Fulminant hepatic failure

The term "fulminant hepatic failure" (FHF) encompasses a pattern of clinical symptoms and pathophysiological responses associated with rapid arrest of normal hepatic function. The syndrome is defined by the presence of hepatic encephalopathy in association with coagulopathy and jaundice. In many cases, the clinical picture is complicated by cerebral edema, renal impairment, sepsis, and multiorgan failure. In this review, we examine the specific causes of FHF, including acetaminophen-related hepatotoxicity, drug- and viral-related FHF, and other less common causes of FHF such as pregnancy and vascular related disease. The approach to FHF should be multidisciplinary and requires a thorough understanding of the biochemical, metabolic, and physiological changes associated with hepatic necrosis. Also examined are management issues pertinent to these complex situations and the role of liver transplantation and liver assist devices are considered.