A pathological study of fulminant hepatic disease

Among 4,030 autopsies, 67 cases of fulminant hepatic failure were selected and studied from a pathological viewpoint. No sex difference in incidence was seen and the patients' age ranged very widely from 3 months to 78 years, showing comparatively high risk in the 20 s and 30 s in both sexes. Hepatitis virus was the most common cause, followed by toxic chemicals, shock, etc. Histopathological study revealed severe and extensive hepatic cell necrosis as the most conspicuous and common change of the liver, which was pathomorphologically quite similar to that experimentally produced by focal intravascular coagulation in rabbit. This evidence, as well as pathological findings of the other organs obtained at autopsy and the patients' reported clinical course, including laboratory data, were consistent with our proposal of a pathological disease entity, fulminant liver disease, which corresponds to the clinical symptom-complex known as fulminant hepatic failure. It is suggested that the characteristic feature of acute, severe and extensive hepatic cell necrosis which is seen in such cases is probably a result of an anoxic state caused in most instances by intrahepatic circulatory disturbances. Besides, we consider that fulminant liver disease can be regarded as a group of systemic diseases with the main focus of illness in the liver, rather than a specific disease of a single organ, the liver.