الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute liver failure is a devastating condition with a high mortality rate. In children, fulminant hepatic failure is a rare multisystem disorder in which severe impairment of liver function, with or without encephalopathy. Recognized etiologies include infections, toxins, metabolic disorders, infiltrative diseases, autoimmune hepatitis, ischemic or irradiation damage; a proportion of cases are cryptogenic. Viral hepatitis is one of the main causes of fulminant hepatic failure in children. The diagnosis of the cause is essential to institute lifesaving medical treatment and decide if transplantation is indicated. Children with fulminant hepatic failure must be treated in specialized centers with facilities for liver transplantation.
The study was conducted on 24 hospitalized children with acute liver failure beyond 2 years of age. The studied children were admitted at Alexandria University Children’s Hospital and Fever Hospital with the clinical and biochemical manifestations of acute liver failure along one year period from July 2011 till June 2012.
The aim was to determine the frequency of hepatitis A virus infection in children with acute liver failure presented to Alexandria University Children’s Hospital and Fever Hospital
The study was started by admitted 24 children with acute liver failure in Alexandria University Children’s Hospital and Fever Hospital. After exclusion of chronic liver diseases, all patients were subjected to the following: history taking, complete clinical examination and staging of hepatic encephalopathy. Investigations included initial laboratory investigations were done included (CBC, T.S.B, D.S.B, ALT, AST, PT, INR, serum albumin, blood sugar level, serum ammonia). Specific investigations were done to determine the cause of ALF as (Anti HAV IgM, Hbs Ag, HCV Ab, autoimmune markers (ANA, Anti DNA, ASMA, ALKMA and total IgG), serum ceruloplasmin, 24-hours urinary copper, alpha-1 antitrypsin, Esptein barr virus IgM (VCA), serum ferritin, and imaging (abdominal ultrasongrophy, CT brain).
The study revealed the following results:
1- Most of children (62.50%) were females with average age between 2-15 years.
2- The study showed that fever and jaundice were present in all children. Epistaxis was the commonest bleeding symptom among other bleeding sites. Diarrhea was the least frequent reported symptom.
3- Hepatomegaly was the commonest sign among the studied children (100%), followed by ascites and lower limb edema.
4- Grade IV hepatic encephalopathy was the commonest one; it was present in eight children, followed by grade I. While five children have not develop hepatic encephalopathy.
5- Three children had co-morbidity, o