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Accession number;05A0313190
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| Title;Management of Hepatic Encephalopathy and Renal Failure in Fulminant Hepatitis |
| Author;
KATSUTA YASUMI
(Nippon Med. Sch.)
KOMEICHI HIROKAZU
(Nippon Med. Sch.)
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Journal Title;Japanese Journal of Intensive Care Medicine
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Journal Code:Z0581B
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ISSN:0389-1194
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VOL.29;NO.2;PAGE.123-129(2005)
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| Figure&Table&Reference;TBL.4, REF.4 |
| Pub. Country;Japan |
| Language;Japanese |
| Abstract;Fulminant hepatitis is a devastating disease and is still associated with high mortality. This acute hepatic failure results in progressive multi-organ failure with a dramatic impact of intracranial hypertension, which is a major cause of death. The intracranial hypertension is resulted from brain edema and hyperemia due to vasodilatation of the brain. An increased ammonia metabolism in the brain plays a central role in the onset of cerebral edema. Acute renal failure is also a serious complication of fulminant hepatitis. The renal failure includes prerenal failure, acute tubular necrosis and hepatorenal syndrome, similarly seen in advanced cirrhosis. Hyperdynamic circulation with an increased cardiac output, reduced peripheral vascular resistance and marked decline of mean arterial pressure contributes to the renal failure in fulminant hepatitis. Therefore, correcting cardiovascular dysfunction and maintaining perfusion pressure to the kidneys are the subjects in the medical treatment of renal failure to which priority must be given. Early diagnosis of fulminant hepatitis, as well as recognition of complications, is necessary to prevent serious outcomes, and prompt and adequate measures improve the patients' prognosis. Plasma exchange and hepatic support using hemodiafiltration device are the bridging to hepatic transplantation or spontaneous hepatic regeneration. (author abst.) |
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