Euroasian Journal of Hepato-Gastroenterology

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VOLUME 2 , ISSUE 1 ( January-June, 2012 ) > List of Articles

REVIEW ARTICLE

Subacute Hepatic Failure: Its Possible Pathogenesis

Santosh Man Shrestha, Shobhana Shrestha

Citation Information : Man Shrestha S, Shrestha S. Subacute Hepatic Failure: Its Possible Pathogenesis. Euroasian J Hepatogastroenterol 2012; 2 (1):41-46.

DOI: 10.5005/jp-journals-10018-1030

License: CC BY-NC 4.0

Published Online: 00-00-0000


Abstract

Background: Subacute hepatic failure (SAHF) is a complication of acute hepatitis (AH) characterized by progressive jaundice and development of ascites within 24 weeks of the onset of icterus. Its pathogenesis is unknown and its treatment is unsatisfactory. This study highlights on the possible pathogenesis of the disease. Materials and methods: Thirty-two with SAHF among 798 patients of AH who had tests for markers of acute hepatitis A, B, C and E had blood and ascitic fluid study and ultrasonogram (US) of liver. US and risk factors for infection were compared with consecutive uncomplicated AH. Blood culture was done in consecutive 307 AH patients at the time of the first visit. Patients with SAHF and control were followed for at least 6 months. Results: SAHF developed in 4% of the patients with AH. Bacteremia was detected in 50% and ascitic fluid showed features of hepatic venous outflow obstruction (HVOO) and bacterial peritonitis. Thrombus was detected in IVC in all. Seventy-five percent of the patients who received antibiotic recovered. Recurrence of the symptoms in five and development of cirrhosis in seven patients were noted at follow-up but none among patients with uncomplicated acute hepatitis (AH). Bacteremia was also detected in 25% of consecutive AH patients presenting with fever, with high incidence in those with complications. Conclusion: Bacteremia was common among patients with AH. Clinical features of SAHF could be explained by occurrence superadded bacterial infection that caused thrombophlebitis of hepatic portion of the IVC resulting in HVOO.


