A fulminant course with dismal outcomes is generally a result of a chemical or viral insult to the liver. Identifying the etiology is important in guiding therapy, avoiding further parenchymal damage, and determining prognosis. A careful history and suspicion of recent drug exposures are useful to help determine risk factors for viral hepatitis. Family history of liver failure also suggests fulminant Wilson’s disease.
Patients with a viral liver disease are often tested for Epstein-Barr virus, Herpes simplex virus, and cytomegalovirus infection. Serum ceruloplasmin and urinary copper are also important tests to screen for viral hepatitis. The presence of massive hemolysis, renal failure, and granulocytopenia are also suggestive of fulminant Wilson’s disease.
The diagnosis of viral liver disease is usually made after a complete serological profile is obtained. Testing for Epstein-Barr virus, Herpes simplex virus, and cytomegalovirus is recommended. Acute non-A/non-B hepatitis is diagnosed with the presence of granulocytopenia and massive hemolysis. These are the only signs of fulminant Wilson’s disease.
A complete serologic profile is performed to identify viral liver disease. Hepatitis C, Herpes simplex virus, and cytomegalovirus are the most common causes. Blood chemistry is a key indicator of hepatitis. Hepatitis A/B hepatitis may be the cause of fulminant hepatitis. However, it is unclear whether or not this is the cause of the patient’s symptoms.
A complete serologic profile is performed to diagnose viral hepatitis. Herpes simplex virus, Epstein-Barr virus, and cytomegalovirus are the main causes of viral hepatitis C. The patient may have elevated levels of urinary copper and serum ceruloplasmin. A fulminant course of hepatitis C is often characterized by renal failure and massive hemolysis.
Liver failure can occur in two distinct stages: subacute and fulminant. The first stage is characterized by the onset of hepatic failure within eight weeks. The second phase is subacute and manifests eight to twenty weeks after the liver disease has begun. In fulminant hepatic failure, the liver begins to die. The patient may suffer from severe pain and fatigue.
