Overview
The term fulminant hepatitis-like syndrome refers to a group of non-viral hepatitis syndromes with fulminant hepatitis-like manifestations. These include acute fatty liver of pregnancy, tetracycline-induced toxic hepatitis, and Reye syndrome. However, if cured, the liver can be completely normalized. This group of syndromes presents with acute onset, severe nausea, vomiting and abdominal distension, bleeding tendency, and impaired consciousness.
Etiology
Acute fatty liver in pregnancy mostly occurs in primigravid women between 20 and 30 years old in late pregnancy (36-40 weeks), acute fatty liver due to tetracycline poisoning is due to taking a large number of tetracycline antibiotics to cause acute fatty liver, and Reye syndrome, also known as encephalopathic fatty liver syndrome, is due to viruses, poisoning and metabolic disorders caused by cerebral edema and fat deposition in liver, kidneys and other organs.
Symptoms
1. Acute fatty liver in pregnancy
The patients are mostly primigravida aged 20-30 years old, in late pregnancy (36-40 weeks), they have sudden onset of facial edema, proteinuria, hypertension, followed by epigastric pain, nausea, vomiting, bleeding tendency, progressive deepening of jaundice, impaired consciousness, markedly elevated blood bilirubin, negative urinary bilirubin, non-increased blood ALT as its characteristics, and often have hypoglycemia. The case fatality rate is as high as 70% to 80%. The causes of death can be acute hepatic and renal failure, fatal hypoglycemia, DIC, hemorrhagic pancreatitis and gastrointestinal bleeding.
2.Acute fatty liver due to tetracycline poisoning
Taking a large number of tetracycline antibiotics can cause acute fatty liver, but it is more common in pregnant women. Pathologic manifestations are diffuse steatosis, hepatocellular necrosis and sludge. Clinical manifestations include sudden onset of fever, jaundice, and impaired consciousness.
3. Reye syndrome
Reye syndrome, also known as encephalopathy fatty liver syndrome, refers to cerebral edema and fat deposition in liver, kidney and other organs caused by virus, poisoning and metabolic disorder. Clinical manifestations include first flu-like symptoms, 2 days to 3 weeks later, frequent vomiting with severe headache, followed by impaired liver function and impaired consciousness.
Examination
1. Liver function tests
2. Serum bilirubin test.
3. Urine routine examination
4. CT examination.
Diagnosis
The initial onset of fulminant hepatitis is similar to that of acute jaundice hepatitis, but the disease develops more rapidly and there are volume changes in the liver, resulting in the appearance of many symptoms.
It should mainly be differentiated from viral hepatitis.
Treatment
First of all, all drugs causing liver injury should be discontinued, and a light multivitamin diet should be given; symptomatic treatments such as maintaining water-electrolyte-acid-base balance and anti-shock should be given. Lowering blood ammonia, adjusting amino acid imbalance; cerebral edema application of mannitol to reduce cranial pressure; if necessary, dialysis or blood exchange therapy.