Acute Hepatitis: A Guide for Families Facing Liver Challenges

Please provide information about fulminant hepatitis?

My father is currently 60 years old and has autoimmune disease and is a carrier of hepatitis B.
Two years ago, he experienced polymyositis due to autoimmune issues and has been on long-term steroid treatment (three pills).
He has been monitored for liver function and muscle inflammation at Veterans General Hospital and National Taiwan University Hospital.
During a routine follow-up at Veterans General Hospital on October 30 of this year, his GPT and GOT levels were found to be as high as 769 and 613, respectively.
On November 8, these levels peaked at 1502 and 1152.
Since my father does not consume alcohol or smoke, the doctor diagnosed him with an acute exacerbation of hepatitis B leading to fulminant hepatitis.
On November 8, he also exhibited a total bilirubin (TB) level of 8.5, which reached a maximum of 36.2 one month later (on December 10).
His coagulation function (PT) was 1.5 upon admission and peaked at 3.2 by December 15.
He is still hospitalized.
Currently, my father's indices show GPT and GOT levels around 50 and 80, respectively, while bilirubin has fluctuated between 32 and 34 since December 10, and coagulation function (PT) has fluctuated between 2.6 and 2.8 since December 15.
His kidney function, sodium, and potassium levels have remained normal, but serum ammonia is elevated.
During his hospitalization, he experienced mild hepatic encephalopathy twice, each lasting about a day.
My father is currently taking Hepatoprotective medication (one pill daily), diuretics, bile acid medications, ammonia-lowering syrup, and receiving two bags of yellow plasma.
An abdominal ultrasound showed signs of ascites, while a chest X-ray showed no abnormalities.
Since my father is unable to accept a liver transplant due to the lifelong need for immunosuppressive medication (pending transplant evaluation), he hopes to rely on his body to regenerate and recover.
Given this situation, is there a chance for him to repair liver cells and function on his own? Besides trusting the doctor's treatment plan, what else can I, as his son, do to help my father?

Nuoha, 30~39 year old female. Ask Date: 2005/01/07

Dr. Chen Zhiping reply Gastroenterology and Hepatology

Hello, currently your father's condition seems to be characterized by ongoing liver function failure, with persistent jaundice and abnormal coagulation function, showing no significant improvement.
The current treatments (such as diuretics, plasma transfusions, and ammonia removal) are reasonable and necessary.
The next step is to wait for liver regeneration and recovery of function.
I believe the physicians at the Veterans General Hospital will closely monitor your father's condition and follow up with blood tests and abdominal ultrasounds.
Supportive care, along with encouragement from family and prayers for the patient, is what can be done at this moment.
I hope your father's condition improves progressively, and that he will not require a liver transplant.
However, if necessary, it is still advisable to follow the recommendations of the experts at the Veterans General Hospital for treatment.
Sincerely, Dr.
Chen Chi-Ping, Internal Medicine.

Reply Date: 2005/01/07

More Info

Acute hepatitis, particularly in the context of a patient with underlying conditions such as autoimmune diseases and chronic hepatitis B, presents a complex clinical scenario that requires careful management and monitoring. Your father's case, characterized by significant elevations in liver enzymes (GPT and GOT), jaundice, and coagulation abnormalities, indicates a severe form of acute hepatitis, likely exacerbated by his pre-existing conditions and possibly influenced by the long-term steroid use for his autoimmune disorder.

Understanding Acute Hepatitis
Acute hepatitis can be caused by various factors, including viral infections (like hepatitis A, B, C), drug-induced liver injury, and autoimmune processes. In your father's case, the rapid rise in liver enzymes and the development of jaundice suggest a severe inflammatory response in the liver, which can lead to liver cell death and impaired liver function. The presence of abdominal fluid (ascites) and fluctuating coagulation parameters further complicates his condition, indicating significant liver dysfunction.

Potential for Liver Recovery
The liver has a remarkable ability to regenerate, but the extent of recovery depends on several factors, including the underlying cause of the liver injury, the duration of the insult, and the overall health of the liver prior to the acute event. In cases of acute hepatitis, if the underlying cause is addressed and the liver is not severely damaged, there is potential for recovery. However, in cases of "fulminant" or "explosive" hepatitis, where there is rapid and extensive liver cell death, the prognosis can be more guarded.

Treatment and Supportive Care
Your father's current treatment regimen, which includes hepatoprotective agents, diuretics, and ammonia-lowering medications, is appropriate for managing his symptoms and supporting liver function. The use of medications like "肝安能" (likely a hepatoprotective agent) and diuretics for managing ascites is standard practice. Additionally, maintaining a balanced diet, ensuring adequate hydration, and avoiding any substances that could further stress the liver (such as alcohol or certain medications) are crucial.

Role of Family Support
As a family member, your support can be invaluable. Here are some ways you can assist your father during this challenging time:
1. Emotional Support: Being there for him emotionally can help alleviate some of the stress and anxiety associated with his condition. Encourage open communication about his feelings and concerns.

2. Advocacy: Stay informed about his condition and treatment options. Engage with healthcare providers during visits to ensure all your questions are answered and that you understand the treatment plan.

3. Nutrition: Work with a dietitian if possible to ensure he receives a liver-friendly diet that is low in sodium (to manage ascites) and rich in nutrients to support recovery.

4. Monitoring Symptoms: Keep a close eye on any changes in his symptoms, such as increased jaundice, changes in mental status, or signs of infection, and report these to his healthcare team promptly.

5. Encouragement for Rehabilitation: If he is able, encourage gentle physical activity as tolerated, which can help improve overall health and potentially aid in recovery.

Conclusion
While the situation is serious, there is hope for recovery, especially if the underlying causes are managed effectively. The liver's regenerative capacity is significant, and with appropriate medical care and supportive measures, your father may have the potential to regain liver function. Continue to work closely with his healthcare team, and do not hesitate to seek additional opinions or support from liver specialists if needed. Your involvement and support can make a meaningful difference in his recovery journey.

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