptoms appear, 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
Fulminant hepatitis progresses and new symptoms appear:
- Slowing down the patient's speech, slurred nature of spoken words.
- Decrease in the speed of psychomotor reactions, inhibition of actions or thoughts.
- The appearance of indifference and apathy to what is happening around.
- The patient's voice becomes monotonous, the emotional coloring of speech is absent.
- Dysfunctional bowel disorder, manifested by diarrhea.
- Development of ischuria when the patient is unable to empty the bladder of urine on his own.
Through 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 organ becomes softer. At this stage, the disease begins to progress with renewed vigor, especially with regard to intoxication.
Stages of development of a malignant form of the disease
There are several stages in the development of a malignant formhepatitis:
- Initial, flowing in latent form.
- The second stage, characterized by the achievement of a pre-coma state of the liver as a result of active death of hepatocytes.
- Liver coma. This condition develops as a result of inhibition of the functions of the organ. The patient may lose consciousness, experience problems with breathing and the circulatory system.
Fulminant viral hepatitis can be fatal if left untreated.
Diagnosis of this disease
The diagnosis is made based on several criteria, including signs of hepatic coma and massive hepatocyte death. The icteric syndrome in this case is not a fundamental symptom, since it does not progress with this form of acute viral hepatitis.
Hepatologists call the following symptoms of this pathology, indicating the transition of the disease to a malignant form:
- The patient's serious condition, prone to progression.
- Sudden changes in the psycho-emotional state of the patient, when lethargy is replaced by sudden euphoria, and elation is replaced by irritability.
- Because the size of the glands is constantly changing, the pain syndrome tends to increase or decrease in intensity.
- Body temperature can rise up to 40 degrees.
- Teleangiectasia or spider veins indicates hemorrhagic syndrome.
- Bad, livery breath.
- Shortness of breath, swellingbrain provokes sudden pressure drops in the arteries.
- Reduced diuresis.
Diagnosis of fulminant type hepatitis is carried out by examining the patient both by instrumental methods and by laboratory tests. The disease is diagnosed based on the results of the following tests:
- General blood test. Indicates abnormal levels of neutrophils in the blood.
- Coprogram or fecal examination may reveal an increased content of stercobilin, which is a bile enzyme. Discoloration of fecal matter indicates a violation of the metabolism of carbohydrates and fats in the body.
- Urine test detects increased levels of urobilinogen, which helps restore bilirubin.
- Biochemical blood test. 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 falls. In addition, a biochemical study will show a deficiency in the blood of prothrombin and albumin.
- A blood test for the presence of markers of hepatitis 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 assessthe degree of organ damage, get its visual image. To do this, the patient is prescribed ultrasound, computed and magnetic resonance imaging, in some cases, a biopsy. The latest study involves taking 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 the necrosis becomes extensive, the entire surface of the liver is destroyed. Functionality is retained in only a few cells. The submassive variety of necrosis indicates the destruction of cells only in the central part of the hepatic lobule. This increases the favorable prognosis of survival.
Palpation shows a significant decrease in the size of the liver, characterized as an empty hypochondrium. The organ becomes soft and flabby.
Complications of this pathology
The most severe complication of fulminant hepatitis is liver coma. This condition occurs as a result of extensive death of hepatocytes and is characterized by a complete and irreversible loss of organ functionality.
In addition, the following pathological processes can become complications of malignant hepatitis:
- Swelling of brain tissue, which manifests itself along with respiratory depression and circulatory disorders. The amount of oxygen in the blood decreases while the level of carbon dioxide rises. A similar condition manifests itself with symptoms such as pain in the head, rednessskin on the face, frequent urge to vomit, heart rhythm disturbance, rapid breathing.
- Bleeding from the digestive system as a result of a bleeding disorder.
- Renal insufficiency of the parenchymal type. Due to vasoconstriction, there is a violation of the transport of oxygen and various nutrients to the kidneys. This can lead to a dysfunctional disorder in the functioning of the organ, which will cause a decrease in the daily volume of urine excreted, dry mouth, an increase in creatinine, urea and non-protein nitrogen in the blood.
- Tissue and organ infection resulting from a weakened immune system.
To prevent complications, you should start treatment in time, without delaying going 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 correct treatment will slow down the rate of death of liver cells, but it will not be possible to completely stop the disease. Complete recovery from this diagnosis is unlikely. The only chance to increase life expectancy under certain circumstances may be a liver transplant.
Fulminant Hepatitis Treatment
Let's figure out what the therapy of this disease is.
A diagnosed patient must remain in bed. He is hospitalized and stays in the intensive care unit. Get out of bedallowed only after manipulations aimed at improving test results and reducing the intensity of symptoms. The patient is hospitalized until the symptoms of icteric syndrome subside.
The patient is shown symptomatic treatment of fulminant hepatitis using both hepatoprotectors like "Essentiale" or "Gepabene" and detoxifying drugs aimed at cleansing the blood of harmful substances. In some cases, immunomodulatory therapy is also prescribed, which consists in taking interferons. Antivirals are not always recommended and should be decided by a physician.
Urgent measures for illness
Urgent measures in the treatment of malignant forms of viral hepatitis are:
- High-dose steroid use.
- Interferon therapy.
- Tracheal intubation is performed to restore depressed respiratory function. Occasionally, mechanical ventilation may be required.
- A special catheter is placed to control the volume of urine excreted per day.
- Gastric lavage is performed to stop the process of intoxication of the body and the penetration of harmful substances into the walls of the digestive organs.
- Taking sedatives can relieve emotional arousal.
- Monitoring the pulse and pressure in the patient's arteries.
- Infusion administration of solutions of polyglucin, glucose, trisol, etc.
- Taking antibiotics.
- Diuretic treatment.
- Transfusion of plasma and platelets.
- Taking antacids.
To eliminate signs of intoxication, hemosorption is prescribed, which involves the purification of blood through adsorption, and plasmapheresis, when the patient's blood is purified and flows back into the bloodstream.
In the case when drug treatment does not give positive dynamics, a decision is made to transplant the liver. The operation is quite complicated and has many complications. In addition, the patient's body may reject the transplanted material.
If the course of the disease becomes acute, the introduction of parenteral solutions is prescribed, which allows compensating for energy costs. When the patient's condition can be stabilized, he begins to receive food through the tube.
In the future, the patient is allowed to eat in the usual way, but with a strict diet. Fried and fatty foods, alcohol, seasonings, canned food and semi-finished products are subject to exclusion from the diet. Do not eat sour vegetables and fruits.
Fulminant hepatitis in children and adults is a severe pathology of the liver, the course of which is rapid and life-threatening. The sooner it is possible to identify the pathological process, the more effectively and longer it will be possible to restrain its progress.
Children are vaccinated against hepatitis after birth, which should not be ignored. It is important to undergo a scheduled medical examination every year for the purpose of early diagnosis of pathologies.internal organs.
