Subacute Hepatic Failure-a Clinical Profile

Abstract

A combined experience of 37 cases ofsubacute hepatic failure encountered in five major gastroenterology centres over a period of ten years is discussed. Majority (65%) were males with average age of 38 years. Maximum (54%) were in 5th decade. Jaundice (100%), abdominal distention (38.7%), swelling feet (64%), fever (54%), abdominal pain (54%), exhaustion (78.3%) were the major presenting features. Jaundice and ascites were present in all cases. Pedal oedema (78.3%), hepatomegaly (54%), splenomegaly (32.4%) and encephalopathy (27%) were the other important clinical features. Hypoalbuminemia and prolonged prothrombin time were significant laboratory findings in addition to hyperbilirubinemia and elevated ALT and AST. Hbs Ag was detected in 46%. Major complications encountered were renal failure (48.7%), spontaneous bacterial peritonitis (43.2%), other infections (43.2%), encephalopathy (43.2%) and upper gastrointestinal bleed (22%). 54% died during stay in hospital. To conclude subacute hepatic failure is potentially fatal condition. MJAF11998; 54: 335-336

Late-Onset Hepatic Failure in Children: Risk Factors that Determine the Outcome

“…Hence with renewed interest, we analyzed our cohort of pediatric LOHF in an effort to recognize and understand this clinical entity better. Clinically detectable ascites was seen in 94% of our children with LOHF which is similar to Indian adults with LOHF (97-100%) [1,7]. However, a lower proportion of ascites (62%) in LOHF is reported from West [4].…”

“…Advanced HE was infrequent in our study (10%), which is similar to Gimson et al [4] who reported HE in 68% (21% advanced HE). In contrast, HE was reported to be uncommon feature (16-27%) in 2 adults LOHF studies from India [1,7]. None of the patients in our study had clinical evidence of cerebral edema, which is a rare fea-ture in LOHF (8.5%) in contrast to fulminant hepatic failure (66.7%) [4].…”

“…Consensus statements from various societies currently agree that features of advanced liver dysfunction in ALF and ACLF present within first 3-4 weeks of illness [13][14][15][16]. There are different viewpoints regarding the duration of illness in LOHF in the definitions proposed by various authors [3][4][5][6][7]. By and large, most agree that late-onset, sub-fulminant, or late-onset liver failures (terminologies interchangeably used) have delayed presentation after 4th week of illness [16,17].…”

“…Recent surveys in Japan have shown that LOHF especially with hepatitis A continues to have a major impact on intractable liver diseases [2,3]. The disease has a smouldering course with most of the adult studies showing poor survival [4][5][6][7]. Longterm follow-up in adults has also shown development of chronic hepatitis in LOHF [4].…”

Acute Hepatic Failure and Nutrition

“…Presentations that evolve more slowly, or subacutely, can be confused with chronic liver disease . These subacute cases have a consistently less favorable outcome with medical care alone than those with the more rapid onset . Although ALF is initially a manifestation of liver injury, it quickly evolves into multiorgan dysfunction and has many clinical manifestations (Figure ).…”