Q:

Which of the following statement(s) is/are true concerning acute, fulminant hepatic failure?

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Which of the following statement(s) is/are true concerning acute, fulminant hepatic failure? 


  1. The most frequent cause of acute hepatic failure world-wide is hepatitis B infection
  2. Higher grades of encephalopathy are associated with a worse prognosis
  3. Hypoglycemia is a common complication of all liver diseases
  4. Liver transplantation would appear indicated in all patients with hepatic coma secondary to acute liver failure

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b. Higher grades of encephalopathy are associated with a worse prognosis 

The diagnosis of acute (fulminant) hepatic failure is based on the development of encephalopathy within eight weeks of the onset of symptoms. The overall prognosis is poor, but the hepatic lesions are potentially reversible, and recovery can lead to restoration of normal liver function. The most frequent cause of acute hepatic failure world-wide is non-A, nonB viral hepatitis. A variety of other viral agents and hepatotoxins can also cause this condition.

No reliable criteria predict outcome and response to treatment. Higher grades of encephalopathy (depth of coma) on admission are associated with the worst prognosis. Management should include general supportive measures and specific treatment for hepatic encephalopathy, cerebral edema, electrolyte and metabolic disturbances, infection, and pain. Hypoglycemia is an unusual complication of most liver diseases except in patients with acute hepatic failure or hepatic neoplasms. The enormous reserve capacity of the liver accounts for the rarity of hypoglycemia except as a preterminal event. Bleeding is also a frequent cause of death in patients with acute hepatic failure secondary to depressed liver synthesis of clotting factors and qualitative or quantitative platelet disorders. The lack of a definitive medical treatment for acute hepatic failure makes liver transplantation seem attractive especially for patients with little or no chance of recovering normal liver function. Perhaps the most significant drawback to widespread acceptance of liver transplantation for acute hepatic failure is the lack of criteria reliability to predict which patients are likely to benefit from operation. Patients with mild to moderate degrees of coma are likely to recovery spontaneously without the need for liver transplantation while rapid deterioration and neurologic status to grade III or grade IV coma are associated in some centers with a mortality of 95%.

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