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  1. Joshi YK, Tandon HD, Tandon BN. Study of subacute hepatitis. Journal Association of Physicians of India 1978;26:1-5
  2. Subacute hepatic failure. Is it a distinct entity? J Clin Gastroenterol 1982; 4:343-46
  3. Clinical profile of subacute hepatic failure in Bangladesh population. Journal of Bangladesh College of Physicians and Surgeons 1990; 8:1-7
  4. Subfulminant liver failure: Clinical presentations prognostic indices and treatment option. Bangladesh Journal of Medicine 1992;3(1):14-20
  5. Subacute hepatic failure due to hepatitis E. J Gastroenterol Hepatol 2008; 23:879-82
  6. Characteristics of acute and subacute liver failure in China: Nomination, classification and interval. J Gastroenterol Hepatol 2007;22: 2101-06
  7. Recommendations of the International Association for the Study of the Liver Subcommittee on nomenclature of acute and subacute liver failure. J Gastroenterol Hepatol 1999;14:403-04
  8. Pathological and immunological study of subacute hepatic failure and acute liver failure. In: Tandon BN (Ed). Subacute hepatic failure. New Delhi. Charak Publishing House 1983: 13-21
  9. Management and prognosis of subacute hepatic failure. In: Subacute hepatic failure. In: Tandon BN (Ed). Charak Publishing House 1983:23-26
  10. Molecular investigation of hepatitis E virus infection in patients with hepatitis in Kathmandu, Nepal. J Med Virol 2003;69:207-14. Santosh Man Shrestha, Shobhana Shrestha 46 JAYPEE 11. Shrestha SM, Shrestha S, Tsuda F, et al. Genetic change in hepatitis E virus of subtype 1a in patients with sporadic acute hepatitis E in Kathmandu, Nepal, from 1997-2002. J Gen Virol 2004;85:97-104
  11. Hepatitis E in Nepal. Kathmandu University Medical Journal 2006;4:530-44
  12. Cavographic study of an early stage of obstruction of the hepatic portion of the inferior vena cava. J Gastroenterol Hepatol 2000;15:202-10
  13. Bacterial peritonitis in hepatic inferior vena cava disease: A hypothesis to explain the cause of infection in high protein ascites. Hepatolo Res 2002;24:42-49
  14. Diagnostic utility of ultrasonography in hepatic venous outflow tract obstruction in tropical country. J Gastroentrol Hepatol 1991; 6:368-73
  15. Fulminant hepatitis: Induction by hepatitis B virus mutants defective in precore region and incapable of encoding e antigen. Gastroentrology 1991;100: 1087-94
  16. A hepatitis B virus mutant associated with an epidemic of fulminant hepatitis. N Eng J Med 1991;324:1705-09
  17. Mutation in the precore region of hepatitis V virus DNA in patients with fulminant and severe hepatitis. N Eng J Med 1991;324:1699- 1704
  18. Hepatitis B virus strains with mutations in the core promoter in patients with fulminant hepatitis. Ann Intern Med 1995;122:241-48
  19. Association between severity of type A hepatitis and nucleotide variations in the 5' nontranslated region of the hepatitis A virus RNA: Strains from fulminant hepatitis have fewer nucleotide substitutions. Gut 2002;51:82-88
  20. Possible risk factors for transmission of hepatitis E virus and for severe form of hepatitis E acquired locally in Hokkaido, Japan. J Med Virol 2005;76: 341-49
  21. Hepatitis E virus. In: Knipe DM, Howley PM, Griffin DE, Lamb RA, Martin MA, Roizman B, Straus SE (Eds) Fields Virology (4th ed). Lippincott Williams & Wilkins, Pheldelphia, PA. 2001a;3051-61
  22. Hepatitis E virus in Nepal: Similarities with the Burmese and Indian variants. Virus Res 1997;52:87-96
  23. Hepatitis E virus-an update. Liver 1999;19:171-76
  24. A large waterborne viral hepatitis E epidemic in Kanpur, India. Bull WHO 1992;70(5):597-604
  25. Hepatitis and enteric fever: An epidemiological review. Epidemiology Division, Ministry of Health, Kathmandu, Nepal, 1993
  26. Antibiotics in Gram-negative sepsis. Trop Gastroenterol 2000;21:95-102
  27. Budd-Chiari syndrome. Seminars in Liver Disease 2008;28:259-69
  28. Obstruction of the inferior vena cava in the hepatic portion and hepatic veins: Report of eight cases and review of the Japanese literature. Angiology 1968;19:479-98
  29. Hepatic outflow obstruction (Budd-Chiari syndrome). Experience with 177 patients and a review of literature. Medicine 1994;73:21-36
  30. Management of Budd-Chiari syndrome: Experience from 430 cases. Asian J Surg 1996;19:23-30
  31. Endemicity and clinical picture of liver disease due to obstruction of the hepatic portion of the inferior vena cava in Nepal. J Gastroenterol Hepatol 1996; 11:170-79
  32. Hepatic vena cava disease: Etiologic relation to bacterial infection. Hepatology Research 2007;37: 196-204
  33. Liver cirrhosis and hepatocellular carcinoma in hepatic vena cava disease, a liver disease caused by obstruction of the hepatic portion of the inferior vena cava. Hepatolo Intern 2009;3:392-402
  34. Sodium excretion in dogs with low-grade caval obstruction: Role of hepatic nerves. Am J Physiol 1987; 253:F672
  35. Pleural effusion in hepatic vena cava disease. Kathmandu University Medical Journal 2007;5:218-24
  36. Hepatocyte transport of bile acids and organic anions in endotoxemic rats: Impaired uptake and secretion. Gastroenterology 1997;112:214-25
  37. Early events in sepsis-associated cholestasis. Gastroenterology 1999;116:486-88
  38. Morphological changes in the liver in subacute hepatic failure. Tandon BN (Ed). Subacute hepatic failure. New Delhi. Charak Publishing House 1983:7-11
  39. Pathology of liver in Budd-Chiari syndrome: Portal vein thrombosis and histogenesis of venocentric cirrhosis, and large regenerative nodules. Hepatology 1998;27:488-96.
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